Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.85 - GENERAL MEDICAID SERVICES › Subchapter 37.85.11 - Montana Medicaid Provider Incentive Program for Electronic Healthcare Records › Rule 37.85.1103 - DEFINITIONS

Current through Register Vol. 13, July 5, 2024
For purposes of the Montana Medicaid Provider Incentive
				  Program (MMPIP), the following definitions apply:
(1) "Act" means the Health Information
				Technology for Economic and Clinical Health Act or "HITECH" Title XIII of
				Division A and Title IV of Division B of the American Recovery and Reinvestment
				Act of 2009 (ARRA), Pub. L.
				No. 111-5 (2009).
(2) "Electronic Health Records" (EHR) means a
				systematic collection of electronic health information about individual
				patients or populations. For the purposes of these rules, the term "EHR" will
				refer to an electronic health record information system that is certified by
				the Certification Commission for Health Information Technology and therefore
				qualifies for the Montana Medicaid Provider Incentive Program.
(3) "Eligible hospital" (EH) means an acute
				care hospital (including critical access hospitals and cancer hospitals) with
				at least 10% Medicaid patient volume and a children's hospital with no Medicaid
				patient volume requirements. An EH must have a Centers for Medicare and
				Medicaid (CMS) Certification Number with the last four digits in the series
				0001-0879 as defined in
				42
				CFR 495.302 (2011).
(4) "Eligible hospital patient volume
				encounter" means the services rendered during one day by an eligible hospital
				to individuals, per inpatient discharges, or in an emergency department, for
				which Medicaid, or a Medicaid demonstration projection under
				42 USC
				1315 (2011), paid all or part of the fee or
				paid all or part of the individual's premiums, copayments, and/or
				cost-sharing.
(5) "Eligible
				provider" (EP) means a physician, dentist, nurse practitioner, certified nurse
				midwife, physician assistant practicing at a federally qualified health center
				(FQHC) or rural health clinic (RHC) so led by a physician assistant, critical
				access hospital, or acute care hospital.
(6) "Eligible provider patient volume
				encounter" means services rendered during one day by an eligible provider to
				individuals for which Medicaid, or a Medicaid demonstration project under
				42 USC
				1315 (2011), paid part or all of the fee or
				paid all or part of the individual's premiums, copayments, and/or
				cost-sharing.
(7) "Encounter" means
				a face-to-face meeting between a patient and health care provider taking place
				on any one day and at a single location.
(8) "Federally qualifying health clinics"
				(FQHC) means an entity defined at
				42 USC
				1395 x(aa)(3) and
				42 USC
				1395 y(aa)(3). This includes an outpatient
				health program or facility operated by a tribe or tribal organization receiving
				funds under Title V of the Indian Health Care Improvement Act for the provision
				of primary health services. In considering this definition, it should be noted
				that programs meeting FQHC requirements commonly include the following (but
				must be certified and meet all requirements stated above):
(a) Community Health Centers;
(b) Migrant Health Centers;
(c) Healthcare for the Homeless
				Programs;
(d) Public Housing
				Primary Care Programs;
(e)
				Federally Qualified Health Center Look-Alikes; and
(f) Tribal Health Centers.