Find out How the Stage 2 Rule Affects Medicaid EHR Incentive Program Participants
On August 23, 2012, the Centers for Medicare & Medicaid Services (CMS) published the final rule for Stage 2 of the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. The rule provides new criteria that eligible professionals (EPs) and eligible hospitals must meet in order to successfully participate in the EHR Incentive Programs.
Included in the Stage 2 final rule are important changes to the Medicaid EHR Incentive Program, including the determination of patient volume calculations. Importantly, the changes to Medicaid patient volume calculations are applicable to eligible providers regardless of which stage of the EHR Incentive Program they are participating in. It is important for Medicaid providers that they understand these changes and how they affect their participation in the program.
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Medicaid changes to patient volume calculations
Q: The Stage 1 Rule stated that, in order for a Medicaid encounter to count towards the patient volume of an eligible provider, Medicaid had to either pay for all or part of the service, or pay all or part of the premium, deductible or coinsurance for that encounter. The Stage 2 Rule now states that the Medicaid encounter can be counted towards patient volume if the patient is enrolled in the state's Medicaid program (either through the state's fee-for-service programs or the state's Medicaid managed care programs) at the time of service without the requirement of Medicaid payment liability. How will this change affect patient volume calculations for Medicaid eligible providers?
A: Billable services provided by an eligible provider to a patient enrolled in Medicaid would count toward meeting the minimum Medicaid patient volume threshold, regardless of Medicaid's payment liability for the services, and irrespective of whether the provider is in Stage 1 or Stage 2 of the incentive program. Read the rest of the answer here.
CHIP patients eligible to be included in Medicaid patient volume totals
Q: The Stage 2 Rule describes changes to how a state considers CHIP patients in the Medicaid patient volume total when determining provider eligibility. Patients in which kinds of CHIP programs are now appropriate to be considered in the Medicaid patient volume total?
A: States that have offered CHIP as part of a Medicaid expansion under Title 19 or Title 21 can include those patients in their provider's Medicaid patient volume calculation as there is cost liability to the Medicaid program in either case (in Stage 1, only CHIP programs created under a Medicaid expansion via Title 19 were eligible). This change to the patient volume calculation is applicable to all eligible providers, regardless of the stage of the incentive program they are participating in. Read the rest of the answer here.
Changes to the base year of the Medicaid EHR Incentive Program for hospital incentive payment calculation
Q: Are there any changes to the base year for the Medicaid EHR Incentive Program hospital incentive payment calculation?
A: Yes, but depending on when a hospital starts participating in the incentive program. Under the Stage 1 Rule, all Medicaid eligible hospitals calculated the base year using a 12-month period ending in the Federal fiscal year before the hospital's fiscal year that serves as the first payment year. But as described in the Stage 2 rule, hospitals that begin participating in the incentive program in program year 2013 or later will use the most recent continuous 12‑month period for which data are available prior to the payment year. Read the rest of the answer here.
To find out more information about the Stage 2 final rule, visit the Stage 2 section of the EHR website.
Want more information about the EHR Incentive Programs?
Make sure to visit the EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.
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