CMS FINALIZES REQUIREMENTS FOR THE MEDICAID ELECTRONIC HEALTH RECORDS (EHR) INCENTIVE PROGRAM

The Centers for Medicare & Medicaid Services (CMS) today announced the final rule to implement the provisions of the American Recovery and Reinvestment Act of 2009 (Recovery Act) that provide incentive payments for the adoption and meaningful use of certified electronic health record (EHR) technology. The Medicare EHR incentive program will provide incentive payments to eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) that are meaningful users of certified EHRs. The Medicaid EHR incentive program will provide incentive payments to EPs and eligible hospitals for efforts to adopt, implement, upgrade, or meaningfully use certified EHR technology .

This fact sheet summarizes provisions in the final rule affecting state Medicaid programs and Medicaid providers.

The Office of the National Coordinator for Health Information Technology (ONC) is issuing a closely related final rule that completes the Secretary’s adoption of an initial set of standards, implementation specifications, and certification criteria for EHRs. ONC also issued a final rule establishing a temporary certification program for health information technology on June 24, 2010 and will issue a final rule for establishing a permanent program later this year.

The Recovery Act amended the Medicaid statute to provide for a 100 percent Federal financial participation (FFP) match for state expenditures for provider incentive payments to encourage Medicaid health care providers to adopt, implement, upgrade or meaningfully use certified EHR technology. It also established a 90 percent FFP match for reasonable state expenses related to administration of the incentive payments and to promote EHR adoption and health information exchange.

On September 1, 2009, CMS released a State Medicaid Director’s Letter that provided preliminary guidance on state expenses related to activities in support of the administration of incentive payments to providers. CMS has worked with all States and territories to facilitate their planning efforts for the purposes of administering the incentive payments to providers, ensuring their proper payments, and auditing and monitoring of such payments, and participating in statewide efforts to promote interoperability and meaningful use of EHRs. Subsequent guidance to States on implementation funding will be forthcoming.

The final rule CMS released today provides further guidance to states and Medicaid providers on the Medicaid EHR Incentive Program. CMS anticipates that the majority of States will launch their Medicaid EHR Incentive programs between January and August of 2011.

The Medicaid provisions of the final rule address seven topics:

  • Eligibility
  • Payments
  • Adopting, implementing, or upgrading certified EHR technology
  • Demonstrating meaningful use of EHR technology
  • Conditions for FFP for states
  • Financial oversight/combating fraud and abuse