Medicare Incentive Program
 
MEDICARE INCENTIVE PROGRAM

CMS PROPOSES REQUIREMENTS FOR THE ELECTRONIC HEALTH RECORDS (EHR) MEDICARE INCENTIVE PROGRAM

The Centers for Medicare & Medicaid Services (CMS) today announced a proposed rule to implement the provisions of the American Recovery and Reinvestment Act of 2009 (Recovery Act) that provide incentive payments for the meaningful use of certified EHR technology. The Medicare EHR incentive program will provide incentive payments to eligible professionals (EP), eligible hospitals, and critical access hospitals (CAHs) that are meaningful users of certified EHRs. The Medicaid EHR incentive program will provide incentive payments to eligible professionals and hospitals for efforts to adopt, implement or upgrade certified EHR technology or for meaningful use in the first year and for meaningful use for up to another five years.

This fact sheet focuses on the Medicare EHR incentive program.

The Office of the National Coordinator for Health Information Technology (ONC) will be issuing a closely related interim final rule with comment period that specifies the Secretary's adoption of an initial set of standards, implementation specifications, and certification criteria for EHRs. ONC will also issue a separate notice of proposed rulemaking related to the certification of health information technology. Providers must use such certified EHRs to qualify as meaningful users in the incentive programs.

MEDICARE ELIGIBLE PROFESSIONALS (EPs)

A Medicare EP is a doctor of medicine or osteopathy, a doctor of dental surgery or dental medicine, a doctor of podiatric medicine, a doctor of optometry, or a chiropractor, who is legally authorized to practice under state law. A qualifying EP is one who demonstrates meaningful use for the HER reporting period.

Hospital-based EPs who furnish substantially all their services in a "hospital setting" are not eligible for incentive payments. CMS proposes that a hospital-based EP be defined as an EP who furnishes 90 percent or more of his/her allowed services in a hospital, including all hospital inpatient, outpatient, and emergency department settings.

A qualifying EP can receive EHR incentive payments for up to five years with payments beginning as early as 2011. In general, the maximum amount of total incentive payments that an EP can receive under the Medicare program is $44,000.

For the first year an EP applies for and receives an incentive payment, CMS proposes that an EHR Reporting Period is 90 days for any continuous period beginning and ending within the year. For every year after the first payment year, CMS proposes that the EHR reporting period is the entire year.

A Payment Year equals a Calendar Year (CY). Incentive payments for meaningful EHR use end after 2016.

A qualifying EP will receive an incentive payment equal to 75 percent of Medicare allowable charges for covered professional services furnished by the EP in a payment year, subject to maximum payments.

In general, a qualifying EP can receive an annual incentive payment as high as $18,000 if their first payment year is 2011 or 2012. Otherwise, the annual incentive payment limits in the first, second, third, fourth, and fifth years are $15,000, $12,000, $8,000, $4000, and $2,000 respectively. In general, the maximum amount of total incentive payments that an EP can receive under the Medicare program is $44,000. An EP who predominantly furnishes services in a geographicHealth Professional Shortage Area is eligible for a 10 percent increase in the maximum incentive payment amount. The maximum amount of total incentive payments that such an EP can receive under the Medicare program is $48,400. For EPs who begin to be meaningful EHR users in 2014, their payment calculations will be made as if they began meaningful use in 2013. (That is, if an EP were to begin meaningful use in 2014, the EP would receive $12,000 for that year, the second year's amount as if they had begun in 2013). 2014 is the last year for which an EP can begin receiving incentive payments for meaningful use. Incentive payments for meaningful HER use ends after 2016.

Maximum Total Amount of EHR Incentive Payments for a Medicare EP is outlined in the table below:

EPs who meet the eligibility requirements for both the Medicare and Medicaid incentive programs may participate in only one program and must designate the program in which they would like to participate. CMS proposes that, after the initial designation, EPs be allowed to change their program selection only once during payment years 2012 through 2014.

Payments under Medicare will be disbursed through Medicare Administrative Contractors (MAC) or carriers to the Tax Identification Number provided by the qualifying EP.

Provided they meet certain conditions, EPs can reassign the entire amount of their incentive payment to one employer or entity.

Incentive payments will be made to qualifying Medicare Advantage (MA) organizations for the adoption and meaningful use of EHR technology by their affiliated EPs.

MA-Affiliated EPs are EPs who are employed or subcontracted by an MA organization and on average provide at least 20 hours of patient care services per week. For a subcontracted EP, at least 80 percent of his/her professional services are furnished to enrollees of the MA organization.

EPs who are not meaningful EHR users will be subject to lower payment updates for their covered professional services beginning in 2015. MA organizations will also be subject to payment adjustments if their affiliated EPs are not meaningful users of EHR technology beginning in 2015.

http://www.federalregister.gov/OFRUpload/OFRData/2010-14999_PI.pdf

This is Establishment of the Temporary Certification Program for Health Information Technology from health and human services released on june 24th

below is from: http://healthit.hhs.gov/portal/server.pt?open=512&mode=2&objID=2886&PageID=19629 These are FAQs on the health and human services certification process

A. Background/General

Key Messages

Health Care Providers: Key Points In order to qualify for Medicare and Medicaid EHR incentive payments, providers must use EHR technology that has been certified by an Office of the National Coordinator for Health Information Technology-Authorized Testing and Certification Body (ONC-ATCB, or ATCB). The temporary certification program provides assurances that the EHR technology adopted by health care providers is technically capable of supporting their efforts to achieve meaningful use.

Developers of EHR Technology: Key Points The temporary certification program provides a way for developers of EHR Technology to have their EHR technology tested and certified so that it can be subsequently adopted by health care providers who seek to achieve meaningful use.

A1. What is the temporary certification program final rule? The Secretary of Health and Human Services (the Secretary) issued the temporary certification program final rule to establish a process through which organizations may become ONC-ATCBs. An ONC-ATCB is authorized by the National Coordinator to test and certify EHR technology (Complete EHRs and/or EHR Modules).

A2. What is the purpose of the temporary certification program? The temporary certification program is the first part of ONC's two-part approach to establish a transparent and objective certification process. The temporary certification program was established to ensure that "Certified EHR Technology" will be available for adoption by health care providers who seek to qualify for the Medicare and Medicaid EHR incentive payments beginning in 2011. ONC-ATCBs will be required to test and certify EHR technology (Complete EHRs and/or EHR Modules) as being in compliance with the standards, implementation specifications, and certification criteria to be adopted by the Secretary in a forthcoming final rule.

A3. When will the temporary certification program end? The temporary certification program will be in effect until the permanent certification program is in place. We anticipate that certifications issued under the permanent certification program will occur no earlier than January 1, 2012.

A4. How will ONC work with the National Institute of Standards and Technology (NIST) in regard to certification and standards? ONC will work with NIST to ensure the availability of relevant test methods and other resources for the temporary certification program. ONC will continue to work with NIST in developing the permanent certification program.

B. Application Process

B1. How does an organization become an ONC-ATCB? An organization must submit an application to the National Coordinator to demonstrate its competency and ability to test and certify EHR technology (Complete EHRs and/or EHR Modules). Once authorized, ONC-ATCBs are required to comply with the principles and conditions applicable to the testing and certification of EHR technology as specified in the temporary certification program final rule.

B2. Can you provide an overview of the application process? Applicants are required to request, in writing, an application for ONC-ATCB status from the National Coordinator at ATCBapplication@hhs.gov. The application has two parts:

Part I: Provide general identifying and contact information; complete and submit the results of self-audits to all sections of ISO/IEC Guide 65:1996 (Guide 65) and ISO/IEC 17025:2005 (ISO 17025); submit additional documentation related to Guide 65 and ISO 17025; and agree to adhere to the Principles of Proper Conduct for ONC-ATCBs.

Part II: Successfully complete a proficiency examination.

Applicants are required to complete and submit both parts of the application to the National Coordinator for the application to be considered complete. Please review Section III of the final rule for more details about the application and application review processes.

B3. When will ONC begin accepting applications, and when will applicants be informed if they have received ONC-ATCB status? The National Coordinator will begin accepting applications on July 1st and any time thereafter while the temporary certification program is operating. Because the final rule is effective immediately, the National Coordinator will review, process, and make determinations regarding submitted applications as soon as possible.

B4. Will ONC limit the number applicants who apply for ONC-ATCB status? ONC will not restrict the number of applicants who may apply for ONC-ATCB status. Having available more organizations with ONC-ATCB status will give developers of EHR technology more options for testing and certification.

C. Certification Process

C1. I have an EHR technology ready for market. Is there anything I can do to get the technology certified now so that I can start marketing to hospitals and physicians? Until organizations are authorized by the National Coordinator to perform testing and certification, EHR technology cannot be tested and certified in accordance with the temporary certification program final rule. At this time, no organizations are currently authorized to test and certify EHR technology under the temporary certification program established by HHS, but when organizations attain ONC-ATCB status ONC will make it publicly known and post their names on our website. ONC will work with ATCBs to encourage them to begin certifying EHR technology as soon as possible after they are authorized to do so.

C2. When will ONC-ATCBs be up and running? ONC-ATCBs are permitted to start testing and certifying EHR technology consistent with the scope of their authorization as soon as it is received. Some ONC-ATCBs may need more time to establish their processes than others; however, we anticipate that ONC-ATCBs would be ready to test and certify EHR technology within a few weeks of attaining their authorization.

C3. How long will it take for an EHR technology to be certified? This will vary according to the process used by the ONC-ATCB.

C4. What does a developer of EHR technology need to do to get its EHR technology tested and certified? A developer of EHR technology will need to (1) select an ONC-ATCB that is authorized to test and certify its EHR technology (Complete EHR or EHR Module), and (2) demonstrate in accordance with the ONC-ATCB's processes that the EHR technology provides the capabilities required by all applicable certification criteria adopted by the Secretary.

C5. Where can I find out information about EHR technology that has been certified? ONC will maintain on its website a Certified HIT Products List (CHPL) as a single, aggregate source of all certified Complete EHRs and EHR Modules reported by ONC-ATCBs to the National Coordinator. The CHPL will comprise all of the certified Complete EHRs and EHR Modules that could be used to meet the definition of Certified EHR Technology. It will also include the other pertinent information we require ONC-ATCBs to report to the National Coordinator, such as a certified Complete EHR's version number. Eligible professionals and eligible hospitals that elect to use a combination of certified EHR Modules may also use the CHPL webpage to validate whether the EHR Modules they have selected satisfy all of the applicable certification criteria that are necessary to meet the definition of Certified EHR Technology.

C6. Will EHR technology previously certified under any other programs or organizations automatically be certified by this new process? No. In order to meet regulatory requirements implementing the HITECH Act, including the definition of "Certified EHR Technology," EHR technology (Complete EHRs and/or EHR Modules) must be tested and certified by an ONC-ATCB. Any other certifications issued by an organization that is not an ONC-ATCB at the time of issuance will be invalid for purposes of meeting the definition of Certified EHR Technology and cannot be used to qualify for incentive payments under the Medicare and Medicaid EHR Incentive Programs. Unless reissued in accordance with the requirements of the temporary certification program, certifications previously issued by an organization that has subsequently become an ONC-ATCB will also be invalid for purposes of satisfying the definition of "Certified EHR Technology," because such certifications were issued prior to the organization achieving ONC-ATCB status.

Certification by an ONC-ATCB means that EHR technology meets the specific standards, implementation specifications, and certification criteria established for the temporary certification program. (HHS issued an interim final rule outlining specific standards and certification criteria on December 30, 2009, and a final rule is expected to be issued in the near future.)

EHR technology must be tested and certified by an organization authorized by ONC as an ONC-ATCB, using currently adopted standards and certification criteria. Once ONC has authorized testing and certification organizations as ONC-ATCBs, the follow actions are appropriate: Developers of EHR technology who wish to have their EHR technology tested and certified should contact an ONC-ATCB Health care providers who are eligible under the Medicare and Medicaid EHR Incentive Programs should contact their vendors to ensure their EHR technology is tested and certified by an ONC-ATCB under the temporary certification program requirements

C7. Will EHR technology certified under the temporary certification program be automatically certified under the permanent certification program? EHR technology tested and certified by an ONC-ATCB under the temporary certification program will remain certified once the permanent certification program replaces the temporary certification program. The change in certification programs will not affect the certified status of EHR technology at the time of change. However, we anticipate that new or modified certification criteria will be adopted by the Secretary to support future stages of meaningful use, and as a result, certifications issued by ONC-ATCBs will presumably no longer indicate or represent that a Complete EHR or EHR Module can provide all of the capabilities necessary for an eligible professional or eligible hospital to achieve a future stage of meaningful use.

C8. Whose responsibility is it to make sure that EHR technology gets tested and certified as required to meet the certification criteria adopted to support meaningful use? In most cases it will be the responsibility of developers of EHR technology that sell EHR technology. However, a health care provider that has developed its own EHR technology and is eligible under Medicare and Medicaid EHR Incentive Programs likely will be responsible for getting it tested and certified.

C9. If I buy an EHR technology that is tested and certified, does that qualify me for the Medicare or Medicaid EHR incentive payments? Having EHR technology that is certified by an ONC-ATCB is an essential part of qualifying for the EHR incentive payments. For details on the Medicare and Medicaid EHR Incentive Programs, please visit http://www.cms.gov/Recovery/11_HealthIT.asp.

C10. I already use EHR technology. If it gets certified, will I qualify for the Medicare or Medicaid EHR incentive payments? If the EHR technology you currently use is certified in the HHS temporary certification program, you may be eligible for incentive payments. For details on the Medicare and Medicaid EHR Incentive Programs, please visit http://www.cms.gov/Recovery/11_HealthIT.asp.

D. Comments on Proposed Rule

D1. Where can I learn about how my comments on the proposed rule on the Establishment of Certification Programs for Health Information Technology issued in March were addressed in the temporary certification program final rule? ONC staff carefully reviewed and considered each comment received on the proposed rule. Section III of the temporary certification program final rule includes a discussion of how the comments were incorporated into the temporary certification program final rule.

E. Related Rules

E1. How does this final rule relate to the Medicare and Medicaid EHR Incentive Programs Proposed Rule? The National Coordinator will use the temporary certification program to authorize organizations to test and certify EHR technology (Complete EHRs and/or EHR Modules). Once tested and certified, these types of HIT may be used to meet the regulatory definition of "Certified EHR Technology." Health care providers who are eligible to qualify for incentive payments under the Medicare and Medicaid EHR Incentive Programs are required to use Certified EHR Technology, as promulgated in the CMS final rule. HHS expects to issue final rules related to the initial set of standards, implementation specifications, and certification criteria and to the Medicare and Medicaid EHR Incentive Programs in the near future.

E2. When will the permanent certification program final rule be published? We anticipate that a final rule for the permanent certification program will be issued by fall 2010 and that the permanent program will be in place in 2012.

For other questions related to the Temporary Certification program, please email ONC.Certification@hhs.gov.