Eligible Hospital (EH) FAQs

What is the formula for determining if an acute care hospital meets the 10% minimum threshold patient encounters for Medicaid EHR Incentive Payments?

  • Provider Type: Both
  • Category: Meaningful Use

In addition to the NY-SMHP (which discusses the patient volume calculation on pages C-10 through C-17), many of the details of the patient volume calculation are specified in federal rules and regulations 42 CFR § 495.306 and the Final Rule for the Electronic Health Record Incentive Program.

According to the State's proposed implementation plan, providers, including acute care hospitals, will have a certain amount of flexibility in how they demonstrate that they meet the patient volume requirements for eligibility. Essentially, hospitals have two options for calculating the Medicaid patient volume:

  1. Dividing the number of Medicaid patient encounters in a given 90-day period in the prior calendar year by the total number of patient encounters in the same period.
  2. Adding the number of Medicaid patients current on the hospital's managed care patient panel in a given 90-day period in the prior calendar year plus the number of Medicaid patient encounters during the period for patients not on the managed care patient panel, and dividing that by the sum of the total number of patients current on the hospital's managed care patient panel during the period and the number of patient encounters during the period for patients not on the managed care patient panel.

Medicaid providers will have the freedom to select the 90-day period they wish to use for the patient volume calculation, although it must be representative of their overall patient volume. "Medicaid patient encounter" is defined as: (1) Services rendered on any one day to an individual where Medicaid or a Medicaid demonstration project under section 1115 of the Act paid for part or all of the service; or (2) Services rendered on any one day to an individual for where Medicaid or a Medicaid demonstration project under section 1115 of the Act paid all or part of their premiums, co-payments, and/or cost-sharing. For the purposes of the second patient volume methodology, patients on the provider's patient panel are deemed to be "current" if they had an encounter with the provider within the previous calendar year prior to the 90-day period.

Note that the requirement to meet the 10% Medicaid patient volume applies only to acute care hospitals, which for this program are defined in federal regulation as "those hospitals with an average patient length of stay of 25 days or fewer, and with a CCN" (i.e., CMS Certification Number, formerly known as Medicare Provider Number or OSCAR number) "that falls in the range 0001-0879 or 1300-1399." Children's hospitals, defined as "a hospital that is separately certified as a children's hospital, with a CCN in the 3300-3399 series and predominantly treats individuals under the age of 21", do not have any Medicaid patient volume requirement.

How can I certify the use of an Office of the National Coordinator for Health Information Technology certified system for Inpatient acute care to meet the overlapping "core" measures for meaningful use for an eligible provider who sees outpatients for the acute care hospital?

  • Provider Type: Eligible Hospitals
  • Category: ONC EHR Certification

NY Medicaid does not have a direct role in certifying EHR technology. Questions about certification should be directed to ONC at ONC.Certification@hhs.gov.

Is my hospital eligible for the EHR incentive?

  • Provider Type: Eligible Hospitals
  • Category: Eligibility

For a facility to be eligible to directly receive an EHR incentive payment, it must be one of the following:

  1. An acute care hospital with an average length of stay of 25 days or less, and have a CMS Certification Number whose last four digits are in the range 0001-0879 or 1300-1399. Acute care hospitals must have a minimum 10% Medicaid patient volume.
  2. A separately certified children's hospital with a CMS Certification Number (also known as Medicare Provider Number or OSCAR number) whose last four digits are in the range 3300-3399. Children's hospitals have no minimum Medicaid patient volume.

What about a children's wing or unit in an acute care hospital, or a children's facility in a multi-campus hospital system?

  • Provider Type: Eligible Hospitals
  • Category: Eligibility

To qualify as a children's hospital for the Medicaid EHR Incentive Program, the facility must have a separate CMS Certification Number (also known as Medicare Provider Number or OSCAR number) whose last four digits are in the range 3300-3399. Any other type of children's facility does not qualify as a "children's hospital" and therefore must satisfy the definition of "acute care hospital" and demonstrate a minimum 10% Medicaid patient volume. The only benefit of qualifying as a children's hospital is the exemption from the minimum Medicaid patient volume, all other aspects of the program are identical for all facilities.

What about outpatient clinics, diagnostic and treatment centers (D&TCs), community health centers, rural health clinics, etc.?

  • Provider Type: Eligible Hospitals
  • Category: Eligibility

If your facility does not qualify as an eligible hospital, using the criteria above, then the individual practitioners in the facility may be able to qualify for the Medicaid EHR Incentive as eligible professionals. These practitioners may then voluntarily assign their incentive payments to the facility, assuming there is an existing employer-employee or billing relationship between the facility and the practitioners.

Even if your facility qualifies as an eligible hospital, any practitioners who provide more than 10% of their covered professional services outside the inpatient or hospital emergency department settings, defined as place of service (POS) codes 21 and 23, respectively, may also be eligible to receive the individual incentive.

Can you please define the term "acute care"?

  • Provider Type: Eligible Hospitals
  • Category: Other Topics

Generally, acute care is a term used for immediate short-term treatment or stabilization of a disease, injury, or disorder. Acute care is generally provided in settings such as emergency, intensive care, coronary care, and cardiology departments. In contrast, sub-acute care is provided in units and facilities such as long-term care, skilled nursing, and rehabilitation.

The Medicaid EHR Incentive Program provides incentives only to acute care facilities and children's hospitals. Even within an eligible acute care or children's hospital, there are some units that are not considered acute care and are not counted in the calculations for determining eligibility or calculating the incentive payment. The following types of services are considered sub-acute and should be excluded from all calculations:

  • Nursery care, although neonatal intensive care services are acute care and should be counted
  • Skilled nursing or long-term care
  • Rehabilitation
  • Psychiatric services

When can a hospital receive an incentive payment?

  • Provider Type: Eligible Hospitals
  • Category: Incentive Payment

In order to receive the incentive, providers will need to register first with a national system and then attest to their patient volume and other eligibility criteria using a system that is being set up by New York. This system is expected to be complete and available for general use some time in the fourth quarter of calendar year 2011. Once a provider's attestations are complete and accepted by the state, payment will be made within 45 days.

Hospital participation in the incentive program is based on the federal fiscal year (FFY), which runs from October 1 to September 30. All qualifying activities for a given payment year such as adopt/implement/upgrade of certified EHR technology and meaningful use activities must be completed within that year; however, attestation may be completed after the end of the payment year. Hospitals that have completed all qualifying activities in FFY 2010-2011 will be able to receive the incentive payment for that year, even if the system is not available by September 30, 2011.

Meaningful use reporting for hospitals' second participation year is based on a 90-day reporting period, so hospitals that attest to adoption, implementation, or upgrade for FFY 2010-2011 could conceivably be ready to complete attestation for their second participation year (FFY 2011-2012) by December 31, 2011. The second and subsequent years of meaningful use attestation (i.e., third and subsequent participation years) will be based on a full-year reporting period, so hospitals will not be able to complete attestation for their third participation year until October 1, 2013.

Payment years for the EHR incentives to eligible professionals are based on calendar years, so Eligible Professionals have until December 31, 2011 to complete qualifying activities to receive their incentive payments for payment year 2011.

How is the hospital incentive payment calculated?

  • Provider Type: Eligible Hospitals
  • Category: Incentive Payment

The total value of the Medicare and Medicaid EHR Incentive payments that an eligible hospital receives is determined by a formula set forth in federal law. The Medicaid incentive payment is calculated as:

  • 1. The sum of:
    • a. A base amount of $2 million, plus
    • b. A differential based on the number of acute care discharges from the hospital,
  • 2. Multiplied by a fraction representing the proportion of Medicaid bed days relative to overall bed days over the previous year called the "Medicaid share".

Any charity care furnished by the hospital increases the Medicaid share, and thus the overall incentive payment. The Medicare incentive payment uses a similar formula, substituting Medicare bed days for Medicaid bed days.

The total amount of the hospital incentive is calculated when the hospital attests to AIU in the first year. Thereafter, the incentive is paid in three annual lump sum payments:

  • 50% of the total amount is paid in the first year when the hospital attests to AIU.
  • 40% of the total is paid in the second program participation year, when the hospital attests to meaningful use based on a 90-day reporting period.
  • 10% of the total is paid in the third program participation year, when the hospital attests to meaningful use based on a full-year reporting period.

Where do the numbers for the incentive payment calculation come from?

  • Provider Type: Eligible Hospitals
  • Category: Incentive Payment

New York has identified locations in the Institutional Cost Report (ICR) where each input to the hospital incentive payment calculation can be found. New York will use the data from the hospital's submitted ICR for the period in question to ensure consistency between the values used for the Medicaid EHR Incentive Program and the values the hospital has previously certified in the ICR submission. This approach is consistent with the approach CMS is adopting for the Medicare EHR Incentive Program, which will use the values reported in CMS Form 2552 to calculate the Medicare incentive amount.

According to federal regulations, New York must derive the hospital incentive payment amount from hospital cost reports for the cost reporting period ending in the federal fiscal year (FFY) prior to the FFY that serves as the first payment year. Therefore, for hospitals that wish to receive payment for FFY 2010-2011, New York will require that the inputs to the hospital payment calculation be drawn from the 2009 ICR.

Can I skip years of participation in the Medicaid EHR Incentive Program?

  • Provider Type: Eligible Hospitals
  • Category: General

For the Medicaid incentive program, hospitals may participate in non-consecutive years, i.e., "skip years", without penalty up to 2016. But to receive payments after 2016 they must receive a payment in 2016 and every consecutive year thereafter.

In contrast, the Medicare Incentive Program defines payment years as consecutive years beginning with the first year the hospital receives a payment, regardless of whether the hospital qualifies in a given year. A hospital that fails to attest to meaningful use in their second or subsequent participation year permanently loses the incentive payment it would have received that year.