Minnesota EHR Incentive Program (MEIP) Guidance Manual for Eligible Professionals and Hospitals
Transcription
Minnesota EHR Incentive Program (MEIP) Guidance Manual for Eligible Professionals and Hospitals
Minnesota EHR Incentive Program (MEIP) Guidance Manual for Eligible Professionals and Hospitals Released October 18, 2012 MEIP Guidance for Eligible Professionals and Hospitals Released October 18, 2012 Table of Contents Section 1: Guidance for Eligible Professionals (EP) Page 1.1 Prerequisites Part I: Preparation and Registration with CMS ............…………………………………..3 1.2 Prerequisites Part II: Preparing, Enrolling & Attesting for MEIP …………………………………………..6 1.3 Medicaid Patient Volume (MPV) Calculation for Eligible Professionals (EP) ……………..…………8 1.4 Attesting for Medicaid Patient Volume (MPV) Using Group Volumes ……………………………….13 Section 2: Guidance for Eligible Hospitals (EH) 2.1 Prerequisites Part I: Preparation and Registration with CMS …………………….………………………16 2.2 Prerequisites Part II: Preparing, Enrolling & Attesting for MEIP ……………………….……………….19 2.3 Medicaid Patient Volume (MPV) Calculation for Eligible Hospitals (EH) …………………………….23 Section 3: Appendices 3.1 Appendix A – Supporting Documentation for Eligible Professionals and Hospitals .............27 3.2 Appendix B – Sample Group Volume Consent Form ………………………………….………………………29 3.3 Appendix C – Sample Hospital Calculation worksheet ……………………………………………………...30 3.4 Appendix D – Hospital First Enrollment and Attestation Month …………….…………………………31 3.5 Appendix E – Hospital Fiscal Year Start ………………………….…………...……………………………………32 Minnesota EHR Incentive Program (MEIP) Page 2 of 26 MEIP Guidance for Eligible Professionals and Hospitals Released October 18, 2012 Section 1: Guidance for Eligible Professionals (EPs) 1.1 Prerequisites for EPs Part I: Preparation and Registration with CMS Prior to registration in the Minnesota EHR Incentive Program (MEIP) at the Centers for Medicare and Medicaid Services (CMS) website, a provider should first determine if they have the information necessary to complete the initial registration and eventual enrollment in the MEIP. 1. Determine if you are potentially eligible to participate in the MEIP. The CMS Eligibility Tool can help you determine whether you may be eligible. 2. Confirm you have an individual National Provider ID (NPI) valid for participation in the Centers for Medicare and Medicaid Services (CMS) Medicare and Minnesota EHR Incentive Programs. Note: The NPI will need to be an active Individual NPI, not a group NPI. 3. Confirm you are enrolled in Minnesota Health Care Programs (MHCP). The enrollment linked to your NPI must be active and in good standing. If you are not enrolled in MHCP, or you are not in good standing in MHCP, you will not be allowed by rule to participate in the program. Q: What can I do if I am not currently enrolled in Minnesota Health Care Programs or have questions about my enrollment standing? A: You will need to complete your Minnesota Medicaid enrollment first, prior to participating in the MEIP. Contact MHCP Provider Enrollment at (651) 431-2700; Tollfree line at (800) 366-5411; Fax at (651) 431-7462. 4. Confirm your NPI is enrolled in the MHCP system as an Eligible Provider Type According to the CMS Final Rule for the Medicaid EHR Incentive Program and the Minnesota State Medicaid HIT Plan, Eligible Provider Types for the Medicaid EHR Incentive Program are: • Physicians • Dentists • Certified Nurse-Midwifes • Nurse Practitioners. This includes Clinical Nurse Specialists who meet the federal and MN state plan definition of Nurse Practitioners. • Physician Assistants practicing in Federally Qualified Health Centers (FQHCs), Rural Health Centers (RHCs) or Indian Health Services (IHSs) which Minnesota EHR Incentive Program (MEIP) Page 3 of 26 MEIP Guidance for Eligible Professionals and Hospitals Released October 18, 2012 is led by a Physician Assistant Q: What can I do if I am not currently enrolled as an eligible provider type in MHCP? A: You will need to complete a full enrollment with MHCP. This process includes validation of current certifications and licenses. Contact MHCP Provider Enrollment at (651) 431-2700; Toll-free line at (800) 366-5411; Fax at (651) 431-7462. 5. Confirm your Electronic Health Records system is certified by the Offices of the National Coordinator (ONC) for Health Information Technology (HIT). If you are currently adopting, implementing, upgrading, or using an electronic health records system you can determine if your system is certified by ONC by performing a search on this site: ONC EHR Certification Search Q: What if I do not have my EHR Certification Number at this time? A: You may register with CMS for program participation prior to receiving the EHR Certification Number; however you will be required to enter this number in MEIP portal during your enrollment and attestation in order to meet program eligibility requirements and achieve payment. 6. Confirm your Payment Assignment By rule, a provider may assign payment to himself/herself, or to another entity such as a facility or group. In order to assign payment for MEIP, the following is required: a. The Payee NPI and Payee TIN/SSN identified by the Provider at the time of CMS EHR Incentive Program registration must be enrolled in MHCP. The Payee NPI and Payee TIN/SSN must match exactly to the MHCP Enrollment data. Note: When assigning a payee during CMS registration enter a TIN and NPI for the clinic or a TIN/SSN and NPI for the EP, do not enter a clinic TIN and an EP’s NPI. If this occurs no payee will appear in MEIP. b. The enrollment linked to your chosen payee must be active and in good standing. If the Payee NPI and Payee TIN/SSN do not match an enrollment with MHCP, or the Payee NPI and Payee TIN/SSN matches an enrollment with MHCP which is not in good standing, the payee selection will not be allowed for MEIP. Q: What can I do if my Payee NPI and TIN combination is not known to MHCP? Minnesota EHR Incentive Program (MEIP) Page 4 of 26 MEIP Guidance for Eligible Professionals and Hospitals Released October 18, 2012 A: The Provider may: (1) Choose a new payee NPI and payee TIN/SSN combination which is currently enrolled in MHCP; or (2) Request the Payee associated with the Payee NPI and Payee TIN/SSN combination complete a full enrollment in MHCP. Contact MHCP Provider Enrollment at (651) 431-2700; Toll-free line at (800) 3665411; Fax at (651) 431-7462. Q: What can I do if my Payee NPI and Payee TIN/SSN combination is currently enrolled in MHCP, but is not in an active status or good standing? A: The Provider may choose a new payee NPI and payee TIN/SSN combination which is currently enrolled and in good standing in Minnesota Medicaid. The Payee may contact MHCP to discuss the standing of their enrollment. If you are currently enrolled, but have questions about your enrollment standing, Contact MHCP Provider Enrollment at (651) 431-2700; Toll-free line at (800) 366-5411; Fax at (651) 431-7462. Note: A provider may register with CMS for program participation prior to finalizing MHCP Payee Enrollment; however, the provider will not be able to complete the MEIP attestation process required to achieve payment until this information is finalized. 7. Register for participation in the MEIP at CMS’ EHR Incentive Program registration website: CMS EHR Incentive Registration. Your registration, if accepted, will be sent to the Minnesota EHR Incentive Program the next day. Registrations are processed by CMS and Minnesota 7 days a week. Minnesota EHR Incentive Program (MEIP) Page 5 of 26 MEIP Guidance for Eligible Professionals and Hospitals Released October 18, 2012 1.2 Prerequisites for EPs Part II: Preparing, Enrolling & Attesting for MEIP 1. Upon receipt of your CMS registration, Minnesota EHR Incentive Program will send you an email including instructions on to start your MEIP attestation, if the MHCP enrollment matching your registration NPI is: (1) Found in the MHCP system; (2) In good standing/not sanctioned in the MHCP system; and (3) A provider type eligible to participate in the MEIP. Q: How do I seek assistance if an issue is found with my program MHCP enrollment? A: For assistance with your MHCP enrollment, contact MHCP Provider Enrollment at (651) 431-2700; Toll-free line at (800) 366-5411; Fax at (651) 431-7462. Q: How do I seek assistance for questions related to MEIP enrollment? A: For assistance with MEIP enrollment, contact the MEIP help desk at [email protected] or call 1-855-676-0366. 2. Gather and prepare documentation that will be needed during the MEIP enrollment and attestation process. Appendix A: MEIP Guidance on Supporting Documentation provides the list of documentation options that will appear in the drop down menu as you are uploading documentation in support of your enrollment and attestation. Note: There are multiple options for documentation in each of the primary categories. Some categories are required, while others would be situational. Under no circumstances should a provider upload any documentation containing personal health information (PHI). 3. Complete your attestation in the MEIP. Providers will be required to enter and attest to the following types of data: a. Attesting as a pediatrician b. Attesting as part of an FQHC/RHC/IHS c. Attesting as part of a group. MHCP requires hospitals and clinic providers to review their provider affiliations with individual providers per MHCP Provider Update – Provider Affiliations d. Confirmation of the Payee selection e. Volume Attestation by Encounter Method f. Validation of the EHR Certification number g. Attestation to Meaningful Use criteria (Participation year 2 through 6) h. Signing of a Legal Notice confirming attested data Minnesota EHR Incentive Program (MEIP) Page 6 of 26 MEIP Guidance for Eligible Professionals and Hospitals Released October 18, 2012 i. j. Confirming and Submitting your attestation as complete Upload of Certified EHR system ownership documentation 4. Pre-Payment Review Based on DHS Minnesota EHR Incentive Program policy, providers will be processed through automated, and in some cases, manual pre-payment verification procedures. If selected, providers may be required to upload additional information to support the data entered at the time of attestation. 5. If determined eligible, payment will be received following the completion of the attestation in the MEIP within 45 days of the final attestation “Confirm and Submit”. Payments will be disbursed by DHS on a bi-weekly basis and will appear as a gross adjustment on your remittance advice. Minnesota EHR Incentive Program (MEIP) Page 7 of 26 MEIP Guidance for Eligible Professionals and Hospitals Released October 18, 2012 1.3 Medicaid Patient Volume (MPV) Calculation for EPs DHS has received several requests for clarification language contained in the State Medicaid HIT Plan (SMHP) related to which participants may be counted toward their Medicaid Patient Volume (MPV) for purposes of the Minnesota Medicaid EHR Incentive Program (MEIP). This resource is intended to provide clarification on the process used by MHCP to calculate MPV based on the Minnesota Health Care Programs (MHCP) that meet the definitions for eligible encounters in the federal regulations. Minnesota’s approved SMHP indicated the following for EP: Minnesota EPs use Option 1: Patient Encounter, as described in the rule, for calculating their Medicaid patient encounters and can: • Choose the 90-day period; • Count out-of-state encounters; • Calculate volume using the group clinic/proxy methodology; and • Count participants in: o o o o o o o o • MA (Medicaid) EH (Medicaid coverage of certain noncitizens for medical conditions) FF (federally funded demonstration; MinnesotaCare for parents and adult caretakers) LL (federally funded demonstration; MinnesotaCare for pregnant women and children) FP (Family Planning services; family planning services only) QM (Medicare Part A & B premiums, and cost sharing) SL (Medicare Part B premiums) WD (Medicare Part A premium only) EPs practicing predominantly in FQHC/RHC and Physician Assistants also include: o o NM with eligibility type PC (CHIP program) Services provided on a sliding scale or that were uncompensated MA, or Medical Assistance, is Minnesota’s Medicaid program. It is jointly funded with state and federal funds. The Minnesota Department of Human Services oversees the program statewide. The federal Centers for Medicare and Medicaid Services oversees Medicaid nationally. All Medical Assistance subcategories/products (see below) are countable for purposes of determining Medicaid Patient Volume Minnesota EHR Incentive Program (MEIP) Page 8 of 26 MEIP Guidance for Eligible Professionals and Hospitals Released October 18, 2012 under the Minnesota Electronic Health Record Incentive Program. MA is administered through both feefor-service and managed care. Additional details on the managed care products for MA are provided below. Relevant language from CMS Response and Analysis on Comments in the Final Rule: In establishing the Medicaid patient volume thresholds for EPs and acute care hospitals, section 1902(t)(2) of the Act requires that individuals enrolled in a Medicaid managed care plan be included. We interpret this to mean that individuals enrolled in MCOs, prepaid inpatient health plans (PIHPs), or prepaid ambulatory health plans (PAHPs), under 42CFR Part 438 be included in the calculation. Clarification on DHS Programs Administered Through Managed Care Organizations: In an effort to assist Minnesota providers with identifying encounters that can be included, the following overview provides additional details on the DHS programs administered through Managed Care Organizations. MCO’s were asked to provide the group numbers that correspond to the program codes that are eligible for inclusion in the Medicaid Patient Volume calculation under the Minnesota Medicaid Electronic Health Record Incentive Program. Medical Assistance with Federal Financial Participation (FFP): Sub-categories identified under DHS Major Program Code MA include: MA12 – Prepaid Medical Assistance Program MA20 – Prepaid Medical Assistance Program MA17 – Special Needs Basic Care (SNBC Integrated Medicare) MA19 – Special Needs Basic Care (SNBC PIN Non-integrated Medicare) MA37 – Special Needs Basic Care (SNBC Non-integrated Medicare) MA30 – Minnesota Senior Care Plus (MSC+) MA35 – Minnesota Senior Care Plus (MSC+) MA02 – Minnesota Senior Health Options (MSHO) Minnesota EHR Incentive Program (MEIP) Page 9 of 26 MEIP Guidance for Eligible Professionals and Hospitals Released October 18, 2012 Other Programs Administered by Managed Care Organizations with Federal Financial Participation: MinnesotaCare MinnesotaCare is a publicly subsidized program for Minnesota residents who do not have access to affordable health care coverage. This program is also administered by managed care organizations, and is funded by a state tax on Minnesota hospitals and health care providers, as well as federal Medicaid matching funds (in some cases), and enrollee premiums. The MinnesotaCare Products that are eligible for FFP and countable for purposes of determining Medicaid Patient Volume under the Minnesota Medicaid Electronic Health Record Incentive Program (MEIP) include: • • • • MinnesotaCare Basic Plus Two (parents & adult caretakers with income ≤275% FPL) MinnesotaCare Basic Plus ( parents and adult caretakers with income ≤275% FPL) MinnesotaCare Expanded (MinnesotaCare for children under age 21 and pregnant women) MinnesotaCare Expanded (MinnesotaCare for adults without children up to 250% FPL) The MinnesotaCare programs that are not eligible for FFP and are exclusively funded by the state that are not countable for purposes of determining Medicaid Patient Volume under MEIP include: • • MinnesotaCare for noncitizen parents/caretakers with income ≤275%FPL MinnesotaCare for noncitizen children under 21 and pregnant women Children’s Health Insurance Program (CHIP) The Children’s Health Insurance Program (CHIP) is a federal program that provides health coverage to children in families with incomes too high to qualify for Medicaid, but that can’t afford private coverage. Signed into law in 1997, CHIP provides federal matching funds to states to provide this coverage. Under the Medicaid EHR Incentive Program, CHIP enrollees are included in the definition of “needy individuals” who may be counted toward Medicaid patient volume, but only for eligible professionals practicing predominantly in a Federally Qualified Health Center (FQHC), Rural Health Clinic (RHC) or Indian Health Services clinic (IHS). Individuals in the CHIP program are identified under the following code: • CHIP for unborn children of noncitizen mothers ineligible for federally funded MA Minnesota EHR Incentive Program (MEIP) Page 10 of 26 MEIP Guidance for Eligible Professionals and Hospitals Released October 18, 2012 Additional Rules for Counting Encounters for EPs MHCP will filter EP-Specific claim queries in accordance with the following rules: • • • • Identify and separate MHCP encounters from private health plan encounters Multiple visits by an individual to the same rendering provider on one day will count as one encounter EP services provided within a hospital or Emergency Department (ED) setting with Place of Service 21 – Inpatient Hospital or 23 – Emergency Department Hospital are included in the EP patient volumes Claim lines paid for through State-only funded programs will be removed If you are attesting as an individual: 1. 2. 3. 4. 5. Determine Source of Patient Volume Determine your reporting period Calculate Medicaid Patient Encounters Calculate Total Patient Encounters Divide Medicaid Patient Encounters by the Total Patient Encounters Determine your reporting period. The reporting period is any 90-day consecutive period in the previous calendar year To calculate encounters, use the following calculation: Medicaid encounters divided by Total patient encounters times 100: Your Medicaid Patient Encounters * X 100 Your Total Patient Encounters ** * Use all Medicaid encounters from all places where you practice. ** Use all patient encounters from all places where you practice. Minnesota EHR Incentive Program (MEIP) Page 11 of 26 MEIP Guidance for Eligible Professionals and Hospitals Released October 18, 2012 EXAMPLE A Provider #9 also has his own practice in addition to providing services at Group A clinic and will attest as an individual EP: • Chooses to attest to solo practice patient volume • Chooses to attest from March 1, 2011 through May 31, 2011 • Attests to 75 Medicaid patients and 180 total patients seen during this period for a 41% total. Table 1. Provider #9 Patient Volume Provider Medicaid Patients Total Patients 1 75 180 Totals 75 Provider #9 Patient Volume 180 41% Minnesota EHR Incentive Program (MEIP) Page 12 of 26 MEIP Guidance for Eligible Professionals and Hospitals Released October 18, 2012 1.4 Attesting for Medicaid Patient Volume (MPV) Using Group Volumes If you are attesting as part of a group or clinic, the following should be considered: 1. Group as defined under MEIP is a unique pair of Federal Tax Identification Number (TIN) and National Provider Identifier (NPI). Appendix B MEIP Group Consent Form provides a template for providers to account for all professionals employed by the group. 2. All Medicaid encounters performed as part of the group are included for every practitioner in the group/clinic (numerator and denominator), regardless of whether the practitioner is eligible for the incentive program. Do not include encounters from outside the attestation group or the clinic. 3. If an eligible professional (EP) chooses not to participate in the group/clinic, the encounters generated by that EP may still be used in the calculation (numerator and denominator) for that particular group/clinic. The EP cannot use those encounters for calculating volumes for another practice or individually if the group/clinic has already included them in their volume calculation. 4. For Group Attestations: a. The first person attesting will enter the reporting period, the number of members in the group, the group name, and the group volume (numerator and denominator). Each subsequent person in the group to attest will select the group they are attesting with, attest to information provided by the first person in the group, and provide other required information pertaining to their attestation. See “Determining your Group’s Patient Volume” below for information on how to calculate your group’s volume. 5. For Clinic Attestations: a. Each Eligible Professional attesting as part of an FQHC/RHC/IHS will be required to indicate the clinic or individual volume at the time of attestation. Note: Attesting as part of a Clinic may only be done by those Eligible Professionals choosing to attest as part of an FQHC/RHC/IHS. Clinics are not considered Groups in the Minnesota EHR Incentive Program (MEIP). Selection of ‘no’ when prompted with the question “Are you attesting as a group?” directs an EP to the FQHC/RHC/IHS volume attestation screen. The FQHC/RHC/IHS screen provides individual or clinic volume attestation of Needy Patient Encounters. Minnesota EHR Incentive Program (MEIP) Page 13 of 26 MEIP Guidance for Eligible Professionals and Hospitals Released October 18, 2012 Determining your Group’s or Clinic’s Patient Volume To correctly determine the patient volume for a Group: a. b. c. d. e. Determine number of EPs attesting Determine your reporting period Calculate Medicaid Patient Encounters Calculate Total Patient Encounters Divide Medicaid Patient Encounters by the Total Patient Encounters Determine your reporting period. The reporting period is a 90-day consecutive period in the previous calendar year. To calculate encounters , use the following calculation: Medicaid encounters divided by Total patient encounters times 100: Your Medicaid Patient Encounters *, *** X 100 Your Total Patient Encounters **, *** * Use all Medicaid encounters from all practitioners in the group, even those who are not eligible for incentives and those who chose not to participate. ** Use all patient encounters from all practitioners in the group, even those who are not eligible for incentives and those who chose not to participate. *** Providers attesting as part of a Clinic (FQHC/RHC/IHS) include the Needy Patient Volume in the numerator and denominator. EXAMPLE B Group A has a total of 10 Professionals working in their clinic. Of the 10 professionals: • 5 EPs will attest to their patient volume as part of Group A • 3 EPs have elected to attest to their patient volume as an individual using volume from other clinics • 2 professionals are not eligible for MEIP Minnesota EHR Incentive Program (MEIP) Page 14 of 26 MEIP Guidance for Eligible Professionals and Hospitals Released October 18, 2012 • • Group A will add Medicaid and Total patient volume from all 10 professionals Group A has chosen to attest to March 1, 2011 to May 31, 2011 for their 90-day period Table 2. Group A Patient Volume Provider Medicaid Patients Total Patients 1 25 100 2 37 102 3 10 30 4 12 25 5 5 16 6 14 22 7 25 97 8 45 57 9 3 7 10 2 9 Totals 178 Group Patient Volume 465 38% Minnesota EHR Incentive Program (MEIP) Page 15 of 26 MEIP Guidance for Eligible Professionals and Hospitals Released October 18, 2012 Section 2: Guidance for Eligible Hospitals (EHs) 2.1 Prerequisites Part I: Preparation and Registration with CMS Prior to registration in the Minnesota EHR Incentive Program (MEIP) at the Centers for Medicare and Medicaid Services (CMS) website, a provider should first determine if they have the information necessary to complete the initial registration and eventual enrollment in the MEIP. 1. Determine if the Eligible Hospital (EH) is potentially eligible to participate in the MEIP. The CMS Eligibility Tool can help you determine whether you may be eligible. 2. Confirm the EH has an individual National Provider ID (NPI) valid for participation in the Centers for Medicare and Medicaid Services (CMS) Medicare and Minnesota EHR Incentive Programs. 3. Confirm the EH is enrolled in Minnesota Health Care Programs (MHCP). The enrollment linked to the EH’s NPI must be active and in good standing. If the EH is not enrolled in MHCP, or the EH is not in good standing in MHCP, the EH will not be allowed by rule to participate in the program. Q: What can I do if the EH is not currently enrolled in Minnesota Health Care Programs or have questions about my enrollment standing? A: You will need to complete your Minnesota Medicaid enrollment first, prior to participating in the MEIP. Contact MHCP Provider Enrollment at (651) 431-2700; Tollfree line at (800) 366-5411; Fax at (651) 431-7462. 4. Confirm your NPI is enrolled in the MHCP system as an Eligible Provider Type According to the CMS Final Rule for the Medicaid EHR Incentive Program and the Minnesota State Medicaid HIT Plan, EHs for MEIP are those whose last four digits of their CMS Certification Number (CCN) fall into one of the following ranges: • 0001-0879 for acute care hospitals • 1300-1399 for critical access hospitals • 3300-3399 for children’s hospitals Q: What can I do if I am not currently enrolled as an eligible provider type in MHCP? A: You will need to complete a full enrollment with MHCP. This process includes validation of current certifications and licenses. Contact MHCP Provider Enrollment at (651) 431-2700; Toll-free line at (800) 366-5411; Fax at (651) 431-7462. Minnesota EHR Incentive Program (MEIP) Page 16 of 26 MEIP Guidance for Eligible Professionals and Hospitals Released October 18, 2012 5. Confirm your Electronic Health Records system is certified by the Offices of the National Coordinator (ONC) for Health Information Technology (HIT). If you are currently adopting, implementing, upgrading, or using an electronic health records system you can determine if your system is certified by ONC by performing a search on this site: ONC EHR Certification Search Q: What if I do not have my EHR Certification Number at this time? A: You may register with CMS for program participation prior to receiving the EHR Certification Number; however you will be required to enter this number in MEIP portal during your enrollment and attestation in order to meet program eligibility requirements and achieve payment. 6. Confirm your Payment Assignment By rule, a provider assigns payment to the EH. In order to assign payment for MEIP, the following is required: c. The Payee NPI and Payee TIN identified by the Provider at the time of CMS EHR Incentive Program registration must be enrolled in MHCP. The Payee NPI and Payee TIN must match exactly to the MHCP Enrollment data. d. The enrollment linked to your payee must be active and in good standing. If the Payee NPI and Payee TIN do not match an enrollment with MHCP, or the Payee NPI and Payee TIN matches an enrollment with MHCP which is not in good standing, the payee selection will not be allowed for MEIP. Q: What can I do if my Payee NPI and TIN combination is not known to MHCP? A: The Provider may: Request the Payee associated with the Payee NPI and Payee TIN combination complete a full enrollment in MHCP. Contact MHCP Provider Enrollment at (651) 431-2700; Toll-free line at (800) 366-5411; Fax at (651) 4317462. Q: What can I do if my Payee NPI and Payee TIN combination is currently enrolled in MHCP, but is not in an active status or good standing? A: The Payee may contact MHCP to discuss the standing of their enrollment. If you are currently enrolled, but have questions about your enrollment standing, Contact MHCP Provider Enrollment at (651) 431-2700; Toll-free line at (800) 3665411; Fax at (651) 431-7462. Minnesota EHR Incentive Program (MEIP) Page 17 of 26 MEIP Guidance for Eligible Professionals and Hospitals Released October 18, 2012 Note: A provider may register with CMS for program participation prior to finalizing MHCP Payee Enrollment; however, the provider will not be able to complete the MEIP attestation process required to achieve payment until this information is finalized. 7. Register for participation in the MEIP at CMS’ EHR Incentive Program registration website: CMS EHR Incentive Registration. Your registration, if accepted, will be sent to the Minnesota EHR Incentive Program the next day. Registrations are processed by CMS and Minnesota 7 days a week. Minnesota EHR Incentive Program (MEIP) Page 18 of 26 MEIP Guidance for Eligible Professionals and Hospitals Released October 18, 2012 2.2 Prerequisites Part II: Preparing, Enrolling & Attesting for MEIP The following process will need to be followed in order to participate in the Minnesota EHR Incentive Program (MEIP): 1. Upon receipt of your CMS registration, Minnesota EHR Incentive Program will send you an email including instructions on to start your MEIP attestation, if the MHCP enrollment matching your registration NPI is: (1) Found in the MHCP system; (2) In good standing/not sanctioned in the MHCP system; and (3) A provider type eligible to participate in the MEIP. Q: How do I seek assistance if an issue is found with my program MHCP enrollment? A: For assistance with your MHCP enrollment, contact MHCP Provider Enrollment at (651) 431-2700; Toll-free line at (800) 366-5411; Fax at (651) 431-7462. Q: How do I seek assistance for questions related to MEIP enrollment? A: For assistance with MEIP enrollment, contact the MEIP help desk at [email protected] or call 1-855-676-0366. 2. Gather and prepare documentation that will be needed during the MEIP enrollment and attestation process. Appendix A: MEIP Guidance on Supporting Documentation provides the list of documentation options that will appear in the drop down menu as you are up-loading documentation in support of your enrollment and attestation. Note: There are multiple options for documentation in each of the primary categories. Some categories are required, while others would be situational. Under no circumstances should a provider upload any documentation containing personal health information (PHI). 3. Complete Payee designation. As part of the CMS EHR Registration process, the Hospital Payee is defaulted to the Hospital NPI and Hospital Tax Identification Number (TIN) used at the time of registration. Unlike Eligible Professionals, hospitals may not designate their payments to other Medicaid professionals or entities. Payments will be made to the Medicaid Hospital Enrollment which matches the Hospital’s registration NPI and TIN. The MEIP will require the attesting hospital to: a) Confirm the Payee NPI and TIN as part of the attestation process. This will help ensure the appropriate Medicaid payee receives the EHR Incentive payment, if the hospital is determined eligible for an EHR Incentive payment. Minnesota EHR Incentive Program (MEIP) Page 19 of 26 MEIP Guidance for Eligible Professionals and Hospitals Released October 18, 2012 4. Attest to Patient Discharge Volume. The CMS EHR Incentive Program Final Rule requires hospitals to meet a 10% Medicaid Discharge volume in order to participate in the program.* *Children’s Hospitals are not required to meet a Medicaid Discharge volume percentage in order to participate. The MEIP will require attesting hospitals (non-children’s hospitals) to: a) Select the volume reporting period. The reporting period is any 90-day consecutive period in the previous federal fiscal year. b) Input the numerator counting discharges where Medicaid paid part or all of the inpatient discharge and emergency room services on any one day. c) Input the denominator for total discharges and ED encounters (Medicaid Paid and nonMedicaid Paid). d) Derive the numerator and denominator from the same continuous three-month period in the preceding Fiscal year. The calculation appears as follows: Medicaid Discharges + Medicaid ED Encounter Total Discharges + ED Encounters X100 5. Confirm EHR Certification Number. The MEIP requires hospitals to input their Certified EHR Number during the attestation process. The number is then validated real-time against the Office of the National Coordinator (ONC) Certification database. The (MEIP) will require attesting hospitals to Enter the CMS EHR certification identification number on the AIU attestation page. Attestation cannot continue without the entry of your EHR solution’s Certification Number. a. You can determine if your EHR solution is certified by the ONC or obtain an EHR Certification number by visiting this site: ONC EHR Certification website 6. Payment Calculation Attestation . The CMS EHR Incentive Program Final Rule documents the payment calculation to be used by Medicaid states. MEIP payments are to made to hospitals which have been determined eligible to participate in the program. The EH can reference the following tips on how to prepare for attestation: Minnesota EHR Incentive Program (MEIP) Page 20 of 26 MEIP Guidance for Eligible Professionals and Hospitals Released October 18, 2012 • • • • • • A multi-site hospital with one CCN is considered one hospital for purposes of attestation and payment. It is suggested the hospital use an auditable data source, such as the latest Medicare cost report and HAR to complete the EHR Incentive Payment Calculation attestation. Hospitals are to use their MN Hospital Annual Report (HAR) when necessary. If the EH has only one year of data the EH would use the first year data and enter zeroes for the other years then as the years progress the EH would update the worksheet from year to year. The EH is required to review the worksheet amounts every year, attest the amounts are still correct and adjust them if they have changed due to an audit. If an EH has experienced a merge of two facilities and has had to submit cost reports in six month increments during this period of change which cost report should the EH use on the worksheet, the EH must go back to the first full 12-month report for year one. To estimate your hospital payment, access and download the MEIP Hospital Calculation worksheet link found on the MEIP Eligible Hospitals page. The worksheet identifies the Medicare Cost Report data and HAR fields used to verify hospital payment attestation data. The MEIP Hospital Calculation Sample provides EHs with an example of a completed estimated EHR incentive payment. Appendix C Sample MEIP Hospital Calculation provides an example of a completed MEIP Hospital Calculation worksheet. 7. Select enrollment year. Eligible hospitals can choose to enroll for 2013 as the Year 1 EHR incentive payment. The following tables can assist the decision: a) Appendix D: MEIP First Enrollment and Attestation Month provides the Payment Year options based on when the EH has submitted the CMS R&A registration and the month they are performing their attestation in MEIP. b) Appendix E: MEIP Hospital Fiscal Year Start provides the time period to be used for discharge volumes, charges and inpatient days in the MEIP incentive payment calculation based on the desired first payment year. If the EH is enrolling for the 2012 payment year, the EH should review when the EH calendar year ends. The EH must use the cost report year that overlaps the most recent federal fiscal year. If the EH calendar year ends on August 31 for the 2012 payment year then the EH would use the 2010 cost report. To determine the discharge-related amount for the three subsequent payment years that are included in determining the overall EHR amount, the number of discharges will be based on the Minnesota EHR Incentive Program (MEIP) Page 21 of 26 MEIP Guidance for Eligible Professionals and Hospitals Released October 18, 2012 average annual growth rate for the hospital over the most recent three years of available data. Per a CMS.gov outreach document, “For the first payment year, data on hospital discharges from the hospital fiscal year that ends during the federal fiscal year prior to the hospital fiscal year that serves as the first payment year will be used as the basis for determining the discharge-related amount.” 8. Pre-Payment Review Based on DHS Minnesota EHR Incentive Program policy, providers will be processed through automated, and in some cases, manual pre-payment verification procedures. If selected, providers may be required to upload additional information to support the data entered at the time of attestation. Following the completion of the attestation process, a Pre-Payment Review may be conducted. 9. If determined eligible, payment will be received following the completion of the attestation in the MEIP within 45 days of the final attestation “Confirm and Submit”. Payments will be disbursed by DHS on a bi-weekly basis and will appear as a gross adjustment on your remittance advice. Minnesota EHR Incentive Program (MEIP) Page 22 of 26 MEIP Guidance for Eligible Professionals and Hospitals Released October 18, 2012 2.3 Medicaid Patient Volume (MPV) Calculation for EHs DHS has received several requests for clarification language contained in the State Medicaid HIT Plan (SMHP) related to which participants may be counted toward their Medicaid Patient Volume (MPV) for purposes of the Minnesota Medicaid EHR Incentive Program (MEIP). This resource is intended to provide clarification on the process used by MHCP to calculate MPV based on which Minnesota Health Care Programs (MHCP) meet the definitions for eligible encounters in the federal regulations. Minnesota’s approved SMHP indicated the following: Eligible Hospitals The SMA follows the definition in federal regulations for EH Medicaid patient encounters where an “EH Medicaid patient-encounter,” is defined as services rendered to an individual per inpatient discharge or on any one day in the emergency room where Title XIX Medicaid or another state’s Medicaid program paid for part or all of the service, their premiums, co-payments, and/or cost-sharing. Per federal regulations, children’s hospitals are not required to meet any Medicaid patient-volume percentage, and do not provide information on patient encounters. Minnesota has created a hospital incentive calculation template which is available on our EHR Incentive website. Minnesota EHs use Inpatient Discharges and Emergency Department (ED) visits, as described in the rule, for calculating their Medicaid patient encounters and EHs can: • Choose the 90-day period; • Count out-of-state encounters; • Calculate volume using the group clinic/proxy methodology; and • Count participants in: o MA (Medicaid) o EH (Medicaid coverage of certain noncitizens for medical conditions) o FF (federally funded demonstration; MinnesotaCare for parents and adult caretakers) o LL (federally funded demonstration; MinnesotaCare for pregnant women and children) o FP (Family Planning services; family planning services only) Minnesota EHR Incentive Program (MEIP) Page 23 of 26 MEIP Guidance for Eligible Professionals and Hospitals Released October 18, 2012 • o QM (Medicare Part A & B premiums, and cost sharing) o SL (Medicare Part B premiums) o WD (Medicare Part A premium only) EPs practicing predominantly in FQHC/RHC and Physician Assistants also include: o NM with eligibility type PC (CHIP program) o Services provided on a sliding scale or that were uncompensated MA, or Medical Assistance, is Minnesota’s Medicaid program. It is jointly funded with state and federal funds. The Minnesota Department of Human Services oversees the program statewide. The federal Centers for Medicare and Medicaid Services oversees Medicaid nationally. All Medical Assistance subcategories/products (see below) are countable for purposes of determining Medicaid Patient Volume under the Minnesota Electronic Health Record Incentive Program. MA is administered through both feefor-service and managed care. Additional details on the managed care products for MA are provided below. Relevant language from CMS Response and Analysis on Comments in the Final Rule: In establishing the Medicaid patient volume thresholds for EPs and acute care hospitals, section 1902(t)(2) of the Act requires that individuals enrolled in a Medicaid managed care plan be included. We interpret this to mean that individuals enrolled in MCOs, prepaid inpatient health plans (PIHPs), or prepaid ambulatory health plans (PAHPs), under 42CFR Part 438 be included in the calculation. Clarification on DHS Programs Administered Through Managed Care Organizations: In an effort to assist Minnesota providers with identifying encounters that can be included, the following overview provides additional details on the DHS programs administered through Managed Care Organizations. MCO’s were asked to provide the group numbers that correspond to the program codes that are eligible for inclusion in the Medicaid Patient Volume calculation under the Minnesota Medicaid Electronic Health Record Incentive Program. Medical Assistance with Federal Financial Participation (FFP): Sub-categories identified under DHS Major Program Code MA include: MA12 – Prepaid Medical Assistance Program Minnesota EHR Incentive Program (MEIP) Page 24 of 26 MEIP Guidance for Eligible Professionals and Hospitals Released October 18, 2012 MA20 – Prepaid Medical Assistance Program MA17 – Special Needs Basic Care (SNBC Integrated Medicare) MA19 – Special Needs Basic Care (SNBC PIN Non-integrated Medicare) MA37 – Special Needs Basic Care (SNBC Non-integrated Medicare) MA30 – Minnesota Senior Care Plus (MSC+) MA35 – Minnesota Senior Care Plus (MSC+) MA02 – Minnesota Senior Health Options (MSHO) Other Programs Administered by Managed Care Organizations with Federal Financial Participation: MinnesotaCare MinnesotaCare is a publicly subsidized program for Minnesota residents who do not have access to affordable health care coverage. This program is also administered by managed care organizations, and is funded by a state tax on Minnesota hospitals and health care providers, as well as federal Medicaid matching funds (in some cases), and enrollee premiums. The MinnesotaCare Products that are eligible for FFP and countable for purposes of determining Medicaid Patient Volume under the Minnesota Medicaid Electronic Health Record Incentive Program (MEIP) include: • MinnesotaCare Basic Plus Two (parents & adult caretakers with income ≤275% FPL) • MinnesotaCare Basic Plus ( parents and adult caretakers with income ≤275% FPL) • MinnesotaCare Expanded (MinnesotaCare for children under age 21 and pregnant women) • MinnesotaCare Expanded (MinnesotaCare for adults without children up to 250% FPL) The MinnesotaCare programs that are not eligible for FFP and are exclusively funded by the state that are not countable for purposes of determining Medicaid Patient Volume under MEIP include: • MinnesotaCare for noncitizen parents/caretakers with income ≤275%FPL • MinnesotaCare for noncitizen children under 21 and pregnant women Minnesota EHR Incentive Program (MEIP) Page 25 of 26 MEIP Guidance for Eligible Professionals and Hospitals Released October 18, 2012 Children’s Health Insurance Program (CHIP) The Children’s Health Insurance Program (CHIP) is a federal program that provides health coverage to children in families with incomes too high to qualify for Medicaid, but that can’t afford private coverage. Signed into law in 1997, CHIP provides federal matching funds to states to provide this coverage. Under the Medicaid EHR Incentive Program, CHIP enrollees are included in the definition of “needy individuals” who may be counted toward Medicaid patient volume, but only for eligible professionals practicing predominantly in a Federally Qualified Health Center (FQHC), Rural Health Clinic (RHC) or Indian Health Service Clinic (IHS). Individuals in the CHIP program are identified under the following code: • CHIP for unborn children of noncitizen mothers ineligible for federally funded MA Additional Rules for Counting Medicaid Encounters for EHs MHCP will filter EH-Specific claim queries in accordance with the following rules: • • • • • • If a person has an Emergency Department (ED) visit and no inpatient stay on a given day, the ED is one encounter If a person has an inpatient stay but no ED visit, the inpatient discharge is one encounter If a person goes to an ED and is admitted to an inpatient stay where the DISCHARGE from that inpatient stay is any day FOLLOWING the ED visit is TWO encounters If a person has an inpatient stay and is discharged and goes to the ED on the same day as the discharge to the same provider, that will be counted as ONE encounter Contiguous inpatient stays from the same provider are merged and counted as ONE encounter The measurement span includes one month prior and one month after the actual measurement year to evaluate inpatient discharge dates o Inpatient discharge must occur between the start and end dates of the measurement span to be included as an encounter Minnesota EHR Incentive Program (MEIP) Page 26 of 26 Appendix A - MEIP Guidance on Supporting Documentation Category Document Options AIU Other Adopt, Implement, Upgrade Contract Purchase Order/Invoice/Receipt Reconsideration Reconsideration Request – Supporting Documentation Appeal MEIP Appeal Form Pre-Payment Audit Pre-Payment Audit Documentation Post-Payment Audit Post-Payment Audit Documentation EHR Solution EHR Contract EHR Other EHR Purchase Order EHR Software License Group Group Attestation Document Group Members Consent Documentation Group Other Group Volumes Supporting Documentation Required/Situational Required – first year only. In the first year, providers will be required to upload at least one form of AIU documentation. This documentation must clearly show the relationship between the certified EHR vendor, the entity that adopted, implemented or upgraded to the system, and the licensed user. Situational. This documentation type would only be used if a provider is requesting a reconsideration of an initial payment decision. Situational. This documentation type would only be used if a provider is filing a formal appeal of a payment decision. Situational. This documentation type would only be used if a provider has been asked for additional documentation during a pre-payment desk audit. Situational. This documentation type would only be used if a provider has been asked for additional documentation during a post-payment audit. Required – second year and beyond. Providers will be required to upload at least one form of EHR solution documentation in year 2 and beyond. This documentation must clearly show the relationship between the certified EHR vendor, the entity using the system, and the licensed user. Situational. Providers attesting using a group Medicaid Patient Volume (MPV), will be required to upload documentation listing the EPs, whether they intend to attest as part of the group, and documenting their consent to include their patient volume included in the group. The MEIP Group Consent Form available on the MEIP Reference Material website provides a template for providers to account for all professionals employed by the group. Category Document Options Disagreed with Legal Notice Legal Notice Signed & Affirmed Legal Notice Meaningful Use MU Other Patient Volume Hospital Based Patient Encounter Patient Volumes Other Out of State Volume Payment Pediatrician Attestation FQHC/RHC/IHS Attestation Required/Situational Situational. This document is automatically generated and uploaded to the provider’s file if the provider indicates that they disagree with the legal notice. Required. This document is automatically generated and uploaded to the provider’s file when they electronically sign the legal notice. Providers are offered the opportunity to print a copy of this document for their records upon attestation. Situational. If a provider is attesting for meaningful use, they may use this option to upload any related documentation in support of their MU attestation. Situational. Providers may upload documentation in support of their Medicaid patient volume. This is required in situations where providers are including out-ofstate encounters in their MPV attestation. Documentation of out-of-state encounters should specify the number and state in which the encounters occurred. EH Average Length of Stay EH Charity Expenses Supporting Documentation EH Discharge Documentation EH Schedule Adjustment EH Medicaid Share EH Cost Report and/or HAR EP Adjustment Payment Other Situational. Hospitals will be required to submit documentation relevant to their payment calculation. Categories are also available in the event that an EP would need to upload any payment related documentation. Pediatrician Certification Situational. Providers may upload documentation in support of their pediatrician attestation. Per MN Statute, (f) "Pediatrician" means a physician who is certified by either the American Board of Pediatrics or the American Osteopathic Board of Pediatrics. PA So-Led Documentation Situational. Providers may upload documentation in support of their PA-So-Led attestation. Page 44483 of the Final Rule clarifies the CMS definition of Physician Assistant (PA) ‘so-led’. The MEIP PA So-Led Form is available on the MEIP Reference Material website for providers to attest to being employed in a so-led facility. Appendix B. MEIP EP Individual and Group Volume Worksheet From Date (m/d/yy) Medicaid Provider Name NPI To Date (m/d/yy) Group NPI Total Medicaid EP Encounters Total Encounters PV Numerator PV Denominator Attesting with Group (Y/N) Consent to include your patient volume in the group (Y/N) Signature of Consent to attest with the group 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Note: The Medicaid patient volume will be calculated based on any continuous three month reporting period in the previous calendar year starting the first day of the month. Appendix C. MEIP Hospital Calculation Sample MEIP Hospital Incentive Payment Calculation Worksheet Version 1.0 Step 1: Calculate growth rate Total Discharges Previous Year (Source1: CMS-2552-10 Medicare Cost Report Worksheet S-3, Part I, col. 15, line 14) OR (Source2: CMS-2552-96 Medicare Cost Report Worksheet S-3, Part I, Col. 15, Line 12) Year 1 (Federal Fiscal (FF) Year prior to payment year)) Year 2 (1st Previous FF Year) Year 3 (2nd Previous FF Year) Year 4 (3rd Previous FF Year) 18,131 = -0.006397882 18,131 - 17,297 = 834 ÷ 17,297 = 0.048216454 17,297 - 16,773 = 16,773 Average Growth Rate + + + + 18,015 18,015 18,454 18,903 (Source1: CMS-2552-10 Medicare Cost Report Worksheet C, Part I, col. 8, line 200) OR (Source2: CMS2552-96 Medicare Cost Report Worksheet C, Part I, Col. 8, Line 101) Charity Care Charges* Step 4: Calculate aggregate amount Overall EHR Amount Step 5: Apply MN hospital incentive payout schedule Aggregate EHR Amount $4,292,535 × $4,292,535 × $4,292,535 × 18,015 18,454 18,903 19,363 Allowed Discharges Medicaid Share 31.44% Payout Percentage 50% 40% 10% = $939,854,524 = Aggregate EHR Amount 16,865 17,304 17,753 18,213 0.031240684 Years of Data 0.073 ÷ Discharges Rate × × × × 3 Average Growth Rate = Discharge Cost = = = = $200 $200 $200 $200 $3,373,000 $3,460,744 $3,550,625 $3,642,695 % of Noncharity Charges 0.95 × Total Inpatient Days (Source1: CMS-2552-10 Medicare Cost Report Worksheet S3 part I, col. 8, line 1, 2 + lines 8-12) OR (Source2: CMS2552-96 Medicare Cost Report Worksheet S-3, Part I, Col. 6, Line 1, 2 +lines 6-10) 97,530 = Adjusted Inpatient Days 92,879 2.44% Base Amount + + + + Note: There is no dischange allowance for discharges less than 1,150 and more than 23,000 (23,000 - 1,150 = 21,850). Total Charges $44,821,846.00 ÷ 16,773 = (max=21,850) (Source1: CMS-2552-10 Medicare Cost Report Worksheet S10, col. 3, line 20 minus HAR 0621) OR (Source2: CMS-255296 Medicare Cost Report Worksheet S-10, Line 30 minus HAR 0621) OR (Source3: HAR line 0762) $939,854,524.00 - $13,654,544 × 524 ÷ Adjusted Discharges = = = = 0 2.44% 2.44% 2.44% Total Charges Year 1 Year 2 Year 3 Percent Change (116) ÷ Step 3: Calculate Medicaid share Current Yr Previous Year 18,131 = Total Discharges Current Yr Difference 18,015 - Step 2: Calculate initial payments Year 1 Year 2 Year 3 Year 4 Last updated: 09/26/2012 Transition Factor × × × × $2,000,000 $2,000,000 $2,000,000 $2,000,000 Initial EHR Payment 1 = 0.75 = 0.50 = 0.25 = Overall EHR Amount: Medicaid Inpatient Days FFS** Medicaid Inpatient Days MC*** (Source1: CMS-2552-10 Medicare Cost Report Worksheet S3 part I, col. 7, line 1 + lines 8-12) OR (Source2: CMS-255296 Medicare Cost Report Worksheet S-3, Part I, Col. 5, Line 1 + lines 6-10) (Source1: CMS-2552-10 Medicare Cost Report Worksheet S-3 part I, col. 7, line 2) OR (Source2: CMS-2552-96 Medicare Cost Report Worksheet S-3, Part I, Col. 5, Line 2) 8,889 + $5,373,000 $4,095,558 $2,775,313 $1,410,674 $13,654,544.48 20,309 ÷ MEIP Hospital Calculation Worksheet footnotes $4,292,534.96 * Charity Care Charges - Charges amount on CMS-2552-10 Medicare Cost Report Worksheet S-10, col. 3, line 20 and CMS-2552-96 Medicare Cost Report Worksheet S-10, Line 30 is an Uncompensated amount and not exclusive to Charity Care. To calculate Charity Care when using 2552-10 or 2552-96, Bad Debt must be located on HAR Report 0621 then = = = Annual Incentive Payment $2,146,267.48 $1,717,013.98 $429,253.50 $4,292,534.96 Subtracted from the Uncompensated amount. ** Medicaid Inpatient Days FFS - To calculate net value, SUBTRACT Managed Care (MC) patient days, Medicaid eligible days for which no payment was received and nursery days after discharge from CMS-2552-10 Medicare Cost Report Worksheet S-3 part I, col. 7, line 1 + lines 8-12 or CMS-2552-96 Medicare Cost Report Worksheet S-3, Part I, Col. 5, line 1 +lines 6-10. *** Medicaid Inpatient Days MC – To calculate net value, SUBTRACT Medicaid Fee-For-Service (FFS) secondary payer patient days, Medicaid eligible days for which no payment was received and nursery days after discharge from CMS-2552-10 Medicare Cost Report Worksheet S-3 part I, col. 7, line 2 or CMS-2552-96 Medicare Cost Report Worksheet S-3, Part I, Col. 5, Line 2. Requirement: Hospitals are required to use their CMS approved cost report. If a CMS approved cost report is not used then supporting documentation will be required. Hospitals are to use their MN Hospital Annual Report (HAR) when necessary. Adjusted Inpatient Days 92,879 Medicaid Share = 31.44% Appendix D. MEIP First Enrollment and Attestation Month OCT 2012 NOV 2012 DEC 2012 JAN 2013 FEB 2013 MAR 2013 APR 2013 MAY 2013 JUN 2013 JUL 2013 AUG 2013 SEP 2013 OCT 2013 NOV 2013 DEC 2013 JAN 2014 SEPT 2012 2012 or or earlier 2013 OCT 2012 CMS R & A Registration Date NOV 2012 DEC 2012 JAN 2013 FEB 2013 MAR 2013 APR 2013 MAY 2013 JUN 2013 JUL 2013 AUG 2013 SEP 2013 OCT 2013 NOV 2013 DEC 2013 JAN 2013 2013 2012 or 2013 2012 or 2013 2012 or 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 or 2014 2013 or 2014 2013 or 2014 2014 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 or 2014 2013 or 2014 2013 or 2014 2014 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 or 2014 2013 or 2014 2013 or 2014 2014 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 or 2014 2013 or 2014 2013 or 2014 2014 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 or 2014 2013 or 2014 2013 or 2014 2014 2013 2013 2013 2013 2013 2013 2013 2013 2013 or 2014 2013 or 2014 2013 or 2014 2014 2013 2013 2013 2013 2013 2013 2013 2013 or 2014 2013 or 2014 2013 or 2014 2014 2013 2013 2013 2013 2013 2013 2013 or 2014 2013 or 2014 2013 or 2014 2014 2013 2013 2013 2013 2013 2013 or 2014 2013 or 2014 2013 or 2014 2014 2013 2013 2013 2013 2013 or 2014 2013 or 2014 2013 or 2014 2014 2013 2013 2013 2013 or 2014 2013 or 2014 2013 or 2014 2014 2013 2013 2013 or 2014 2013 or 2014 2013 or 2014 2014 2013 2013 or 2014 2013 or 2014 2013 or 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 Appendix E - MEIP Hospital Fiscal Year Start Hospital Fiscal Year Start 2012 Payment Year1 2013 Payment Year2 January January 1, 2010 - December 31, 2010 January 1, 2011 - December 31, 2011 February February 1, 2010 - January 31, 2011 February 1, 2011 - January 31, 2012 March March 1, 2010 - February 28, 2011 March 1, 2011 - February 28, 2012 April April 1, 2010 - March 31, 2011 April 1, 2011 - March 31, 2012 May May 1, 2010 - April 30, 2011 May 1, 2011 - April 30, 2012 June June 1, 2010 - May 31, 2011 June 1, 2011 - May 31, 2012 July July 1, 2010 - June 30, 2011 July 1, 2011 - June 30, 2012 August August 1, 2010 - July 31, 2011 August 1, 2011 - July 31, 2012 September September 1, 2010 - August 31, 2011 September 1, 2011 - August 31, 2012 October October 1, 2010 - September 30, 2011 October 1, 2011 - September 30, 2012 November November 1, 2009 - October 31, 2010 November 1, 2010 - October 31, 2011 December December 1, 2009 - November 30, 2010 December 1, 2010 - November 30, 2011 1 2 – EH must have registered with CMS Registration and Attestation (R&A) prior to September 30, 2012 – During the “120 day grace period” from October 1, 2012 – January 31, 2013, EHs that have completed the CMS R&A registration per footnote 1, have the choice of selecting payment year 2012 or 2013.