Missouri Medicaid EHR Incentive Program Eligible Professionals

Yes

The calculation utilizes both Panel Members and Encounters in Step 2 of the SLR solution. Professionals who see both FFS and managed care patients can enter their FFS encounters and their panel members. Professionals who only have panel members will enter the encounters for those panel members for the representative period in the Total Encounters and Total Medicaid encounters fields. Professionals who have FFS only will enter the FFS encounters in Total Encounters and Medicaid encounters. Professionals cannot double count Panel Members and Encounters.

Eligible Professionals who practice at an FQHC or RHC are required to have at least 30% "needy individuals" volume. "Needy individuals" include those:

1. who receive medical assistance from Medicaid or the Children's Health Insurance Program;
2. who are furnished uncompensated care by the provider; or
3. who are furnished services at either no or reduced cost based on a sliding scale.

The point of this field is to allow you to include the needy patient volume beyond those who receive Medicaid. If you qualify with your Medicaid volume entered above, select the "none" button. The system will be changed to accept zero as a response in the future.

The first section of the eligibility screen is for professionals that do not practice predominantly in an FQHC or RHC. To calculate Medicaid patient volume, the first field requests total encounters – which include CHIP encounters (Title XXI). The next field requests total Medicaid encounters, which includes Medicaid only (Title XIX). If the calculation is 30% or greater, the volume threshold is met.

The second section of the eligibility screen is for professionals that practice predominantly in an FQHC or RHC. This section allows CHIP volume (Title XXI) to be included to supplement Medicaid patient volume. In this case the CHIP (Title XXI) volumes need to be counted separately.

Since CHIP patients are difficult to identify separately from Medicaid patients, MO HealthNet will request permission from CMS to use an average calculation for this purpose. Once we receive a response, we will provide additional guidance.

The Group registration and attestation process is in development and is scheduled for production in late September. The new functionality of the SLR will allow a Group representative or designee to enter Medicaid patient volume data and EHR certification information for each professional associated with the group. It will not be the same functionality as the Medicare Identity and Access Management System. The eligible professional's NPI/TIN will sync up with the Group TIN/NPI to automatically pre-populate the professional's attestation document with the Group's volume and EHR certification. While the representative or designee can enter data on behalf of the professional, they cannot sign or submit the attestation. Each individual professional should sign and submit their own attestation under their individual account. MO HealthNet will provide an update when this functionality is available. In the meantime the help desk will offer assistance to those who want to enter data on behalf of professionals in a group.

At present the period is 90 days. CMS has approved other states requests to have a longer than 90 day reporting period. MO will request CMS approval for this change when the next update to the SMHP is submitted. ACS is developing a change in the SLR application which is targeted to be released in July 2011 to allow new 90 day representative period options for 90 days or more, not to exceed one year.

The User Guide is in the SLR solution and is located at the top right hand side of the screen by clicking the Help button. To obtain a copy of the User Guide without registering, email our Help Desk at SLRHelpdesk@acs-inc.com. A copy is also posted on the Electronic Health Record Incentives page.