Federal EHR Incentive Program Now Applicable to Correctional Providers

Posted Mar 18, 2013

Good news for correctional health care providers whose facilities use or plan to adopt electronic health records: You may be eligible to receive incentive payments of up to $63,750 over six years if you can demonstrate “meaningful use” of the EHR technology.

Administered by the Centers for Medicare and Medicaid Services, the EHR Incentive Program was launched in 2011 to encourage integration of EHRs and health information technology into clinical practice. The program, which has separate components for Medicare and Medicaid, provides incentive payments to eligible professionals and hospitals as they adopt, implement, upgrade or meaningfully use certified EHR technology in ways that improve care.

The Medicaid EHR Incentive Program initially had requirements that precluded correctional providers from participation. To qualify, providers need to have 30% Medicaid patient volume, but patient volume had been calculated based on paid encounters. Revised regulations effective this year take into account all encounters as long as the patients are enrolled in Medicaid, says Thomas Novak, who is HITECH coordinator with CMS’ Consortium for Medicaid and CHIP Operations. Novak is leading efforts to ensure that the correctional health care field is aware of the incentive program and to help potential participants, including EHR developers, qualify for the program.

A common belief is that once a person is incarcerated, he or she is automatically disenrolled from Medicaid. However, the official CMS guidance to state Medicaid agencies is to suspend, not terminate, the enrollees. Unfortunately, not every state has followed that advice.

Because the program is not reimbursing medical services for these Medicaid-enrolled patients, which is typically prohibited, but rather providing an incentive to use EHR technology, correctional providers are now eligible to participate if they meet all of the other requirements.

Participation Overview

First, providers must practice in a state that takes part in the EHR Incentive Program, and almost all of them do. In 2014 Medicaid eligibility will expand significantly, encompassing many more incarcerated individuals, and in states that participate in the Medicaid expansion, there could be a significant increase in eligible providers who see all or some of their patients in prisons or jails, Novak says.

Eligible professionals under the Medicaid EHR Incentive Program include physicians (primarily MDs and DOs), dentists, nurse practitioners, certified nurse-midwives and, if they meet narrow criteria, physician assistants. At least 30% of services must be furnished to Medicaid patients in an outpatient setting (20% for pediatricians).

In their first year of participation, providers can adopt, implement, upgrade to or demonstrate meaningful use of certified EHR technology. CMS and the Office of the National Coordinator for Health Information Technology have established standards and other criteria for structured data that EHRs must use to qualify for this incentive program. A list of certified EHR systems and modules is available online. In the second and subsequent years, providers must show that they are using their EHRs in a meaningful way by meeting thresholds for a number of objectives defined by CMS.

CMS provides detailed guidance about eligibility and participation requirements. For complete information, visit www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms.

Originally published in CorrectCare, Vol. 27, Issue 1, Winter 2013