Health Information Management

CMS outlines changes to the Medicaid EHR Incentive Program

HIM-HIPAA Insider, August 19, 2013

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by Jaclyn Fitzgerald, Online editor 

CMS discussed changes to the Medicaid EHR Incentive Program during the August 13 eHealth provider webinar “Medicaid EHR Incentive Programs: How to Successfully Participate.” Many of these changes relate to the concept of “adopt, implement, and upgrade” (AIU) as it applies to the program while others relate specifically to stage one of meaningful use.

AIU is “the front door for the Medicaid EHR Incentive Program,” Jason McNamara, technical director for health IT at the Center for Medicaid and CHIP Services, said during the webinar.

Initially, Medicaid asked eligible providers (EP) to demonstrate AIU by showing a legal or financial obligation to a certified EHR system. State Medicaid agencies dictated what constituted proof of AIU, such as a signed contract or a purchase order. Beginning in 2014, CMS will require EPs to:

  • Acquire a certified EHR system
  • Attest to adopting or implementing a system that can meet meaningful use requirements in order to meet the criteria for AIU

Medicaid will also implement changes to meaningful use under the EHR Incentive Program. In 2014, EPs who qualify for exclusion from a meaningful use menu objective will not have their number of required menu objectives reduced.

If an EP adopted an EHR in 2013 and will attest for meaningful use in 2014, the EP must adopt the vendor’s 2014 version to comply with the new standards. CMS reduced the reporting period for 2014 to 90 days to allow time for implementing an upgrade.

Many definitions and exclusions will change this year and next year. EPs will have the option within stage one to define a denominator as the “number of orders during the EHR reporting period,” according to McNamara. CMS added an electronic prescribing exclusion for EPs that do not have a pharmacy within their facility and are not within 10 miles of a pharmacy that accepts electronic prescriptions.

The age limit for blood pressure, height, and weight been changed from age 2 to age 3 to comply with national standards, according to McNamara. There is also a new vital signs exclusion, which allows blood pressure to be separated from height and weight so EPs can determine which vital signs are not relevant to their scope of practice. These changes are optional in 2013, but will be required in 2014.

The previous stage one measure for testing health information exchanges (HIE) required one test of electronic transmission of key clinical information. Effective this year, the measure has been removed “because of the robust HIE focus that we have in our subsequent stages,” McNamara said.

In 2014, EPs will be required to provide patients with the ability to view, download, and transmit their health information online. The measure of the new objective is that 50% of patients are provided with the ability to access this information, although they do not necessarily have to access it, according to McNamara.

For the purpose of clarity, the addition of “except where prohibited” has been added to the three public health objectives (immunizations, reportable labs, and sydromic surveillance).

Clinical quality measures (CQM) themselves will remain the same through 2013, although McNamara advised EPs to reach out to their state Medicaid agency to gather information on how their state collects this data. In 2014, CQMs will no longer be a core objective of the program but will still be required for successful demonstration of meaningful use. Up to 2014, EPs should report six of the 44 CQMs. EPs must report nine of 64 CQMs in 2014.

Additional details about the CMS EHR Incentive Program along with a complete list of CQMs required for 2014 reporting along with their National Quality Strategy domains are available at

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