Code of Maine Rules
10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES
144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL
Chapter 101 - MAINECARE BENEFITS MANUAL (FORMERLY MAINE MEDICAL ASSISTANCE MANUAL)
Chapter I - Specific Policies By Service
Sec2 144-101-I-2 - State Medicaid Health Information Technology (HIT) Program
Subsection 144-101-I-2.05 - ELIGIBLE HOSPITAL

Universal Citation: 10 ME Code Rules § 144-101-I-2.05

Current through 2024-38, September 18, 2024

A. To be an Eligible Hospital, an Acute Care Hospital, Critical Access Hospital or Cancer Hospital must have at least a 10% Medicaid patient volume. An Eligible Hospital shall calculate its patient volume in accord with 42 C.F.R. §495.306(c)(2). Children's Hospitals are exempt from meeting a Medicaid patient volume threshold.

B. Application process for EHs

1. A hospital must register with CMS through the CMS National Level Repository (NLR) system.

2. After a hospital registers, CMS sends an electronic notification to OMS of the registration.

3. Using the contact information from the NLR registration, OMS will contact the hospital to begin the application process.

4. A hospital must establish that it is an Eligible Hospital and must meet the following requirements:

a. Consistent with 42 C.F.R. §495.314, attest that it has adopted, implemented or upgraded electronic health records to be eligible for the first payment year, or has met meaningful use requirements to be eligible for subsequent payment years;

b. Attest that it uses an EHR that is included on the list of certified EHRs maintained by CMS;

c. Attest that it has not received an incentive payment for that year from another state;

d. Meet all other requirements under 42 C.F.R. §495.314;

e. Satisfactorily complete the application process; and

f. Meet the meaningful use reporting requirement set forth by 42 C.F.R §495.312(b).

5. After confirming that the hospital meets the above requirements, MaineCare will calculate the total incentive payment for the EH in accord with 42 C.F.R.§§ 495. 310(e), (f) and (g). See for example, Hospital Calculation at: http://www.maine.gov/dhhs/oms/HIT. If data from the hospital is non-existent, the Department shall deem an amount in accordance with 42 C.F.R. §495.310(i).

6. OMS will notify CMS that a payment is being issued, and will issue a payment to the EH according to the requirements of 42 C.F.R. §495.312(e)(2).

7. If the Department determines that a hospital has not met the requirements of Section 2.05, it will notify the hospital in writing within two (2) business days of making that determination.

C. Payment Amounts and Schedule

1. A hospital may receive incentive payments from both Medicare and Medicaid if it meets all eligibility criteria in the payment year.

2. Maine will issue an EHR incentive payment annually for three (3) years:

a. To receive an EHR incentive payment in the first payment year, an EH shall meet the requirements established in 42 C.F.R. §495.314(a).The first year payment amount will be 50% of the total payment amount.

b. To receive EHR incentive payments for the remaining two years, an EH shall meet the requirements established in 42 C.F.R. §495.314(b). The second payment will be 40% of the total incentive payment amount. The third payment will be 10% of the total incentive payment amount.

3. A hospital must submit data on charity care as part of the incentive payment calculation. If the Department that an Eligible Hospital's data on charity care is not available from the hospital, the Department shall determine an appropriate proxy for charitable care in compliance with 42 C.F.R. §495.310(h).

D. Attestation and Meaningful Use Documentation

An EH must have written or electronic documentation that the hospital meets all of the EH requirements for the Program.

1. As proof of adopting, implementing or upgrading a certified electronic health record, the EH must have at least one of the following properly executed documents:

a. Receipt;

b. Invoice;

c. Contract;

d. License Agreement;

e. Purchase Order; or

f. User Agreement.

2. In accordance with 42 C.F.R. §495.8(c)(2), for purposes of the MaineCare HIT Incentive Payment Program, any records used to provide information for registration, application and incentive payments, including attestation that the provider has adopted, implemented or upgraded EHR, and meaningful use, must be kept for six years, unless Federal or State law requires a longer retention period.

2.05-1 COMBATING FRAUD AND ABUSE

A. A hospital must submit an electronic or paper statement supplied by the Department in satisfaction of the requirements of 42 C.F.R. §495.368(b).

B. If an overpayment is owed to the Department, the EH shall repay the entire overpayment within thirty (30) days of the date of the Department's notice to the EH of the overpayment.

C. EHs shall also be subject to the provisions of the MaineCare Benefits Manual, Chapter 1, Section 1, §§ 1.19 and 1.20.

D. The Division of Audit or duly authorized Agents of the Department shall conduct pre-payment reviews and must approve all payments before issuance. The Division of Audit or duly authorized Agent shall have the authority to conduct post-payment audits of hospitals that participate only in the Medicaid incentive payment program, to include desk and on-site audits under the Department's SMHP and IAPD-U and Chapter 1, Section 1, §1.16.

2.05-2 HEARINGS AND APPEALS

A. An EH may appeal the following issues:

1. A determination that the EH is not eligible for the Medicaid HIT Incentive Payment Program;

2. A determination that the EH did not meet attestations of adopting, implementing, or upgrading certified EHRs requirements;

3. An overpayment amount or recoupment as determined by the Department or CMS;

4. The amount of the incentive payment(s); and

5. Audit findings of any of the above.

B. Appeal rights and processes are governed by the MaineCare Benefits Manual, Chapter I, Section 1, §1.21-1.

Disclaimer: These regulations may not be the most recent version. Maine may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.

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