Current through Register Vol. 51, No. 19, September 20, 2024
A. To
be eligible for an EHR adoption incentive under this chapter, a primary care
practice shall:
(1) Adopt a certified
EHR;
(2) Complete and submit an EHR
adoption incentive request to each appropriate payor from which the practice
desires an incentive award; and
(3)
Demonstrate that the primary care practice has either:
(a) Attested to the current meaningful use
requirements under the Medicare or Medicaid EHR Incentive Program; or
(b) Participates in any MHCC approved
patient-centered medical home program and has achieved NCQA level two
recognition.
B. An EHR adoption incentive request shall
include the following:
(1) Practice specific
information:
(a) Name;
(b) Address;
(c) Specialty;
(d) Organizational national provider
identifier number; and
(e) Tax
identification number;
(2) The individual NPIs of each provider
within the primary care practice;
(3) The estimated total number of patients on
the practice panel, if available;
(4) The name and version of the certified EHR
system implemented by the primary care practice;
(5) Documentation that the primary care
practice meets the criteria for the EHR adoption incentive including:
(a) A copy of the confirmation received from
CMS or Medicaid of acceptance of attestation to meaningful use by at least one
physician or nurse practitioner within the practice; or
(b) A copy of the NCQA level two recognition
letter; and
(6) An
attestation signed by an authorized member of the primary care practice that:
(a) The information contained in the request
is accurate;
(b) If the practice is
led by a physician, all the physicians within the primary care practice are
using the certified EHR system; and
(c) If the practice is led by a nurse
practitioner, all the nurse practitioners within the primary care practice are
using the certified EHR system
C. A payor shall issue an EHR adoption
incentive request acknowledgement letter as soon as is reasonably possible and
no later than 45 days after receipt of an EHR adoption incentive
request.
D. The meaningful use
attestation of a physician or nurse practitioner may only be included in a
single EHR adoption incentive request to a payor.
E. A payor may request additional information
as necessary to determine the validity of an EHR adoption incentive
request.
F. A payor shall process
and pay in full the adoption incentive within 75 days of receiving a complete
EHR adoption incentive request.
G.
A payor shall provide each primary care practice requesting an EHR adoption
incentive with a written notification regarding:
(1) The amount of the EHR adoption incentive
awarded to the primary care practice;
(2) The method of distribution of the EHR
adoption incentive; and
(3) The
time period over which the incentive will be distributed.
H. A primary care practice that provided an
attestation to meaningful use must give written notice within 90 days to each
payor that awarded an EHR adoption incentive to the practice under the
following circumstances in the event that the CMS, Medicaid, or its designated
entity:
(1) Conducted a prepayment or
post-payment audit of compliance with the participation requirements of the
Medicare or Medicaid EHR Incentive Program regarding the physician or nurse
practitioner identified by the primary care practice as part of its EHR
adoption incentive request; and
(2)
Determined that the physician or nurse practitioner had not met the
requirements under the Medicare or Medicaid EHR Incentive Program.
I. Payors may request
reimbursement of the incentive payments made under this chapter to the primary
care practice in the event of notice provided by the primary care practice
under §H of this regulation.
J. Nothing in this chapter shall require a
group model health maintenance organization to provide an incentive to a health
care provider who is employed by a multispecialty group of physicians or nurse
practitioners under contract with the group model health maintenance
organization.
