New Mexico Administrative Code
Title 8 - SOCIAL SERVICES
Chapter 300 - MEDICAID GENERAL INFORMATION
Part 22 - ELECTRONIC HEALTH RECORDS INCENTIVE PROGRAM
Section 8.300.22.15 - PAYMENT CALCULATION

Universal Citation: 8 NM Admin Code 8.300.22.15

Current through Register Vol. 35, No. 18, September 24, 2024

MAD will calculate yearly payment amounts and the total payment amounts based on the guidelines described below.

A. An eligible professional provider may receive a maximum of $63,750 in the incentive payments over six years, unless otherwise reduced or increased by CMS.

(1) An eligible professional provider must initiate registration to receive payment in 2016 in order to participate in the program.

(2) An eligible professional provider may receive payment on an annual or non-consecutive basis for up to six years between 2011 through 2021.

(3) Payment will be made one time per year per eligible professional provider.

(4) To receive an incentive payment in the second, third, fourth, fifth and sixth payment year, the eligible professional provider must demonstrate that it is a meaningful user of EHR technology, as described in 42 CFR 495.4.

PY 2011

PY 2012

PY 2013

PY 2014

PY 2015

PY 2016

CY 2011

$21,250

CY 2012

$8,500

$21,250

CY 2013

$8,500

$8,500

$21,250

CY 2014

$8,500

$8,500

$8,500

$21,250

CY 2015

$8,500

$8,500

$8,500

$8,500

$21,250

CY 2016

$8,500

$8,500

$8,500

$8,500

$8,500

$21,250

CY 2017

$8,500

$8,500

$8,500

$8,500

$8,500

CY 2018

$8,500

$8,500

$8,500

$8,500

CY 2019

$8,500

$8,500

$8,500

CY 2020

$8,500

$8,500

CY 2021

$8,500

Potential:

$63,750

$63,750

$63,750

$63,750

$63,750

$63,750

B. An eligible hospital aggregated incentive amount calculation will be a one-time, up front calculation for each hospital, based on the methodology described in Paragraph (2) of Subsection B below.

(1) An eligible hospital has a base amount of $2,000,000 for each of four years, plus a discharge-related amount, times the MAD share of the total. The detailed formula is below.

{Sum over four years of [(base amount + discharge related amount applicable for each year) * transition factor applicable for each year]} * [(MAD inpatient-bed-days + MAD managed care inpatient-bed-days) / {(total inpatient-bed-days) * (estimated total charges - charity care charges) / (estimated total charges)}].

(2) MAD will make payment to a hospital as follows:
(a) A hospital will be eligible for funding over three years with payments distributed at 50 percent of the total payment in the first participation year of program enrollment, 40 percent of the total payment in the second participation year of program enrollment, and 10 percent in the third participation year of program enrollment.

(b) MAD will accept the most recent submitted cost reports as the basis for calculation of EHR incentive program payments.

(c) MAD will use the MAD management information system (MMIS) data as the basis for validating hospital MAD eligible recipient volume.

(d) MAD will use the federal fiscal year as the basis for calculation of all measures related to a hospital.

(e) MAD will use the hospital audit agent to support the MAD calculation of each eligible hospital incentive payment, and reach agreement with the eligible hospital and their representative, the New Mexico hospital association on the accuracy of each eligible hospital calculation before submitting the results for payment.

(f) A hospital may not request a re-calculation of the medicaid EHR incentive program payment once the parties have agreed to the base year for the medicare cost report.

Disclaimer: These regulations may not be the most recent version. New Mexico 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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