Current through all regulations passed and filed through December 16, 2024
(A)
The medicaid
provider incentive program (MPIP) is Ohio's program implementing section 4201
of the American Recovery and Reinvestment Act of 2009 (ARRA),
Pub.
L. No. 111-5, and the published regulations in 42
C.F.R. Part 495 . Certain medicaid eligible professionals and hospitals are
eligible to participate in MPIP. Funding for this program ends in
2021.
(B)
An eligible professional participating in Ohio's MPIP
program is a provider that meets eligibility requirements in
42 C.F.R.
495.304 (as in effect on October 1, 2018) and
practices within his or her scope of practice as recognized under Ohio law for
each type of professional. In addition, an advanced practice registered nurse
(APRN) defined in rule
5160-4-04 of the Administrative
Code with an appropriate scope of practice will be considered as an eligible
provider for Ohio's MPIP program.
(C)
Medicaid eligible
hospitals participating in Ohio's MPIP program are subject to the program
eligibility rules and regulations published in 42 C.F.R. Part 495 (as in effect
on October 1, 2018).
(D)
To be eligible for a year of participation in MPIP,
each eligible professional and hospital must:
(1)
Be an enrolled
Ohio medicaid provider with an active Ohio medicaid provider
agreement;
(2)
Except for eligible hospitals, not have received an
electronic health record (EHR) incentive payment within the current payment
year from another state, MPIP, or the medicare EHR incentive payment
program;
(3)
Not have a current sanction or exclusion identified at
the United States department of health and human services, office of inspector
general, list of excluded individuals and entities, or the Ohio medicaid list
of excluded providers.
(E)
Patient volume
requirements.
(1)
Eligible professionals and hospitals participating in
MPIP must meet annual patient volume requirements in accordance with
42 C.F.R.
495.304 (as in effect on October 1, 2018)
with the exception of children's hospitals;
(2)
Patient volume is
calculated in accordance with the patient encounter methodology defined in
42 C.F.R.
495.306(c) (as in effect on
October 1, 2018);
(F)
Group practices
or clinics patient volume proxy.
(1)
A group practice or clinic will be permitted to
calculate patient volume at the group practice or clinic level, but only in
accordance with all of the limitations defined in
42 C.F.R.
495.306(h) (as in effect on
October 1, 2018).
(2)
Each group practice or clinic must confirm in writing
and provide evidence of consent, in a manner specified by the Ohio department
of medicaid (ODM) on the ODM website,
www.medicaid.ohio.gov, from each eligible professional in the group practice or
clinic that the eligible professional is consenting to one of the
following:
(a)
Attesting as a member of the group practice or clinic and
permitting the group practice or clinic to use his or her encounters in the
group practice or clinic patient volume proxy calculation; or
(b)
Not attesting as
a member of the group practice or clinic but will permit the group practice or
clinic to use his or her encounters in the group practice or clinic patient
volume proxy calculation.
(3)
If an eligible
professional is not attesting as a member of a group practice or clinic but
will permit a group practice or clinic to use his or her encounters in the
patient volume proxy calculation for the group practice or clinic, the
non-participating eligible professional cannot use those encounters toward his
or her individual patient volume calculation.
(4)
If any eligible
professional within the group practice or clinic does not provide written
consent for the group practice or clinic to use his or her encounters in the
patient volume proxy calculation for the group practice or clinic, the group
practice or clinic is precluded from using a group practice or clinic patient
volume proxy.
(5)
Supporting documentation must be provided for
processing through the MPIP system of the attested patient volume proxy and
include the medicaid encounters, total encounters, name and medicaid ID of all
medicaid practitioners used in the group practice or clinic patient volume
proxy calculation. This information shall be provided in a manner specified by
ODM.
(6)
Eligible professionals must be employed by the group
practice or clinic at the time of attestation in order to use the group
practice's or clinic's patient volume proxy.
(G)
Encounters.
(1)
Encounters are
defined in accordance with
42 C.F.R.
495.306(e) (as in effect
October 1, 2018).
(2)
"Out-of-state encounters" are services rendered by an
eligible professional or hospital to a non-Ohio resident and may be used for
calculating patient volume.
(a)
If out-of-state medicaid encounters are included in the
numerator of the calculation to determine patient volume, all out-of-state
encounters for the same representative period should be included in the
denominator.
(b)
Eligible professionals and eligible hospitals are
required to provide documentation to support the use of out-of-state encounters
and must report out-of-state encounters from each state separately through the
MPIP system, in a manner specified by ODM.
(H)
Meaningful use (MU).
(1)
Eligible
professionals and hospitals must:
(a)
Meet all activities required to receive an incentive
payment in accordance with
42 C.F.R.
495.314 (as in effect on October 1, 2018), in
addition to all program eligibility requirements.
(b)
Report which
certified EHR technology they have adopted, implemented or upgraded to by
providing supporting documentation through the MPIP system at the time of
registration and attestation, in a manner specified by ODM.
(c)
Demonstrate that
meaningful use objectives and measures are met, in accordance with
42 C.F.R.
495.40 (as in effect on October 1,
2018).
(2)
Demonstration of MU is subject to review by both ODM
and the centers for medicare and medicaid services (CMS).
(3)
Dual eligible
hospitals meeting MU criteria for the medicare EHR incentive program will be
deemed meaningful users for MPIP, but will be required to meet MPIP program
eligibility requirements.
(I)
Incentive
payments.
(1)
MPIP incentive payments are calculated in accordance with
42 C.F.R.
495.310 and
42 C.F.R.
495.312 (as in effect on October 1, 2018).
Payment will be disbursed to the payee tax identification number selected at
the time of attestation.
(2)
Eligible professionals and hospitals must meet all
requirements set forth in this rule to be eligible for payment.
(3)
Eligible
professionals may reassign incentive payments in accordance with
42
C.F.R. 495.60(f) (as in
effect on October 1, 2018) and other applicable federal and state medicaid
laws, rules, and regulations.
(a)
The employer or entity for which payment is reassigned
must be an Ohio medicaid provider with an active Ohio medicaid provider
agreement.
(b)
In cases where eligible professionals are associated
with more than one practice, the eligible professional must select one tax
identification number to receive any applicable EHR incentive
payment.
(J)
Eligible hospital
incentive payments.
(1)
All data used to calculate the hospital EHR incentive
payment amount must be provided through the MPIP system at the time of the
eligible hospital's application and attestation.
(2)
All eligible
hospital calculations of the aggregate EHR hospital incentive payment made at
the time of MPIP application are subject to review and may be adjusted based on
review findings.
(3)
An eligible hospital may be paid up to one hundred per
cent of the calculated aggregate EHR incentive amount over a four-year period,
if it meets all MPIP eligibility requirements: forty per cent in year one;
thirty per cent in year two; twenty per cent in year three; and ten per cent in
year four.
(4)
An eligible hospital may not alter or modify data
elements used to calculate the hospital EHR incentive payment after MPIP has
processed an application for payment and payment has been disbursed for the
payment year.
(K)
Offsets, adjustments and recoupment of payment.
(1)
MPIP payments are
subject to offsets, adjustments and recoupments. These and other collection
methods will be applied to the medicaid EHR incentive payments to reimburse or
pay for medicaid overpayments, fines, penalties, or other debts owed by the
provider or its assignee(s) to ODM, Ohio county or local governments, the
United States department of health and human services, or any other federal
agency.
(2)
ODM will identify and recoup overpayments made under
the incentive program that result from incorrect or fraudulent attestations,
quality measures, cost data, patient data, or any other submission required to
establish eligibility or qualify for a payment.
(3)
Eligible
professionals and eligible hospitals must report any suspected overpayments of
an incentive payment to ODM within sixty days of its discovery.
Replaces: 5160-57-01