5101:3-57-03 Medicaid provider incentive program (MPIP): incentive payments (calculation, duration, amount and limit).

(A) Medicaid provider incentive program (MPIP) incentive payments.

(1) All MPIP incentive payments will be calculated in accordance with 42 C.F.R. 495.310 (as in effect on January 1, 2013).

(2) An eligible professional or eligible hospital will be eligible to receive the federally specified incentive payment amount, regardless of the purchase or implementation costs of their electronic health record (EHR) system as long as the eligible professional or eligible hospital meets all MPIP program eligibility requirements as specified in Chapter 5101:3-57 of the Administrative Code.

(3) In no case may any medicaid eligible professional or eligible hospital receive an incentive payment after payment year 2021.

(B) Eligible professional incentive payments.

(1) Reassignment of payment.

(a) Assignment of the incentive payment must be consistent with federal and state medicaid laws, rules, and regulations, (including without limitation, fraud, waste, and abuse laws rules and regulations).

(b) Eligible professionals may reassign incentive payments to an employer or entity with which the eligible professional has a valid contractual arrangement allowing the employer or entity to bill for and receive payment for the eligible professional's covered professional services. The employer or entity for which payment is reassigned must be an Ohio medicaid provider with an active Ohio medicaid provider agreement.

(c) An eligible professional may not reassign an incentive payment to more than one employer or entity. 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.

(C) 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, in a manner specified by the Ohio department of medicaid (ODM).

(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 program 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 eligible hospitals application for payment and payment has been disbursed for the payment year.

(D) Issuance of payments.

(1) MPIP incentive payment will be issued and disbursed in compliance with 42 C.F.R. 495.312 (as in effect on January 1, 2013).

(2) Payments will be made to the taxpayer identification number selected at the time of registration.

(E) Offsets, adjustments and recoupment of payment.

(1) MPIP payments are subject to offsets, adjustments and recoupments. These and/or 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 the medicaid state agency, Ohio county or local governments, the 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.

Effective: 10/01/2013
R.C. 119.032 review dates: 08/05/2018
Promulgated Under: 119.03
Statutory Authority: 5111.0215
Rule Amplifies: 5111.0215
Prior Effective Dates: 1/1/12, 09/10/2012