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Ohio Laws and Rules
(A) Medicaid provider incentive program (MPIP) incentive payments.
(1) MPIP incentive payments will be calculated in accordance with 42 C.F.R. 495.310 (as in effect on July 28, 2010).
(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.
(4) "Payment year" means:
(a) For an eligible professional, a calendar year (CY) beginning with CY 2011; and
(b) For an eligible hospital, a federal fiscal year (FFY) beginning with FFY 2011.
(B) Eligible professional incentive payments.
(1) First payment year requirements.
(a) The first payment year for an eligible professional is the first CY for which the eligible professional receives an incentive payment.
(b) In the first payment year, to receive an incentive payment, the medicaid eligible professional must demonstrate the following:
(i) That during the payment year he or she met all eligible professional eligibility requirements defined in rule 5101:3-57-01 of the Administrative Code; and
(ii) That he or she adopted, implemented or upgraded to certified EHR technology pursuant to paragraph (B) of rule 5101:3-57-02 of the Administrative Code.
(c) Payment may not exceed twenty-one thousand two hundred fifty dollars.
(d) Eligible professionals may not begin receiving payments any later than CY 2016.
(2) Requirements in subsequent payment years.
(a) The second, third, fourth, fifth, or sixth payment year for an eligible professional is the second, third, fourth, fifth, or sixth CY for which the eligible professional receives an incentive payment regardless of whether the year immediately follows the prior payment year.
(b) In the second, third, fourth, fifth and sixth payment years, to receive incentive payment, the medicaid eligible professional must demonstrate the following:
(i) That he or she has met all eligible professional eligibility requirements defined in rule 5101:3-57-01 of the Administrative Code; and
(ii) That during the EHR reporting period for the applicable payment year, he or she is a meaningful EHR user of certified EHR technology as defined in rule 5101:3-57-02 of the Administrative Code.
(c) Payment may not exceed eight thousand five hundred dollars.
(d) Eligible professionals may receive payments in non-consecutive years.
(3) An eligible professional shall not participate for more than a total of six payment years, and in no case will the maximum incentive payments over a six-year period exceed sixty-three thousand seven hundred fifty dollars.
(4) The following limitations apply:
(a) An eligible professional who is a pediatrician, as defined in paragraph (C)(4)(b) of rule 5101:3-57-01 of the Administrative Code, with a patient volume of less than thirty per cent, but who meets the patient volume requirement of at least twenty per cent, is limited to the following:
(i) The maximum payment in the first payment year is fourteen thousand one hundred sixty-seven dollars.
(ii) The maximum payment in subsequent years is five thousand six hundred sixty-seven dollars.
(iii) The maximum amount for a pediatrician under this limitation shall not exceed forty-two thousand five hundred dollars.
(iv) Pediatricians meeting the thirty per cent patient volume threshold in a payment year may be eligible to receive the maximum incentive payment amount, for that payment year as defined in paragraphs (B)(1) to (B)(3) of this rule.
(5) An eligible professional who switches to MPIP from the medicare EHR incentive payment program is placed in the payment year that the eligible professional would have been in had the eligible professional begun in, and remained in, the medicare EHR incentive payment program in accordance with 42 C.F.R. 495.10 (as in effect on July 28, 2010).
(6) 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) First payment year requirements.
(a) The first payment year for an eligible hospital is the first FFY for which the eligible hospital receives an incentive payment.
(b) In the first payment year, to receive an incentive payment, the medicaid eligible hospital must demonstrate the following:
(i) That during the payment year it met all eligible hospital eligibility requirements defined in rule 5101:3-57-01 of the Administrative Code; and
(ii) That it has adopted, implemented or upgraded to certified EHR technology pursuant to paragraph (B) of rule 5101:3-57-02 of the Administrative Code.
(2) Subsequent payment year's requirements.
(a) The second, third, fourth, fifth, or sixth payment year for an eligible hospital is the second, third, fourth, fifth, or sixth FFY for which the hospital receives an incentive payment.
(b) In the second, third, fourth, fifth and sixth payment years, to receive incentive payment, the medicaid eligible hospital must demonstrate the following:
(i) That it has met all eligible hospital eligibility requirements defined in rule 5101:3-57-01 of the Administrative Code; and
(ii) That during the EHR reporting period for the applicable payment year, it is a meaningful EHR user of certified EHR technology as defined in rule 5101:3-57-02 of the Administrative Code.
(3) An incentive payment to an eligible hospital is subject to the following conditions:
(a) No eligible hospital may begin receiving incentive payments for any year after FFY 2016.
(b) Prior to FFY 2016, payments may be made to an eligible hospital on a non-consecutive, annual basis for a FFY.
(c) After FFY 2016, a hospital may not receive an incentive payment unless it received an incentive payment in the prior FFY.
(d) A multi-site hospital with one federal centers for medicare and medicaid services (CMS) certification number is considered one hospital for purposes of calculating payment.
(4) Eligible hospital incentive payments will be calculated in accordance with 42 C.F.R. 495.310 (as in effect on July 28, 2010).
(5) 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 job and family services (ODJFS).
(6) 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.
(7) 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.
(8) 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 July 28, 2010).
(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) ODJFS 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 ODJFS within sixty days of its discovery.
Effective:
09/10/2012
R.C.
119.032 review dates:
01/01/2017
Promulgated
Under: 119.03
Statutory
Authority:
5111.0215
Rule
Amplifies:
5111.0215
Prior
Effective Dates: 1/1/2012