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M A I N E P R I M A R Y C A R E A S S O C I A T I O N
F E B R U A R Y 2 2 , 2 0 1 7
MaineCare Medicaid 2016 Meaningful Use Program
2016 Meaningful Use Requirements
Important Notice:
2016 is the last year to begin participation in the Medicaid EHR Incentive Program.
Providers must register with CMS prior to 4/30/2017
Providers then apply with Maine. The deadline date to have all data approved and attested is May 31, 2017.
Year 1 applicants have a choice to apply for AIU (no MU required) or they can submit the first year of MU
AIU does not meet the MU requirement for Medicare payment adjustments
Objectives and Measures
All providers will submit Modified Stage 2 objectives and measures.
For any provider that has not previously submitted two years of Stage 1 there are alternate exclusions for Objective 3, measures 2 and 3.
In 2016, all providers must attest to objectives and measures using EHR technology certified to the 2014 Edition
Alternate Exclusions and Specifications
Many of the alternate exclusions that were available in 2015 are not applicable in 2016.
Objective 3 - Computerized Provider Order Entry (CPOE) Available for any provider that has not previously
submitted two years of Stage 1 MU Alternate Exclusion for Measure 2 (lab orders) Alternate Exclusion for Measure 3 (radiology orders) Or, a provider may choose to attest to the Modified Stage 2 CPOE objective.
Objective 10 - Public Health Reporting
Available for all providers Alternate Exclusion for Measure 2 (syndromic surveillance) Alternate Exclusion for Measure 3 (specialized registry reporting)
Changes to Specific Objectives/Measures in 2016
Objective 9, Secure Electronic Messaging:
2015 objective 9:
o For an EHR reporting period in 2015, the capability for patients to send and receive a secure electronic message with the EP was fully enabled during the EHR reporting period.
2016 Objective 9:
o For an EHR reporting period in 2016, for at least 1 patient seen by the provider during the EHR reporting period, a secure message was sent using the electronic messaging function of CEHRT to the patient or in response to a secure message sent by the patient during the EHR reporting period.
EHR Reporting Period
The 2016 EHR reporting period for all providers is a 90 day period within calendar year 2016 for Objectives and CQMs.
Program year 2017 will have a 90 day reporting period for Objectives and a 365 day reporting period for CQMs.
Payment Adjustments & Attestation Deadlines
New participants who successfully demonstrate meaningful use for program year 2016 will avoid the payment adjustment for CY 2017 and CY 2018.
Returning participants who successfully demonstrate meaningful use for CY 2016 will avoid the payment adjustment for CY 2018.
The deadline date for all submitted data is May 31, 2017.
Objective 1: Protect Patient Health Information
A full security risk analysis is required when certified EHR technology is adopted or implemented in the first reporting year.
In subsequent reporting years, or when changes to the practice or electronic systems occur, a review must be conducted.
Objective 1: Protect Patient Health Information (cont.)
Security Areas to Consider Physical Safeguards
o Your facility and other places where patient data is accessed Building alarm systems Locked offices
o Computer equipment o Screens shielded from secondary viewers
o Portable devices
Administrative Safeguards Designated security officer Workforce training and oversight
Monthly review of user activities
Controlling information access Periodic security reassessment Policy enforcement
Objective 2: Clinical Decision Support
Measure 1: Implement five clinical decision support
interventions related to four or more clinical quality measures at a relevant point in patient care for the entire EHR reporting period. Absent four clinical quality measures related to an EP’s scope of practice or patient population, the clinical decision support interventions must be related to high priority health conditions.
Measure 2: The EP has enabled and implemented the functionality for drug‐drug and drug‐allergy interaction checks for the entire EHR reporting period.
Exclusion: For the second measure, any EP who writes fewer than 100 medication orders during the EHR reporting period.
Objective 3: Computerized Provider Order Entry
An EP, through a combination of meeting the thresholds and exclusions (or both), must satisfy all three measures for this objective. Measure 1: More than 60 percent of medication orders created by the EP during the
EHR reporting period are recorded using computerized provider order entry. Exclusion for Measure 1: Any EP who writes fewer than 100 medication orders
during the EHR reporting period.
Measure 2: More than 30 percent of laboratory orders created by the EP during the EHR reporting period are recorded using computerized provider order entry.
Exclusion for Measure 2: Any EP who writes fewer than 100 laboratory orders during the EHR reporting period.
Alternate Exclusion for Measure 2: Providers submitting MU for the first time in 2016 may claim an exclusion for measure 2 (laboratory orders) of the Stage 2 CPOE objective.
Measure 3: More than 30 percent of radiology orders created by the EP during the EHR reporting period are recorded using computerized provider order entry.
Exclusion for Measure 3: Any EP who writes fewer than 100 radiology orders during the EHR reporting period.
Alternate Exclusion for Measure 3: Providers submitting MU for the first time in 2016 may claim an exclusion for measure 3 (radiology orders) of the Stage 2 CPOE objective.
Objective 4: Electronic Prescribing
EP Measure: More than 50 percent of permissible prescriptions written by the EP are queried for a drug formulary and transmitted electronically using CEHRT.
Exclusions: Any EP who ‐
Writes fewer than 100 permissible prescriptions during the EHR reporting period; or
Does not have a pharmacy within his or her organization and there are no pharmacies that accept electronic prescriptions within 10 miles of the EP's practice location at the start of his or her EHR reporting period.
Objective 5: Health Information Exchange
Measure: The EP that transitions or refers their patient to another setting of care or provider of care must
(1) use CEHRT to create a summary of care record; and
(2) electronically transmit such summary to a receiving provider for more than 10 percent of transitions of care and referrals.
Exclusion: Any EP who transfers a patient to another setting or refers a patient to another provider less than 100 times during the EHR reporting period.
Objective 6: Patient Specific Education
EP Measure: Patient specific education resources identified by CEHRT are provided to patients for more than 10 percent of all unique patients with office visits seen by the EP during the EHR reporting period.
Exclusion: Any EP who has no office visits during the EHR reporting period.
Objective 7: Medication Reconciliation
Measure: The EP performs medication reconciliation for more than
50 percent of transitions of care in which the patient is transitioned into the care of the EP.
Exclusion: Any EP who was not the recipient of any transitions of
care during the EHR reporting period.
Many CEHRT products count every time a medication reconciliation is done during the reporting period and do not limit to only transitions of care
Objective 8: Patient Electronic Access (VDT)
EP Measure 1: More than 50 percent of all unique patients seen by the EP during the EHR reporting period are provided timely access to view online, download, and transmit to a third party their health information subject to the EP's discretion to withhold certain information.
Exclusion for Measure 1: Any EP who: Neither orders nor creates
any of the information listed for inclusion as part of the measures except for “Patient Name” and “Provider’s name and office contact information.”
Objective 8: Patient Electronic Access (VDT) (cont.)
EP Measure 2: For an EHR reporting period in 2016, at least one patient seen by the EP during the EHR reporting period (or patient‐authorized representative) views, downloads or transmits his or her health information to a third party during the EHR reporting period.
2017 the threshold is 5%
Exclusion for Measure 2: Any EP who:
Neither orders nor creates any of the information listed for inclusion as part of the measures except for “Patient Name” and “Provider’s name and office contact information”; or
Conducts 50 percent or more of his or her patient encounters in a county that does not have 50 percent or more of its housing units with 4Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period.
Objective 8: Patient Electronic Access (VDT) (cont.)
Clarifications: Measure 1
The 50% count of patients seen should be based on those patients that have been given the information to access their data on the patient portal if they so choose. This is best captured at the time of checkout when the portal info is reviewed or offered.
If your vendor is not counting when each patient is provided with the information necessary to access the portal then the vendor is not capturing the data correctly.
Some vendors require an email address be entered or they do not count toward the 50%.
If you have a letter from your vendor that explains why they cannot capture the data correctly you should state that on your Medicaid eligibility worksheet and attach the vendor explanation.
Objective 8: Patient Electronic Access (VDT) (cont.)
MEASURE 1 - ACCESS
The specifications for measure 1 allow the provision of access to take many forms and do not require a provider to obtain an email address from the patient. Although many certified EHR technology (CEHRT) products may be designed in that fashion, it is not required by the program. If a provider’s CEHRT does require a patient email address, but the patient does not have or refuses to provide an email address or elects to ‘‘opt out’’ of participation, that is not prohibited by the EHR Incentive Program requirements nor does it allow the provider to exclude that patient from the denominator. The patient may also access their information through their patient authorized representative.
The measure timeline for making any health information available resets to 4 business days for an EP each time new information is available to which the patient should be provided access. Therefore, although a provider does not need to enroll a unique patient a second time if the patient has a second office visit during the EHR reporting period, the provider must continue to update the information accessible to the patient each time new information is available.
Objective 9: Secure Messaging
This measure has changed from a yes/no in 2015 to a calculation for 2016. The numerator must be
1 or more Measure: For an EHR reporting period in 2016, for at
least 1 patient seen by the EP during the EHR reporting period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient‐authorized representative), or in response to a secure message sent by the patient (or the patient‐authorized representative) during the EHR reporting period.
Exclusion: Any EP who has no office visits during the EHR reporting period.
Objective 9: Secure Messaging (cont.)
Definitions of Terms
Secure Message – Any electronic communication between a provider and patient that ensures only those parties can access the communication. This electronic message could be email or the electronic messaging function of a PHR, an online patient portal, or any other electronic means.
Objective 9: Secure Messaging (cont.)
NUMERATOR: The number of patients in the denominator for whom a secure electronic
message is sent to the patient or in response to a secure message sent by the patient.
DENOMINATOR:
Number of unique patients seen by the EP during the EHR reporting period.
THRESHOLD:
Numerator must be equal to or greater than 1.
EXCLUSION: Any EP who has no office visits during the EHR reporting period
Objective 9: Secure Messaging (cont.) Additional Information
The thresholds for this measure increase over time to allow providers to work incrementally toward a higher goal. The measure threshold for this objective was “fully enabled” for 2015, and is at least one patient for 2016, and a threshold of 5 percent for 2017 to build toward the Stage 3 threshold.
Provider initiated action and interactions with a patient-authorized representative, are acceptable for the measure and are included in the numerator.
A patient-initiated message would only count toward the numerator if the provider responds to the patient.
Public Health Reporting
Objective: The EP is in active engagement with a public health agency to
submit electronic public health data from CEHRT except where prohibited and in accordance with applicable law and practice.
Measure Options
Measure 1 ‐Immunization Registry Reporting: The EP is in active engagement with a public health agency to submit immunization data.
Measure 2 – Syndromic Surveillance Reporting: The EP is in active engagement with a public health agency to submit syndromic surveillance data.
Measure 3 – Specialized Registry Reporting: The EP is in active engagement to submit data to a specialized registry.
Public Health Reporting (cont.) Definition of Terms
Active engagement
Means that the provider is in the process of moving towards sending "production data" to a public health agency or clinical data registry, or is sending production data to a public health agency or clinical data registry
Active Engagement Option 1–Completed Registration to Submit Data:
Most Maine Providers are utilizing option 1
The EP registered with the Public Health Agency
Registration was completed prior to or within 60 days after the start of the EHR reporting period
The EP is awaiting an invitation from the PHA to begin testing and validation.
Providers that have registered in previous years do not need to submit an additional registration to meet this requirement for each EHR reporting period.
When new providers join the practice they will use the original date the practice was registered and must be added to the practice registry.
Public Health Reporting (cont.) Definition of Terms
Active Engagement Option 2 ‐Testing and Validation:
The EP is in the process of testing and validation of the electronic submission of data. Providers must respond to requests from the PHA within 30 days
Failure to respond twice within an EHR reporting period would result in that provider not meeting the measure.
Active Engagement Option 3 – Production:
The EP has completed testing and validation of the electronic submission and is electronically submitting production data to the PHA.
Production data
Refers to data generated through clinical processes involving patient care, and it is used to distinguish between data and “test data” which may be submitted for the purposes of enrolling in and testing electronic data transfers.
Public Health Reporting (cont.)
MEASURE 1: Immunization Registry
If a provider has registered for the Immunization Registry they will answer yes for the measure and answer no for the exclusion.
If a provider does not give immunizations they will answer yes for the exclusion and no for the measure
Exclusion: EP ‐ does not administer any immunizations to any of the populations during the EHR reporting period
Public Health Reporting (cont.)
MEASURE 2: Syndromic Surveillance Registry
If a provider has registered for the syndromic surveillance registry they will answer yes for the measure and answer no for the exclusion.
If a provider did not register for the syndromic surveillance because they would not be submitting data to the syndromic surveillance registry they will answer yes for the exclusion and no for the measure
EXCLUSIONS: EP is not in a category of providers from which ambulatory syndromic
surveillance data is collected by their jurisdiction's syndromic surveillance system
ALTERNATE EXCLUSION: Any provider may claim an alternate exclusion for measure 2 (syndromic
surveillance reporting) for an EHR reporting period in 2016.
Public Health Reporting (cont.)
MEASURE 3: Specialized Registry
If you registered for the cancer registry you should mark the box in the wizard where we have listed the Maine Cancer registry.
If you are registered with a specialized registry enter the name of the registry and the date of registration.
If a provider did not register for any specialized registry because they would not be submitting data to a specialized registry they will answer yes for the exclusion and no for the measure
EXCLUSIONS: Does not diagnose or treat any disease or condition associated with, or
collect relevant data that is required by a specialized registry ALTERNATE EXCLUSION:
Any provider may claim an alternate exclusion for measure 3 (specialized registry reporting) for an EHR reporting period in 2016.
2016 Program Year CQM requirements
The CQM measures remain the same as they were for program year 2014 and 2015 – 9 CQMs must be entered to meet the 2016 MU requirements.
There are 64 CQM measures a provider may choose from.
Most providers will be able to find CQMs that apply to their scope of practice.
Depending on the CEHRT package purchased providers may have limited access to the number of CMQs they can choose from.
If a provider does not have data for 9 CQMs they will enter the data as presented by the CEHRT. We will accept zeros if that is all that is available.
Links and Contact Information
CMS Meaningful Use Website https://www.cms.gov/RegulationsandGuidance/Legislation/EHRIncentivePrograms/index.html?redirect=/EHRIncentivePrograms/
Maine Meaningful Use Website http://www.maine.gov/dhhs/oms/HIT/
Maine Public Health Registration Website http://www.maine.gov/dhhs/mecdc/navtabs/providers.shtml
To contact us send an email to: [email protected]
Reference Documents
Documents available on our website for Program Year 2016 include: What You Need to Know for 2016 2016 Program Year - How to Apply with Maine Instruction Guide for completing the Medicaid eligibility worksheet v1e 2016_IncentiveProgramWorksheetv1e 2016 Objective Table of Contents 2016 CQM Measures Table 2016 Attestation Sample Sheet 2016 Alternate Exclusions 2016 Public Health Reporting 2016 Public Health Objective 2016 Security Risk Analysis 2016 Patient Electronic Access 2016 Multiple Locations Tip sheet Medicaid Eligibility Reporting Period and Calculation Options 2016 Reporting Requirements for Secure Electronic Messaging and Public Health
Reporting Objectives
2017 Requirements
90 day reporting period for objectives
365 day reporting period for CQMs
Maine will accept submission of the 2017 Medicaid Eligibility Worksheet after July 1, 2017
Maine will send out the 2017 wizard after January 1, 2018 for those that submit the worksheet early.
For those that submit the worksheet after January we will work on the submissions as received.
2017 Requirements
All providers will submit Modified Stage 2 using the 2014 Certified EHR Technology*
The Modified Stage 2 Objectives for program year 2017
will not have any alternate exclusions.
*Optional: if a provider (group) has upgraded to the 2015 Certified EHR Technology and want to submit Stage 3 in program year 2017 that option will be available
2017 Requirements
Modified Stage 2 Objective changes for 2017
Objective 8 – Patient Electronic Access
measure 2– 2017 – up from 1 patient to more than 5 percent of unique patients seen by the EP during the EHR reporting period views, downloads or transmits
Objective 9 – Secure Electronic Messaging up from 1 patient to more than 5 percent of unique patients seen by
the EP during the EHR reporting period, a secure message was sent using the electronic messaging function of CEHRT to the patient, or in response to a secure message sent by the patient.
2017 Requirements Stage 3
Stage 3
To meet Stage 3 requirements, all providers must use technology certified to the 2015 Edition
8 Objectives
1. Protect Patient Health Information
2. Electronic Prescribing (eRx)
3. Clinical Decision Support
4. Computerized Provider Order Entry (CPOE)
Measure 1 - 60% of medication orders
Measure 2 – 60% of laboratory orders
Measure 3 – 60% or radiology orders
2017 Requirements Stage 3
5. Patient Electronic Access to Health Information
Measure 1: 80% of patients are provided access to health information
Measure 2: The EP must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide electronic access to those materials to more than 35 percent of unique patients seen by the EP during the EHR reporting period. This is similar to the previous objective 6 from Modified Stage 2 but the percentage
has been raised from 10% to 35%
2017 Requirements Stage 3
6. Coordination of Care through Patient Engagement Measure 1: more than 5 percent of all unique patients seen by
the EP actively engage with the electronic health record made accessible by the provider
Measure 2: more than 5 percent of all unique patients seen by the EP during the EHR reporting period, a secure message was sent using the electronic messaging function of CEHRT to the patient or in response to a secure message sent by the patient or their authorized representative. Threshold in 2018 and Subsequent Years: The resulting percentage must be more
than 25 percent in order for an EP to meet this measure.
Measure 3: Patient generated health data or data from a nonclinical setting is incorporated into the CEHRT for more than 5 percent of all unique patients seen by the EP during the EHR reporting period.
2017 Requirements Stage 3
7. Health Information Exchange Measure 1: For more than 50 percent of transitions of care and referrals, the EP
that transitions or refers their patient to another setting of care or provider of care: 1) Creates a summary of care record using CEHRT; and 2) Electronically exchanges the summary of care record
Measure 2: For more than 40 percent of transitions or referrals received and patient encounters in which the provider has never before encountered the patient, the EP incorporates into the patient’s EHR an electronic summary of care document.
Measure 3: For more than 80 percent of transitions or referrals received and patient encounters in which the provider has never before encountered the patient, the EP performs a clinical information reconciliation. The provider must implement clinical information reconciliation for the following three clinical information sets: 1) Medication. Review of the patient’s medication, including the name, dosage,
frequency, and route of each medication. 2) Medication allergy. Review of the patient’s known medication allergies. 3) Current Problem list. Review of the patient’s current and active diagnoses
2017 Requirements Stage 3
Public Health and Clinical Data Registry Reporting
No changes from Modified Stage 2
If a practice site has registered for the Public Health Registries the date of the original practice registration is what is used for MU purposes
New providers that join the practice should be added. They will use the original registration date as a proxy.
