Addendum - Louisiana Department of Health · 2017. 12. 18. · 2.7.1 National Telecommunications and Information Administration (NTIA) Grant ..... 37 2.7.2 Crescent ... profession

Addendum

LOUISIANA STATE MEDICAID HIT PLAN

(LaSMHP)

January 15, 2015

The 2017 SMHP Addendum approved July 27, 2017 can be found here: http://dhh.louisiana.gov/assets/medicaid/EHR/2017SMHPAddendum_Approved07272017.pdf

http://dhh.louisiana.gov/assets/medicaid/EHR/2017SMHPAddendum_Approved07272017.pdf

Page 2 January 2015

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Table of Contents

1. INTRODUCTION .................................................................................................................... 7

1.1 Louisiana State Medicaid Health Information Technology Plan (LaSMHP) .......................... 7

1.2 Planning – Advance Planning Document (P-APD) ................................................................ 8

1.3 LaSMHP v2.0 ......................................................................................................................... 8

1.4 Background ........................................................................................................................... 8

1.5 Coordination with the State Designated Entity (SDE) .......................................................... 9

1.5.1 State Designated Entity to Promote Adoption of EHRs ....................................................... 9

1.6 The Louisiana Health Information Technology (HIT) Coordinator ..................................... 10

1.7 Contractor Services ............................................................................................................ 12

2. STATE “AS-IS” HIT LANDSCAPE ........................................................................................... 13

2.1 Current EHR Status ............................................................................................................. 13

2.2 Current Medicaid Systems ................................................................................................. 14

2.2.1 LMMIS/MITA ...................................................................................................................... 14

2.2.2 Medicaid Eligibility.............................................................................................................. 17

2.2.2.1 Medicaid Eligibility Data System (MEDS) ........................................................................... 17

2.2.2.2 Electronic Medicaid Eligibility Verification System (eMEVS) Application .......................... 18

2.2.2.3 Maximizing Enrollment for Kids ......................................................................................... 18

2.3 DHH HIT Initiatives.............................................................................................................. 19

2.3.1 Louisiana Immunization Network for Kids Statewide (LINKS) ............................................ 19

2.3.2 Public Health Surveillance .................................................................................................. 20

2.3.3 Vital Records ....................................................................................................................... 22

2.3.4 Louisiana Medicaid Clinical Data Inquiry (eCDI) ................................................................. 22

2.3.5 Office of Mental Health – Integrated Information System (OMH-IIS) ............................... 23

2.4 Planned Medicaid Initiatives .............................................................................................. 26

2.4.1 HIPAA 5010 ......................................................................................................................... 27

2.4.2 International Classification of Diseases, Tenth Revision, (ICD-10) ..................................... 27

2.4.3 Louisiana Medicaid Medical Managed Care ....................................................................... 27

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2.4.4 Meaningful Use Definitions ................................................................................................ 28

2.5 Stakeholder Assessment .................................................................................................... 28

2.5.1 Stakeholder HIE Participation ............................................................................................. 28

2.5.2 HIT Strategies...................................................................................................................... 28

2.5.3 Louisiana Indian Tribal clinics ............................................................................................. 29

2.5.4 Department of Defense (DOD) and Veteran Affairs (VA) Medical Clinics .......................... 30

2.5.5 Federally Qualified Health Centers (FQHC)/Rural Health Centers (RHC) ........................... 30

2.6 State Health Information Exchange (HIE) Projects ............................................................. 31

2.6.1 LaHIE - Louisiana Health Information Exchange ................................................................. 33

2.7 State IT Infrastructure ........................................................................................................ 36

2.7.1 National Telecommunications and Information Administration (NTIA) Grant .................. 37

2.7.2 Crescent City Beacon Community (CCBC) .......................................................................... 37

2.7.3 Federal Communications Commission (FCC) Grants .......................................................... 38

2.7.4 SMA Activities Influencing the EHR Incentive Program ..................................................... 38

2.7.5 State Laws/Regulation Changes ......................................................................................... 38

2.7.6 EHR Activities Across State Borders ................................................................................... 38

3. STATE “TO-BE” HIT LANDSCAPE ......................................................................................... 39

3.1 Five-Year Goals ................................................................................................................... 39

3.1.1 LMMIS/MITA ...................................................................................................................... 41

3.1.2 Medicaid Eligibility.............................................................................................................. 43

3.1.3 Office of Public Health (OPH) Programs ............................................................................. 44

3.2 Vision for HIT Architecture ................................................................................................. 45

3.2.1 LMMIS/MITA Vision ............................................................................................................ 45

3.2.2 IT System as it relates to the EHR Incentive Program ........................................................ 47

3.3 Vision for Governance Structure ........................................................................................ 48

3.4 Vision for EHR System ........................................................................................................ 48

3.4.1 EHR Adoption Encouragement ........................................................................................... 48

3.4.2 Federally Qualified Health Centers..................................................................................... 49

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3.4.3 Technical Assistance to Medicaid Providers ...................................................................... 50

3.4.4 Populations with Unique Needs ......................................................................................... 53

3.4.5 Patient-Centered Medical Home (PCMH) Transformation Initiative ................................. 54

3.4.6 Leveraging HIT-Related Grants ........................................................................................... 55

3.4.7 Changes to State Legislation............................................................................................... 56

4. STATE MEDICAID EHR INCENTIVE PAYMENT PLAN ............................................................ 57

4.1 Introduction ........................................................................................................................ 57

4.2 Background ......................................................................................................................... 57

4.3 Medicaid’s EHR Incentive Payment System ....................................................................... 58

4.3.1 NLR File Processing ............................................................................................................. 61

4.3.2 Provider Instructions .......................................................................................................... 62

4.3.3 Provider Registration .......................................................................................................... 69

4.3.4 Application and Attestation Process .................................................................................. 70

4.3.5 Verification of Certified EHR (EP) ....................................................................................... 83

4.3.6 Patient Volume Methodology (EP and EH)......................................................................... 85

4.3.7 Meaningful Use Measures .................................................................................................. 89

4.3.8 2014 CEHRT Flexibility Rule .............................................................................................. 189

4.3.9 Verification of Certified EHR (EH) ..................................................................................... 194

4.3.10 Calculating EP Payments .................................................................................................. 271

4.3.11 Payments to Eligible Providers through Managed Care Plans ......................................... 271

4.3.12 Calculating EH Payments .................................................................................................. 272

4.3.13 Application Review ........................................................................................................... 272

4.3.14 Attestation Use Cases ....................................................................................................... 275

4.3.15 Requirements and High-Level Design – Detailed Systems Design (RAHD-DSD) ............... 278

4.4 Provider Appeals Process ................................................................................................. 280

4.4.10 Provider Informal Dispute Resolution and Administrative Appeals Process ................... 280

4.4.11 Informal Dispute Resolution Process ............................................................................... 281

4.5.1 Notice of Informal Dispute Resolution Decision ............................................................. 281

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4.5.2 Administrative Appeal...................................................................................................... 281

4.5 Segregation of HIT Federal Funding ................................................................................. 283

4.6 Verify Incentive Payments ................................................................................................ 283

4.7 Audit Process .................................................................................................................... 284

4.7.10 Methods for Recoupment of EHR Incentive Overpayments ............................................ 284

4.7.11 Payment Adjustment Reasons: ........................................................................................ 284

5. COMMUNICATION PLAN .................................................................................................. 286

5.3 Call Center Assessment .................................................................................................... 289

6. STATE HIT ROADMAP ....................................................................................................... 289

APPENDIX A: Louisiana Hospital Information Technology Survey 2010 ............................................ 298

APPENDIX B: Louisiana Provider Information Technology Survey 2010 .................................... 313

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1. INTRODUCTION

This document describes the method by which the Louisiana Department of Health and Hospitals

(DHH), Bureau of Health Services Financing, referenced as LA Medicaid, will implement

Section 4201- Medicaid Provision of the American Recovery and Reinvestment Act (ARRA) of

2009. This Act provides for incentive payments to Eligible Professionals (EPs) and Eligible

Hospitals (EHs) participating in Medicaid and Medicare for the adoption and meaningful use of

certified Electronic Health Record (EHR) technology.

1.1 Louisiana State Medicaid Health Information Technology Plan (LaSMHP)

The purpose of this Louisiana State Medicaid Health Information Technology Plan (LaSMHP) is

to describe Louisiana’s strategic vision for State Health Information Technology (HIT)

transformation. The LaSMHP enables Louisiana Medicaid to achieve this vision by providing a

roadmap to follow on our path toward provider adoption and meaningful use of EHRs and a

statewide exchange of patient health information. The events of Hurricanes Katrina and Rita in

2005 highlighted the urgency for the adoption of HIT to enable secure electronic access to this

information when needed.

The overall goals of widespread HIT adoption are to: 1) enhance care coordination and patient

safety; 2) reduce paperwork and improve efficiencies; 3) facilitate electronic information sharing

across providers, payers, and state lines; and 4) enable data sharing using state Health

Information Exchanges (HIE) and the National Health Information Network (NHIN). Achieving

these goals will improve health outcomes, facilitate access, simplify care, and reduce costs of

health care nationwide.

The LaSMHP will include a comprehensive HIT strategic plan for moving from the current “As-

Is” HIT Environment to the “To-Be” Vision over the next five years. In addition, this LaSMHP

describes the implementation activities of the Medicaid provider incentive payment program.

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Those activities include, but are not limited to, administering the incentive payments to

providers, ensuring their proper payments, auditing and monitoring of such payments, and

participating in statewide efforts to promote interoperability and meaningful use of EHRs.

Louisiana Medicaid will work closely with our federal and state partners to ensure the Medicaid

EHR incentive payment program fits into the overall strategic plan for the Louisiana State

Medicaid HIE Plan thereby advancing national goals for health information exchange.

1.2 Planning – Advance Planning Document (P-APD)

On March 23, 2010, the Centers for Medicare and Medicaid Services (CMS) awarded Louisiana

$1,847,836.00 in funding through the approval of Louisiana Medicaid’s Planning – Advance

Planning Document (P-APD) to initiate the planning phase of this project. Louisiana submitted

an IAPD in October, 2010 for $383,700, of which $158,713 was spent. An IAPD Update was

submitted and approved in Decembers, 2012 for $1,325,865; of which LA Medicaid expended

$337,500. LA Medicaid has submitted an updated IAPD for FFY 2013 and FFY 2014 for the

total sum of $16,039,096.

1.3 LaSMHP v2.0

This document, version 2.0 of Louisiana’s SMHP, incorporates CMS comments made in the last

SMHP submission (v1.3) as well as updating the progress made thus far with the Louisiana HIT

program.

1.4 Background

On July 16, 2010, CMS released the Final Rule to implement provisions of the ARRA. This

provided incentive payments to EPs, EHs, and critical access hospitals (CAHs) participating in

Medicare and Medicaid programs that are meaningful users of certified EHR technology. The

incentive payments are not a reimbursement but are made to incent eligible professionals and

Page 9 January 2015

hospitals to adopt, implement, or upgrade certified EHR technology, and subsequently achieve

meaningful use of the technology. EPs and EHs participating in the Medicaid incentive program

may qualify in their first year of participation for an incentive payment by demonstrating any of

the following: meaningful use in the first year of participation, or adopting (acquired and

installed), implementing (trained staff, deployed tools, exchanged data) or upgrading (expanded

functionality or interoperability) a certified EHR. Incentive payments may also be paid to

providers who demonstrate meaningful use for an additional five years culminating in 2021.

1.5 Coordination with the State Designated Entity (SDE)

The Louisiana Health Care Quality Forum (LHCQF), a non-profit corporation, is the State

Designated Entity (SDE) for HIT and HIE, with the primary purpose of coordinating and

managing Louisiana’s efforts to create a statewide HIE infrastructure. LHCQF was awarded the

$10,583,000 Statewide Health Information Exchange Cooperative Agreement in March 2010 and

the Regional Extension Center (REC) Grant for $6,207,802 in April 2010 from the Office of the

National Coordinator (ONC). Through HIE strategic and operational planning sessions

coordinated by the LHCQF, stakeholder input was gained regarding the HIT landscape and HIE

goals, which assisted both Medicaid and the LHCQF in developing the LaSMHP and State HIE

Plan, respectively.

Because the Medicaid meaningful use provider incentive payment system and LHCQF’s HIE

efforts are interrelated efforts, we will also focus on the integration of marketing, outreach, and

education for both initiatives. It will be made clear to providers across the state that Medicaid

and LHCQF are working together for common goals and a shared vision and the messaging will

be coordinated and consistent.

1.5.1 State Designated Entity to Promote Adoption of EHRs

Louisiana Health Care Quality Forum (LHCQF) is Louisiana’s state designated entity to promote

adoption of EHRs. This designation is established through (1) House Concurrent Resolution 75

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of the 2007 Regular Session of the Legislature; and (2) the Cooperative Endeavor Agreement

between LHCQF and DHH. In accordance with 42 C.F.R. 495.302, LHCQF meets the definition

of an entity promoting adoption of EHRs by actively “enabling the exchange and use of

electronic clinical and administrative data between participating providers, in a secure manner,

including maintaining the physical and organizational relationship integral to the adoption of

certified EHR technology by eligible providers.”

Reassignment of Incentive Payments As the SDE, LHCQF is permitted to accept incentive

payments from providers participating in the EHR Incentive Program. In its Cooperative

Endeavor Agreement with DHH, the LHCQF ensures that 95% of reassigned incentive payments

will be used exclusively toward costs related to certified EHR technology. Providers wishing to

reassign payment to the SDE, must provide signed authorization during attestation that the

reassignment is voluntary. This documentation will be reviewed by Medicaid staff prior to

approval and issuance of the payment. Providers must provide signed authorization during

attestation each time they wish to reassign their annual incentive payment.

1.6 The Louisiana Health Information Technology (HIT) Coordinator

The Louisiana State HIT Coordinator reports to the DHH Secretary, and serves as the key

advisor on issues related to health information technology and exchange. The Coordinator will

assist Louisiana Medicaid with the planning, development, and oversight of the Medicaid EHR

Incentive Payment System and related activities. In addition, the HIT Coordinator will work

cooperatively with multiple stakeholders – including health care providers, health plans, health

profession schools, consumers, technology vendors, public health agencies, and health care

purchasers – to determine priorities and provide recommendations that will facilitate and expand

the electronic movement and use of health information.

The Coordinator will work in collaboration with the LHCQF to:


Assist with the development of the Louisiana Health Information Exchange (LaHIE)

strategic and operational plans

Assist with the implementation the LaHIE and support expansion of statewide health

information exchange

Maintain relationships with public and private partners/stakeholders to ensure coordination

of electronic information systems planning, development, implementation and exchange of

information that meets national privacy and security standards, policies, and timelines, and

that fits within the ONC, National Health Information Network (NHIN) strategic plan

Identify improvements in the management, availability and use of public health and health

care data to assess and improve the health status of Louisiana citizens

Assess the readiness of healthcare entities to meet the ‘meaningful EHR user’ status

(defined by ONC) and provide direction and assistance with achieving the required level of

adoption necessary to participate in HIE

Engage, inform, and educate consumers about the use, benefits, and limitations of HIT/HIE

Identify new grant/funding opportunities, serve as principle investigator (PI) as needed for

grants, and assist with the preparation of grant applications for long term sustainability of

HIT/HIE projects

Act as the State lead for HIT/HIE and participate in state, regional, and national

health/scientific meetings focused on HIT/HIE

Coordinate HIT/HIE activities across state and federal agencies, including Medicaid and

public health

Assure coordination of other ARRA programs in Louisiana (i.e. regional extension center,

broadband and workforce)

Execute financing strategies to secure additional funding needs and enable sustainability


Coordinate statewide activities related to the implementation of HIT/HIE in Louisiana in

order to improve the efficiency and effectiveness of health data collection, analysis and use

to improve the health of individuals and their communities

Coordinate resources and activities to assist with readiness assessments of public and

private health care entities to implement electronic information systems that meet federal

and state requirements and fit within the state HIE strategic and operational plan

Foster pilot projects and coordinate HIE-related activities in collaboration with the

LHCQF, public and private healthcare providers and health plans

Collaborate with federal standards and policy committees to develop common data

reporting formats and methods of transmission within Louisiana and across state borders

for all pertinent health data

1.7 Contractor Services

Louisiana Medicaid has contracted with Myers and Stauffer to conduct the EHR Incentive post-

payment audits. The current contract expires on June 30, 2016.

Also, LA Medicaid has completed a Cooperative Endeavor Agreement with Louisiana’s REC,

Louisiana Health Care Quality Forum (LHCQF) to promote the adoption of HIT and HIE.


2. STATE “AS-IS” HIT LANDSCAPE This section will describe existing resources available and how the state will leverage these

existing resources already devoted to HIT. The HIT landscape will include an assessment of

current rates of EHR adoption and establish a baseline for “As-Is” state of environment. It will

describe existing State IT activities as they relate to HIT and HIE.

2.1 Current EHR Status

As of December 20, 2013:

Eligible Professionals (EPs):

AIU 2011 2012 2013 Total

Total Providers Paid (AIU) 757 779 372 1908

Total Paid Amount (AIU) $16,032,836 $16,504,169 $7,855,419 $40,392,424

MU 2011 2012 2013 Total

Total Providers Paid (MU) 0 235 350 585

Total Paid Amount (MU) $1,997,500, $2,941,004 $4,938,504

Eligible Hospitals (EHs)

AIU 2011 2012 2013 Total

Total Providers Paid (AIU) 69 29 4 102 Total Paid Amount (AIU) $77,213,165 $26,766,909 $2,584,863 $106,564,937

MU 2011 2012 2013 Total

Total Providers Paid (MU) 0 24 43 67 Total Paid Amount (MU) $12,558,675, $30,504,037 $43,062,712

Attestations by Provider Types

2011 AIU 2012 AIU 2012 MU 2013 AIU 2013 MU Total AIU Total MU

Physician 407 431 139 223 208 1061 347

Nurse Practitioner 27 26 11 19 17 72 28

Dentist 48 104 3 35 3 187 6

Optometrist 0 7 0 17 2 24 2


Certified Nurse Midwife 0 0 0 0 0 0 0

Pediatricians 263 205 74 72 119 540 193

Physician Assistant 13 5 8 6 1 24 9

Acute Hospitals 68 29 24 4 42 101 66

Childrens Hospital 1 0 0 0 1 1 1

Total per year - EP 758 778 235 372 350 1908 585

Total per year - EH 69 29 24 4 43 102 67

Total per year 827 807 259 376 393 2010 652

2.2 Current Medicaid Systems

The current Louisiana MMIS (LMMIS) contract is with Molina. Louisiana is continuing to

develop plans for modernization of both its LMMIS and Eligibility Systems. This section

describes the current systems status.

2.2.1 LMMIS/MITA

MITA (Medicaid Information Technical Architecture) is a framework that envisions the

Medicaid Enterprise in layered structure, fostering integration and defining interrelationships

between business and information technology, thus improving the administration and operation

of Medicaid management. Ultimately, the collaboration will improve the healthcare delivery and

experiences of many stakeholders associated with the Medicaid Enterprise.

The MMIS is the entity responsible for maintaining and updating the MITA State Self-

Assessment (SS-A) with input from relevant Medicaid sections. Policy has been established that

requires all MITA Business Processes to be reviewed for possible updates, acceptance, and

approval by MMIS. Reviews shall occur whenever procurements are needed, new contracts are

established, new processes implemented, etc.

MITA is more than a technical standard. The MITA Framework also lays out a roadmap for

enhancing the operations of the Medicaid Program with its Maturity Model. A MITA-compliant


MMIS and a MITA-compliant MEDS (Medicaid Eligibility Data System) is an opportunity to

assist in the evolution of Medicaid from a simple payer program to truly managing the access,

quality and costs of services and to attain the goals of higher levels of MITA Maturity Model.

This can be facilitated by a MMIS and MEDS that integrates clinical and administration data

from other department programs and agencies as well as from contracted provider clinical

systems. Enhanced data management and decision support will improve the timeliness and

quality of decision making by Department personnel. A MITA-compliant MMIS and MITA-

compliant MEDS will support the ability to track participants across all state healthcare

programs and to support a truly client-centric model of care.

As requested by CMS, in 2008 Louisiana conducted a MITA self-assessment (SS-A) based on

version 2.0 criteria to determine its business capabilities and document plans for transformation

to achieve higher levels of maturity. The SS-A asks States to align their business processes to

those in the MITA Business Process Model and examine the Business Capability Matrix to

assess their current level of maturity. Louisiana submitted an APD with a Request for Proposals

(RFP) which was approved by CMS. This RFP resulted in awarding a contract to MAXIMUS to

map the current LMMIS business processes and technical capabilities and to facilitate gap

analysis of those processes. MAXIMUS was also utilized to help the State prioritize capabilities

and develop a unique MITA implementation plan which resulted in the SFP for the LMMIS

replacement.

The mapping of the Medicaid business processes and cross-referencing to the MITA business

areas and Medicaid staff revealed that Louisiana currently has business process models and

workflows for each of the business processes associated with each of the eight MITA business

process areas. This information was used to identify existing challenges in the “As-Is”

environment in order to move toward a more integrated and robust LMMIS and identify areas in

which Louisiana can improve and integrate our existing processes in order to improve the

administration of our Medicaid program.


The result of the MITA “As-Is” SS-A was to document Medicaid’s current business processes

and workflows. This effort formed the foundation for a common understanding of the business

processes across sections and the basis for identifying future changes that should be explored.

Louisiana mapped 79 business processes to the MITA Business Process Model and determined

the current maturity level of each process. The MITA scale of 1 to 5 assesses the degree of

automation, standardization and integration. The highest level of maturity for all 79 business

processes was at level 1 or 2, therefore no level 3 - 5 capabilities were demonstrated.

Louisiana Medicaid conducted its last full MITA 2.0 “To-Be” SS-A in August 2009 and

submitted the report to CMS. At that time, it was determined that the majority of Louisiana's

business processes have goals of achieving Maturity Level 2 over the next three to five years.

However, progression to higher maturity levels is dependent upon the implementation of new

system components. The procurement for these services is currently in the planning phase under

the guidance and oversight of CMS.

In March 2012, CMS announced the release of the MITA Framework version 3.0, which takes

into account new legislative requirements and reflects the use of newer technologies and recent

policies. Louisiana Medicaid is currently conducting a full MITA 3.0 “As-Is” and “To-Be” SS-

A. The Department estimates that it is 45% completed with the current MITA SS-A version 3.0

report; completion of the assessment is a component of the overall MMIS modernization, all of

which is anticipated to be completed December 31, 2017

The HIT component shall be addressed when a process is reviewed for updates. The results shall

be identified in the MITA update. The majority of the State's MITA transition shall occur with

implementation of the replacement MMIS.


2.2.2 Medicaid Eligibility

Determining recipient eligibility for programs such as Medicaid involves a myriad of eligibility

factors and program-specific rules. Many different factors are used to determine participant

eligibility. Information relating to these factors must be obtained, evaluated, and verified by the

State for applicants and enrollees. Manually performing these steps is a time-consuming,

inefficient, and error-prone process. Louisiana has already taken proactive steps to improve the

current automated eligibility systems to facilitate the eligibility and verification process,

including enabling the HIE to query for Medicaid, Medicare, and other TPL coverage.

2.2.2.1 Medicaid Eligibility Data System (MEDS)

The Medicaid Eligibility Data System (MEDS) is the system responsible for capturing,

maintaining and transmitting Medicaid eligibility to the LMMIS on a daily basis. This ensures

that providers of Medicaid services can bill and receive payment for services performed. MEDS

is also responsible for providing data necessary to produce true and accurate reports for

management of the Medicaid Program. MEDS is a mainframe system which utilizes the State’s

Department of Social Services mainframe. The system is vital to the Department of Health and

Hospitals to ensure established Medicaid eligibility is available for clients to receive services in a

timely manner. MEDS is a stand-alone Medicaid/LaCHIP eligibility system.

The State of Louisiana provides numerous services through state and federally supported

programs which rely on an accurate establishment of Medicaid eligibility. The process begins

with the recording of the Medicaid Application for Assistance on the MEDS system.

Applications are either approved or rejected after the analyst reviews all potential types of

assistance for which an applicant may be eligible. The MEDS system houses current person and

case demographic and financial information as well as provides history of the system events for

all current Medicaid and LaCHIP programs. MEDS contains approximately one million active

recipients at any given time and maintains approximately 2.55 million person records.


MEDS maintains many required interfaces which allow the transmittal and receipt of information

regarding applicant/recipients from other state and federal agencies. MEDS currently interfaces

with the following: Social Security Administration (SSA), Centers for Medicare and Medicaid

Services (CMS), Department of Social Services (DSS), Health Management Systems (HMS)

Office of Group Benefits (OGB) and Molina (Fiscal Intermediary).

The primary function of MEDS is to capture Medicaid eligibility data. While the actual

determination of Medicaid eligibility is a function done by the eligibility caseworker, the MEDS

system both records the results of the determination and provides assistance in making the

determination using budget worksheets. However, LA Medicaid is pursuing a significant

architecture upgrade to automate the process of eligibility determination and to accommodate the

anticipated influx of individuals into Medicaid programs because of the new Patient Protection

and Affordable Care Act (PPACA) of 2010. The long term plans are for Louisiana to pursue a

new Eligibility system via a RFP.

2.2.2.2 Electronic Medicaid Eligibility Verification System (eMEVS) Application

Louisiana Medicaid’s Electronic Medicaid Eligibility Verification System (eMEVS) Web

Application provides a secure web-based tool for low-volume providers who do not work with a

switch vendor to verify Medicaid eligibility information.

Louisiana has implemented measures to leverage current eligibility verification capabilities and

facilitate future electronic eligibility determination by EPs and EHs via the HIE

2.2.2.3 Maximizing Enrollment for Kids

In February 2009, Louisiana was selected as one of eight grantees of the Robert Wood Johnson

Foundation’s (RWJF) Maximizing Enrollment for Kids Program, an almost $4 million initiative

that has the goal of helping states improve the enrollment and retention of eligible children in


Medicaid and the Children’s Health Insurance Program (CHIP). Under the direction of the

National Academy for State Health Policy (NASHP), which serves as the national program

office, Maximizing Enrollment for Kids aims to help states improve their systems, policies and

procedures to increase the proportion of eligible children enrolled and retained in these

programs.

2.3 DHH HIT Initiatives

Louisiana is currently engaged in several HIT efforts to improve the health delivery in the State.

2.3.1 Louisiana Immunization Network for Kids Statewide (LINKS)

Louisiana Immunization Network for Kids Statewide (LINKS) is a State immunization registry

implemented by the Office of Public Health (OPH). This web-based system allows Medicaid

enrolled providers to search and view patient’s vaccination records, and provides read-write

access or data exchanges to WIC Clinics, STD Clinics, Hospitals, Health Plans, Correctional

Facilities, Elementary Schools and Head Start and Military. Moreover, LINKS serves as a part

of the EHR for one of the largest hospital systems in the state (Ochsner Health System) and has

real time interface with all LSU Hospital Systems.

This immunization registry, referred to as LINKS, sends and receives HL7 immunization queries

and updates, allowing it to connect to private providers, other state registries, hospitals, and other

state health systems. The messages sent and accepted by LINKS conform to HL7 specification

version 2.3 and in the case of immunization specific messages, the Center for Disease Control

(CDC) Implementation Guide for Immunization Transactions version 2.1.

Louisiana Medicaid’s efforts will expand to supporting the LINKS and LAPHIE interface as the

State HIE capabilities mature. Louisiana Medicaid’s efforts will expand to supporting the

LINKS and LAPHIE interface as the State HIE capabilities mature. Louisiana intends to assess


how best to leverage current capabilities of LINKS and facilitate integration between this system

and the EHRs of the EPs and EHs for the purpose of reporting clinical quality measures as

required for Stage 2 MU implementation in 2014.

2.3.2 Public Health Surveillance

Louisiana Public Health Information Exchange (LAPHIE) is a collaborative initiative between

the Louisiana Office of Public Health, the Louisiana State University (LSU) Health Care

Services, and the Louisiana Public Health Institute. The programs have connected a public health

information system with the registration system and electronic medical record (EMR) of seven

LSU hospitals (emergency departments, inpatient units and outpatient clinics). The purpose of

the exchange is to provide clinicians with critical information to identify patients who had

previously been out of care or lost to follow up for communicable conditions, including: HIV,

syphilis and tuberculosis in order to facilitate entry/re-entry into treatment.

One important job for the Louisiana Office of Public Health (OPH) is ensuring that Louisianans

with infectious diseases learn about their diagnosis and receive appropriate medical care. For

certain conditions (including HIV, syphilis and tuberculosis), OPH works to fulfill this duty by

sending a staff person to speak with newly diagnosed patients about undergoing proper

treatment. However, such methods can’t reach every Louisiana patient with an infectious

disease. Sometimes, OPH can’t find patients after an initial diagnosis. Other times, patients may

drop out of care years after learning that they have an infectious illness. Obviously, connecting

such individuals to treatment would help improve both individual and population health in

Louisiana—especially in light of recent research which shows that persons taking HIV

antiretroviral medications are less likely to transmit the disease.

With the above challenges in mind, OPH partnered with seven Louisiana State University (LSU)

Health Care Services Division hospitals, and the Louisiana Public Health Institute to create the

Louisiana Public Health Information Exchange (LaPHIE). The exchange uses OPH’s


surveillance data to alert LSU clinicians that a patient might have an untreated case of HIV,

tuberculosis or syphilis requiring a doctor or nurse’s attention. Specifically, OPH sends a

LaPHIE message to LSU clinicians when they meet with the following types of patients:

Individuals who have tested positive for HIV but may be unaware of their status

(according to OPH records),

Individuals with confirmed HIV infection who currently do not appear to be in care (OPH

has no recent viral load or CD4 laboratory tests on file), Children of HIV-positive

mothers who may have HIV (but OPH’s records are insufficient for a conclusive

diagnosis),

Individuals who have tested positive for syphilis or tuberculosis and do not appear to

have completed a full course of treatment (according to OPH records).

This program creates a secure, limited connection between a protected list of “out of care”

persons housed on the OPH computers and the electronic medical record (EMR) system at LSU.

The result: each time a patient checks into a LSU emergency room, clinic, or hospital, LaPHIE

logic automatically examines the OPH file to determine if the patient is on OPH’s out of care list.

If LaPHIE’s logic determines that a patient is out of care, it automatically sends a message to

LSU’s EMR. Then, when an authorized LSU clinician logs in to the patient’s record, he or she

sees a message from OPH—along with a list of suggested actions. The content of these

messages varies depending on the patient’s illness and type of care that the patient might need.

(http://www.lsms.org/site/images/stories/LaPhie-Non-techincal%20Guide.pdf)

The success of this public health primary care integration project includes the following: 1. Of

those who were identified through LaPHIE, 18% had never been in care and of those, 57% were

successfully linked into care within 90 days after the LaPHIE alert occurred. 2. Of those who

were identified through LaPHIE, 30% had been out of care for more than two years and of those,

67% were successfully linked into care within 90 days after the LaPHIE alert occurred. 3.

Persons who had been out of care for a shorter period of time (12-24 months) were more likely to

re-enter care following the LaPHIE alert (77%). 4. From the inception of the project through

August 2013, more than 1,200 individuals have been identified through this system and of those

http://www.lsms.org/site/images/stories/LaPhie-Non-techincal%20Guide.pdf


with sufficient follow-up data to analyze (i.e., more than 90 days following a LaPHIE alert), 69%

have been successfully linked to care within 90 days.

(http://www.astho.org/PCPHCollaborative/Successes/Stories/Louisiana-HIV/)

2.3.3 Vital Records

The Vital Records division of the Office of Public Health conducted a re-engineering to expedite

collection and dissemination of vital records in the State of Louisiana which was completed in

March, 2012. The re-engineering entailed the development of a web-based integrated vital

records application, Louisiana Electronic Event Registration System (LEERS), which replaced

the manual OPH processes currently in place for the Louisiana Vital Records Registry, including

birth, death, fetal death, marriage, divorce and induced termination of pregnancy data. It

included a business system and also an imaging module to scan and save approximately 10

million archived birth, death and Orleans Parish marriage records onsite at OPH and associate

the images with the corresponding data record. The application has been made available

statewide to designated users and will be utilized by data providers such as OPH, hospitals,

issuance offices, funeral homes, parish Clerks of Court, physicians, coroners and additional

remote sites located throughout the State. The re-engineering was geared towards implementing

electronic registration of vital events, expanding the number of locations where information is

available, allowing remote sites to process and issue certified copies of certificates, integrating

various software systems used by Vital Records (Mainframe, Encounter), reducing request

processing time, reducing paperwork and keypunching, and improving reporting capabilities .

2.3.4 Louisiana Medicaid Clinical Data Inquiry (eCDI)

Louisiana Medicaid has implemented a web based Clinical Data Inquiry web based application

to provide most Medicaid enrolled providers (physicians, pharmacies, hospitals, clinics,

specialists, psychologists, etc.) with patient-centric clinical information that is organized by type


or place of service (drugs, physician visits, outpatient setting, inpatient setting, ancillary services,

etc.). The patient services data presented is derived from paid claims data received and

processed by the Louisiana Medicaid’s LMMIS system. Pharmacy (drug) claims data is

refreshed every night, 7 days per week whereas all other claims data is refreshed weekly each

Sunday evening. The web application uses secured sockets layer (SSL) at 128-bit cipher

strength and all databases are encrypted.

The eCDI system contains a Decision Support Tool (DST) that has two web-based components:

an alert component that functions with the e-CDI application, and a stand-alone web application

that is provider-centric, whereby a primary care provider (PCP) can view claims history

utilization information for their assigned Medicaid recipients, as well as a quality profile of their

patients that are indicated to have specific disease states. Disease state measures are established

using current Healthcare Effectiveness Data and Information Set (HEDIS) guidelines and are

coded and administered by the Office of Outcomes Research & Evaluation at the University of

Louisiana at Monroe (ULM).

The Alert Application is tightly integrated with e-CDI so that when a provider inquires into a

patient’s clinical data, if the patient is indicated with one of the implemented disease states, a

clinical alert will “pop-up” in front of the e-CDI screen. If the recipient has been identified

(using HEDIS guidelines) as a diabetic, then this alert page will “pop-up” on the e-CDI main

menu after the provider looks up a recipient.

2.3.5 Office of Mental Health – Integrated Information System (OMH-IIS)

On March 1, 2012, the Office of Behavioral Health (OBH), in conjunction with the State

Management Organization (SMO), Medicaid, the Office of Juvenile Justice (OJJ), Department of

Children and Family Services (DCFS), and the Department of Education (DOE), formed the

Louisiana Behavioral Health Partnership (LBHP). The LBHP is a system of Medicaid and non-

Medicaid adults and children who require specialized behavioral health services. In this business


model, OBH took on a monitoring role, while the SMO became the manager of behavioral health

services for Louisiana.

The SMO provided members of the LBHP with an electronic behavioral health record (EBHR),

Clinical Advisor. Clinical Advisor is a web-based EBHR which offers a multi-agency view of

the patient. Functionality includes billing, charting, and scheduling. OBH is continuously

working with the SMO to improve Clinical Advisor functionality. Future endeavors for Clinical

Advisor include attaining Meaningful Use and connecting to the Louisiana Health Information

Exchange (LAHIE) to further the cause of statewide integration.

Once Clinical Advisor was implemented, OBH ceased use of OBH-IIS (Office of Behavioral

Health-Integrated Information System), a state-custom-built comprehensive, web-based

information system that operated in all state community mental health centers (except for one

LGE). Until the formation of the LBHP, OBH-IIS had been the primary data source for URS

and client-level data reporting.

While OBH continues to develop its role as a monitoring entity in the LBHP, the current

business model also assumes OBH fosters independence for the local governing entities (LGEs).

In doing so, the LGEs have the option of using Clinical Advisor as an electronic behavioral

health record. Other LGEs have adopted their own EBHR.

OBH developed the OBH Client-level Data Manual; a comprehensive behavioral health data

dictionary consolidating data collection and reporting requirements for both mental health and

addictive disorders. The manual sets forth the standards and procedures for the data sets, file

structures, data elements, data definitions, data collection guidelines, data element values and

formats, and the method, schedule, and means by which client-level data is to be electronically

and securely transferred to OBH. The OBH Client-level Data Manual is intended for use by

personnel involved in the collection, extraction, transformation, and submission of the client-


level data files to OBH. OBH has used this manual in working with Magellan and other EHR

vendors.

Since 1997, OBH has operated a comprehensive Data Warehouse/Decision Support System to

provide access to and use of integrated data. An integral part of the Decision Support System

has been a web-based interface called Decision-Support On-line, which provided a state-built

suite of tools for statewide reports and downloads for local and ad hoc analysis and reporting.

DataQuest, a web-based ad-hoc reporting system using a simple point-and-click interface,

enabled managers to run a myriad of reports on data (by LGE, by facility, by provider) based on

the comprehensive set of client and service data integrated in the OBH Data Warehouse.

DataMaker provided further ad hoc decision-support capabilities; allowing download of user-

specific integrated data sets from the data warehouse for use in ad hoc analyses to explore data

quality issues.

Implementation of the LBHP and Clinical Advisor, created the need for a new integrated

behavioral health Data Warehouse/Decision Support System, bridging legacy systems and

Clinical Advisor data for reporting. Once the data warehouse was in place, OBH began work on

developing DataQuest2 and DataMaker2 to provide these same user-friendly decision support

and data quality management tools for access and use of Clinical Advisor data. OBH

implemented DataQuest2 and DataMaker2 in July 2013 and provided training which included

standardized definitions and step-by-step instruction on how to access these tools, how to create

customized reports using user-specified parameters, and how to create data sets that can then be

exported for data analysis and reporting.

OBH has also developed the OBH Data Collection Requirements Manual; a companion

document to the OBH Client-level Data Manual. The purpose of the OBH Data Collection

Requirements Manual is to inform provider agency front line, clinical, and management

personnel of what type of information is required by OBH and when the information should be


collected and recorded. In the future, OBH will be scheduling data collection and data quality

management training sessions. OBH also plans to develop automated data quality reports for

each LGE providing a listing of client records with data elements that have missing values.

This package of documentation and training, along with ongoing technical assistance and

support, provides EHR vendors and provider staff the information and guidance needed to assure

standardized data collection and reporting to meet state and federal reporting requirements.

In September of 2013, OBH began researching the possibility of procuring an EBHR for the

inpatient psychiatric hospitals, East Louisiana Mental Health System and Central Louisiana State

Hospital, still under OBH leadership. This process has been ongoing, and has now reached the

procurement phase. In early 2014, OBH will be contracting with the Louisiana Regional

Extension Center (REC), Louisiana Health Care Quality Forum (LHCQF) for consulting

services. The LHCQF consulting services will include workflow assessment, project

coordination assistance, and vendor selection assistance. Once the EBHR is procured and

implemented, OBH will work with the hospitals to ensure the EBHR achieves meaningful use

and connects to LAHIE.

2.4 Planned Medicaid Initiatives

On January 15, 2009, the U.S. Department of Health and Human Services (HHS) released two

final rules supporting the continued transformation of the U.S. healthcare system toward a

comprehensive electronic data exchange environment. These two rules represent the transaction

code set components of the Health Insurance Portability and Accountability Act (HIPAA) of

1996.


Louisiana Medicaid has completed the adoption of Version 5010 transactions and is moving

forward with ICD-10-CM diagnosis coding standardization.

2.4.1 HIPAA 5010

Louisiana implemented 5010 on January 1, 2012 but some Providers had not yet tested and

converted. A contingency Plan was submitted to CMS after not meeting the June 30, 2012

extension deadline and all others were converted by October 1, 2012. Providers had until

September 17, 2012 to convert. After September 30, 2012, Louisiana no longer accepted 4010

transactions.

2.4.2 International Classification of Diseases, Tenth Revision, (ICD-10)

The other rule addresses the adoption of the ICD-10 Clinical Modifications for diagnosis coding

and the ICD-10 Procedure Coding System for in-patient hospital procedure coding. ICD-10 will

replace the current ICD-9 versions which were developed nearly 30 years ago. The ICD-10-CM

and ICD-10-PCS (ICD-10) compliance date is October 1, 2014 and Louisiana plans to be in

compliance with this date.

2.4.3 Louisiana Medicaid Medical Managed Care

In early 2013, Louisiana Medicaid launched Bayou Health, an integrated system of public and/or

private primary care providers, specialty care groups, and hospital providers to provide a patient-

centered medical home for specific eligibility categories within Medicaid. Through Bayou

Health, Medicaid recipients enroll in one of five health plans that are under contract with

Louisiana Medicaid: The five health plans are: Amerigroup, Louisiana Healthcare, AmeriHealth

Caritas Louisiana, Community Health Solutions and United Healthcare. The health plans assist

providers in transitioning to the National Committee for Quality Assurance (NCQA) definition


of a medical home and implement electronic health records, report quality, satisfaction and

efficiency data on the performance.

2.4.4 Meaningful Use Definitions

While Louisiana appreciates the provisions in the rule-making permitting changes to Meaningful

Use definitions, we do not anticipate proposing any changes to the Meaningful Use definitions.

2.5 Stakeholder Assessment

2.5.1 Stakeholder HIE Participation

Approximately 60 percent of all hospitals in Louisiana are currently participating in LaHIE. In

addition, several health systems have exchange capability within their own network.

Currently, more than 620,000 patients have records in LaHIE which represents 13 percent of all

Louisiana residents. As additional participants continue to “go-live” on LaHIE, this number

continues to rise rapidly.

2.5.2 HIT Strategies

To increase provider participation in the Louisiana Health Information Exchange (LaHIE),

Louisiana Medicaid, through partnership with the LHCQF, plans to implement the HIE

Integration Assistance Program. The program will provide assistance to high Medicaid volume

practices and hospitals to help offset the initial, upfront cost associated with HIE

integration. The assistance to providers will be a one-time, “start-up” offering to be made

available to providers during a specified timeframe. This initiative is described in Section 2.6.1

LaHIE Louisiana State Health Information Exchange (HIE) Projects. Although this initiative was

funded in Louisiana’s FFY 13-14 IAPD-U, it was not implemented in FFY 13, as planned, due to

delays in getting the contract with the LHCQF approved by Louisiana’s Office of Contractual


Review. It has yet to be determined if Louisiana Medicaid will request funding for this inititiave

in another FFY.

Louisiana Medicaid is currently implementing the Medicaid Specialist Outreach Initiative, which

is modeled after a program in New Jersey. The initiative will allow Louisiana’s REC, Louisiana

Health Care Quality Forum (LHCQF) to provide technical and consultative support to Medicaid

specialists. Prior to this initiative, LHCQF was able to provide federally-funded services to only

Medicaid primary care physicians. Through this initiative, Louisiana Medicaid will provide

services through the LHCQF to Medicaid specialists. As outlined in the Cooperative Endeavor

Agreement between Louisiana Medicaid and LHCQF, Louisiana Medicaid will provide payment

to the LHCQF based on the achievement of established milestones. The performance-based

payment methodology mimics that used by ONC for the existing program. This program is

further described on Section 3.4.3 Technical Assistance to Medicaid Providers. Due to delays in

the contract approval process, this initiative was launched in FFY 14.

2.5.3 Louisiana Indian Tribal clinics

There are four federally recognized Indian tribes in Louisiana: the Chitimacha Tribe of

Louisiana, the Coushatta Tribe of Louisiana, the Jenna Band of Choctaw Indians, and the

Tunica-Biloxi Tribe. Of these four tribes, the Chitimacha Tribe and Coushatta Tribe operate

medical clinics that service their members. The other two tribes do not offer direct healthcare

services and contract with local providers for health services.

The medical clinics operated by the Coushatta and Chitimacha Tribes utilize a clinical

information system called the Resource and Patient Management System (RPMS) to capture

clinical and public health data. This system, developed 30 years ago by the VA, offers facilities

access to decades of personal health information and epidemiological data on local populations.


The primary clinical component of RPMS, Patient Care Component (PCC), was launched in

1984. This system utilizes paper based clinical forms that are entered into the RPMS by a data

entry clerk after the office visit.

DHH has contacted all tribes to discuss the SMHP and the Louisiana Medicaid EHR Incentive

Program. The LHCQF will also continue to reach out to the Indian tribes as needed. Finally,

LaHIE will work with both the Coushatta Tribe of Louisiana and Chitimacha Tribe of Louisiana

to help them to engage in HIE when they are prepared to connect with the statewide exchange.

2.5.4 Department of Defense (DOD) and Veteran Affairs (VA) Medical Clinics

The DOD and the VA operate medical clinics in Louisiana. All DOD Installations and VA sites

worldwide (including those at Barksdale and NOLA) use the military's electronic health record

system Armed Forces Health Longitudinal Technology Application (AHLTA). AHLTA is an

enterprise-wide medical and dental information management system that provides secure online

access to Military Health System (MHS) beneficiaries’ records. It is used by medical clinicians

in all fixed and deployed Military Treatment Facilities (MTFs) worldwide. This centralized

EHR allows health care personnel worldwide to access complete, accurate health data to make

informed patient care decisions - at the point of care - anytime, anywhere. AHLTA is the first

system to allow for the central storage of standardized electronic health record (EHR) data that is

available for worldwide sharing of patient information. Please visit the following link for more

information on MHS http://dhims.health.mil/userSupport/ahlta/about.aspx

2.5.5 Federally Qualified Health Centers (FQHC)/Rural Health Centers (RHC)

There are 25 Federally Qualified Health Centers (FQHCs) operating 73 sites throughout

Louisiana. The goals of these organizations are to expand access to health care services to the

underserved and to work towards the elimination of health disparities. The majority of FQHCs

and RHCs utilize paper based practice management methods.

http://dhims.health.mil/userSupport/ahlta/about.aspx


Although, according to the Health Resources and Services Administration (HRSA) website, no

Rural Health Grants have been awarded at this time, these clinics have benefited from a $100

million dollar Primary Care Access and Stabilization Grant (PCASG) grant awarded to the

Louisiana Department of Health and Hospitals (DHH) and the Louisiana Public Health Institute

(LPHI). This grant was designed to meet the increasing demand for healthcare services in the

four-parish Greater New Orleans area (Jefferson, Orleans, Plaquemines and St. Bernard

parishes), provide high quality primary and behavioral health care at the community level, and

decrease reliance on emergency rooms for conditions more appropriately treated in an outpatient

setting. The funds assist the State FQHCs in stabilizing, improving, and expanding services

through methods including opening satellite clinics, extending hours of operation and hiring

additional qualified medical staff. The participating organizations provide affordable services to

everyone, without regard to ability to pay. Practices benefiting from PSASG funding were not

allowed to utilize the grant funds to procure HIT.

2.6 State Health Information Exchange (HIE) Projects

As the state-designated entity for the receipt of HITECH funding under ARRA, LHCQF Board

of Directors will be the primary governing body over LaHIE. The HIT Advisory Council (new

name) is active and will continue to consist of an independent group of health IT experts and

health care consumers that represent the Louisiana health care environment. The Council

membership will consist of no more than fifteen (15) members, serving as a representative body

for the following stakeholder groups:

Hospitals/Health Systems

Physicians

Consumers

Payers/Health Plans

Employers/Businesses

http://www.gnocommunity.org/

http://www.gnocommunity.org/


Other health care providers (i.e. Pharmacies, Clinical and Reference Labs, Nursing

Homes, Home Health, etc.)

The State HIT Coordinator and the Health IT Program Manager for LHCQF will serve as co-

chairs of the HIT Advisory Council. A member of the Board of Directors will serve as a Board

Liaison to the HIT Advisory Council. The HIT Advisory Council shall meet monthly (i.e., face-

to-face or by teleconference). Ad hoc task forces may be assigned to address specific needs

(e.g., health care financing and reimbursement, legal/policy, etc.).

The HIT Advisory Council is accountable to the full Board of Directors for establishing and

meeting measurable goals and objectives and acceptance of these duties and responsibilities:

To provide strategic direction and assist in the implementation of LaHIE.

To contribute to the efficient operation of the HIT programs, including LaHIE and the

LHIT Resource Center.

To make recommendations to the full Board of Directors and provide the information the

group needs to make a sound decision, or to communicate effectively a decision made by

the group.

To generate innovative ideas on how health IT can meet the escalating demands within

the health care environment.

To be the body to whom the Board of Directors looks to drive HIT initiatives.

To serve as subject matter/content experts to the staff and LHCQF as it relates to health

IT.

To provide guidance and advice with regard to federal (i.e., ONC) and state (i.e., DHH)

HIT directives and initiatives.

More than 180 health care organizations including hospitals, clinics, home health and emergency

medical service have signed participation agreements with LaHIE. Forty-five of these


organizations are currently live in LaHIE with 100 additional organizations in active onboarding.

LaHIE currently offers:

Master Patient Index

Record Locator Service

User Identity Management

Audit Services

Consent Management

Data Exchange

CCD Repository

Referrals

Direct Messaging and Notifications

Clinical Portal

Single Sign-On

Public Health Reporting

2.6.1 LaHIE - Louisiana Health Information Exchange


Louisiana Medicaid, through partnership with the LHCQF, plans to implement the HIE

Integration Assistance Program. The program will provide assistance to high Medicaid volume

practices and hospitals to help offset the initial, upfront cost associated with HIE

integration. The assistance to providers will be one-time, “start-up” offering to be made

available to providers during a specified timeframe

The assistance offered to providers will cover the cost associated with integration that would

normally be charged to a provider/hospital by the Health Information Exchange. This includes

cost from the HIE vendor and staff resources to complete onboarding activities. The provider is


responsible for 100% of charges from its EHR vendor. The integration includes all that is

required from the Health Information Exchange to provide required elements of Phase 1

Meaningful Use through LaHIE, including CCD exchange for coordination of care, public health

reporting, and demographics updates. For an average hospital, five interfaces are

required. Eight interfaces are required for clinics.

In addition to a fully executed five-year participation agreement with LaHIE, program

participants must meet one of the following criteria:

Hospitals must:

o Be classified as a critical access as determined by CMS; or,

o Be designated as a rural hospital as determined by the Louisiana Office of Public

Health, Bureau of Primary Care and Rural Health; or,

o Have a Medicaid patient volume greater than or equal to 35%

Group practices must:

o Demonstrate that more than 50% of all eligible provider types employed qualify for

the EHR Incentive Payment Program; or,

o Demonstrate that the group Medicaid patient volume is greater than 30% (i.e., using

group proxy to determine eligibility).


Although this initiative was funded in Louisiana’s FFY 13-14 IAPD-U, specifically for FFY 13,

it was not implemented in FFY 13, as planned, due to delays in the contract approval process

with Louisiana’s Office of Contractual Review. It has yet to be determined if Louisiana

Medicaid will request funding for this initiative in a future IAPD-U. If so, the program will be

launched in conjunction with promotional activities that convey the benefits of LaHIE and the

limited timeframe in which providers have to participate in the program.

The payment allocation methodology for the Integration Assistance Program is modeled after the

payment methodology described in the Final Rule that governs incentive payments to Eligible

Professionals and Eligible Hospitals that are participating in the EHR incentive program. For

hospitals, the Integration Assistance Program will pay a portion of the HIE integration cost equal

to the percentage of reported Medicaid patient volume in the most recent program year. The

average Medicaid patient volume for a hospital is 30%, and the estimated integration cost for a

hospital is $25,200, which equates to an average payment of $7,560 for a hospital. However,

Louisiana Medicaid is using the average patient volume only to estimate program costs. The

integration assistance payment will vary by hospital, according to Medicaid patient volume. In

regard to practices, the estimated integration cost for a group practice is $8,800. As with the

EHR incentive program, practices that meet program requirements will receive 100% of the

integration cost. As described in the Cooperative Endeavor Agreement between Louisiana

Medicaid and LHCQF, LHCQF will issue the integration assistance payment to a qualified

provider, and Louisiana Medicaid will issue payment to LHCQF on a cost reimbursement basis.

Maximum Cost of HIE Integration Assistance Program

FFY13

Number of

Program

Participants

Payment Per

Participant

Total

Maximum

Program Cost


Hospital 66 $7,560 498,960

Group Practice 300 $8,800 2,640,000

Total $3,138,960

2.7 State IT Infrastructure

The ability to transmit and share patient information between providers is a key element of a

HIE. For this to occur, it is imperative that the providers are linked over a network. While it

would be feasible to transmit patient data over a slow network such as dial-up, HIE expectations

today rely on the availability of high-speed, reliable, secure connections. Many physician offices

in the State use DSL (digital subscriber line) connections with fast download speeds, typically

1.5 mbps, and slower upload speeds. However, faster T-1 connections with 1.5 mbps download

and upload speeds is generally preferred. With slower communication speeds, providers may be

presented with a disincentive to use linked systems and discouraged from attempting to retrieve

linked data over the network. Therefore, to have reasonable response times in a HIE, it is

imperative that the HIE is built on a fast, high-speed connection.

However, one of the realities of current connectivity is that although high-speed networking may

be readily available in urban areas, it may not be available in semi-rural and rural areas, which

comprise much of the geography of Louisiana. Broadband coverage is spreading in Louisiana,

but there are still gaps in rural areas, particularly in the northern part of the state. One of the

goals for the LaHIE project is to ensure that health care facilities will have the ability to connect

via high-speed networks. In an effort to modernize the networking environment, State entities

are applying for and receiving funding for broadband assessment and deployment.


2.7.1 National Telecommunications and Information Administration (NTIA) Grant

The NTIA awarded an $80 million broadband stimulus grant to the Louisiana Broadband

Alliance to help bridge the technological divide, boost economic growth, create jobs, and

improve education and healthcare. The grant will bring high-speed Internet access to more than

80 community anchor institutions – including universities, K-12 schools, libraries, healthcare

facilities – and lay the groundwork for bringing affordable broadband services to thousands of

homes and businesses in the region.

NTIA also awarded an $8,797,668 grant to the Louisiana State Library as part of the “Louisiana

Libraries Connecting People to their Potential” project, designed to expand broadband

infrastructure and training in all of Louisiana’s public libraries. This project will develop public

computing centers and provide training to improve computer literacy. The Deaf Action Center

of Louisiana also received $1.4M in grants under this program.

2.7.2 Crescent City Beacon Community (CCBC)

On behalf of local partners Ochsner, Tulane Medical Center, Interim LSU Public Hospital and

504 HealthNet, the Louisiana Public Health Institute (LPHI) in New Orleans put forth a winning

application for a federally funded pilot “Beacon Site“ program for achieving meaningful use of

electronic medical records and showing measurable improvements in quality through health

information technology. The focus of the program, known locally as the Crescent City Beacon

Community (CCBC), is to improve population health in Orleans and Jefferson Parishes. These

parishes sustained significant damage after Hurricane Katrina and have since made concerted

efforts to ensure that the lack of patient data and coordination of care would not be a hazard for

the citizens of the area in the future. Through this grant, the Beacon Community will build on

recent clinical HIT investments to achieve higher-quality, more efficient, patient-focused health

care, and thereby improving population health.


2.7.3 Federal Communications Commission (FCC) Grants

In an effort to modernize the networking environment, the Federal Communications Commission

(FCC) and the U.S. Department of Agriculture (USDA) oversee programs that provide funding

for broadband deployment in rural areas. The LaHIE project will also leverage an existing FCC

grant administered by the Louisiana DHH that will provide broadband connectivity to 160 health

care facilities statewide. The overall FCC grant is funded for $15,925,270. Collaborating with

the FCC sites will allow this project to build on the infrastructure already provided by the FCC

grant.

2.7.4 SMA Activities Influencing the EHR Incentive Program

There are no activities currently underway that will influence the direction of the EHR Incentive

Program over the next five years.

2.7.5 State Laws/Regulation Changes

There have not been any recent changes to state laws or regulations that might affect the

implementation of the EHR Incentive Program

2.7.6 EHR Activities Across State Borders

Louisiana Medicaid will work closely with our federal and state partners to ensure the Medicaid

EHR Incentive Program, as well as related HIT activities, follows national standards and fits into

the overall strategy for the Louisiana State Medicaid HIE Plan. Louisiana Medicaid’s current

efforts will focus primarily on supporting local EPs and EHs, but such work will expand to

supporting HIT/HIE activities across state borders and beyond as capabilities arise.


3. STATE “TO-BE” HIT LANDSCAPE

3.1 Five-Year Goals

Looking forward to the next five years, what specific HIT/E goals and objectives does the SMA expect to

achieve? Be as specific as possible; e.g., the percentage of eligible providers adopting and meaningfully

using certified EHR technology, the extent of access to HIE, etc.

Louisiana Medicaid’s vision five years down the road is to achieve an environment where health

information is being used efficiently and effectively. This will be accomplished by putting into

place a flexible, CMS-approved architecture that will allow the sharing of information within

LaHIE and the participation of Medicaid’s EPs and EHs in the State HIE. This infrastructure

will enable improvements in the quality of care provided and the facilitation of authorized

information sharing among all stakeholders. It will ultimately support the overarching

framework for promoting HIT adoption within the State of Louisiana.

The overall goals Louisiana Medicaid intends to accomplish are:

1) Enhance care coordination and patient safety

2) Reduce paperwork and improve efficiencies

3) Facilitate electronic information sharing across providers, payers and state lines

4) Enable data sharing using the State HIE and the National Health Information Network

(NHIN)

Louisiana Medicaid will accomplish the above goals through three major steps:

First, encourage the adoption of certified EMRs through the Incentive Payment Program which

went live on January 2011. By encouraging the adoption of certified EHR technology, Louisiana

Medicaid intends to enable the effective and efficient use of health information by individuals

and organizations within Louisiana to optimize patient safety, health care quality and resource


utilization. Second, leverage the planned LaHIE framework and connect certified EHRs to the

State HIE. Third, build a framework within Louisiana Medicaid to enable communication

among EPs/EHs, LaHIE, LMMIS and other Department of Health clients (OPH, OBH, OCDD,

etc.). In the backend of these efforts, Louisiana Medicaid will maintain business processes to

ensure the integrity of privacy and security as well as integrate existing system silos to enhance

data sharing.

Louisiana Medicaid intends to measure performance through the following metrics:

Performance measure Description Initial target

Percent of providers

participating in Incentive

Payment Program

Percent of Providers


Payment Program.

To be calculated as: (Number

of Providers having

successfully attested for an

AIU Incentive

Payment )/(Total number of

providers eligible for the

Incentive Payment

Program)*100

50% participation by the end

of year 2

16% of the eligible LA

Medicaid providers have

successfully attested (as of

December 20, 2013)

Percent of hospitals


Payment Program

Percent of hospitals


Payment Program.

To be calculated as: (Number

of hospitals that have

successfully attested for an

AIU Incentive Payment/(Total

number of eligible hospitals -

130)*100

30% participation by the end

of year 2

60% of the hospitals are

participating in the Incentive

Payment Program


Performance measure Description Initial target

Percent of EPs that meet

Meaningful Use Stage 1

Eligible Providers

participating in the Incentive

Payment Program that meet

meaningful use.

To be calculated as:

(Number of providers that

demonstrate that they meet

meaningful use criteria)/Total

number of providers that have

successfully attested for AIU)

* 100

20% of providers participating

in the Incentive Payment

Program meet meaningful use

criteria Stage 1 by the end of

in Year 2

30.6% of the Eligible

Providers having successfully

attested for AIU have

achieved Stage 1 Meaningful

Use

Percent of EHs that meet

Meaningful Use Stage 1

Eligible hospitals participating


Program that meet meaningful

use.

To be calculated as:

(Number of hospitals that

demonstrate that they meet

meaningful use criteria)/Total

number of hospitals that have

successfully attested for AIU)

* 100

20% of hospitals participating


Program meet meaningful use

Stage 1 criteria by the end of

in Year 2

65.7% of the Eligible

Hospitals having successfully

attested for AIU have

achieved Stage 1 Meaningful

Use

3.1.1 LMMIS/MITA

The current Louisiana MMIS, initially launched in 1990, has over 40 components comprised of a

mixture of mainframe hardware, coding, and software applications residing on client servers,

computers, or web-based servers. This mixture of coding and applications has limited


Medicaid’s ability to respond in times of crisis as well as comply with regulatory changes.

Limitations include:

Hard coded logic that must be changed by technical staff

A reliance on stovepipe systems and/or workarounds – the current MMIS cannot easily

support new functionality

Inadequate or incomplete system documentation

The inability to easily generate ad hoc or new management reports

Paper-intensive processes

Because of these limitations and others, Louisiana is developing long term plans to pursue a

MMIS Replacement via a RFP.

Some of the top objectives for the MMIS Replacement and Fiscal Intermediary (FI) Services

project include:

Implementing a MMIS that is cost-effective and efficient

Providing the information and processing capabilities necessary to support all HIPAA

requirements

Providing a replacement system that is driven by a relational database with on-line Web

capabilities for all authorized users, including providers and enrollees

Utilizing a rules-based structure to allow for easy modification to edits, audits, and

business rules by authorized users to eliminate the delays and programming issues related

to hard coding

On-line real-time query capability

On-line entry of provider enrollment applications; tracking and automated workflow

management of the process; and on-line verification of provider enrollment status


Real-time, on-line ability to enter claims, obtain enrollee eligibility verification, conduct

claim status inquiry, view remittance and status reports, and submit and view the status of

Service Authorization (SA) requests via Web screens for authorized providers and other

authorized users

A portal to provide enrollees with on-line and real-time ability to view their data, to make

authorized changes, to see claims filed for services rendered by providers, to request a

replacement Medicaid card, to quickly and easily select managed care plans and to view

and append their electronic health record

Increased automation, system integration and decreased reliance on manual processes.

Capabilities that allow for continual modernization to support implementation of

innovative technologies

A system that conforms to the ongoing goals and objectives of the Medicaid Information

Technology Architecture (MITA)

A system that conforms to the specific goals of the Department as detailed in the “To-Be”

section of the Department’s State Self- Assessment

A robust Data Warehouse that not only supports executive decision making, but also

Program Integrity activities, Surveillance and Utilization Reviews, Management and

Administrative Reports.

3.1.2 Medicaid Eligibility

In the next five years, the Medical Eligibility Determination System (MEDS) will be undergoing

an architecture upgrade project to accommodate the anticipated business needs of the Medical

Vendor Administration (MVA) program.


To prepare for the Architecture Upgrade Project, Louisiana’s Department of Health and

Hospitals drafted in October and November 2010 a Planning Advanced Planning Document (P-

APD) for the Center for Medicare and Medicaid Services (CMS) outlining the Statement of

Need, the Project Management Plan, and the Proposed Planning Budget for the upgrade. Once

the P-APD is approved by CMS, the MVA will begin preparing several planning documents – a

Requirements Analysis, Feasibility Study, Alternatives Analysis, and Cost / Benefit Analysis –

that will result in a Request for Information (RFI) to request information on system upgrades,

system replacements, and turnkey solutions (COTS).

Louisiana has opted to default to the Federal Health Benefits exchange and is not participating in

the Medicaid expansion program

3.1.3 Office of Public Health (OPH) Programs

Program 5 Year Goals

Louisiana

Immunization

Network for Kids

Statewide (LINKS)

Leverage current capabilities of the LINKS system so that certified

EHR technology will have the capacity to submit electronic data to

the immunization registries. The integration of LINKS and the EHR

Incentive Program will allow EPs and EHs using certified EHR

technology to submit electronic data to the LINKS immunization

registry and subsequently meet one of the Stage 2 meaningful use

measures as defined by CMS.

Public Health

Surveillance

For the purposes of meeting Stage 1 meaningful use requirements,

leverage the existing public health information exchange to allow

certified EHR technology to submit electronic syndromic

surveillance data to public health agencies.

Vital Records Set in place a web-based integrated vital records application that is

available to multiple data providers across the state.


3.2 Vision for HIT Architecture

3.2.1 LMMIS/MITA Vision

As mentioned previously, Louisiana Medicaid’s vision five years down the road is to achieve an

environment where health information is being used efficiently and effectively. As part of this

effort, Louisiana Medicaid is developing long term plans for a RFP for the implementation of a

new MMIS in the State, which will take over the one that has been operated by Molina Medicaid

Solutions since 1984. Louisiana MMIS will undergo changes transitioning it from system silos

to a consolidated platform that shall utilize federally approved and flexible technology. These

changes will allow Louisiana MMIS to be more responsive to user needs and to be able to

support the implementation of the Department of Health’s IT initiatives.

Louisiana Medicaid is committed to align its technology approach with that of the State’s HIE

(LaHIE) through coordination with LHCQF. The SMA technical infrastructure will conform to

all HHS adopted standards and certifications for HIE, as well as industry accepted standards (i.e.

HL7). It is the State’s intention to implement a standardized architecture for Louisiana Medicaid

to enable communication among LaHIE, LMMIS and other internal Department of Health’s

customers.


Figure 3.2.1-1 shows what the Louisiana Medicaid IT System Architecture would look like:

MEDICAID

Integrated Platform (Architecture TBD)

Quickly adapts to incorporate changes in program policies

Consolidates and streamlines business functions

Provides seamless and secure services

Connectivity with State HIE

through standardized method of communication

Relational

databaseNPI

State and Federal

databases

CMS files

LaMedicaid Eligibility

Financial Management

Visit Verification Management

Pharmacy Benefits Mgmt

Pharmacy POS

Portal for enrollees

State EHRs

Commercial-Off-The-Shelf products

Replacement/Claims

DSS/DW Reporting

LaHIE

Enterprise Service Bus

Internal DHH Customers

Figure 3.2.1-1 SMA IT Architecture

As shown in Figure 3.2.1-2, Medicaid will connect to LHCQF’s technical architecture. This

will create a framework for the exchange of health information to improve the quality of health

care in Louisiana. The activities include the coordination of patient-centered care and public

health management and the support of clinical quality improvement. The foundation of the

technical architecture will be an Enterprise Services Bus (ESB), an existing technology that

supports distributed (e.g., federated) computing and is flexible, scalable and robust.


Figure 3.2.1-2 Louisiana HIE Architecture Source: Louisiana Health Quality Forum

3.2.2 IT System as it relates to the EHR Incentive Program

How will Medicaid providers interface with the SMA IT system as it relates to the EHR Incentive

Program (registration, reporting of MU data, etc.)?

Please refer to Section 4 (State Medicaid EHR Incentive Payment Plan) of this document.


3.3 Vision for Governance Structure

Given what is known about HIE governance structures currently in place, what should be in place by 5

years from now in order to achieve the SMA’s HIT/E goals and objectives? While we do not expect the

SMA to know the specific organizations will be involved, etc., we would appreciate a discussion of this in

the context of what is missing today that would need to be in place five years from now to ensure EHR

adoption and meaningful use of EHR technologies.

Governance is discussed within the LAHIE and LAPHIE sections.

3.4 Vision for EHR System

3.4.1 EHR Adoption Encouragement

What specific steps is the SMA planning to take in the next 12 months to encourage provider adoption of

certified EHR technology?

Louisiana Medicaid is taking the following steps to encourage adoption of certified EHR

technology:

Providing financial incentive payments to eligible Medicaid providers and hospitals for

adopting and meaningfully using certified electronic health record (EHR) technology

Working closely with the DHH director of Media and Communication, the Medicaid

provider community, the public, internal and external stakeholders, and the media to

promote awareness of the progress made toward providing incentives

Conducting statewide outreach program aimed directly at providers as part of the Making

Medicaid Better initiative

Maintaining the current website targeting Medicaid enrolled providers regarding EHR

incentives (www.lamedicaid.com/ehrincentives/)

http://www.lamedicaid.com/ehr


Enhancing the “Making Medicaid Better” website for targeted outreach to providers while

working towards the creation of a HIT Department page with program information

(http://new.dhh.louisiana.gov/index.cfm/page/47/n/81)

Collaborating with the REC to educate targeted EPs and EHs

Providing educational information and outreach to key publics via available media

Conducting news releases

Creating printed materials and mailing out to enrolled Medicaid providers through fiscal

intermediary

Distributing e-mails to more than 14,000 Medicaid health providers and organizations

Providing information through social media (including Facebook, Twitter and blogs)

Including information regarding the program in the “Making Medicaid Better” e-

newsletter, issued weekly to providers and other stakeholders

Identifying barriers the EP and EH community may face (i.e. cost, security/privacy

concerns, lack of technical knowledge, time concerns, mindset changes, etc.) in order to

address these concerns through messaging and to encourage adoption of EHR technology

Measuring and reporting on provider participation to track EHR adoption

3.4.2 Federally Qualified Health Centers

If the State has FQHCs with HRSA HIT/EHR funding, how will those resources and experiences be

leveraged by the SMA to encourage EHR adoption?

The Louisiana Primary Care Association (LPCA) received HRSA “Health Center Controlled Network”

funding in 2013 to assist in the challenges faced by Federally Qualified Health Centers (FQHC) to

implement and sustain the meaningful use of HIT. The HCCN project award project award

announcements were made in December of 2012 with funding beginning in 2013. The project will run

for a 3 year period with annual funding of $475,000. The project began with 16 FQHCs participating, and

5 more FQHCs are in the process of being added. The FQHCs have made substantial progress as a result

http://new.dhh.louisiana.gov/index.cfm/page/47/n/81


of this funding and in conjunction with the “Accelerating Clinical Quality through Health Information

Technology” launched in collaboration with the Crescent City Beacon Community Program. FQHCs have

been able to sustain these gains and continue to build upon quality improvement efforts by leveraging

their use of common HIT platforms to engage EMR vendors, and supporting the sharing of best practices

and the use of performance based monitoring to improve care to underserved populations. Sites will

focus on the attainment of national measures for Meaningful Use Stage 2 requirements, Patient

Centered Medical Home recognition, and Healthy People 2020 goals.

The Louisiana Department of Health and Hospital’s Bureau of Primary Care and Rural Health, the

designated lead agency for FQHC efforts across Louisiana, is fully supportive of these efforts and is

committed to continuing to provide technical assistance, information related to federal and state health

policies, healthcare data sources and strategic guidance to the Louisiana Primary Care Association and

this project. Collectively, the affiliation between BPCRH, the Louisiana Public Health Institute, and LPCA

will continually strive to improve services that offer beneficial solutions to the residents of Louisiana.

3.4.3 Technical Assistance to Medicaid Providers

How will the SMA assess and/or provide technical assistance to Medicaid providers around adoption and

meaningful use of certified EHR technology?

In FFY 14,Louisiana Medicaid began implementation of the the Medicaid Specialist Outreach

Initiative, which is modeled after a program in New Jersey. The initiative will allow Louisiana’s

REC, Louisiana Health Care Quality Forum (LHCQF) to provide technical and consultative

support to Medicaid specialists. Prior to this initiative, LHCQF was able to provide federally-

funded services to only Medicaid primary care physicians. Through this initiative, Louisiana

Medicaid will provide services through the LHCQF to Medicaid specialists. The performance-

based payment methodology mimics that used by ONC for the existing program.


Louisiana Medicaid, through partnership with the LHCQF, is considering implementation of the

HIE Integration Assistance Program. The program will provide assistance to high Medicaid

volume practices and hospitals to help offset the initial, upfront cost associated with HIE


integration. The assistance to providers will be one-time, “start-up” offering that will be made

available to providers during a specified timeframe. Assistance will be offered only to the first 66

qualifying hospitals and 300 qualifying practices. To receive assistance, the hospital or practice

must have a fully executed five-year participation agreement with LaHIE. Louisiana Medicaid

received funding for this initiative in its FFY 13-14 IAPD-U, specifically for FFY 13. However,

due to delays in the contract approval process, the initiative was not launched in FFY 13 as

planned.

In addition to typical provider outreach and education activities, Louisiana Medicaid will

implement three innovative programs that are designed to increase CEHRT adoption and HIE

connectivity among Louisiana Medicaid providers.

Medicaid Specialist Outreach Initiative

Patient-Centered Medical Home Transformation Initiative

LaHIE Integration Assistance Program

The programs will be implemented through partnership with Louisiana’s Regional Extension

Center, the Louisiana Health Care Quality Forum (LHCQF). In addition to implementing the

state’s health information exchange (LaHIE), LHCQF has a proven record of reaching out to

providers, eliminating obstacles to adoption, and helping providers achieve meaningful use.

LHCQF has trained, experienced staff that has established working relationships with

Louisiana’s Medicaid provider community. The scope of work and deliverables to be provided

by LHCQF are outlined in an amendment to a Cooperative Endeavor Agreement with Louisiana

Medicaid. Louisiana Medicaid explored alternatives for implementation of its HIT outreach

activities; however, LHCQF can provide the most effective results with the greatest level of

efficiency.


The assistance offered to providers will cover the cost associated with integration that would

normally be charged to a provider/hospital by the Health Information Exchange. This includes

cost from the HIE vendor and staff resources to complete onboarding activities. The provider is

responsible for 100% of charges from its EHR vendor. The integration includes all that is

required from the Health Information Exchange to provide required elements of Phase 1

Meaningful Use through LaHIE, including CCD exchange for coordination of care, public health

reporting, and demographics updates. For an average hospital, five interfaces are required. Eight

interfaces are required for clinics.

In addition to a fully executed five-year participation agreement with LaHIE, program

participants must meet one of the following criteria:

Hospitals must:

o Be classified as a critical access as determined by CMS; or,

o Be designated as a rural hospital as determined by the Louisiana Office of Public

Health, Bureau of Primary Care and Rural Health; or,

o Have a Medicaid patient volume greater than or equal to 35%

Group practices must:

o Demonstrate that more than 50% of all eligible provider types employed qualify for the

EHR Incentive Payment Program; or,

o Demonstrate that the group Medicaid patient volume is greater than 30% (i.e., using

group proxy to determine eligibility).

The program will be offered to providers in a specified timeframe. It will be launched in

conjunction with promotional activities that convey the benefits of LaHIE and the limited

timeframe in which providers have to participate in the program.


The payment allocation methodology for the Integration Assistance Program is modeled after the

payment methodology described in the Final Rule that governs incentive payments to Eligible

Professionals and Eligible Hospitals that are participating in the EHR incentive program. For

hospitals, the Integration Assistance Program will pay a portion of the HIE integration cost equal

to the percentage of reported Medicaid patient volume in the most recent program year. The

average Medicaid patient volume for a hospital is 30%, and the estimated integration cost for a

hospital is $25,200, which equates to an average payment of $7,560 for a hospital. However,

Louisiana Medicaid is using the average patient volume only to estimate program costs. The

integration assistance payment will vary by hospital, according to Medicaid patient volume. In

regard to practices, the estimated integration cost for a group practice is $8,800. As with the

EHR incentive program, practices that meet program requirements will receive 100% of the

integration cost. As described in the Cooperative Endeavor Agreement between Louisiana

Medicaid and LHCQF, LHCQF will issue the integration assistance payment to a qualified

provider, and Louisiana Medicaid will issue payment to LHCQF on a cost reimbursement basis.

Due to delays in the contract approval process, this initiative was not launched in FFY 13 as

planned.

3.4.4 Populations with Unique Needs

How will the SMA assure that populations with unique needs, such as children, are appropriately

addressed by the EHR Incentive Program?

The SMA and the Regional Extension Center (REC) have reached out to the pediatric

community, to obstetricians, and to Children's Hospital expressly to provide specific education

for them regarding the EHR Incentive Program.

Children’s Hospital of New Orleans attested to meaningful use in 2013 with the assistance of the

REC. The REC remains engaged with Children’s Hospital as it continues to progress through


meaningful use stages. The REC has assisted more than 300 pediatricians over the last four

years including those affiliated with the state’s only children’s hospital and many of the state’s

School-Based Health Centers. Through our IAPD, the State has engaged LHCQF to provide

outreach to ensure that all providers are aware of the incentive program. In this role, LHCQF

has planned advertising, public relations, and speaking engagements throughout the state to

promote the EHR incentive program.

3.4.5 Patient-Centered Medical Home (PCMH) Transformation Initiative

Louisiana Medicaid recognizes the value of the Patient-Centered Medical Home model in

improving patient care and furthering providers’ adoption and use of CEHRT. Louisiana

Medicaid will partner with LHCQF to implement the PCMH transformation initiative. LHCQF

will identify Medicaid practices with at least three providers and offer subsidized coaching and

technical assistance to assess the practices for PCMH readiness. Based on the results of the

assessment, LHCQF will assign a local coach, familiar with the surrounding community and

health resources, who will develop a customized implementation plan for the practice that

emphasizes EHR use in alignment with meaningful use, HIE participation, and the

implementation of the team-based model inherent to PCMH. As the practice progresses along the

maturity curve of HIT adoption, coaches will incorporate key elements of quality improvement

to empower practices to leverage data to focus on continuous and measured quality improvement

initiatives. Due to the varied nature of the communities served by LHCQF, the model will be

deployed regionally to maximize urban and rural health resources in supporting the key drivers

of the PCMH model to build a sustainable medical neighborhood for Medicaid beneficiaries.

LHCQF will receive payment based on the achievement of established milestones. The table

below shows the performance-based payment methodology as described in the Cooperative

Endeavor Agreement between Louisiana Medicaid and LHCQF. The maximum cost for this

initiative for two years is $4,880,000 million.


Year 1

Established

Milestone

Contract

Sign

40%

Submission

40%

Recognition

20%

Maximum Cost Per

Practice

Number

Targeted

Practices

Total Maximum

Cost Year 1

Payment

Amount

7,808 7,808 3,904 19,520 125 $2,440,000

Year 1

Established

Milestone

Contract

Sign 40%

Submission 40%

Recognition 20%

Maximum Cost Per

Practice

Number

Targeted

Practices

Total Maximum

Cost Year 2

Payment

Amount

7,808 7,808 3,904 19,520 125 $2,440,000

Total Maximum Program Cost $4,880,000

3.4.6 Leveraging HIT-Related Grants

If the State included a description of a HIT-related grant award (or awards) in Section A, to the extent

known, how will that grant, or grants, be leveraged for implementing the EHR Incentive Program, e.g.

actual grant products, knowledge/lessons learned, stakeholder relationships, governance structures,

legal/consent policies and agreements, etc.?

The State has included in this document a description of the following four grant awards:

National Telecommunications and Information Administration Grant (Section 2.7.1)

Crescent City Beacon Community (Section 2.7.2)

Federal Communications Commission (FCC) Grants (Section 2.7.3)

Of the four grants, the Crescent City Beacon Community Grant is directly related to the EHR

Incentive Program. The Louisiana Public Health Institute in New Orleans put forth a winning

application for a federally funded pilot to achieve meaningful use of electronic medical records

and show measurable improvements in quality through health information technology. The


focus of the program is to improve population health in Orleans and Jefferson Parishes.

Through this $13.5 million federal grant, the Beacon Community continues to build on recent

clinical HIT investments to achieve higher-quality, more efficient, patient-focused health care,

thereby improving population health.

3.4.7 Changes to State Legislation

Does the SMA anticipate the need for new State legislation or changes to existing State laws in order to

implement the EHR Incentive Program and/or facilitate a successful EHR Incentive Program (e.g. State

laws that may restrict the exchange of certain kinds of health information)? Please describe.

At this time, we do not anticipate the need for new State legislation, or changes to existing State

laws that would affect the EHR Incentive Program.

However, Louisiana Medicaid has modified the SPA and gained CMS approval to enable

optometrists to be eligible for the EHR Incentive Payment.


4. STATE MEDICAID EHR INCENTIVE PAYMENT PLAN

Provide a description of the processes the SMA will employ to ensure that eligible professionals

and eligible hospitals have met Federal and State statutory and regulatory requirements for the

EHR Incentive Payments.

4.1 Introduction

The objective in this section is to describe Louisiana Medicaid’s registry and attestation

application for an EHR Incentive Payment Program. This program is based on provisions of the

American Recovery and Reinvestment Act of 2009 (ARRA) intended to provide incentive

payments to EPs and EHs participating in Medicaid who adopt and meaningfully use electronic

health record (EHR) technology.

4.2 Background

In order to successfully participate in providing patient data to an HIE, healthcare providers must

face the challenge of implementing a longitudinal EHR. Such challenges have traditionally been

tied to the difficulties relating to institutional adoption and investment commitments required to

achieve clinical interoperability with other organizations. One step towards creating an

electronic health record requires that individual organizations first implement their own

electronic medical records. With ARRA, hospitals and physicians will receive incentives to

automate their patient records systems.

The success of the EHR Incentive Payment Program and the LaSMHP will be dependent on a

number of factors and assumptions. These include:

The timeliness of the NLR testing and the ability to connect with and successfully

exchange transaction files with the NLR.

The ability to validate provider registration information via the LMMIS provider database


The successful implementation of the technical infrastructure required for the EHR

Incentive Program, including the web-based registry and attestation application

The ability to process EP and EH applications, rectify erroneous application information

promptly, and issue payments to providers

The state’s ability to communicate and reach out to the provider community through the

Regional Extension Center and other outreach programs to encourage EHR adoption

The ability of EPs and EHs to register for the EHR incentive program through the NLR-

Louisiana Medicaid assumes EPs and EHs will have easy access to the internet and will be

able to provide all documentation required during the registration and attestation process

The desire of EPs and EHs to implement a certified EHR system, despite any up-front

investment costs and inconveniences

4.3 Medicaid’s EHR Incentive Payment System

What will be the role of existing SMA contractors in implementing the EHR Incentive Program – such as

LMMIS, fiscal agent, et cetera?

During the initial planning phase, Louisiana Medicaid explored various options to enable the

implementation of the HITECH provision requiring the development of a registration and

attestation system to support EHR incentives. The various options explored included the

possible procurement of a COTS system that could perform the registration and attestation

functions, whether a solution could be developed through the existing LMMIS system, or

whether the modification of an existing freestanding system could provide the necessary

functionality under a very tight timeline.

It was determined that the modification of the P4P system would be the best option. Moving in

this direction would offer the State a low-cost strategy (developed under the scope of the current


fiscal agent contract) based on already proven technology framework that could be developed in

a considerably shorter timeline.

A freestanding, fully-functional Medicaid Pay-for-Performance (P4P) Immunization Program

was evaluated as a possible prototype for the proposed EHR incentive system. This existing P4P

Immunization Program contained a number of functionalities that would be required of our

proposed system such as a:

Secure web portal accessed through the existing LA Medicaid web site

Front-end registration and attestation capabilities for eligible Medicaid providers requesting

to participate and demonstrate that they meet the criteria to receive payments

Back-end payment calculation and provider reimbursement capabilities performed at a

DHH specified frequency

Administrative reporting capabilities for tracking, assessment, audit, and forecasting

By modeling our proposed EHR incentive payment system using the “backbone” of an already

tested P4P system, we benefited from a solution that was secure, stable, low-cost, flexible, and

was developed under a tight implementation schedule.

Louisiana’s EHR Incentive Payment system has the following general features:

1. Ability of the system to receive a file from the NLR via ConnectDirect listing registered

providers and hospitals

2. Ability to verify that the registrants are an eligible provider type, not sanctioned or

deceased

3. Creation of a web application for the Medicaid providers register and attest to their

Medicaid patient volume and use of a qualified EHR system in a way specified by CMS

through the Final Rule


4. Ability to calculate whether the EP or EH meets the required patient volume criteria based

on information provided through attestation

5. Ability to verify that the registrants have adopted, implemented, or upgraded certified EHR

technology based on the requirements of the Final Rule

6. Ability to communicate with the registrants via email addresses collected during the

provider enrollment process

7. Ability to generate a web-based registrant confirmation and the ability to request additional

information from the registrant as needed

8. Creation of an intranet web application for DHH to view these attestations for audit

purposes

9. Ability to capture an alphanumeric code associated with the certified EHR product

provided by the registrant and have the ability to verify that the product is certified via

application programming interface (API) to the ONC-hosted web-service

10. Ability to upload a list of errors to the NLR for resolution

11. Ability to calculate incentive payment amount based on CMS formula

12. Ability to process incentive payments on a weekly basis dependent on the files received

containing registrant information from the NLR

13. Ability to issue an annual incentive payment by DHH’s Standard Payment System (SPS)

by electronic funds transfer (EFT) to the bank account captured during the provider

enrollment process and authorized by the eligible EP or hospital

14. Ability to upload payment data to the NLR at an increment and format specified by CMS

15. Ability to upload worksheets and supporting documentation during the Medicaid

application and attestation process


16. Ability to capture Stage 1 and 2 Meaningful Use data for both Eligible Professionals and

Eligible Hospitals and Critical Access Hospitals. Stage 2 will be implemented in the first

half of 2014 pending CMS approval.

17. Creation of an external e-mail ([email protected]) to address administrative review

questions prior to/in lieu of formal appeals using a tiered process, as appropriate

4.3.1 NLR File Processing

The National Level Registry (NLR) will electronically notify Louisiana Medicaid of registration

of EPs and EHs choosing to access Louisiana’s Medicaid Incentive Program by sending the state

a B6 file via ConnectDirect daily. Via an automated process, the B6 file will be placed on an

FTP site for processing by the EHR incentives system. The registrant data listed in the B6 will

be compared against the LMMIS system data to validate that the NPIs in the transaction file are

linked to a provider IDs on file in Louisiana Medicaid’s MMIS Provider database. The ID’s will

also be compared against the provider enrollment cancel reason codes to ensure that the

providers are not sanctioned or deceased. The system will run a series of database queries in the

back end to verify information such as patient encounters, volume information, non-hospital

based status and that the provider practices predominantly in a Federally Qualified Health Center

or Rural Health Center and have a minimum 30% patient volume attributable to needy

individuals as mentioned in Appendix C: Audit for the Medicaid EHR Incentive Program. This

process will be completed daily and a B7 will be generated with the results of the validations,

automatically uploaded to the SFTP site and returned to CMS via ConnectDirect. It will be

through the same automated process that the state will send D16 files, receive D16 response files

and D18 files to verify that the payment amount calculated by the state is correct and that the

state is authorized to process payment. The State Medicaid Agency plans to make EHR

mailto:[email protected]


incentive payments on a weekly basis to the EP or EH by generating a resulting payment file that

will post weekly on Fridays to an FTP site dedicated to DHH’s Standard Payment System (SPS).

The SPS was developed by the Department of Health and Hospitals/Division of Fiscal

Management in 2003 to process payments (paper checks or EFT’s) for various DHH sub-

systems. SPS serves as the payment system for several sub-systems including the Access to

Recovery Program, Medicaid Enrollment Centers, Provider Stabilization Grant, Traumatic Brain

Injury Program, and the Immunization Pay for Performance Program. The following are the

steps followed in the processing of payments through the Standard Payment System:

The sub-systems listed above interface a standardized electronic payment file to SPS

The Division of Fiscal Management performs a checkwrite and issues a paper

check/electronic funds transfer (EFT) payment to the vendor/provider/client identified in

the payment file

The Division of Fiscal Management mails the paper checks and submits the electronic EFT

file to the States Treasury for processing

The Standard Payment System creates an export file that contains check register

information that the sub-systems have the option of downloading into their system

The expenditure information is interfaced into the State’s general ledger maintained in the

Integrated Statewide Information System (ISIS) and DHH’s Bank Recon system

The system and processes described above have been reviewed by the State’s A-133 auditors and

as of this date, no issues or recommendations for improvements have been made.

4.3.2 Provider Instructions

On the Medicaid EHR incentive payment program home page, downloadable forms will be

available for EPs and EHs to complete in preparation for the online application and attestation


process. These forms include the EH Incentive Payment worksheet and the EP & EH Patient

Volume worksheet, both of which are shown below. The EH Incentive Payment worksheets uses

the expense information provided by the EH to calculate the EHR incentive payment based on

the regulations established by CMS in 42 CFR Parts 412, 413, 422, and 495. During the

application and attestation process, EHs will be required to input data resulting from the

worksheet calculations and upload the completed worksheet that will be maintained for audit

purposes.


EHR Incentive Payment Worksheet

Hospital Name

Medicaid Provider Number

Eligible Hospital EHR Incentive Payment Calculation Wizard

Enter the following data from your CMS Cost Reports (CMS-2552-10) and the worksheet will

automatically calculate your incentive payments. Please note that the payment amounts are only

estimates and subject to review and audit.

Title Data Data Source

Total Discharges Most Current Year (CY)

WS S-3, Part

1, Column 15,

Line 14

Total Discharges Previous Year (PY) 1

WS S-3, Part

1, Column 15,

Line 14


WS S-3, Part

1, Column 15,

Line 14


WS S-3, Part

1, Column 15,

Line 14

Total Medicaid Days excluding nursery, swing bed, SNF,

psych and rehab units

WS S-3, Part

1, Column 7,

sum of Lines 1

and 8-12.

Include NICU,

PICU, Burn

Unit, and/or


Transplant

Unit from an

auditable data

source.

Total Medicaid HMO Days

WS S-3, Part

1, Column 7,

Line 2.

Total Hospital Charges (CY)

WS C, Part 1,

Column 8, Line

200

Charity Care Charges (CY)

WS S-10,

Column 3, Line

20.

Total Hospital Days excluding nursery, swing bed, SNF,

psych and rehab units

WS S-3, Part

1, Column 8,

sum of Lines

1,2 and 8-12

*Hospitals may use any auditable data source for this field, including their financial statements.

Calculation of Medicaid Electronic Health Record (EHR) Incentive Payment

The overall "EHR" amount is the sum over 4 years of (a) the base amount of $2,000,000 plus (b) the

discharge related amount defined as $200 for the 1,150 through 23,000 discharge for the first payment

year, then a prorated amount of 75% in year 2, 50% in year 3, and 25% in year 4.

For years 2 - 4, the rate of growth is assumed to be the previous 3 years' average.

Step 1

Calculate the average annual growth rate for the last 3 years of available data using

previous hospital cost reports.

Prior Year

Current

Year

Increase/

Decrease Growth Rate

Previous Cost Report Year (-2) 0 0 0 0.00%

Previous Cost Report Year (-1) 0 0 0 0.00%


Previous Cost Report Year 0 0 0 0.00%

Average 3 year Growth Rate 0.0000%

Step 2

Calculate the discharge related amount using the annual growth rate to adjust discharges

for years 2 - 4.

Per

Discharg

e

Amount

Total

Discharges

Disallowe

d

Discharges

Allowable

Discharges Amount

Year 1 $200 0 1,149 0 $0

Year 2 $200 0 1,149 0 $0

Year 3 $200 0 1,149 0 $0

Year 4 $200 0 1,149 0 $0

Total Discharge Related Amount $0

Step 3 Calculate the Initial Amount for 4 Years

Year 1 Year 2 Year 3 Year 4

Base Amount

$2,000,00

0

$2,000,00

0 $2,000,000 $2,000,000

Discharge Related Amt $0 $0 $0 $0

Aggregate EHR

Amount

$2,000,00

0

$2,000,00

0 $2,000,000 $2,000,000

Step 4 Apply Transition Factor


Year 1 Year 2 Year 3 Year 4

Transition Factor 1 0.75 0.5 0.25

Transition Factor

$2,000,00

0

$1,500,00

0 $1,000,000 $500,000

Step 5 Calculate Overall EHR Amount for 4 Years

$5,000,000

Step 6 Calculate Medicaid Share from Hospital Cost Report data

(estimated Medicaid inpatient-bed-days + estimated Medicaid CCN inpatient-bed-days) /

(est. Medicaid IP-bed-days x ((est. total charges - est. charity care charges) / est. total charges))

Total Medicaid Inpatient Bed Days

0

Total CCN Inpatient Bed Days 0

Total Medicaid FFS and CCN Inpatient Bed Days

0

Total Hospital Charges

$0

Less Charity/UCC charges $0

Total Non-charity charges

$

-

Non-charity percentage

0.00%

Total Hospital Inpatient Bed Days

0

Total Hospital Inpatient Bed Days excluding charity

0

Medicaid Share 0.00%

Step 7 Calculate Medicaid Aggregate EHR Incentive Amount

Overall Amount for 4 years $5,000,000

Medicaid Share 0.00%

Medicaid Aggregate EHR Incentive Amount $0


Step 8 Calculate Annual Incentive Payment Amount

Percentage Payment

Year 1 Payment 50% $0.00




Prepared by:

Signature:

Date:


EP & EH Patient Volume worksheet

4.3.3 Provider Registration

Upon completion of the NLR registration, the EP or EH will receive a message directing them to

the state’s registration website to complete the state Medicaid application and attestation process.

This process will include entering data, uploading supporting documentation, and attesting to the

accuracy of the data entered.


4.3.4 Application and Attestation Process

EPs and EHs will login to the LA Medicaid provider site using their provider ID and password

and will select the link to the Medicaid EHR incentives program welcome page. They will be

required to review their provider information populated from the NLR and from the LMMIS

provider file for accuracy. The providers are given directions on how to update the information

as needed. The provider will then be prompted to enter primary and secondary contact

information containing name, phone number, email address, and job title. The email address

provided will be used to communicate information to the provider about the application status.

LA Medicaid Provider Site page; Provider chooses ”LAConnect” to enter EHR application


This is the initial screen a provider (EPs and EHs) will see to begin attestation. If a provider has not

registered with the NLR first or did not pass the state’s B6 transaction review, they will not be allowed to

continue and a message will be displayed informing them of their next steps.

If the provider has not registered with the NLR first, the following will be displayed:


If the provider did not pass the B6 NLR review, the following will be displayed:


LA Medicaid and SLR data review - The provider (EPs and EHs) is required to review their

provider information populated from the NLR and from the LMMIS provider file for accuracy.

The providers are given directions on how to update the information as needed. An ‘*’ will be

displayed if the information from the NLR does not match the information on Molina’s files:



Payee Information - CMS allows the provider to designate to whom to send the incentive

payments to. This is the screen that will appear if the provider wants the payments sent to them.

The provider is not allowed to change any information on this screen. Clicking the red “?” icon

(upper right corner) will display a help screen


Assign Payment - This is the screen that will appear if the provider wants to assign the

payments to another entity. A paper check will be created and sent to the name and address the

provider enters here. Clicking the red “?” icon (upper right corner) will display a help screen.


Contact Person - Every provider will have to enter at least a primary contact person. These will be the

email addresses the system will send corresponding emails to. Clicking the red “?” icon (upper right

corner) will display a help screen



At this point in the process, the process differs for EPs and EHs; the EP process will be presented

first, and then the EH process will follow.

In the following sections, the EP (only) will be prompted to input information and upload

supporting documentation to demonstrate eligibility.

EP Practice Characteristics - Clicking the red “?” icon (upper right corner) will display a help

screen.. The results of the CMS EHR Certification ID verification will be posted to the “Review

and Attestation” web page and the provider’s Summary Report. .


The following “Tool Tips” can be viewed from the Practice Characteristics screen by clicking on

the underlined links:

90% Tool Tip:


Practice Predominantly Tool Tip:


FQHC or RHC Tool Tip:

Physician Assistant Tool Tip:


4.3.5 Verification of Certified EHR (EP)

The EP will be required to upload supporting documentation regarding the AIU of certified

electronic health record technology into the Louisiana Medicaid EHR incentive payment website

during the application and attestation process. Acceptable documentation includes receipts,

contracts, cost reports, purchase orders, etc.

EP Adopt, Implement or Upgrade - The provider will enter a vendor name, product name,

product number and version. The additions will be added to a data grid displayed on the screen.

The user has the option of marking an entry in the grid as “disregard” notifying DHH not to use

this product in its analysis


CMS EHR Certification ID Tool Tip:


4.3.6 Patient Volume Methodology (EP and EH)

In order to calculate patient volume, Louisiana Medicaid will divide the total number of

Medicaid (or needy) patient encounters in a 90 day period by the total encounters in the same 90

day period. During the application process, the EP and EH will be prompted to enter data

regarding Medicaid or needy patient volume to demonstrate that they meet the requirements of

the program. The attested number of Medicaid encounters is verified against claims submitted to

the MMIS. This information will be entered from the EP & EH Patient Volume Worksheet

previously completed prior to registration. Further, the Medicaid encounters will be evaluated to

determine how many of those encounters were billed with a Place of Service (POS) of either 21

(inpatient) or 23 (Emergency Department) to determine if the less than 90% of the Medicaid

encounters were delivered in an outpatient or ambulatory setting. In accordance with Section

495.306(h) of the EHR Final Rule, Louisiana Medicaid will allow EPs to calculate patient

volume at the group practice/clinic level. When completing the worksheet, EPs and EHs will

enter the number of Medicaid/Needy Patient Days and Total Patient Days for each site location

that Medicaid/Needy patients are treated. The provider will then be prompted to attest to the

accuracy of the information provided and to upload the completed worksheet and any supporting

documentation (i.e. screen shots of the provider’s system proving the accuracy of Medicaid

patient days, etc.) for audit purposes.

EP Patient Encounter Volume – this is the screen the EP enters their encounter information.

Please note the addition of the 2013 rule changes indicating the time period consisting of either a


90 day period from the previous calendar year OR from the previous 12 months. This definition

of the reporting period (90-day period from the previous calendar year or previous 12 months) is

consistent with the way Louisiana has applied the reporting period for program years 2011 and

2012.


90 Day Reporting Tool Tip

Medical and Needy Encounters Tool Tip


Group Practice/Clinic Tool Tip:


4.3.7 Meaningful Use Measures

The following pages present the screens the providers utilize to enter Meaningful Use data. The

initial screens are selected according to the payment year the provider is attesting to.

This screen should be used by an EP attesting to their 3rd

payment year prior to April 1, 2014:


This screen should be used by an EP attesting to their 3rd

payment year after April 1, 2014:


This screen should be used by an EP attesting to their 4th payment year for Stage 2. This screen

is applicable to the 2014 Program Year only. For all other years, the MU attestation period will

be 365 days:


MU Attestation Period Tool Tip


Stage 1 Meaningful Use Measures required of Eligible Professionals

For eligible professionals prior to 2014, the following Stage 1 criteria must be met:

All 14 required core objectives

5 objectives chosen from a list of 10 menu set objectives.

6 total CQM’s: 3 required core measures (or 3 alternate core measures) and 3 additional

measures (selected from a set of 38 clinical quality measures).

The attesting provider selects the core, menu, core CQM and additional CQMs by selecting the

appropriate link.

For CQM attestations starting with the 2014 payment year – both Stage 1 and Stage 2:

EPs must complete 9 of 64 CQMs from the 2014 CQMs (see “EP 2014 Clinical Quality

Measuers”). EPs need to choose their 9 CQMs covering at least 3 domains. Providers are

encourages to select from the recommended core sets for either the Pediatric population or the

Adult population. If one of more of the measures from the recommended core set is not relevant

to the EP’s organization, they can choose from the other measures. If the EP does not have

patient data for 9 CQMs, then they must report the CQMs for which they have patient data and

report the remaining as zero denominators. If there are no applicable CQMs for the EP, then they

report 9 CQMs even if the result is zero in either the denominator or numerator of the measure.


EP Stage 1 Core Measures





Example of an Eligible Professional meeting the required Stage 1 Core Measures.

Example of an Eligible Professional who did not meet the Stage 1 minimum required Core

Measures


EP Stage 1 Menu Measures





Example of an Eligible Professional meeting the required Stage 1 Menu Set Measures.

Example of an Eligible Professional who did not meet the Stage 1 minimum required Menu

Set Measures


EP Stage 1 Clinical Quality Measures – Core CQMs

NOTE: These measures are listed in the SMHP only for historical and auditing purposes only;

they will not be presented in the SLR



EP Stage 1 Clinical Quality Measures – Alternate CQMs



EP Stage 1 Clinical Quality Measures – Additional CQMs












Example of an Eligible Professional meeting the required Stage 1 Clinical Quality

Measures

Example of an Eligible Professional who did not meet the Stage 1 minimum required

Clinical Quality Measures


Stage 2 Meaningful Use Measures required of Eligible Professionals

For eligible professionals the following Stage 2 criteria must be met:



9 out of 64 total CQMs covering at least 3 NQS domains.

The attesting provider selects the core, menu, and CQMs by selecting the appropriate link.

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/EP_MeasuresTable_Posting_CQMs.pdf


EP Stage 2 Core Measures












Example of an Eligible Professional meeting the required Stage 2 Core Measures

Example of an Eligible Professional who did not meet the Stage 2 minimum required Core

Measures.


EP Stage 2 Menu Measures






Example of an Eligible Professional meeting the required Stage 2 Menu Set Measures

Example of an Eligible Professional who did not meet the Stage 2 required Menu Set

Measures


EP 2014 Clinical Quality Measures

For CQM attestations starting with the 2014 payment year – both Stage 1 and Stage 2:

EPs must complete 9 of 64 CQMs from the 2014 CQMs (see “EP 2014 Clinical Quality

Measures”). EPs need to choose their 9 CQMs covering at least 3 domains. Providers are

encourages to select from the recommended core sets for either the Pediatric population or the

Adult population. If one of more of the measures from the recommended core set is not relevant

to the EP’s organization, they can choose from the other measures. If the EP does not have

patient data for 9 CQMs, then they must report the CQMs for which they have patient data and

report the remaining as zero denominators. If there are no applicable CQMs for the EP, then they

report 9 CQMs even if the result is zero in either the denominator or numerator of the measure.

The list of the Clinical Quality Measures begins on the next page.


1

CMS Measure ID 146 Status

Title Appropriate Testing for Children with Pharyngitis Not Completed

Description

Percentage of children 2-18 years of age who were diagnosed with

pharyngitis, ordered an antibiotic and received a group A streptococcus

(strep) test for the episode.

National Quality Strategy

Domain Efficient Use of Healthcare Resources

2


Title Initiation and Engagement of Alcohol and Other Drug Dependence Treatment Not Completed

Description

Percentage of patients 13 years of age and older with a new episode of

alcohol and other drug (AOD) dependence who received the following. Two

rates are reported.


Domain Patient and Family Engagement

*Numerator: Children with a group A streptococcus test in the

7-day period from 3 days prior through 3 days after the

diagnosis of pharyngitis. A positive whole number.

Denominator: Children age 2-18 years who had an outpatient

or emergency department (ED) visit with a diagnosis of

pharyngitis during the measurement period and an antibiotic

ordered on or three days after the visit.

Percentage

*Numerator 1: Patients who initiated treatment within 14 days

of the diagnosis

*Denominator 1: Patients age 13 years of age and older who

were diagnosed with a new episode of alcohol or drug

dependency during a visit in the first 11 months of the

measurement period

Percentage


3


Title Controlling High Blood Pressure Not Completed

Description

Percentage of patients 18-85 years of age who had a diagnosis of

hypertension and whose blood pressure was adequately controlled

(<140/90mmHg) during the measurement period.


Domain Clinical Process/Effectiveness

*Numerator 2: Patients who initiated treatment and who had

two or more additional services with an AOD diagnosis within

30 days of the initiation visit

*Denominator2: Same as above.

Percentage

*Numerator: Patients whose most recent blood pressure is

adequately controlled (systolic blood pressure < 140 mmHg and

diastolic blood pressure < 90 mmHg) during the measurement

period. A positive whole number.

*Denominator: Patients 18-85 years of age who had a diagnosis

of essential hypertension within the first six months of the

measurement period or any time prior to the measurement


Percentage


4


Title Use of High Risk Medications in the Elderly Not Completed

Description

Percentage of patients 66 years of age and older who were ordered high-risk

medications. Two rates are reported.


Domain Patient Safety

*Numerator 1: Patients with an order for at least one

high-risk medication during the measurement period. A

positive whole number.

*Denominator 1: Patients 66 years and older who had a visit

during the measurement period. A positive whole number.

Percentage

*Numerator 2: Patients with an order for at least two

different high-risk medications during the measurement


*Denominator 2: Patients 66 years and older who had a visit

during the measurement period. A


Percentage


5


Title

Weight Assessment and Counseling for Nutrition and Physical Activity for

Children and Adolescents Not Completed

Description

Percentage of patients 3-17 years of age who had an outpatient visit with a

Primary Care Physician (PCP) or Obstetrician/ Gynecologist (OB/GYN) and

who had evidence of the following during the measurement period. Three

rates are reported.


Domain Population/Public Health

*Numerator 1: Patients who had a height, weight and

body mass index (BMI) percentile recorded during the

measurement period. A positive whole number.

*Denominator 1: Patients 3-17 years of age with at least one

outpatient visit with a primary care physician (PCP) or an

obstetrician/ gynecologist (OB/GYN) during the measurement


Percentage

*Numerator 2: Patients who had counseling for nutrition during

the measurement period. A


*Denominator2: Same as above.

Percentage

*Numerator 3: Patients who had counseling for physical activity


*Denominator2: Same as above. Percentage


6


Title

Preventative Care and Screening: Tobacco Use: Screening and Cessation

Intervention Not Completed

Description

Percentage of patients aged 18 years and older who were screened for

tobacco use one or more times within 24 months AND who received

cessation counseling intervention if identified as a tobacco user..


Domain Population/Public Health

7


Title Breast Cancer Screenings Not Completed

Description

Percentage of women 40-69 years of age who had a mammogram to screen

for breast cancer



*Numerator: Patients who were screened for tobacco use at

least once within 24 months AND who received tobacco

cessation counseling intervention if identified as a tobacco user.

A positive whole number.

*Denominator: All patients aged 18 years and older. A positive

whole number.

Percentage

*Numerator: Women with one or more mammograms

during the measurement period or the year prior to the


*Denominator: Women 42-69 years of age with a

visit during the measurement period. A positive whole

number.

Percentage

*Exclusion: A positive whole number.


8


Title Cervical Cancer Screenings Not Completed

Description

Percentage of women 21-64 years of age, who received one or more Pap

tests to screen for cervical cancer.


Domain

Clinical Process/Effectiveness

*Numerator: Women with one or more Pap tests during the

measurement period or the two years prior to the


*Denominator: Women 24–64 years of age with a visit during

the measurement

Percentage


9


Title Chlamydia Screening for Women Not Completed

Description

Percentage of women 16- 24 years of age who were identified as sexually

active and who had at least one test for chlamydia during the measurement

period.


Domain

Population/Public Health

*Numerator 1: Women 16 – 20 years of age with at least one

chlamydia test during the measurement period. A positive

whole number.

*Denominator 1: Women 16-20 years of age who are sexually

active and who had a visit in the measurement period. A


Percentage

*Numerator 2: Women 21 – 24 years of age with at least one

chlamydia test during the measurement period. A positive

whole number.

*Denominator 2: Women 21-24 years of age who are sexually

active and who had a visit in the measurement period. A


Percentage

*Numerator 3: Total women with at least one chlamydia test


*Denominator 3: Total women who are sexually active and

who had a visit in the measurement period. A positive whole

number.

Percentage


10


Title Colorectal Cancer Screening Not Completed

Description

Percentage of adults 50-75 years of age who had appropriate screening for

colorectal cancer.


Domain


*Numerator: Patients with one or more screenings for

colorectal cancer. A positive whole number.

*Denominator: Patients 51-75 years of age with a

visit during the measurement period. A positive whole

number.

Percentage


11


Title Use of Appropriate Medications for Asthma Not Completed

Description

Percentage of patients 5-64 years of age who were identified as having

persistent asthma and were appropriately prescribed medication during the

measurement period.


Domain


*Numerator 1: Patients 5 – 11 years of age who were dispensed

at least one prescription for a preferred therapy during the


*Denominator 1 : Patients 5-11 years of age with

persistent asthma and a visit during the


Percentage

*Numerator 2 : Patients 12 – 18 years of age who were

dispensed at least one prescription for a preferred therapy


*Denominator 2: Patients 12 – 18 years of age with



Percentage

*Numerator 3: Patients 19 – 50 years of age years of age who

were dispensed at least one prescription for a preferred therapy


*Denominator 3: Patients 19 - 50 years of age with



Percentage


12


Title Childhood Immunization Status Not Completed

Description

Percentage of children 2 years of age who had four diphtheria, tetanus and

acellular pertussis (DTaP); three polio (IPV), one measles, mumps and rubella

(MMR); three H influenza type B (HiB); three hepatitis B (Hep B); one chicken

pox (VZV); four pneumococcal conjugate (PCV); one hepatitis A (Hep A); two

or three rotavirus (RV); and two influenza (flu) vaccines by their second

birthday


Domain


*Numerator 4: Patients 51 – 64 years of age who were

dispensed at least one prescription for a preferred therapy


*Denominator 4: Patients 51-64 years of age with



Percentage

*Numerator: Children who have evidence showing

they received recommended vaccines, had

documented history of the illness, had a seropositive

test result, or had an allergic reaction to the vaccine

by their second birthday. A positive whole number.

*Denominator: Children who turn 2 years of age during the

measurement period and who have a visit during the


Percentage


13


Title Preventive Care and Screening: Influenza Immunizations Not Completed

Description

Percentage of patients aged 6 months and older seen for a visit between

October 1 and March 31 who received an influenza immunization OR who

reported previous receipt of an influenza immunization.


Domain


14


Title Pneumonia Vaccination Status for Older Adults Not Completed

Description

Percentage of patients 65 years of age and older who have ever received a

pneumococcal vaccine


Domain


*Numerator: Patients who received an influenza

immunization OR who reported previous receipt of an

influenza immunization. A positive whole number.

*Denominator: All patients aged 6 months and older and seen

for a visit between

October 1 and March 31. A positive whole number.

Percentage

*Numerator: Patients who have ever received a

pneumococcal vaccination. A positive whole

number.

*Denominator: Patients 65 years of age and

older with a visit during the measurement period.


Percentage


15


Title Use of Imaging Studies for Low Back Pain Not Completed

Description

Percentage of patients 18-50 years of age with a diagnosis of low back pain

who did not have an imaging study (plain X- ray, MRI, CT scan) within 28

days of the diagnosis.


Domain

Efficient Use of Healthcare Resources

*Numerator: Patients with an imaging study conducted on the

date of the outpatient or emergency department visit or in the

28 days following the outpatient or emergency department

visit. A positive whole number.

*Denominator: Patients 18-50 years of age with a

diagnosis of low back pain during an outpatient or

emergency department visit. A positive whole number.

Percentage


16


Title Diabetes: Eye Exam Not Completed

Description

Percentage of patients 18-75 years of age with diabetes who had a

retinal or dilated eye exam by an eye care professional during the

measurement period or a negative retinal exam (no evidence of

retinopathy) in the 12 months prior to the measurement period


Domain


17


Title Diabetes: Foot Exam Not Completed

Description Percentage of patients aged 18-75 years of age with diabetes who had a foot

exam during the measurement period.


Domain


*Numerator: Patients with an eye screening for diabetic

retinal disease. A positive whole number.

*Denominator: Patients 18-75 years of age with

diabetes with a visit during the measurement period.


Percentage

*Numerator: Patients who received a foot exam (visual

inspection with either a sensory exam or pulse exam) during the





Percentage


18


Title Diabetes: Hemoglobin A1c Poor Control Not Completed

Description

Percentage of patients 18-75 years of age with diabetes who had

hemoglobin A1c > 9.0% during the measurement period.


Domain


19


Title Hemoglobin A1c Test for Pediatric Patients Not Completed

Description

Percentage of patients 5-17 years of age with diabetes with an HbA1c

test during the measurement period


Domain


*Numerator: Patients whose most recent HbA1c level

(performed during the measurement period) is >9.0%. A





Percentage

*Numerator: Patients with documentation of date and

result for a HbA1c test during the measurement period. A


*Denominator: Patients 5 to 17 years of age with a diagnosis of

diabetes and a face-to-face visit for diabetes care between the

physician that predates the most recent visit by at least 12

months. A positive whole number.

Percentage


20


Title Diabetes: Urine Protein Screening Not Completed

Description

The percentage of patients 18-75 years of age with diabetes who had a

nephropathy screening test or evidence of nephropathy during the

measurement period.


Domain


21


Title Diabetes: Low Density Lipoprotein (LDL) Management Not Completed

Description

Percentage of patients 18-75 years of age with diabetes whose LDL-C was

adequately controlled (<100 mg/dL) during the measurement period.


Domain


*Numerator: Patients with a screening for nephropathy or

evidence of nephropathy during the measurement period. A





Percentage

*Numerator: Patients whose most recent LDL-C level

performed during the measurement period is < 100 mg/dL. A





Percentage


22


Title Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic Not Completed

Description

Percentage of patients 18 years of age and older who were discharged

alive for acute myocardial infarction (AMI), coronary artery bypass graft

(CABG) or percutaneous coronary interventions (PCI) in the 12 months

prior to the measurement period, or who had an active diagnosis of

ischemic vascular disease (IVD) during the measurement period, and who

had documentation of use of aspirin or another antithrombotic during

the measurement period..


Domain


23


Title Appropriate Treatment for Children with Upper Respiratory Infection (URI) Not Completed

Description

Percentage of children 3 months-18 years of age who were diagnosed

with upper respiratory infection (URI) and were not dispensed an

antibiotic prescription on or three days after the episode


Domain


*Numerator: Patients who have documentation of use of

aspirin or another antithrombotic during the measurement


*Denominator: Patients 18 years of age and older with a visit

during the measurement period, and an active diagnosis of

ischemic vascular disease (IVD) or who were discharged alive

for acute myocardial infarction (AMI), coronary artery bypass

graft (CABG) or percutaneous coronary interventions (PCI) in

the 12 months prior to the measurement period. A positive

whole number.

Percentage

Numerator: Children without a prescription for antibiotic

medication on or 3 days after the outpatient or ED visit for an

upper respiratory infection. A positive whole number. Denominator: Children age 3 months to 18 years who had an outpatient or emergency department (ED) visit with a diagnosis of upper respiratory infection (URI) during the measurement period. A positive whole number Percentage


24


Title Dysfunction (LVEF<40%) Not Completed

Description

Percentage of patients aged 18 years and older with a diagnosis of

coronary artery disease seen within a 12 month period who also have a

prior MI or a current or prior LVEF <40% who were prescribed beta-

blocker therapy.


Domain


*Numerator 1: Patients with a prior (resolved) MI who were

prescribed beta blocker therapy. A positive whole number.

*Denominator: All patients aged 18 years and older with a

diagnosis of coronary artery disease seen within a 12 month

period who also have prior MI.A positive whole number.

Percentage

*Numerator: Patients with a left ventricular systolic

dysfunction (LVEF < 40%) who were prescribed beta blocker

therapy. A positive whole number.


diagnosis of coronary artery disease seen within a 12 month

period who also have LVEF <40% .A positive whole number.

Percentage


25


Title Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control Not Completed

Description

Percentage of patients 18 years of age and older who were discharged

alive for acute myocardial infarction (AMI), coronary artery bypass graft

(CABG) or percutaneous coronary interventions (PCI) in the 12 months

prior to the measurement period, or who had an active diagnosis of

ischemic vascular disease (IVD) during the measurement period, and who

had a complete lipid profile performed during the measurement period

and whose LDL-C was adequately controlled (< 100 mg/dL)..


Domain


*Numerator 1: Patients with a complete lipid profile performed

during the measurement period.

*Denominator : Patients 18 years of age and older with a visit

during the measurement period, and an active diagnosis of

ischemic vascular disease (IVD) during the measurement period,

or who were discharged alive for acute myocardial infarction

(AMI), coronary artery bypass graft (CABG) or percutaneous

coronary interventions (PCI) in the 12 months prior to the

measurement period.

Percentage

*Numerator 2: Patients whose most recent LDL-C level

performed during the measurement period is <100 mg/dL.

*Denominator 2 : Same as above.

Percentage


26


Title

Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or

Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic

Dysfunction (LVSD) Not Completed

Description

Percentage of patients aged 18 years and older with a diagnosis of heart

failure (HF) with a current or prior left ventricular ejection fraction (LVEF)

< 40% who were prescribed ACE inhibitor or ARB therapy either within a

12 month period when seen in the outpatient setting OR at each hospital

discharge.


Domain


27


Title

Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic

Dysfunction (LVSD) Not Completed

Description

Percentage of patients aged 18 years and older with a diagnosis of heart

failure (HF) with a current or prior left ventricular ejection fraction (LVEF)

< 40% who were prescribed beta-blocker therapy either within a 12

month period when seen in the outpatient setting OR at each hospital

discharge


Domain


*Numerator: Patients who were prescribed ACE inhibitor or

ARB therapy either within a 12 month period when seen in

the outpatient setting or at hospital discharge. A positive

whole number.

*Denominator: All patients aged 18 years and older

with a diagnosis of heart failure with a current or

prior LVEF < 40%. A positive whole number.

Percentage

*Numerator Patients who were prescribed beta-blocker

therapy either within a 12 month period when seen in the

outpatient setting or at hospital discharge

*Denominator All patients aged 18 years and older

with a diagnosis of heart failure or a current or prior

LVEF < 40%

Percentage


28


Title Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation Not Completed

Description

Percentage of patients aged 18 years and older with a diagnosis of POAG

who have an optic nerve head evaluation during one or more office visits

within 12 months


Domain


29


Title

Diabetic Retinopathy: Documentation of Presence or Absence of Macular

Edema and Level of Severity of Retinopathy Not Completed

Description


diabetic retinopathy who had a dilated macular or fundus exam

performed which included documentation of the level of severity of

retinopathy and the presence or absence of macular edema during one

or more office visits within 12 months


Domain


*Numerator Patients who have an optic nerve head

evaluation during one or more office visits within 12 months


with a diagnosis of primary open-angle glaucoma

Percentage

*Numerator Patients who had a dilated macular or fundus

exam performed which included documentation of the level

of severity of retinopathy AND the presence or absence of

macular edema during one or more office visits within 12

months


with a diagnosis of diabetic retinopathy

Percentage


30


Title

Diabetic Retinopathy: Communication with the Physician Managing Ongoing

Diabetes Care Not Completed

Description


diabetic retinopathy who had a dilated macular or fundus exam

performed with documented communication to the physician who

manages the ongoing care of the patient with diabetes mellitus regarding

the findings of the macular or fundus exam at least once within 12

months


Domain


31


Title Falls: Screening for Future Fall Risk Not Completed

Description

Percentage of patients 65 years of age and older who were screened for

future fall risk during the measurement period


Domain

Patient Safety

*Numerator Patients with documentation, at least once

within 12 months, of the findings of the dilated macular or

fundus exam via communication to the physician who

manages the patient’s diabetic care


with a diagnosis of diabetic retinopathy who had a

dilated macular or fundus exam performed

Percentage

*Numerator Patients who were screened for future fall risk

at least once within the measurement period

*Denominator Patients aged 65 years and older

with a visit during the measurement period

Percentage


32


Title Major Depressive Disorder (MDD): Suicide Risk Assessment Not Completed

Description

Percentage of patients aged 18 years and older with a new diagnosis or

recurrent episode of MDD who had a suicide risk assessment completed

at each visit during the measurement period


Domain

Clinical Process/ Effectiveness

*Numerator Patients who had suicide risk assessment

completed at each visit


with a new diagnosis or recurrent episode of MDD

Percentage


33


Title Anti-depressant Medication Management Not Completed

Description

The percentage of patients 18 years of age and older who were

diagnosed with a new episode of major depression, treated with

antidepressant medication, and who remained on an antidepressant

medication treatment.


Domain


*Numerator 1 Patients who have received antidepressant medication for at least 84 days (12 weeks) of continuous treatment during the 114-day period following the Index Prescription Start Date

*Denominator 1 Patients 18 years of age and older

with a diagnosis of major depression in the 180 days

(6 months) prior to the measurement period or the

first 180 days (6 months) of the measurement

period, who were treated with antidepressant

medication, and with a visit during the

measurement period

Percentage

*Numerator 2 Patients who have received antidepressant medications for at least 180 days (6 months) of continuous treatment during the 231-day period following the Index Prescription Start Date

*Denominator 2 Same as denominator 1

Percentage


34


Title

ADHD: Follow-Up Care for Children Prescribed Attention

Deficit/Hyperactivity Disorder (ADHD) Medication Not Completed

Description

Percentage of children 6-12 years of age and newly dispensed a medication

for attention deficit/hyperactivity disorder

(ADHD) who had appropriate follow-up care. Two rates are reported.

a. Percentage of children who had one follow-up visit with a practitioner

with prescribing authority during the 30-Day Initiation Phase.

b. Percentage of children who remained on ADHD medication for at least 10

days and who, in addition to the visit in the Initiation Phase, had at least two

additional follow up visits with a practitioner within 270 days (9months) after

the Initiation Phase ended.


Domain


*Numerator 1: Patients who had at least one face-to-face visit with a practitioner with prescribing authority within 30 days after the IPSD

*Denominator 1: Children 6-12 years of age who were

dispensed an ADHD medication during the Intake Period and

who had a visit during the measurement period. A positive

whole number.

Percentage

*Numerator 2: Patients who had at least one face-to-face

visit with a practitioner with prescribing authority during

the Initiation Phase, and at least two follow-up visits during

the Continuation and Maintenance Phase. One of the two

visits during the Continuation and Maintenance Phase may

be a telephone visit with a practitioner. A positive whole

number.

*Denominator 2: Children 6-12 years of age who were

dispensed an ADHD medication during the Intake Period and

who remained on the medication for at least 210 days out of

the 300 days following the IPSD, and who had a visit during the


Percentage


35


Title

Bipolar Disorder and Major Depression: Appraisal for alcohol or chemical

substance use Not Completed

Description

Percentage of patients with depression or bipolar disorder with evidence

of an initial assessment that includes an appraisal for alcohol or chemical

substance use


Domain


*Numerator: Patients in the denominator with evidence of an

assessment for alcohol or other substance use following or

concurrent with the new diagnosis, and prior to or concurrent

with the initiation of treatment for that diagnosis. A positive

whole number.

*Denominator: Patients 18 years of age or older at the start of

the measurement period with a new diagnosis of unipolar

depression or bipolar disorder during the first 323 days of the

measurement period, and evidence of treatment for unipolar

depression or bipolar disorder within

42 days of diagnosis. The existence of a 'new diagnosis' is

established by the absence of diagnoses and treatments of

unipolar depression or bipolar disorder during the 180 days

prior to the diagnosis. A positive whole number.

Percentage


36


Title Oncology: Radiation – Pain Intensity Quantified Not Completed

Description

Percentage of patient visits, regardless of patient age, with a diagnosis of

cancer currently receiving chemotherapy or radiation therapy in which

pain intensity is quantified


Domain

Patient and Family Engagement

37


Title Colon Cancer: Chemotherapy for AJCC Stage III Colon Cancer Patients Not Completed

Description

Percentage of patients aged 18 through 80 years with AJCC Stage III

colon cancer who are referred for adjuvant chemotherapy, prescribed

adjuvant chemotherapy, or have previously received adjuvant

chemotherapy within the 12-month reporting period.


Domain


*Numerator: Patient visits in which pain intensity is quantified.


*Denominator: All patient visits, regardless of patient age,

with a diagnosis of cancer currently receiving chemotherapy or

radiation therapy. A positive whole number.

Percentage

*Numerator: Patients who are referred for chemotherapy,

prescribed chemotherapy, or who have previously received

adjuvant chemotherapy within the 12 month reporting period.

*Denominator: All patients aged 18 through 80 years with

colon cancer

Percentage


38


Title

Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/

Progesterone Receptor (ER/PR)Positive Breast Not Completed

Description

Percentage of female patients aged 18 years and older with Stage IC

through IIIC, ER or PR positive breast cancer who were prescribed

tamoxifen or aromatase inhibitor (AI) during the 12-month reporting

period


Domain


*Numerator: Patients who were prescribed tamoxifen or

aromatase inhibitor (AI) during the 12-month reporting period

*Denominator: All female patients aged 18 years and older

with a diagnosis of breast cancer with stage IC through IIIC,

estrogen receptor (ER) or progesterone receptor (PR) positive

breast cancer

Percentage


39


Title

Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk

Prostate Cancer Patients Not Completed

Description

Percentage of patients, regardless of age, with a diagnosis of prostate

cancer at low risk of recurrence receiving interstitial prostate

brachytherapy, OR external beam radiotherapy to the prostate, OR

radical prostatectomy, OR cryotherapy who did not have a bone scan

performed at any time since diagnosis of prostate cancer


Domain


40


Title HIV/AIDS: Medical Visit Not Completed

Description

Percentage of patients, regardless of age, with a diagnosis of HIV/AIDS

with at least two medical visits during the measurement year with a

minimum of 90 days between each visit


Domain


*Numerator Patients who did not have a bone scan performed

at any time since diagnosis of prostate cancer

*Denominator All patients, regardless of age, with a diagnosis

of prostate cancer at low risk of recurrence receiving

interstitial prostate brachytherapy, OR external beam

radiotherapy to the prostate, OR radical prostatectomy, OR

cryotherapy

Percentage

*Numerator: Patients with at least two medical visits

during the measurement year with a minimum of 90 days

between each visit. A positive whole number.

*Denominator: All patients, regardless of age, with a

diagnosis of HIV/AIDS seen within a 12 month period. A


Percentage


41


Title HIV/AIDS: Pneumocystis jiroveci pneumonia (PCP) Prophylaxis Not Completed

Description Percentage of patients aged 6 weeks and older with a diagnosis of HIV/AIDS

who were prescribed Pneumocystis jiroveci pneumonia (PCP) prophylaxis


Domain


*Numerator 1: Patients who were prescribed pneumocystis

jiroveci pneumonia (PCP)

prophylaxis within 3 months of CD4 count below 200c ells/mm3.


*Denominator 1: All patients aged 6 years and older with a

diagnosis of HIV/AIDS and a CD4 count below 200 cells/mm3

who had at least two visits during the measurement year, with

at least

90 days in between each visit. A positive whole number.

Percentage

*Numerator 2: Patients who were prescribed pneumocystic


prophylaxis within 3 months of CD4 count below 500c ells/ mm3

or a CD4 percentage below

15%. A positive whole number.

*Denominator 2: All patients aged 1-5 years of age with a

diagnosis of HIV/AIDS and a CD4 count below 500 cells/mm3 or

a CD4 percentage below 15%who had at least two visits during

the measurement year, with at least 90 days in between each


Percentage


*Numerator 3: Patients who were prescribed Pneumocystic


prophylaxis at the time of diagnosis of HIV. A positive whole

number.

*Denominator 3: All patients aged 6 weeks to 12 months

with a diagnosis of HIV who had at least two visits during the

measurement year, with at least 90 days in between each


Percentage


42


Title HIV/AIDS: RNA control for Patients with HIV Not Completed

Description

Percentage of patients aged 13 years and older screened for clinical

depression on the date of the encounter using an age appropriate

standardized depression screening tool AND if positive, a follow up plan is

documented on the date of the positive screen


Domain


43


Title

Preventive Care and Screening: Screening for Clinical Depression and Follow-

Up Plan Not Completed

Description

Percentage of patients aged 12 years and older screened for clinical

depression on the date of the encounter using an age appropriate

standardized depression screening tool AND if positive, a follow up plan is

documented on the date of the positive screen


Domain

Population/ Public Health

*Numerator: Patients whose most recent HIV RNA level is

<200 copies/mL. A positive whole number.


diagnosis of HIV/AIDS with at least two visits during the

measurement year, with at least 90 days between each visit. A


Percentage

*Numerator: Patients screened for clinical depression on the

date of the encounter using an age appropriate standardized

tool AND if positive, a follow-up plan is documented on the date

of the positive screen. A positive whole number.

*Denominator: All patients aged 12 years and older before

the beginning of the measurement period with at least one

eligible encounter during the measurement period. A positive

whole number.

Percentage


44


Title Documentation of Current Medications in the Medical Record Not Completed

Description

Percentage of specified visits for patients aged 18 years and older for which

the eligible professional attests to documenting a list of current medications

to the best of his/her knowledge and ability. This list must include ALL

prescriptions, over-the counters, herbals, and vitamin/mineral/dietary

(nutritional) supplements AND must contain the medications’ name,

dosage, frequency and route of administration


Domain

Patient Safety

*Numerator: Eligible professional attests to documenting a list

of current medications to the best of his/her knowledge and

ability. This list must include ALL prescriptions, over-the-

counters, herbals and vitamin/mineral/dietary (nutritional)

supplements AND

must contain the medications’ name, dosages, frequency and

route of administration. A positive

*Denominator: All visits occurring during the 12 month

reporting period for patients aged 18 years and older before

the start of the measurement period. A positive whole

number.

Percentage


45


Title

Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-

Up Not Completed

Description

Percentage of patients aged 18 years and older with an encounter during the

reporting period with a documented calculated BMI during the encounter or

during the previous six months AND when the BMI is outside of normal

parameters, follow-up plan is documented during the encounter or during the

previous 6 months of the encounter with the BMI outside of normal

parameters. Normal Parameters: Age 65 years and older BMI ≥ 23 and < 30

Age 18-64 years BMI ≥18.5 and < 25


Domain


*Numerator 1: Patients 65 years old and older with a

documented calculated BMI during the encounter or during

the previous six months, AND when the BMI is outside of

normal parameters, follow up is documented during the

encounter or during the previous six months of the encounter

with the BMI outside of normal parameters. A positive whole

number.

*Denominator : Initial Patient Population 1 : All patients 65

years of age and older before the beginning of the

measurement period with at least one eligible encounter during

the measurement period and

Percentage

*Numerator 2: Patients 18 through 64 years old with a

documented calculated BMI during the encounter or during

the previous six months, AND when the BMI is outside of

normal parameters, follow up is documented during the

encounter or during the previous six months of the encounter

with the BMI outside of normal parameters. A positive whole

number.

*Denominator 2 : All patients 18 through 64 years before the

beginning of the measurement period with at least one eligible

encounter during the measurement period

Percentage


46


Title

Cataracts: Complications within 30 Days Following Cataract Surgery Requiring

Additional Surgical Procedures Not Completed

Description


uncomplicated cataract who had cataract surgery and had any of a specified

list of surgical procedures in the 30 days following cataract surgery which

would indicate the occurrence of any of the following major complications:

retained nuclear fragments, endophthalmitis, dislocated or wrong power

IOL, retinal detachment, or wound dehiscence.


Domain

Patient Safety

*Numerator: Patients who had one or more specified

operative procedures for any of the following major

complications within 30 days following cataract surgery:

retained nuclear fragments, endophthalmitis, dislocated or

wrong power IOL, retinal detachment, or wound

dehiscence. A positive whole number.

*Denominator: All patients aged 18 years and older who had

cataract surgery and no significant preoperative ocular

conditions impacting the surgical complication rate. A positive

whole number.

Percentage


47


Title

Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract

Surgery Not Completed

Description


uncomplicated cataract who had cataract surgery and no significant ocular

conditions impacting the visual outcome of surgery and had best corrected

visual acuity of 20/40 or better (distance or near) achieved within 90 days

following the cataract surgery.


Domain


48


Title Pregnant women that had HBsAg testing Not Completed

Description This measure identifies pregnant women who had a HBsAg (hepatitis B) test

during their pregnancy.


Domain


*Numerator: Patients who had best corrected visual acuity of

20/40 or better (distance or near)

achieved within 90 days following cataract surgery. A positive

whole number.

*Denominator: All patients aged 18 years and older who had

cataract surgery. A positive whole number.

Percentage

*Numerator: Patients who were tested for Hepatitis B surface

antigen (HBsAg) during pregnancy within 280 days prior to

delivery. A positive whole number.

*Denominator: All female patients aged 12 and older who

had a full term delivery during the measurement period. A


Percentage


49


Title Depression Remission at Twelve Months Not Completed

Description

Adult patients age 18 and older with major depression or dysthymia and an

initial PHQ-9score > 9 who demonstrate remission at twelve months defined

as PHQ-9 score less than 5. This measure applies to both patients with newly

diagnosed and existing depression whose current PHQ-9 score indicates a

need for treatment.


Domain


*Numerator: Adults who achieved remission at twelve

months as demonstrated by a twelve month (+/- 30 days)

PHQ-9 score of less than five. A positive whole number.

*Denominator: Adults age 18 and older with a diagnosis of

major depression or dysthymia and an initial PHQ-9 score

greater than nine during an outpatient encounter. A positive

whole number.

Percentage


50


Title Depression Utilization of the PHQ-9 Tool Not Completed

Description

Adult patients age 18 and older with the diagnosis of major depression or

dysthymia who have a PHQ-9 tool administered at least once during a 4

month period in which there was a qualifying visit..


Domain


*Numerator 1: Adult patients diagnosed during the months of

January through April

*Denominator 1: Adult patients age 18 and older with an

office visit and the diagnosis of major depression or dysthymia

during January through April. A positive whole number.

Percentage


May through August.



during May through August . A positive whole number.

Percentage


September through December.



during September through December . A positive whole

number.

Percentage


51


Title Children who have dental decay or cavities Not Completed

Description Percentage of children ,ages 0-20 years, who have had tooth decay or cavities



Domain


52


Title Child and Adolescent Major Depressive Disorder: Suicide Risk Assessment Not Completed

Description Percentage of patient visits for those patients aged 6 through 17 years with a

diagnosis of major depressive disorder with an assessment for suicide risk.


Domain

Patient Safety

*Numerator: Children who had cavities or decayed teeth.

*Denominator: Children, age 0-20 years, with a visit during

the measurement period.

Percentage

*Numerator: Patient visits with an assessment for suicide risk.


*Denominator: All patient visits for those patients aged 6

through 17 years with a diagnosis of major depressive

disorder. A positive whole number.

Percentage


53


Title Maternal Depression Screening Not Completed

Description

The percentage of children who turned 6 months of age during the

measurement year, who had a face-to-face visit between the clinician and the

child during child’s first 6 months, and who had a maternal depression

screening for the mother at least once between 0 and 6 months of life.


Domain


*Numerator: Children with documentation of maternal

screening or treatment for postpartum depression for the

mother. A positive whole number.

*Denominator: Children with a visit who turned 6 months of

age in the measurement period. A


Percentage


54


Title

Primary Caries Prevention Intervention as Offered by Primary Care Providers,

including Dentists Not Completed

Description Percentage of children, age 0-20 years, who received a fluoride varnish

application during the measurement period.


Domain


*Numerator: Children age 0 – 5 who receive a fluoride

varnish application .

*Denominator: Children, age 0-5 years, with a visit during the

measurement period .

Percentage



*Denominator: Children, age 6 - 12 years, with a visit during the

measurement period .

Percentage



*Denominator: Children, age 13-20 years, with a visit during

the measurement period .

Percentage


55


Title

Preventive Care and Screening: Cholesterol –Fasting Low Density Lipoprotein

(LDLC) Test Not Completed

Description Percentage of patients aged 20 through 79 years whose risk factors have been

assessed and a fasting LDL-C test has been performed.


Domain


*Numerator 1: Patients whose most recent fasting LDL-C

test is <100 mg/dl

*Denominator 1: (High Risk)

All patients aged 20 through 79 years who had a fasting LDL-C or a calculated LDL-C test performed during the measurement period and have CHD or CHD Risk Equivalent OR Have Multiple Risk Factors (2+) of the following: Cigarette Smoking, Hypertension, Low High Density Lipoprotein (HDL-C)**, Family History of Premature CHD, or Age (men >= 45; women >= 55) AND a 10-year Framingham risk >20% **HDL-C > or equal to 60 mg/dl subtracts 1 risk from the above (This is a negative risk factor.) .

Percentage

*Numerator 2: Patients whose most recent fasting LDL-C test is <130 mg/dL

*Denominator 2: (Moderate Risk) All patients aged 20 through 79 years who had a fasting LDL-C or a calculated LDL-C test performed during the measurement period and have Multiple Risk Factors (2+) of the following: Cigarette Smoking, Hypertension, Low High Density Lipoprotein (HDL-C)**, Family History of Premature CHD, or Age (men >= 45; women >= 55) AND a 10-year Framingham risk <=20% **HDL-C > or equal to 60 mg/dL subtracts 1 risk from the above (This is a negative risk factor.) (HDL-C)**, Family History of Premature CHD, or Age (men >= 45; women >= 55) AND a 10-year Framingham risk >20%

**HDL-C > or equal to 60 mg/dL subtracts 1 risk from the above

(This is a negative risk factor.) . Percentage


*Numerator 3: Patients whose most recent fasting LDL-C test is <160 mg/dL

*Denominator 3: (Low Risk) All patients aged 20 through 79 years who had a fasting LDL-C or a calculated LDL-C test performed up to 4 years prior to the current measurement period and have 0 or 1 of the following risk factors: Cigarette Smoking, Hypertension, Low High Density Lipoprotein (HDL), Family History of Premature CHD, or Age (men >= 45; women >= 55) AND a 10-year Framingham risk <=20%. **HDL-C > or equal to 60 mg/dL subtracts 1 risk from the above (This is a negative risk factor). Percentage


56


Title

Preventive Care and Screening: Risk-Stratified Cholesterol – Fasting Low

Density Lipoprotein (LDLC) Not Completed

Description

Percentage of patients aged 20 through 79 years who had a fasting LDL-C test

performed and whose risk-stratified fasting LDL-C is at or below the

recommended LDL-C goal.


Domain


*Numerator 1 Patients whose most recent fasting LDL-C test is <100 mg/dL

*Denominator 1: ( High Risk) All patients aged 20 through 79 years who had a fasting LDL-C or a calculated LDL-C test performed during the measurement period and have CHD or CHD Risk Equivalent OR Have Multiple Risk Factors (2+) of the following: Cigarette Smoking, Hypertension, Low High Density Lipoprotein (HDL-C)**, Family History of Premature CHD, or Age (men >= 45; women >= 55) AND a 10-year Framingham risk >20% **HDL-C > or equal to 60 mg/dL subtracts 1 risk from the above (This is a negative risk factor.)

Percentage


*Denominator 2: (Moderate Risk) All patients aged 20 through 79 years who had a fasting LDL-C or a calculated LDL-C test performed during the measurement period and have Multiple Risk Factors (2+) of the following: Cigarette Smoking, Hypertension, Low High Density Lipoprotein (HDL-C)**, Family History of Premature CHD, or Age (men >= 45; women >= 55) AND a 10-year Framingham risk <=20% **HDL-C > or equal to 60 mg/dL subtracts 1 risk from the above (This is a negative risk factor.)

Percentage


57


Title Dementia: Cognitive Assessment Not Completed

Description

Percentage of patients, regardless of age, with a diagnosis of dementia for

whom an assessment of cognition is performed and the results reviewed at

least once within a 12 month period


Domain



*Denominator 3: (Low Risk) All patients aged 20 through 79 years who had a fasting LDL-C or a calculated LDL-C test performed up to 4 years prior to the current measurement period and have 0 or 1 of the following risk factors: Cigarette Smoking, Hypertension, Low High Density Lipoprotein (HDL), Family History of Premature CHD, or Age (men >= 45; women >= 55) AND a 10-year Framingham risk <=20%. **HDL-C > or equal to 60 mg/dL subtracts 1 risk from the above (This is a negative risk factor)

Percentage

*Numerator: Patients for whom an assessment of

cognition is performed and the results reviewed at least

once within a 12-month period. A positive whole number.

*Denominator: All patients, regardless of age, with a

diagnosis of dementia. A positive whole number.

Percentage


58


Title Hypertension: Improvement in blood pressure Not Completed

Description

Percentage of patients aged 18-85 years of age with a diagnosis of

hypertension whose blood pressure improved during the measurement

period


Domain


59


Title Closing the referral loop: receipt of specialist report Not Completed

Description

Percentage of patients with referrals, regardless of age, for which the

referring provider receives a report from the provider to whom the patient

was referred


Domain

Care Coordination

*Numerator: Patients whose follow-up blood pressure is at

least 10 mmHg less than their baseline blood pressure or is

adequately controlled. A positive whole number.

*Denominator: All patients aged 18-85 years of age, who had

at least one outpatient visit in the first six months of the

measurement year, who have a diagnosis of hypertension

documented during that outpatient visit, and who have

uncontrolled baseline blood pressure at the time of that visit. A


Percentage

*Numerator: Number of patients with a referral, for which the

referring provider received a report from the provider to whom

the patient was referred. A positive whole number.

*Denominator: Number of patients, regardless of age, who

were referred by one provider to another provider, and who

had a visit during the measurement period. A positive whole

number.

Percentage


60


Title Functional status assessment for knee replacement Not Completed

Description

Percentage of patients aged 18 years and older with primary total knee

arthroplasty (TKA) who completed baseline and follow-up (patient-reported)

functional status assessments.


Domain


*Numerator: Patients with patient reported functional status

assessment results (e.g.,VR-12, VR-

36, PROMIS-10 Global Health; PROMIS-29, KOOS) not

more than 180 days prior to the primary TKA procedure,

and at least 60 days and not more than 180 days after TKA

procedure. A positive whole number.

*Denominator: : Adults, aged 18 and older, with a primary

total knee arthroplasty (TKA) and who had an outpatient

encounter not more than 180 days prior to procedure, and

at least 60 days and not more than 180 days after TKA

procedure. A positive whole number

Percentage


61


Title Functional status assessment for hip replacement Not Completed

Description

Percentage of patients aged 18 years and older with primary total

hiparthroplasty (THA) who completed baseline and follow-up (patient-

reported)functional status assessments


Domain


62


Title Functional status assessment for complex chronic conditions Not Completed

Description

Percentage of patients aged 65 years and older with heart failure who

completed initial and follow-up patient-reported functional status

assessments


Domain


*Numerator: Patients with patient reported functional status

assessment results (e.g.,VR-12, VR-

36, PROMIS10-GlobalHealth,PROMIS29,HOOS) not more than

180 days prior to the primary THA procedure, and at least 60

days and not more than 180 days after THA procedure. A


*Denominator: Adults aged 18 and older with a primary total

hip arthroplasty (THA) and who had an outpatient encounter

not more than 180 days prior to procedure, and at least 60 days

and not more than 180 days after THA procedure. A positive

whole number.

Percentage

*Numerator: Patients with patient reported functional

status assessment results (e.g., VR-12; VR-36; MLHF-Q; KCCQ;

PROMIS-10 Global Health, PROMIS-29) present in the EHR at

least two weeks before or during the initial encounter and the

follow-up encounter during the measurement year .

*Denominator: Adults aged 65 years and older who had two

outpatient encounters during the measurement year and an

active diagnosis of heart failure. .

Percentage


63


Title ADE Prevention and Monitoring: Warfarin Time in Therapeutic Range Not Completed

Description

Average percentage of time in which patients aged 18 and older with atrial

fibrillation who are on chronic warfarin therapy have International

Normalized Ratio (INR) test results within the therapeutic range (i.e., TTR)



Domain

Patient Safety

64


Title

Preventive Care and Screening: Screening for High Blood Pressure and

Follow-Up Documented Not Completed

Description

Percentage of patients aged 18 years and older seen during the reporting

period who were screened for high blood pressure AND a recommended

follow-up plan is documented based on the current blood pressure (BP)

reading as indicated.


Domain


*Numerator: Average percentage of time that patients in the

measure have INR results within the therapeutic range (i.e.

TTR)

*Denominator: Patients aged 18 and older with atrial

fibrillation without valvular heart disease who had been on

chronic warfarin therapy for at least 180 days before the start

of and during the measurement period. Patient should have at

least one outpatient visit during the measurement period .

Percentage

*Numerator: Patients who were screened for high blood

pressure AND a recommended follow-up plan is documented

as indicated if the blood pressure is pre-hypertensive or

hypertensive

*Denominator: Percentage of patients aged 18 years and

older before the start of the measurement period

Percentage


Example of an Eligible Professional meeting the required Stage 2 Clinical Quality

Measures

Example of an Eligible Professional who did not meet the Stage 2 required Clinical Quality

Measures


4.3.8 2014 CEHRT Flexibility Rule

In developing its approach to implementing the 2014 CEHRT Flexibility Rule, Louisiana

Medicaid consulted with its State Level Repository (SLR) vendor, Molina Health Care

Solutions; audit contractor, Myers & Stauffer; and Regional Extension Center, Louisiana Health

Care Quality Forum, to establish policies, procedures, and system changes that are consistent

with the Final Rule and that facilitate an efficient and economical implementation.

Policy/System Modifications

Providers who are unable to fully implement a 2014 edition CEHRT in the 2014 reporting period

due to certain delays in CEHRT availability can benefit from the Flexibility Rule. In order to

attest to an earlier CEHRT edition, the delay must be attributable to issues related to software

development, certification, implementation, testing, or delay in release of the product by the

EHR vendor. Louisiana providers seeking to attest to Meaningful Use will be able to use EHRs

that have been certified under the 2011 Edition, a combination of the 2011 and 2014 Edition, or

the 2014 Edition.

Providers who are unable to fully implement a 2014 edition CEHRT in the 2014 reporting period

will not be able to use the Flexibility Rule for the following reasons:

Financial Issues;

Inability to meet one or more measures;

Staff turnover or change;

Provider waited too long to engage a vendor;

Refusal to purchase the requisite software;

Providers who fully implemented 2014 Edition CEHRT and can report in 2014.

Upon logging into the SLR, a meaningful use attester will be prompted to choose between the

2013 definition and 2014 definition of MU. A pop-up message, describing eligibility

requirements for the Flexibility Rule, will appear when the provider hovers over the options. If a

provider selects the 2013 definition of MU, the system will prompt the provider to answer a


series of open-ended questions regarding his/her inability to fully implement 2014 CEHRT.

Should an EP qualify for the Flexibility Rule, the completed security risk assessment should be

completed between January 1, 2014 and no later than December 31, 2014 (i.e., the security risk

analysis may be completed outside of the EHR reporting period timeframe, but must take place

no earlier than the start of the reporting year and end of the reporting year.) The provider will

also be required to upload supporting documentation. Documentation includes, but is not limited

to:

Dates of initial requests to vendor, contracts/addendums, etc.

Documentation of vendor delays in installation, training, etc.

Documentation of bugs or issues that prevent or delay the EP or EH from full

implementation of the 2014 Edition CEHRT, that prevent the practice from achieving one

or more measures, or that present safety issues

Help ticket numbers, dates of submission, etc.

Email exchanges with vendor contacts to document practice action in resolving issues

Minutes from internal meetings held to address issues stemming from vendor delays

Providers attesting to Adoption/Implementation/Upgrade cannot benefit from the CEHRT

Flexibility Rule. Providers attesting to AIU in 2014 will be required to provide the CMS

Certification Number of a 2014 Edition EHR only.

Modifications to the system will be in production by January 15, 2015.

Extension of Tail End Period

Louisiana Medicaid utilizes a 90-day tail end period – which extends the program year to December 31

for Eligible Hospitals and March 31 for Eligible Professionals. However, as a result of the late

implementation of the Flexibility Rule, Louisiana Medicaid requested and received approval to extend

the deadline for Eligible Hospitals by an additional 60 days to March 1, 2015. The extended deadline will

be applicable to all EHs, including those not taking advantage of the Flexibility Rule.

Provider Support


In Louisiana, providers can rely on Louisiana Medicaid staff and the Regional Extension Center,

Louisiana Health Care Quality Forum (LHCQF), for information on the Flexibility Rule.

Louisiana Medicaid staff has been and will continue to field calls and email inquiries from

providers seeking information regarding the rule and its relationship with avoidance of the

Medicare penalty. Louisiana Medicaid has posted to its EHR Incentive webpage links to CMS

sites and information about webinars hosted by LHCQF. Louisiana Medicaid received funding

in its current IAPDU specifically for HIT promotional activities and initiatives to be conducted

through contract with LHCQF. In addition to promoting the adoption and meaningful use of

CEHRT, the LHCQF will help providers navigate the complexities of the Flexibility Rule via

webinars, contact with provider groups, speaking opportunities, and website links and updates.

The LHCQF also administers a number of initiatives through contract with Louisiana Medicaid

(e.g., Medicaid Specialist Outreach Program, LaHIE Integration Assistance Program), which

require one-on-one contact with providers and the opportunity to disseminate information and to

provide guidance on utilization of the Flexibility Rule.

Audit

Louisiana Medicaid has worked closely with its contract auditor, Myers and Stauffer (M&S), on

the implementation of the Flexibility Rule. In addition to helping assure that Louisiana’s

approach is consistent with the Final Rule, M&S representatives made certain the attestation data

would be captured and formatted in a manner to support sample selection and risk assessment for

future audit work. Consequently, the system changes to be implemented by the SLR vendor will

include properly formatted attestation data and access to uploaded support documents related to

the Flexibility Rule. M&S will verify during post-payment audit the reason attested to by the

EPs for their inability to fully implement 2014 CEHRT; and the validity of the supporting

documentation for non-2014 CEHRT attestations. The Audit Guide will be updated to include

review procedures for the Flexibility Rule.


Appeals

Provider appeals regarding the Flexibility Rule will be handled in the same manner as appeals

relating to other matters of eligibility for the EHR Incentive Program. See section ….for the

appeals process.

Staff Training

Louisiana Medicaid staff has undergone training on the Flexibility Rule through participation in

LHCQF and CMS webinars and informational links on both websites. Staff that reviews and

approves/denies attestations is knowledgeable of the eligibility requirements and the

documentation to support eligibility. Staff is also well versed on the Medicare penalty, hardship

applications, and related deadlines; however, when unable to answer provider inquiries on these

topics, direct providers to the appropriate CMS contacts.

Reporting

Attestation data will be monitored upon launch of the system changes to determine the impact of

the Flexibility Rule on continued provider participation. The LHCQF will make efforts to reach

out to providers who have not returned in the hopes of encouraging participation through use of

the Flexibility Rule.

Review Screen – this screen is a review of the data that has been entered for the attestation. The

EP has the opportunity to correct data at this point.



Eligible Hospital Process - The following screens are specific for an EH. Both processes do

merge at the end for the “Application Certification” and “Confirmation” screens (shown after the

EH screens).

4.3.9 Verification of Certified EHR (EH)

The EH will be required to upload supporting documentation regarding the AIU of certified

electronic health record technology into the Louisiana Medicaid EHR incentive payment website

during the application and attestation process. Acceptable documentation includes receipts,

contracts, cost reports, purchase orders, etc. to demonstrate the provider’s compliance with either

acquiring, implementing, or upgrading to Certified EHR technology. Louisiana verifies the

Certification number via an electronic interface with CMS’ CHPL file.

The state will be implementing changes for 2014 to ensure verification for CEHTs adhering to

the revised 2014 standards and verification of 2014 CEHRT capabilities.

EH Adopt, Implement or Upgrade - The provider will enter a vendor name, product name,

product number and version. The additions will be added to a data grid displayed on the screen.

The user has the option of marking an entry in the grid as “disregard” notifying DHH not to use

this product in its analysis



CMS Certification ID Tool Tip



EH Payment Calculation -


EH Meaningful Use –

This screen is for an EH submitting for the 3rd

payment year prior to 1/1/14:


This screen is for an EH submitting for the 3rd

payment year on or after 1/1/14:


This screen is for an EH submitting for the 4th

payment year (Stage 2). This screen is applicable

for the 2014 Program Year only. In all other years, the MU attestation period will be 365 days.

:


Stage 1 Meaningful Use Measures required of Eligible Hospitals Prior to 2014.

For eligible hospitals and CAHs prior to 2014, the following Stage 1 criteria must be met:



All 15 CQM’s

The attesting provider selects the core, menu, and CQMs by selecting the appropriate link.


Stage 1 Meaningful Use Measures required of Eligible Hospitals Beginning in 2014

For eligible hospitals and CAHs beginning in 2014, the following Stage 1 criteria must be met:



16 out of 29 total 2014 CQMs

The attesting provider selects the core, menu, and CQM by selecting the appropriate link.

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/2014_CQM_EH_FinalRule.pdf


EH Stage 1 Core Measures






Example of an Eligible Hospital meeting the required Stage 1 Core Measures

Example of an Eligible Hospital who did not meet the Stage 1 minimum required Core Measures


EH Stage 1 Menu Measures






Example of an Eligible Hospital meeting the required Stage 1 Menu Set Measures

Example of an Eligible Hospital who did not meet the Stage 1 minimum required Menu Set

Measures


EH Stage 1 Clinical Quality Measures

NOTE: These measures are listed in the SMHP only for historical and auditing purposes only;

they will not be presented in the SLR







Example of an Eligible Hospital meeting the required Stage 1 Clinical Quality Measures

Example of an Eligible Hospital who did not meet the Stage 1 minimum required Clinical

Quality Measures


EH Stage 2 Core Measures

# Measure Information Measure Value

1 CPOE for Medication, Laboratory and Radiology Orders

Objective: Use computerized provider order entry (CPOE) for medication, laboratory, and radiology orders directly

entered by any licensed healthcare professional who can enter orders into the medical record per state, local, and

professional guidelines.

Measure: More than 60 percent of medication, 30 percent of laboratory, and 30 percent of radiology orders created by

authorized providers of the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) during the

EHR reporting period are recorded using CPOE.

Numerator 1 (Medication): The number of medication orders in the denominator

recorded using CPOE.

Denominator 1 (Medication): Number of medication orders created by the EP or

authorized providers in the eligible hospital's or CAH's inpatient or emergency

department (POS 21 or 23) during the EHR reporting period.

Medication Exclusion: Any EP who writes fewer than 100 medication orders during

the EHR reporting period.

Numerator 2 (Radiology): Number of radiology orders in the denominator entered

using CPOE

Denominator 2 (Radiology): Number of radiology orders created by the EP or

authorized providers in the eligible hospital's or CAH's inpatient or emergency

department (POS 21 or 23) during the EHR reporting period.

Radiology Exclusion: Any EP who writes fewer than 100 radiology orders during


Numerator 3 (Laboratory): Number of laboratory orders in the denominator entered

using CPOE

Denominator 3 (Laboratory): Number of laboratory orders created by the EP or

authorized providers in the eligible hospital's or CAH's inpatient or emergency department

(POS 21 or 23) during the EHR reporting period.

Laboratory Exclusion: Any EP who writes fewer than 100 laboratory orders during




2 Record Demographics

Objective: Record the following demographics: preferred language, sex, race, ethnicity, date of birth and preliminary

cause of death in the event of mortality in the EH.

Measure: More than 80% of all unique patients admitted to the EH’s inpatient or emergency department (POS 21 or 23)

during the EHR reporting period have demographics recorded as structured data.

Numerator: The number of patients in the denominator who have all the elements of

demographics (or a specific notation if the patient declined to provide one or more

elements or if recording an element is contrary to state law) recorded as structured data.

Denominator: Number of unique patients seen by the EP or admitted to an eligible

hospital or CAH inpatient or emergency department (POS 21 or 23) during the EHR

reporting period.


3 Record Vital Signs

Objective: Record and chart changes in the following vital signs: height/length and weight (no age limit); blood

pressure (ages 3 and over); calculate and display body mass index (BMI); and plot and display growth charts for

patients 0-20 years, including BMI.

Measure: More than 80 percent of all unique patients admitted to the eligible hospital's or CAH's inpatient or emergency

department (POS 21 or 23) during the EHR reporting period have blood pressure (for patients age 3 and over only)

and/or height/length and weight (for all ages) recorded as structured data.

Numerator: Number of patients in the denominator who have at least one

entry of their height/length and weight (all ages) and/or blood pressure (ages 3

and over) recorded as structured data.

Denominator: Number of unique patients seen by the EP or admitted to an

eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23)

during the EHR reporting period


4 Record Smoking Status

Objective: Record smoking status for patients 13 years old or older.

Measure: More than 80 percent of all unique patients 13 years old or older admitted to the eligible hospital's or CAH's

inpatient or emergency departments (POS 21 or 23) during the EHR reporting period have smoking status recorded as

structured data.

Numerator: The number of patients in the denominator with smoking status

recorded as structured data.

Denominator: Number of unique patients age 13 or older seen by the EP or admitted

to an eligible hospital's or CAH's inpatient or emergency departments (POS 21 or 23)

during the EHR reporting period.

Exclusion: Any eligible hospital of CAH that neither sees nor admits any patients 13

years old or older.



5 Clinical Decision Support Rule

Objective: Use clinical decision support to improve performance on high-priority health conditions.

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

eligible hospital or CAH’s patient population, the clinical decision support interventions must be related to high-

priority health conditions. It is suggested that one of the five clinical decision support interventions be related to

improving healthcare efficiency.

Numerator: N/A. Yes No

Denominator N/A


6 Patient Electronic Access

Objective: Provide patients the ability to view online, download, and transmit information about a hospital

admission.

Measure: 1. More than 50 percent of all unique patients discharged from the inpatient or emergency departments of the

eligible hospital or CAH (POS 21 or 23) during the EHR reporting period have their information available online within

36 hours of discharge. 2. More than 5 percent of all unique patients (or their authorized representatives) who are discharged from the

inpatient or emergency department (POS 21 or 23) of an eligible hospital or CAH view, download or transmit to a third

party their information during the EHR reporting period.

Exclusion (for Second Measure Only): Any eligible hospital or CAH that is located in a county that does not have 50

percent or more of its housing units with 3Mbps broadband availability according to the latest information available

from the FCC on the first day of the EHR reporting period is excluded from the second measure

Does this exclusion apply to you? Yes No

Numerator 1: The number of patients in the denominator whose information is

available online within 36 hours of discharge.

Denominator 1: Number of unique patients discharged from an eligible

hospital's or CAH's inpatient or emergency department (POS 21 or 23) during


Numerator 2: The number of unique patients (or their authorized

representatives) in the denominator who have viewed online, downloaded, or

transmitted to a third party the discharge information provided by the eligible

hospital or CAH.

Denominator 2: Number of unique patients discharged from an eligible

hospital's or CAH's inpatient or emergency department (POS 21 or 23) during




7 Protect Electronic Health Information

Objective: Protect electronic health information created or maintained by the Certified EHR Technology through

the implementation of appropriate technical capabilities.

Measure: Conduct or review a security risk analysis in accordance with the requirements under 45 CFR

164.308(a)(1), including addressing the encryption/security of data stored in CEHRT in accordance with

requirements under 45 CFR 164.312 (a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as

necessary and correct identified security deficiencies as part of the provider's risk management process for eligible

hospitals.


Denominator N/A


8 Clinical Lab - Test Results

Objective: Incorporate clinical lab test results into Certified EHR Technology as structured data.

Measure: More than 55 percent of all clinical lab tests results ordered by authorized providers of the eligible

hospital or CAH for patients admitted to its inpatient or emergency department (POS 21 or 23) during the EHR

reporting period whose results are either in a positive/negative affirmation or numerical format are incorporated in

Certified EHR Technology as structured data.

Numerator: Number of lab test results which are expressed in a positive or negative

affirmation or as a numeric result which are incorporated in CEHRT as structured data.

Denominator: Number of lab tests ordered during the EHR reporting period by the EP

or by authorized providers of the eligible hospital or CAH for patients admitted to its

inpatient or emergency department (POS 21 or 23) whose results are expressed in a

positive or negative affirmation or as a number.


9 Patient Lists

Objective: Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities,

research, or outreach.

Measure: Generate at least one report listing patients of the eligible hospital or CAH with a specific condition.

Note: This measure only requires a yes/no answer


Denominator N/A



10 Patient-Specific Education Resources

Objective: Use clinical relevant information from Certified EHR Technology to identify patient-specific education

resources and provide those resources to the patient.

Measure: More than 10 percent of all unique patients admitted to the eligible hospital's or CAH's inpatient or

emergency departments (POS 21 or 23) are provided patient-specific education resources identified by Certified EHR

Technology.

Exclusion: No exclusion

Numerator: Number of patients in the denominator who are subsequently provided

patient-specific education resources identified by CEHRT.

Denominator: Number of unique patients admitted to the eligible hospital's

or CAH's inpatient or emergency departments (POS 21 or 23) during the

EHR reporting period.


11 Medication Reconciliation

Objective: The eligible hospital or CAH who receives a patient from another setting of care or provider of care

or believes an encounter is relevant should perform medication reconciliation.

Measure: The eligible hospital or CAH performs medication reconciliation for more than 50 percent of transitions of

care in which the patient is transitioned into the care of the EP or admitted to the eligible hospital's or CAH's inpatient

or emergency department (POS 21 or 23).

Exclusion: No Exclusions

Numerator: The number of transitions of care in the denominator where

medication reconciliation was performed.

Denominator: Number of transitions of care during the EHR reporting period for which

the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) was

the receiving party of the transition.



12 Summary of Care

Objective: The eligible hospital or CAH who transitions their patient to another setting of care or provider of care

or refers their patient to another provider of care provides a summary care record for each transition of care or

referral.

Measure 1:

• The eligible hospital or CAH that transitions or refers their patient to another setting of care or provider of care

provides a summary of care record for more than 50 percent of transitions of care and referrals.

Measure 2:

• The eligible hospital or CAH that transitions or refers their patient to another setting of care or provider of care

provides a summary of care record for more than 10 percent of such transitions and referrals either (a) electronically

transmitted using CEHRT to a recipient or (b) where the recipient receives the summary of care record via exchange

facilitated by an organization that is a NwHIN Exchange participant or in a manner that is consistent with the

governance mechanism the ONC establishes for the nationwide health information network.

Measure 3:

The eligible hospital or CAH must satisfy one of the two following criteria:

• Conducts one or more successful electronic exchanges of a summary of care document, which is counted in "measure

2" (for eligible hospitals and CAHs the measure at §495.6(l)(11)(ii)(B)) with a recipient who has EHR technology

that was designed by a different EHR technology developer than the sender's EHR technology certified to 45 CFR

170.314(b)(2); or

• Conducts one or more successful tests with the CMS designated test EHR during the EHR reporting period.


Numerator 1: The number of transitions of care and referrals in the

denominator where a summary of care record was provided.

Denominator 1: Number of transitions of care and referrals during

the EHR reporting period for which the eligible hospital's or CAH's

inpatient or emergency department (POS 21 or 23) was the

transferring or referring provider.

Numerator 2: The number of transitions of care and referrals in the

denominator where a summary of care record was a) electronically

transmitted using CEHRT to a recipient or b) where the recipient

receives the summary of care record via exchange facilitated by an

organization that is a NwHIN Exchange participant or in a manner that

is consistent with the governance mechanism the ONC establishes for

the nationwide health information network. The organization can be a

third-party or the sender's own organization.

Denominator 2: Number of transitions of care and referrals during

the EHR reporting period for which the eligible hospital's or CAH's

inpatient or emergency department (POS 21 or 23) was the

transferring or referring provider.

Measure 3 (Y/N) Yes No



13 Immunization Registries Data Submission

Objective: Capability to submit electronic data to immunization registries or immunization information systems

except where prohibited, and in accordance with applicable law and practice.

Measure: Successful ongoing submission of electronic immunization data from Certified EHR Technology to an

immunization registry or immunization information system for the entire EHR reporting period

Exclusion: Any eligible hospital or CAH that meets one or more of the following criteria may be excluded from this

objective:

(1) The eligible hospital or CAH does not administer any of the immunizations to any of the populations for

which data is collected by their jurisdiction's immunization registry or immunization information system during

the EHR reporting period;

(2) The eligible hospital or CAH operates in a jurisdiction for which no immunization registry or immunization

information system is capable of accepting the specific standards required for Certified EHR Technology at the start

of their EHR reporting period;

(3) The eligible hospital or CAH operates in a jurisdiction where no immunization registry or immunization

information system provides information timely on capability to receive immunization data; or

(4) The eligible hospital or CAH operates in a jurisdiction for which no immunization registry or immunization

information system that is capable of accepting the specific standards required by Certified EHR Technology at the

start of their EHR reporting period can enroll additional eligible hospitals or CAHs.

Does any of these exclusion apply to you? Yes No

Measure 13 Yes No


14 Electronic Reportable Laboratory Results

Objective: Capability to submit electronic reportable laboratory results to public health agencies, where except

where prohibited, and in accordance with applicable law and practice.

Measure: Successful ongoing submission of electronic reportable laboratory results from Certified EHR Technology to

a public health agency for the entire EHR reporting period.

Exclusion: Any eligible hospital or CAH that meets one or more of the following criteria:

(A) Operates in a jurisdiction for which no public health agency is capable of receiving electronic reportable

laboratory results in the specific standards required for Certified EHR Technology at the start of their EHR reporting

period.

(B) Operates in a jurisdiction for which no public health agency provides information timely on capability to

receive electronic reportable laboratory results.

(C) Operates in a jurisdiction for which no public health agency that is capable of accepting the specific standards

required by Certified EHR Technology at the start of their EHR reporting period can enroll additional eligible

hospitals or CAHs.


Measure 14 Yes No



15 Syndromic Surveillance Data Submission

Objective: Capability to submit electronic Syndromic surveillance data to public health agencies, except where

prohibited, and in accordance with applicable law and practice.

Measure: Successful ongoing submission of electronic Syndromic surveillance data from Certified EHR Technology

to a public health agency for the entire EHR reporting period.

Exclusion: Any eligible hospital or CAH that meets one or more of the following criteria may be excluded from this

objective:

(1) Does not have an emergency or urgent care department;

(2) Operates in a jurisdiction for which no public health agency is capable of receiving electronic Syndromic

surveillance data in the specific standards required by Certified EHR Technology at the start of their EHR

reporting period;

(3) Operates in a jurisdiction where no public health agency provides information timely on capability to receive

Syndromic surveillance data; or (4) Operates in a jurisdiction for which no public health agency that is capable of

accepting the specific standards required by Certified EHR Technology at the start of their EHR reporting period can

enroll additional eligible hospitals or CAHs.


Measure 15 Yes No


16 Electronic Medication Administration Record (eMAR)

Objective: Automatically track medications from order to administration using assistive technologies in

conjunction with an electronic medication administration record (eMAR).

Measure: More than 10 percent of medication orders created by authorized providers of the eligible hospital's or

CAH's inpatient or emergency department (POS 21 or 23) during the EHR reporting period for which all doses are

tracked using eMAR.

Exclusion: Any eligible hospital or CAH with an average daily inpatient census of fewer than 10 patients.


Numerator: The number of orders in the denominator for which all doses are

tracked using eMAR.

Denominator: Number of medication orders created by authorized providers in

the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23)

during the EHR reporting period.


Example of an Eligible Hospital meeting the required Stage 2 Core Measures

Example of an Eligible Hospital who did not meet the Stage 2 minimum required Core

Measures


EH Stage 2 Menu Measures

Meaningful Use Menu Measures - Eligible hospitals and CAHs must fill out 3 out of 6

menu measures


1 Advance Directive

Objective: Record advance directives for patient 65 years old or older

Measure: More than 50 percent of all unique patients 65 years old or older admitted to the eligible hospital’s

or CAH’s inpatient (POS 21) have an indication of an advance directive status recorded as structured data

Exclusion: An eligible hospital or CAH that admitted no patients age 65 years old or older during the EHR

reporting period would be excluded from this requirement


Numerator: Number of patients in the denominator with an indication of an

advanced directive entered using structured data.

Denominator: Number of unique patients age 65 or older admitted to an

eligible hospital’s or CAH’s inpatient department (POS 21) during the EHR

reporting period.


2 Electronic Notes

Objective: Record electronic notes in patient records.

Measure: Enter at least one electronic progress note created, edited and signed by an authorized

provider of the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) for more

than 30 percent of unique patients admitted to the eligible hospital or CAH's inpatient or emergency

department during the EHR reporting period. The text of the electronic note must be text searchable and

may contain drawings and other content.

Numerator: The number of unique patients in the denominator who have at least

one electronic progress note from an authorized provider of the eligible hospital's

or CAH's inpatient or emergency department (POS 21 or 23) recorded as text

searchable data.

Denominator: Number of unique patients admitted to an eligible hospital or

CAH's inpatient or emergency department (POS 21 or 23) during the EHR

reporting period.



3 Imaging Results

Objective: Imaging results consisting of the image itself and any explanation or other accompanying

information are accessible through Certified EHR Technology.

Measure: More than 10 percent of all tests whose result is one or more images ordered by an authorized

provider of the eligible hospital or CAH for patients admitted to its inpatient or emergency department (POS 21 or 23) during the EHR reporting period are accessible through Certified EHR Technology.

Numerator: Number of tests whose result is one or more images ordered by an

authorized provider on behalf of the eligible hospital or CAH for patients

admitted to its inpatient or emergency department (POS 21 and 23) during the

EHR reporting period.

Denominator: The number of results in the denominator that are accessible

through Certified EHR Technology.


4 Measure Information

Objective: Record patient family health history as structured data Measure: More than 20 percent of all unique patients admitted to the eligible hospital or CAH's inpatient or

emergency department (POS 21 or 23) during the EHR reporting period have a structured data entry for one

or more first-degree relatives.

Numerator: The number of patients in the denominator with a structured data

entry for one or more first-degree relatives.

Denominator: Number of unique patients admitted to the eligible hospital's or

CAH's inpatient or emergency departments (POS 21 or 23) during the EHR

reporting period.


5 e Prescribing (eRx)

Objective: Generate and transmit permissible discharge prescriptions electronically (eRx).

Measure: More than 10 percent of hospital discharge medication orders for permissible prescriptions (for

new, changed, and refilled prescriptions) are queried for a drug formulary and transmitted electronically using

certified EHR technology.

Exclusion: Does not have an internal pharmacy that can accept electronic prescriptions and is not located

within 10 miles of any pharmacy that accepts electronic prescriptions at the start of their EHR reporting period


Numerator: The number of prescriptions in the denominator generated, queried

for a drug formulary and transmitted electronically.

Denominator: Number of new, changed, or refill prescriptions written for drugs

requiring a prescription in order to be dispensed other than controlled substances

for patients discharged during the EHR reporting period.



6 Lab Results to Ambulatory Providers

Objective: Provide structured electronic lab results to ambulatory providers.

Measure: Hospital labs send structured electronic clinical lab results to the ordering provider

for more than 20 percent of electronic lab orders received.

Alternate Measure: Hospital labs send structured electronic clinical lab results to the

ordering provider for more than 20 percent of lab orders received.


Numerator: The number of structured clinical lab results

sent to the ordering provider.

Denominator: The number of electronic lab orders received.


Example of an Eligible Hospital meeting the required Stage 2 Menu Set Measures

Example of an Eligible Hospital who did not meet the Stage 2 minimum required Menu Set

Measures


EH 2014 Clinical Quality Measures

Eligible hospitals and CAHs for any MU stage will be required to submit 16 out of 29 CQMs

using their. In addition, all providers must select CQMs from at least 3 of the key health care

policy domains recommended by the Department of Health and Human Services’ National

Quality Strategy

EPs must complete 16 of 29 CQMs from the 2014 CQMs (see “EH 2014 Clinical Quality

Measures”). EHs need to choose their 16 CQMs covering at least 3 domains. If one of more of

the measures from the recommended core set is not relevant to the EP’s organization, they can

choose from the other measures. If the EH does not have patient data for 16 CQMs, then they

must report the CQMs for which they have patient data and report the remaining as zero

denominators. If there are no applicable CQMs for the EH, then they report 16 CQMs even if the

result is zero in either the denominator or numerator of the measure.

The Stage 2 CQMs listing begins on the next page.


1


Title Median time from ED arrival to ED departure for admitted ED patients Not Completed

Description

Median time from emergency department arrival to time of departure

from the emergency room for patients admitted to the facility from the

emergency department.



Exemption: Eligible hospitals and CAHs with 5 or fewer

inpatient discharges per quarter or fewer discharges during

the relevant EHR reporting period (if attesting to a 90-day

period), or 20 or fewer discharges during the year (if

attesting to a full year EHR reporting period) as defined by

the CQM’s denominator population would be exempted

from reporting on that CQM.

Does this exemption apply to you for this CQM?

Yes

No

*Numerator: Median time (in minutes) from ED arrival to

ED departure for patients admitted to the facility from the

emergency department.

Denominator: All ED patients admitted to the facility from

the ED and stratified according to Inpatient Admission or

Diagnosis of Psychiatric/Mental Health condition.

Percentage


2


Title Median Admit decision time to ED departure time for admitted patients Not Completed

Description

Median time (in minutes) from admit decision time to time of departure

from the emergency department for emergency department patients

admitted to inpatient status.











Yes

No

*Numerator 1: Median time (in minutes) from Decision to

Admit to ED departure for patients admitted to the facility

from the emergency department. *Denominator 1: All ED patients admitted to the facility

from the ED and stratified according to Inpatient Admission

or Diagnosis of Psychiatric/Mental Health condition. Percentage


3


Title Discharged on anti-thrombotic therapy Not Completed

Description

Ischemic stroke patients prescribed antithrombotic therapy at hospital

discharge











Yes

No

*Numerator: Ischemic stroke patients prescribed

antithrombotic therapy at hospital discharge .

*Denominator: Ischemic stroke patients.

Percentage


4


Title Anticoagulation Therapy for Atrial Fibrillation/Flutter Not Completed

Description

Ischemic stroke patients with atrial fibrillation/flutter who are prescribed

anticoagulation therapy at hospital discharge.


Domain Clinical Process/ Effectiveness









Yes

No

*Numerator: Ischemic stroke patients prescribed

anticoagulation therapy at hospital discharge.

*Denominator: Ischemic stroke patients with documented

atrial fibrillation/flutter.

Percentage


5


Title Thrombolytic Therapy Not Completed

Description

Acute ischemic stroke patients who arrive at this hospital within 2

hours (120 minutes) of time last known well and for whom IV t-PA was

initiated at this hospital within 3 hours (180 minutes) of time last known

well.











Yes

No

*Numerator : Acute ischemic stroke patients for

whom IV thrombolytic therapy was initiated at this

hospital within 3 hours (less than or equal to 180

minutes) of time last known well.

*Denominator : Acute ischemic stroke patients whose

time of arrival is within 2 hours (less than or equal to 120

minutes) of time last known well.

Percentage


6


Title Antithrombotic therapy by end of hospital day two Not Completed

Description

Ischemic stroke patients administered antithrombotic therapy by the

end of hospital day two











Yes

No

*Numerator: Ischemic stroke patients who had

antithrombotic therapy administered by end of hospital day

two.

*Denominator: Ischemic stroke patients.

Percentage


7


Title Discharged on Statin Medication Not Completed

Description

Ischemic stroke patients with LDL greater than or equal to 100 mg/dL,

or LDL not measured, or, who were on a lipid- lowering medication

prior to hospital arrival are prescribed statin medication at hospital

discharge











Yes

No

*Numerator: Ischemic stroke patients prescribed statin

medication at hospital discharge.

*Denominator: Ischemic stroke patients with an

LDL greater than or equal to 100 mg/dL, OR LDL

not measured, OR who were on a lipid- lowering

medication prior to hospital arrival

Percentage


8


Title Stroke education Not Completed

Description

Ischemic or hemorrhagic stroke patients or their caregivers who were

given educational materials during the hospital stay addressing all of

the following: activation of emergency medical system, need for follow-

up after discharge, medications prescribed at discharge, risk factors for

stroke, and warning signs and symptoms of stroke


Domain










Yes

No

*Numerator: Ischemic or hemorrhagic stroke patients with

documentation that they or their caregivers were given educational material addressing all of the following: 1. Activation of emergency medical system 2. Need for follow-up after discharge 3. Medications prescribed at discharge 4. Risk factors for stroke

5. Warning signs and symptoms of stroke

*Denominator: Ischemic stroke or hemorrhagic stroke

patients discharged to home

Percentage


9


Title

Stroke-10 Ischemic or hemorrhagic stroke – Assessed for

Rehabilitation Not Completed

Description

Ischemic or hemorrhagic stroke patients who were assessed for

rehabilitation services.


Domain

Care Coordination









Yes

No

*Numerator: Ischemic or hemorrhagic stroke

patients assessed for or who received rehabilitation

services.

*Denominator: Patients admitted to the hospital for

inpatient acute care with a principal diagnosis code

for ischemic or hemorrhagic stroke with hospital

stays <= 120 days during the measurement period

for patients age 18 and older at the time of hospital

admission. .

Percentage


10


Title Venous Thromboembolism (VTE)-1 VTE prophylaxis Not Completed

Description

This measure assesses the number of patients who received VTE

prophylaxis or have documentation why no VTE prophylaxis was given

the day of or the day after hospital admission or surgery end date for

surgeries that start the day of or the day after hospital admission.


Domain

Patient Safety









Yes

No

*Numerator: Patients who received VTE prophylaxis or

have documentation why no VTE prophylaxis was given:

the day of or the day after hospital admission

the day of or the day after surgery end date

for surgeries that start the day of or the day

after hospital admission

*Denominator: All patients in the initial patient

population.

Percentage


11


Title Unit (ICU) VTE prophylaxis Not Completed

Description

This measure assesses the number of patients who received VTE

prophylaxis or have documentation why no VTE prophylaxis was given

the day of or the day after the initial admission (or transfer) to the ICU

or surgery end date for surgeries that start the day of or the day after

ICU admission (or transfer).


Domain

Patient Safety









Yes

No

*Numerator: Patients who received VTE prophylaxis or

have documentation why no VTE prophylaxis was given:

the day of or the day after ICU admission (or transfer)

the day of or the day after surgery end date for

surgeries that start the day of or the day after ICU

admission (or transfer) .

*Denominator: Patients directly admitted or

transferred to ICU.

Percentage


12


Title VTE-3 VTE Patients with Anticoagulation Overlap Therapy Not Completed

Description

This measure assesses the number of patients diagnosed with

confirmed VTE who received an overlap of parenteral (intravenous [IV]

or subcutaneous [subcu]) anticoagulation and warfarin therapy. For

patients who received less than five days of overlap therapy, they must

be discharged on both medications or have a reason for

discontinuation of overlap therapy. Overlap therapy must be

administered for at least five days with an international normalized ratio

(INR) greater than or equal to 2 prior to discontinuation of the

parenteral anticoagulation therapy, discharged on both medications or

have a reason for discontinuation of overlap


Domain










Yes

No

*Numerator: Patients who received overlap therapy

(warfarin and parenteral anticoagulation):

Five or more days, with an INR greater than or equal to 2 prior to discontinuation of parenteral therapy, OR

Five or more days, with an INR less than 2 and discharged on overlap therapy, OR

Less than five days and discharged on overlap therapy, OR

With documentation of reason for discontinuation of overlap therapy, OR

With documentation of a reason for no

overlap therapy.

*Denominator: Patients with confirmed VTE who

received warfarin

Percentage


13


Title

VTE-4 VTE Patients Receiving Unfractionated Heparin (UFH) with

Dosages/Platelet Count Monitoring by Protocol (or Nomogram) Not Completed

Description


confirmed VTE who received intravenous (IV) UFH therapy dosages

AND had their platelet counts monitored using defined parameters

such as a nomogram or protocol.


Domain










Yes

No

*Numerator Patients who have their IV UFH therapy

dosages AND platelet counts monitored according to

defined parameters such as a nomogram or protocol

*Denominator: Patients with confirmed VTE receiving IV

UFH therapy.

Percentage


14


Title VTE-5 VTE discharge instructions Not Completed

Description


confirmed VTE that are discharged to home, home care, court/law

enforcement or home on hospice care on warfarin with written

discharge instructions that address all four criteria: compliance issues,

dietary advice, follow-up monitoring, and information about the

potential for adverse drug reactions/interactions


Domain










Yes

No

*Numerator: Patients with

documentation that they or their caregivers were given written discharge instructions or other educational material about warfarin that addressed all of the following: 1. compliance issues 2. dietary advice 3. follow-up monitoring

4. potential for adverse drug reactions and

interactions.

*Denominator: Patients with confirmed

VTE discharged to home or court/law

enforcement on warfarin therapy.

Percentage


15


Title VTE-6 Incidence of potentially preventable VTE Not Completed

Description


confirmed VTE during hospitalization (not present at admission) who

did not receive VTE prophylaxis between hospital admission and the

day before the VTE diagnostic testing order date.


Domain

Patient Safety









Yes

No

*Numerator: Patients who received no VTE prophylaxis

prior to the VTE diagnostic test order date.

*Denominator: Patients who developed confirmed

VTE during hospitalization.

Percentage


16


Title AMI-2-Aspirin Prescribed at Discharge for AMI Not Completed

Description AMI patients who are prescribed aspirin at hospital discharge


Domain










Yes

No

*Numerator: Acute Myocardial Infarction patients

who are prescribed aspirin at hospital discharge.

*Denominator: All AMI patients age 18 and

older with an ICD-9- CM Principal Diagnosis

Code for Acute Myocardial Infarction. Percentage


17


Title Elective Delivery Prior to 39 Completed Weeks Gestation Not Completed

Description Patients with elective vaginal deliveries or elective cesarean sections

at >= 37 and < 39 weeks of gestation completed.


Domain










Yes

No

*Numerator: Patients with elective deliveries.

*Denominator: Patients delivering newborns

with >= 37 and < 39 weeks of gestation

completed

Percentage


18


Title

AMI-7a Fibrinolytic Therapy Received Within 30 minutes of Hospital

Arrival Not Completed

Description

Acute myocardial infarction (AMI) patients with ST-segment

elevation or LBBB on the ECG closest to arrival time receiving

fibrinolytic therapy during the hospital stay and having a time from

hospital arrival to fibrinolysis of 30 minutes or less.


Domain










Yes

No

*Numerator AMI patients whose time from hospital

arrival to fibrinolysis is 30 minutes or less.

*Denominator: AMI patients age 18 and older

with ST-elevation or LBBB on ECG who received

fibrinolytic therapy with an ICD-9- CM Principal

Diagnosis Code for AMI AND ST-segment

elevation or LBBB on the ECG performed closest

to hospital arrival AND Fibrinolytic therapy within

6 hours after hospital arrival AND Fibrinolytic

therapy is primary reperfusion therapy.

Percentage


19


Title AMI-8a Primary PCI Received Within 90 Minutes of Hospital Arrival Not Completed

Description

Acute myocardial infarction (AMI) patients with ST-segment elevation or LBBB on the ECG closest to arrival time receiving primary PCI during the hospital stay with a time from hospital arrival to PCI of 90 minutes or less


Domain










Yes

No

*Numerator: AMI patients whose time

from hospital arrival to

primary PCI is 90 minutes or less. *Denominator: Principal diagnosis of

AMI (International Classification of Diseases, 9th revision, Clinical Modification [ICD-9-CM] principal diagnosis code: 410.00, 410.01, 410.10, 410.11, 410.20, 410.21, 410.30, 410.31, 410.40, 410.41, 410.50, 410.51, 410.60, 410.61, 410.70, 410.71, 410.80, 410.81, 410.90, 410.91); and PCI procedure ICD-9-CM principal or other procedure code for PCI: 00.66; and AMI patients age 18 and older with ST-elevation or LBBB on ECG who received primary PCI with an ICD- 9-CM Principal Diagnosis Code for AMI AND PCI (ICD-9-CM Principal and Other Procedure Codes for PCI) AND ST-segment elevation or LBBB on the ECG performed closest to hospital arrival; and PCI performed within 24 hours after hospital arrival. .

Percentage


20


Title AMI-10 Statin Prescribed at Discharge Not Completed

Description Acute Myocardial Infarction (AMI) patients who are prescribed a

statin at hospital discharge.


Domain










Yes

No

*Numerator: AMI patients who are prescribed a statin

medication at hospital discharge .

*Denominator: AMI patients .

Percentage


21


Title

Initial Antibiotic Selection for Community-Acquired Pneumonia (CAP)

in Immunocompetent Patients Not Completed

Description PN-6 Initial Antibiotic Selection for Community-Acquired

Pneumonia (CAP) in Immunocompetent Patients.


Domain










Yes

No

*Numerator 1: Immunocompetent ICU patients with

Community-Acquired Pneumonia patients who received an

initial antibiotic regimen consistent with current guidelines

during the first 24 hours of hospitalization.

*Denominator 1: Pneumonia patients 18 years

of age and older with an ICD-9-CM Hospital

Measures- Principal Diagnosis Code of

pneumonia, OR ICD-9-CM Hospital Measures-

Principal Diagnosis Code of septicemia or

respiratory failure (acute or chronic) and also a

secondary ICD-9-CM Other Diagnosis Code of

pneumonia, and abnormal findings on chest x-ray

or CT scan of the chest within 24 hours prior to

hospital arrival or during the hospitalization.

Percentage

*Numerator 2: Immunocompetent non-ICU

patients with Community-Acquired Pneumonia

patients who received an initial antibiotic regimen

consistent with current guidelines during the first

24 hours of hospitalization.

*Denominator 2: same as Denominator 1.

Percentage


22


Title

SCIP-INF-1 Prophylactic Antibiotic Received within 1 Hour Prior

to Surgical Incision Not Completed

Description

Surgical patients with prophylactic antibiotics initiated within

one hour prior to surgical incision. Patients who received

Vancomycin or a Fluoroquinolone for prophylactic antibiotics

should have the antibiotics initiated within 2 hours prior to

surgical incision. Due to the longer infusion time required for

Vancomycin or a Fluoroquinolone, it is acceptable to start

these antibiotics within 2 hours prior to incision time National Quality Strategy

Domain

Patient Safety









Yes

No

*Numerator: Number of surgical patients with

prophylactic antibiotics initiated within one hour prior to

surgical incision (two hours if receiving vancomycin or a

fluoroquinolone.

*Denominator 1 : All selected surgical patients 18 years

of age and older with no evidence of prior infection with an

ICD-9- CM Principal Procedure Code of Coronary artery

bypass graft (CABG) procedures.

Percentage

Denominator 2: All selected surgical patients 18 years of

age and older with no evidence of prior infection with an

ICD-9- CM Principal Procedure Code of Other cardiac

surgery.

Percentage



ICD-9- CM Principal Procedure Code of Hip arthroplasty.

Percentage



ICD-9- CM Principal Procedure Code of knee arthroplasty.


Percentage



ICD-9- CM Principal Procedure Code of colon surgery.

Percentage



ICD-9- CM Principal Procedure Code of Abdominal

hysterectomy.

Percentage



ICD-9- CM Principal Procedure Code of Vaginal

hysterectomy.



ICD-9- CM Principal Procedure Code of Vascular surgery.

Percentage


23


Title SCIP-INF-2 Prophylactic Antibiotic Selection for Surgical Patients Not Completed

Description Surgical patients who received prophylactic antibiotics consistent

with current guidelines (specific to each type of surgical procedure


Domain










Yes

No

*Numerator: Number of surgical patients who

received recommended prophylactic antibiotics for

their specific surgical procedures.

*Denominator 1 : All selected surgical patients 18 years

of age and older with no evidence of prior infection with an

ICD-9- CM Principal Procedure Code of Coronary artery

bypass graft (CABG) procedures.

Percentage



ICD-9- CM Principal Procedure Code of Other cardiac

surgery.

Percentage



ICD-9- CM Principal Procedure Code of Hip arthroplasty.

Percentage



ICD-9- CM Principal Procedure Code of knee arthroplasty.

Percentage



ICD-9- CM Principal Procedure Code of colon surgery.


Percentage



ICD-9- CM Principal Procedure Code of Abdominal

hysterectomy.

Percentage



ICD-9- CM Principal Procedure Code of Vaginal

hysterectomy.

Percentage



ICD-9- CM Principal Procedure Code of Vascular surgery.

Percentage


24


Title

SCIP-INF-9 Urinary catheter removed on Postoperative Day 1

(POD1) or Postoperative Day 2 (POD2) with day of surgery

being day zero Not Completed

Description

Surgical patients with urinary catheter removed on

Postoperative Day 1 or Postoperative Day 2 with day of

surgery being day zero.


Domain

Patient Safety









Yes

No

*Numerator: Number of surgical patients whose

urinary catheter is removed on POD 1 or POD 2 with

day of surgery being day zero.

*Denominator: All selected surgical patients 18 years

of age and older with a catheter in place

postoperatively with an ICD-9-CM Principal

Procedure Code of selected surgeries. Percentage


25


Title

ED-3 Median time from ED arrival to ED departure for discharged ED

patients Not Completed

Description

Median time from emergency department arrival to time of

departure from the emergency room for patients discharged from

the emergency department


Domain

Care Coordination









Yes

No

*Numerator 1: Median time (in minutes) from ED arrival

to ED departure for patients discharged from the

emergency department – all patients.

*Denominator 1 : All patients discharged from the ED.

Percentage



emergency department – all patients with a diagnosis

consistent with Mental Disorders.

*Denominator 2 : All patients discharged from the ED .

with a diagnosis consistent with Mental Disorders.

Percentage



emergency department to another Acute Care Hospital.

*Denominator 3 : All patients discharged from the to

another Acute Care Hospital.

Percentage


26


Title

Home Management Plan of Care (HMPC) Document Given to

Patient/Caregiver Not Completed

Description

An assessment that there is documentation in the medical record

that a Home Management Plan of Care document was given to the

pediatric asthma patient/caregiver.


Domain










Yes

No

*Numerator: Pediatric asthma inpatients with

documentation that they or their caregivers were given a written HMPC document that addresses all of the following: 1. Arrangements for follow-up care 2. Environmental control and control of other triggers 3. Method and timing of rescue actions 4. Use of controllers

5. Use of relievers.

*Denominator: Pediatric asthma inpatients

with an age of 2 through 17 years, length of stay

less than or equal to 120 days, and discharged

to home or police custody.

Percentage


27


Title Exclusive Breast Milk Feeding Not Completed

Description Exclusive breast milk feeding during the newborn's entire

hospitalization


Domain










Yes

No

*Numerator Newborns that were fed breast milk only

since birth.

*Denominator Single term newborns

discharged from the hospital who have no

diagnosis of galactosemia, no procedure of

parenteral infusion, no diagnosis of premature

newborn, and length of stay less than or equal

to 120 days.

Percentage


28


Title Healthy Term Newborn Not Completed

Description

Percent of term singleton live births (excluding those with

diagnoses originating in the fetal period) who DO NOT have

significant complications during birth or in nursery care


Domain

Patient Safety









Yes

No

*Numerator The absence of

conditions or procedures reflecting morbidity that

happened during birth and nursery care to an otherwise

normal infant.

*Denominator singleton, term (>=37 weeks),

inborn, live births in their birth admission. The

denominator further has eliminated fetal

conditions likely to be present before labor.

Maternal and obstetrical conditions (e.g.,

hypertension, prior cesarean, malpresentation)

are not excluded unless evidence of fetal effect

prior to labor (e.g., IUGR/SGA).

Percentage


29


Title EHDI-1a Hearing screening before hospital discharge Not Completed

Description This measure assesses the proportion of births that have been

screened for hearing loss before hospital discharge


Domain










Yes

No

*Numerator All live births during the measurement

time period born at a facility and screened for hearing

loss prior to discharge, or screened but still not

discharged; or not screened due to medical reasons or

medical exclusions.

*Denominator All live births during the

measurement time period born at a facility and,

discharged without being screened, or screened

prior to discharge, or screened but still not

discharged.

Percentage


Example of an Eligible Hospital meeting the required Stage 2 Clinical Quality Measures

Example of an Eligible Hospital who did not meet the Stage 2 minimum required Clinical

Quality Measures.


EH Review and Attestation


The next two screens are used for both EP s and EHs.

Application Certification - This is the screen on which the applicant certifies all the data is correct.

Clicking Submit will signal the system that a new/updated application has been submitted. An email will

be sent to the provider and DHH by Molina


Confirmation of Submission – after the EP completes the Application Certification and clicks

“Save and Submit”, the following screen is presented:

4.3.10 Calculating EP Payments

The Incentive payment formulas have been designed to calculate the payment amounts in

accordance with 42.CFR parts 412, 413, 422, and 495. After review of the attestation verifying

the EP meets all of the qualification for the Incentive Payment, they will receive $21,250 if first

year (AIU) and $8,500 years 2 – 6 (MU). Pediatricians with a Medicaid patient volume of 20-

29% will receive two-thirds of the $21,250, or $14,167 the first year (AIU) and $5,667 for year 2

– 6 (MU). Louisiana Medicaid will verify that the EP does not receive more than this amount by

sending a B16 file to the NLR to authorize the payment. The provider will then be prompted to

attest to the accuracy of the information provided and to upload the completed worksheet for

audit purposes.

4.3.11 Payments to Eligible Providers through Managed Care Plans

This requirement does not apply because LA Medicaid plans to pay incentive payments to

managed care providers directly, the same for providers not in managed care. Managed care

providers will need to enroll with LA Medicaid in order to participate in the LA EHR Program.


4.3.12 Calculating EH Payments

The Incentive payment formulas, built onto the EH Payment Calculator, have been designed to

calculate the payment amounts in accordance with 42.CFR parts 412, 413, 422, and 495. EHs

will be required to input data from the completed EH Incentive Payment worksheet that will be

used to determine the Medicaid aggregate EHR incentive amount. Incentive payments to EHs

will be disbursed over a period of four (4) years. Payments will be disbursed as follows: 50% in

year 1, 30% in year 2, 10%, in years 3 and 4. The provider will then be prompted to attest to the

accuracy of the information provided and to upload the completed worksheet for audit purposes.

4.3.13 Application Review

The system will notify the Medicaid Program Monitor (PM) when an application has been

submitted. The PM will log in to the system and review the information and supporting

documentation for completeness. Pending a complete application, the PM will issue an approval

which will trigger the creation of a D16 file to be generated and sent to CMS. Louisiana

Medicaid will be checking prior to distributing payments to ensure that providers who are

excluded per the State do not receive incentive payments. This will be done by the Medicaid

Program Monitor. In the event of an incomplete or disqualifying application, the PM will notate

in the system the reason for denial. The provider will be automatically notified via email of the

results of the application review. In the event of a denial, the provider will be directed to return

to the Louisiana Medicaid EHR incentive payment website for denial reason and will receive

instructions on how to resubmit deficient information or to proceed with the appeal process, if

desired.

This is the Menu page for the DHH read-only users via the SPT (LMMIS Inquiry). They will

first have to log into the SPT system and then click on the “LAConnect - EHR” to arrive at this

page.



Main Menu:

Clicking on EHR Case Inquiry displays this screen:


The user will complete the criteria needed (none are mandatory) and click “Search” to proceed.

This screen will allow the DHH user to view the attestation information submitted by the

provider. A “Yes” in the Attachments column will show whether or not (YES/NO) the provider

uploaded any supporting documents. Clicking on “Yes” will allow the DHH user to select and

then view these documents individually.The same applies to the Notes column. Clicking on the

“View Report” will display the information entered during the attestation

4.3.14 Attestation Use Cases

The details of the attestation process and review are noted in the previous sections, however, the

following two uses cases are presents as a summary of the process:

Scenario A: EP successfully registers and receives payments.

Steps Provider Back End

1 EH registers with the NLR. NLR sends the state a B6 file

via ConnectDirect notifying LA

Medicaid of EP or EH

registration.



2 EH is notified by the NLR with

login information.

EH downloads and completes the

EP & EH Patient Volume WS and

the EH Incentive Payment WS.

Registrant data in the B6 will

be verified.

A B7 will be generated with

validation results and sent to

CMS via ConnectDirect.

3 EH registers on the LA Medicaid

Incentive Program website.

Completes state-side application and

attests to the accuracy of the

information provided.

EH is automatically notified via e-

mail confirming the application

submission. They are notified of the

10 business day application

processing.

Program monitor is notified via

e-mail.

4 EP waits maximum of 10 business

days.

Program monitor verifies the

EP’s information and approves

the application.

5 EP is notified of application

acceptance.

D16 is automatically generated

and sent to CMS.

6 CMS verifies information in

the D16.

7 EHR incentive system will

generate a payment file.

8 Payment file is posted weekly

on Fridays to an FTP site

dedicated to DHH’s Standard

Payment System.

9 The DHH SPS processes the

payment file and creates an

export file that contains check

register information.

10 EP receives payment. The file is processed and the

check is submitted

11 A D18 verification file is



automatically generated and

sent to CMS

Scenario B: EP is denied and submits deficient information.

Step Provider Back-End

1-3 Add steps from scenario A. Add steps from Scenario A.

4 EH waits maximum of 10 business

days.

Program monitor reviews the

EH’s information and denies

the application due to

deficient information.

5 EH automatically notified of

application denial.

EH is instructed to return to the EHR

incentive payment website for denial

reason and instructions for further

steps.

Provider decides to appeal.

6 Within 15 days, EH submits written

request for an informal hearing.

State reviews the request for

consideration and determines

whether a hearing is

necessary.

7 EH receives an e-mail with date,

time, and location of the informal

hearing.

The State approves the EH’s

request and notifies the EH.

8 EH attends hearing. Case is reviewed.

9 EH receives notification of hearing

results in writing. EH is denied and

decides to request an administrative

appeal.

10 Within 30 days, EH submits an

administrative appeal request.

State reviews the case and

determines whether or not the

EH request will be accepted.


4.3.15 Requirements and High-Level Design – Detailed Systems Design (RAHD-DSD)

The current EHR Incentive Payment program is being revised for changes as defined by CMS.

The changes required for the 2013 attestation rules were implemented May 1, 2013 and are

currently in operation.


Figure 4.3-1. Conceptual diagram of the EHR Incentive Payment System


4.4 Provider Appeals Process

4.4.10 Provider Informal Dispute Resolution and Administrative Appeals Process

Once the EP or EH has completed the application and attestation process with LA Medicaid, the

application is reviewed by the Program Monitor (PM) for completeness. The PM will render a

decision based on the information provided. The EP or EH will receive an email from the state

EHR incentive system notifying them of deficiencies (i.e., EHR system not meeting 100%

certification criteria, and insufficient documentation submitted). Providers may also be directed

to return to the provider portal if the State has not received notice from the NLR of completed

registration. Upon receipt of complete submissions, a final determination will be rendered.

Louisiana Medicaid may deny an EP or EH for the following reasons:

Eligibility

Insufficient Medicaid Patient Encounter Volume

Failure to adopt, implement or upgrade certified EHR technology

Failure to demonstrate meaningful use of certified EHR technology

Louisiana Medicaid may adjust prior year incentive payments during the next consecutive

payment year for the following reasons:

Submission of updated calculation data

An audit being performed by DHHs Program Integrity Section

Recoupment


4.4.11 Informal Dispute Resolution Process

An EP or EH who has received a denial notice, may informally dispute the decision by

submitting a written request (email) within 30 calendar days of the notice. The request shall:

Identify in the Subject Line “EHR Decision Dispute”

Clearly identify the EH or EP and Provider #

Clearly identify the issue being disputed

Include supporting documentation

The Program Monitor, within 10 business days of receipt of the email, will conduct a review of

the submitted documentation. The Department will allow 10 business days for the EP or EH to

submit any additional documentation. A final decision will be rendered no more than 30 business

days from the initial date of receipt of the dispute email from the provider.

4.5.1 Notice of Informal Dispute Resolution Decision

Upon final review of the disputed issue, the Department shall inform the EP or EH in writing of

the decision rendered, and their right to file an administrative appeal if they disagree with the

decision. The notice of decision from the informal dispute resolution shall be signed by the

Medicaid Director, the original mailed to the EP or EH, and a copy sent via email.

4.5.2 Administrative Appeal

The EP or EH may seek an administrative appeal from the final informal dispute resolution

decision. The request for an administrative appeal must be submitted in writing to the Division of

Administrative Law within 30 calendar days of receipt of the denial notice or dispute resolution

decision.

The request shall:

Identify “EHR Decision Appeal”


Clearly identify the EH or EP and Provider #

Clearly identify the issue being appealed

Include supporting documentation

Provide the name, mailing address, and telephone number of individuals who are

expected to attend the hearing

The request must be mailed to the following address:

Division of Administrative Law – HH Section

P.O. Box 4189

Baton Rouge, LA 70821-4189

Ph.: (225)342-0443

Fax: (225)219-9823

An applying entity may not file a request for an administrative appeal prior to receiving the

Department‘s written notice of the informal dispute resolution decision.

If the applying entity is not satisfied with the final administrative appeal decision, it may seek

judicial review by filing a petition for review of the decision in the 19th Judicial District Court

for East Baton Rouge Parish, Louisiana.

A timely filed request for an administrative appeal shall not stay activities by the department

pertaining to the adjustment of prior year payments until the administrative appeal process,

including any judicial review proceeding, is final.


4.5 Segregation of HIT Federal Funding

Louisiana has established separate cost center accounts for the ARRA Provider Incentive

Payments (100% FFP) and for the administrative functions associated with developing programs

such as planning, development, implementation and outreach (90% FFP)

4.6 Verify Incentive Payments

Louisiana is encouraging providers via an aggressive provider outreach and education program,

to participate in the Incentive Payment Program, with the overall State goal of adopting and

meaningfully using certified EHR technology. Those interested EPs and EHs adopting certified

EHR technology will register with the NLR voluntarily to participate in Louisiana’s Medicaid

Incentive Program.

In order to ensure the legitimacy of Providers, the application process also involves:

Cross-checking provider information between state and federal data bases to ensure

applicants are currently active, are not under any sanction, and the payee information

(NPI/TIN combination; verification of group entities) is verified

Obtaining relevant information to verify applicant eligibility such as a patient encounters,

EHR system description, etc. – all of which will be submitted through applicable

spreadsheets and supporting documentation

Online attestation of the accuracy and validity of the information submitted

Regular auditing to ensure the accuracy of the payments and applicants’ information.

This will entail reviews of attestation and payments in place that will be processed out of

a random set of Providers.

Louisiana Medicaid has relayed the payment methodology information to the Providers through

the State by the web, forums and collaborative outreach with the REC.

Also, the state will conduct post-payment audits: The audit plan is described in detail in the

following section (4.7).


4.7 Audit Process

Louisiana Medicaid will submit the 2014 Audit Strategy separately from the SMHP.

4.7.10 Methods for Recoupment of EHR Incentive Overpayments

In the case that Medicaid Program Integrity (or other designated entity) makes a determination

that an erroneous payment occurred and the applying entity was overpaid, a demand/recoupment

letter shall be sent to the applying entity at the mailing address on file from the provider

enrollment information. The letter will contain detailed steps on how to repay the amount due

and directions regarding their right to file an appeal. Louisiana Medicaid will utilize their

existing recoupment process for future improper payments.

4.7.11 Payment Adjustment Reasons:

Adjustments may be made on receipt of an audited cost report which changes payment

calculation data.

Payments may be recouped on receipt of information from Medicare that meaningful use

was not attained during the specific year (if dual hospital).

Payments may be recouped based on State audit findings (i.e. doesn’t meet meaningful use,

insufficient patient volume, etc.).

4.8 Privacy and Security Plan

Louisiana's EHR Incentive Program’s Privacy and Security Plan will conform to all HITECH

and HIPAA privacy and security requirements. Because Louisiana's EHR Project will be

modeled after existing Pay for Performance (P4P) program features, it will utilize existing

privacy and security plans that already meet the privacy and security requirements. Providers

will use Molina’s Provider web site, under the secured applications area. This web site uses

secured sockets layer (SSL) via Verisign to encrypt transmissions bi-directionally and uses a 3


token account (provider ID, login, and password) to secure individual provider access. DHH

will use the secured intranet LMMIS Inquiry web site.


5. COMMUNICATION PLAN

Objective Statement – Louisiana Medicaid is committed to implementing the provisions of the

American Recovery and Reinvestment Act (ARRA) by providing incentive payments to eligible

Medicaid providers and hospitals for adopting and meaningfully using certified electronic health

record (EHR) technology. Furthermore, Louisiana Medicaid is committed to working closely

with the Medicaid provider community, the public, internal and external stakeholders and the

media to promote awareness of the progress made toward providing incentives.

Summary Statement – The purpose of the Louisiana Medicaid EHR Incentive Payment

Program is to facilitate the adoption and meaningful use of certified electronic health record

(EHR) technology through financial incentives to eligible Medicaid providers and hospitals. By

doing so, the program intends to leverage these technologies to improve health outcomes,

facilitate access, simplify care and reduce costs of health care nationwide by:

Enhancing care coordination and patient safety

Reducing paperwork and improving efficiencies

Facilitating information sharing across providers, payers, and state lines

Enabling communication of health information to authorized users through state Health

Information Exchanges (HIEs) and the National Health Information Network (NHIN).

The Louisiana Department of Health and Hospitals is proposing to transform the Medicaid

program, moving toward a system that is more effective at managing patients’ care, while

providing more incentives to providers. The health department is holding a statewide outreach

program for this as part of the Making Medicaid Better initiative, and the early phases of

outreach are aimed directly at providers. This presents a unique opportunity the state’s EHR

incentive payment program can capitalize on to coordinate outreach to the provider community,


particularly since EHR adoption is one of the standards providers will be asked to meet as the

Making Medicaid Better proposal moves forward.

The following are strategies Louisiana Medicaid intends to use in informing the provider

community of the State’s EHR incentive payment program.

Objectives:

Maintain current website targeting Medicaid enrolled providers regarding EHR incentives

(www.lamedicaid.com/ehrincentives/)

Enhance the web presence of the Louisiana Medicaid EHR incentive payment program

using the existing “Making Medicaid Better” website for targeted outreach to providers

while working toward the creation of a HIT Department page that prominently features

program information

Work with the DHH director of Media and Communications to develop communication

approach to keep stakeholders informed of progress and to ensure that all information is

shared amongst stakeholders in a consistent manner.

Tactics

Louisiana Medicaid is currently implementing the Medicaid Specialist Outreach Initiative,

which is modeled after a program in New Jersey. The initiative will allow Louisiana’s

REC, Louisiana Health Care Quality Forum (LHCQF) to provide technical and

consultative support to Medicaid specialists. Prior to this initiative, LHCQF was able to

provide federally-funded services to only Medicaid primary care physicians. Through this

initiative, Louisiana Medicaid will provide services through the LHCQF to Medicaid

specialists. As outlined in the Cooperative Endeavor Agreement between Louisiana

Medicaid and LHCQF, Louisiana Medicaid will provide payment to the LHCQF based on

http://www.lamedicaid.com/ehr


the achievement of established milestones as shown below. The performance-based

payment methodology mimics that used by ONC for the existing program.

Provide educational information and outreach to key publics via available media:

Website (MakingMedicaidBetter.com and, later, to-be-developed Health IT Web site)

News releases

Printed materials: “Making Medicaid Better” filers, postcard mail out to enrolled Medicaid

providers through fiscal intermediary

“Making Medicaid Better” Forums and community meetings

(http://new.dhh.louisiana.gov/index.cfm/page/42)

E-mail distribution through the Making Medicaid Better database of more than 14,000

Medicaid health providers and organizations

Social media (Department’s available social media include Facebook, Twitter and blogs)

“Making Medicaid Better” e-newsletter, issued weekly to providers and other stakeholders

Identify barriers the EP &EH community may face (i.e. cost, security/privacy concerns,

lack of technical knowledge, time concerns, mindset, etc) to address these concerns

through messaging and encourage adoption of EHR technology.

Statement of success measurement – The ultimate goal is to have all of Louisiana’s enrolled

EPs and EHs participate in the program and receive incentive payments for the adoption and

meaningful use certified electronic health record (EHR technology). As the program is

implemented, we will measure and report on provider participation against this goal as we track

adoption. The measures were anticipated to begin in January 2011, but due to delays in the

contract approval process, this initiative was launched in FFY 14.. As we progress toward

implementation and enrollment, the following will serve as measurement indicators that this


communications plan is successful in reaching the target audience (Medicaid provider

community):

Increased inquiries to state’s EHR Incentive Payment Program manager

Increased e-mails/comments submitted regarding this program through the Department

Web site

Distribution/interest in printed flier about the program at Making Medicaid Better Forums

5.3 Call Center Assessment

Louisiana Medicaid has an EHR Incentive Payment Call Center staff to answer any questions

providers may have concerning the EHR Incentive Payment Program goes live. . Louisiana

Medicaid operates its EHR Incentive Payment Call Center using existing Medicaid staff.

6. STATE HIT ROADMAP

6.3 HIT Pathway

Provide CMS with a graphical as well as narrative pathway that clearly shows where the SMA is starting

from (As-Is) today, where it expects to be five years from now (To-Be), and how it plans to get there.

On June 9, 2011, the Department awarded a contract to Client Network Services Incorporated

(CNSI), a Maryland-based health care technology services company to replace the state’s current

MMIS and fiscal agent operations. The contract was canceled on March 21, 2013 due to the

discovery of issues arising from the procurement process and subsequent implementation of the

contract. The State is presently undergoing a full review of that procurement.

Despite the cancellation of the contract, DHH is required to submit a plan to comply with the

Centers for Medicare & Medicaid Services (CMS) Seven Conditions and Standards (MITS-11-


01-v1.0, April 2011) by June 2014. DHH sought the guidance of CMS and the State’s Division

of Administration (DOA) to evaluate available options and determine the path forward. As a

result of these discussions, the State is seeking to procure a modernized MMIS and associated

Enterprise Architecture components based on an approach that complies with the CMS Seven

Conditions and Standards (MITS-11-01-v1.0, April 2011).

Medicaid’s Eligibility and Enrollment (E&E) system will also be modernized and will leverage

the shared Enterprise Architecture.

6.4 Current Landscape

6.5 Overview

Molina Medicaid Solutions, the current fiscal intermediary, and its corporate predecessors, have

operated the Louisiana MMIS since January 1, 1984. The landscape of Louisiana Medicaid has

significantly changed over the past couple of years. Louisiana Medicaid has introduced managed

care in multiple forms. The following is a snap shot in time of Medicaid as of June 30, 2013:

Pre-paid (at risk) component, three plans service the medical needs of approximately 437,000

individuals; Shared savings plan, two plans service the prior authorization and the preprocessing

of claims for approximately 460,000 individuals; Behavioral health component, one plan

provides the mental health care needs for approximately 1 million individuals; the number of

fee-for-service Medicaid recipients were approximately 369,000. With the introduction of

managed care we have seen a decrease in fee-for-service claims and a rise in encounters. In State

Fiscal Year 2013, approximately 42.3 million Fee-for-Service claims were processed and

approved for a total of nearly $5.6 billion in provider payments. An additional 16.2 million

encounter claims that year were processed and approved with the implementation of the

Department’s Managed care initiatives, Bayou Health in February 2012 and the Louisiana

Behavioral Health Partnership in March 2012. With a phased implementation of Bayou Health


starting in February 2012, these statistics are not completely representative of the State’s new

service delivery model. The State estimates that approximately 70% of enrollees were in a

Bayou Health Managed Care Plan, as of June 2013. In SFY 2013 Louisiana Medicaid had 1.4

million unduplicated eligibles. The MMIS maintains recipient eligibility and claims data for

nearly 2.6 million individuals. The fiscal intermediary enrolls and the MMIS maintains data on

approximately 34,661 qualified Medicaid providers, including submitters and providers who are

prescribing only from a health plan.

6.6 Challenges

The current Louisiana MMIS has over forty (40) components distributed across multiple

platforms and software applications. This fragmented environment has limited Medicaid’s

ability to respond in times of crisis as well as comply with regulatory changes.

The Department has concluded that the current MMIS system configuration does not

adequately or efficiently address the vision for the Louisiana Medicaid Enterprise.

• The current MMIS has hard coded logic that must be changed by technical staff. New

systems are easier to maintain since they are more table driven or rules based. This

means that nontechnical staff can make changes resulting in decreased costs to

maintain system or make changes;

• Limitations of current system have caused Medicaid to invest dollars in stovepipe

systems and/or workarounds because the current MMIS cannot easily support the new

functionality or cannot be changed timely. Those systems and/or workarounds

sometimes only meet the minimal needs while increasing costs for maintaining data

in multiple places which will be synchronized or exchanged;

• Current system has limited documentation for the data models. The learning curve for

new staff to become familiar with the MMIS is lengthy and Louisiana has not started

a knowledge transfer;

• Ability to generate ad hoc or new management reports is limited to a select number of

persons who have knowledge of the system and data. In most instances, the data

resides in multiple databases and data may differ depending on the person creating

the report and where the data was obtained;


• Many processes within Medicaid are paper intensive because of system limitations. A

new system would allow users to enter data directly. This would reduce the number

of manual processes;

• The current system is limited in the data elements and/or historical data that can be

maintained to support Medicaid operations during disasters. The ability to easily turn

on/off specific edits to support disaster related claims processing does not exist. As

such, Medicaid is required to turn on/turn off more edits than required. This can

result in higher claim costs;

• Cost avoidance programs must be maintained outside the core MMIS. Newer technology

would allow the State to implement fraud and overpayment detection systems that

would be integrated into the MMIS, which would greatly increase the ability of the

State to avoid improper payments;

• Current system requires long development periods, has a high total cost of operations,

and few reusable modules. These are contrary to the current CMS objectives.

6.7 Design and Architecture Objectives

The Department’s goal is to modernize the MMIS with the information management tools and

business processes that can assist in managing the program in an era of rapid transformation of

the healthcare delivery systems.

Raising the MITA maturity from the current level 1 is a big step up in the direction of reducing

paper based processes, manual editing, and increased automation. Modular approach to

architecture, the use of rules engines for establishing edits, the use of MITA structured interfaces

to exchange data within and external to the organization, centralized data repositories all create

an environment where personnel have sufficient data to analyze their programs, perform daily

work efficiently, and create opportunities to establish and meet goals to improve care to

Medicaid clients. Attainment of higher MITA maturity levels require solid policy guidance,

flexible system architecture, adequate data storage, user-based data access, and a strong

commitment to using standards to their best advantage.


The Department will need to procure new information technology to replace the 29-year-old

MMIS, modernize the business processes, and procure a set of more effective professional

services. The Department has established the following objectives that are the key drivers for the

modernization:

System Implementation Timelines;

Maximizing Enhanced Federal Funding;

Ensuring Louisiana will comply with the CMS Seven Conditions & Standards;

Integration with other statewide systems (E&E in particular);

Performance-based Service Levels for Services;

Obtaining Federal Certification;

Louisiana will strive to involve stakeholders in the development, implementation and change

process. Stakeholders include CMS, Medicaid providers and associations, billing organizations,

Medicaid clients, sister State organizations and MMIS users.

Key business drivers for this effort include Affordable Care Act compliance, modernization of

the MMIS service delivery processes, and simplification of business processes which will

increase efficiency across the Medicaid landscape.

6.8 Roadmap to Modernization

The Road Map proposes a sequence of milestones for procurement of the components required to

achieve modernization objectives. This process is composed of four distinct procurements

designed to achieve specific objectives and the delivery of tangible work products which will be

contributory to the final MMIS Modernization solutions.

Completion of these deliverables will utilize the combined inputs and contributions from the

Department, DOA, and CMS in an advisory and consultative role, and external Contractors. The

Staff Augmentation Contractor will be requested to supply skilled resources to provide the


relevant value-added expertise required to supplement resource gaps, validate and document the

artifacts required to advance completion of the proposed procurement roadmap.



Figure 6.1-1 LMMIS and LaHIE Timelines

.

6.9 Annual Benchmarks for the Louisiana Medicaid’s goals

Describe the annual benchmarks for each of the SMA’s goals that will serve as clearly measurable

indicators of progress along this scenario.


As Louisiana Medicaid progresses with the system Modernization and process changes, more

information will be provided.

6.10 Annual Benchmarks for Audit and Oversight Activities

Please refer to the Audit Strategy, submitted separately.


APPENDIX A: Louisiana Hospital Information Technology

Survey 2010

May 18, 2010

Prepared for:

The Louisiana Health Care Quality Forum

Prepared by:

Mark L. Diana, MBA, MSIS, PhD

Introduction

The Louisiana Health Care Quality Forum (LHCQF), as the state designated entity for Louisiana

for activities of the HITECH Act provisions of the American Recovery and Reinvestment Act

(ARRA), is in the strategic planning stages of the Health Information Exchange cooperative

agreement with the Office of the National Coordinator (ONC). A key piece of the strategic

planning process is an environmental scan, which is a comprehensive collection of information

about the current state of health information exchange in Louisiana. This survey was conducted

as part of the overall environmental scan and is specifically focused on hospitals. The survey

collected information on hospitals information technology environment, including the status of

adoption of electronic records, awareness of the HITECH provisions, preparation for receipt of

incentive payments, and of participation in health information exchange. The survey was

developed in collaboratively by the LHCQF, the Louisiana Hospital Association (LHA), and the

state Medicaid Office.

Survey Methodology

The Louisiana Health Care Quality Forum (LHCQF) in cooperation with the Louisiana Hospital

Association (LHA) and the State Medicaid Office developed an online survey of hospital’s

information technology environment. The survey targeted primarily areas impacted by the

American Recovery and Reinvestment Act (ARRA) and its HITECH provisions.

The LHA developed the survey in an online survey tool, fielded the survey, and collected

responses. The survey was fielded for three weeks. The LHA sent initial notices of the survey

and three follow-up notices to its membership list of hospitals in an attempt to achieve a high

response rate.


The unit of analysis is the hospital. The sample consisted of the universe of the LHA list of

hospitals, which constituted 250 facilities in the state. Characteristics of these hospitals are

provided in Table 1.

Table 1: Hospital characteristics

All hospitals Responding

Hospitals

Non-responding

Hospitals

Responding Medicaid

Hospitals

Sample size 250 68 182 59

Licensed Beds (s.d.) 87 (113) 132 (124) 71 (104) 136 (125)

Staffed Beds (s.d.) 86 (128) 135 (146) 66 (114) 142 (152)

Tax status

-For profit

-Not for profit

-Government

121 (53%)

42 (18%)

66 (29%)

17 (25%)

18 (27%)

32 (48%)

104 (64%)

24 (15%)

34 (21%)

13 (22%)

16 (27%)

30 (51%)

System Affiliated

-Yes

-No

91 (36%)

159 (64%)

27 (40%)

41 (60%)

64 (35%)

118 (65%)

22 (37%)

37 (63%)

Geographic location*

-Urban

-Rural

203 (81%)

47 (19%)

57 (84%)

11 (16%)

146 (80%)

36 (20%)

49 (83%)

10 (17%)

Organizational Type

-General Med/Surg

-Specialty

-Children’s

-Acute Long-term Care

125 (50%)

82 (133%)

3 (1%%)

40 (16%)

57 (84%)

7 (10%)

1 (1%)

3 (4%)

68 (37%)

75 (41%)

2 (1%)

37 (20%)

53 (90%)

5 (8%)

1 (2%)

0 (0%)

* Hospitals were classified as located in an urban area if they were located in a metropolitan

statistical area.

There were 68 valid surveys returned, for an overall response rate of 27%. Response rates vary

by individual survey item, as not all respondents answered every question. Individual response

rates are noted in each items result. Only descriptive analyses are presented in this report.

Information Technology Personnel

Respondents were asked to provide the number of information technology (IT) staff they had

available, both on staff and contracted. There were 61 respondents to the staff question, and 50

respondents to the contract staff question. Results are given in Table 2.


Table 2: Information technology personnel

Mean Median SD Min Max

Staff (n = 61) 8.4 3 13.8 0 75

Contract (n = 50) 10.5 0 57.1 0 400

Four hospitals (6.5%) indicated they had no IT personnel on staff, and 31 hospitals (62%)

indicated they had no IT personnel on contract. One hospital indicated it had 400 staff on

contract through the parent hospital system.

Type of Internet Access

Respondents were asked what type of Internet access they have. Multiple responses were

allowed. A total of 68 hospitals responded to this question. Table 3 shows the numbers of types

of access hospitals indicated they have. Two hospital indicated they have no access, 30 indicated

they had one type of access, 20 indicated they had two types of access, 11 indicated they had

three types of access, four indicated they had four types of access, and 1 indicated they had five

types of access.

Table 3: Number of Internet access types

Types of Access Number of Hospitals Percent

0 2 3%

1 30 44%

2 20 29%

3 11 16%

4 4 6%

5 1 1%

Responses 68 99%

Table 4 indicates the specific types of Internet access hospitals have.

Table 4: Types of Internet access

Type of Access Number of Hospitals Percent*

DSL 25 37%

Cable 12 18%

Satellite 7 10%

T-1 42 62%

Fiber 27 40%


FiOS 1 1%

Other 10 15%

* Percentages add up to more than 100% because respondents were allowed to choose multiple

responses.

Table 5 indicates the other types of Internet access hospitals reported.

Table 5: Other types of Internet access

Type of Access Number of Hospitals Percent

Metro Ethernet 6 9%

OC3 1 1%

T-3 1 1%

DS3 1 1%

Wireless 1 1%

Impact of the ARRA incentives

Respondents were asked if they had assessed the impact and value of ARRA incentives. Table 6

shows the results.

Table 6: Assessed impact of ARRA incentives

No 18 28%

Yes 46 72%

Responses 64 100%

Pursuit of an EMR implementation incentive

Hospitals were asked if they were pursuing one or more EMR implementation incentives. Table

7 shows the results. Seventy hospitals responded to this item.

Table 7: Pursuing ARRA incentives

Response Number Percent*

Yes from Medicaid 27 40%

Yes from Medicare 34 50%

No 6 9%

Unsure 20 29%


* Percentages add up to more than 100% because respondents were allowed to choose multiple

responses.

Estimated Medicaid Share

Hospitals were asked to estimate their Medicaid share (they were provided with the formula to

make the calculation). There were 25 respondents to this item. Seventeen respondents indicated

they were unsure or did not know, and eight provided the estimate. Table 8 provides the results

of those eight responses.

Table 8: Estimated Medicaid share (millions of $)


Medicaid share (n = 8) 59.27 7.88 90.68 1.74 240


When hospitals will be ready to apply for Medicaid incentive payments

Table 9 indicates the dates that the 12 respondents to this question indicated that they would be

ready to apply for Medicaid incentive payments.

Table 9: Date ready to apply for Medicaid incentives

October 2010 1 8.3%

December 2010 1 8.3%

January 2011 1 8.3%

June 2011 2 16.6%

July 2011 3 25%

December 2011 1 8.3%

January 2012 1 8.3%

July 2012 1 8.3%

January 2013 1 8.3%

Respondents 12 100%

Management Information Systems

Respondents were asked about their management information systems. Table 10 indicates the

responses.

Table 10: Management information systems

Do not have one 1 1.64%

Integrated with EMR 31 50.82%

Stand alone system 25 40.98%

Unsure/Do not know 4 6.56%

Respondents 61 100%

EMR implementation

Respondents were asked to indicate the degree of EMR implementation in their hospitals. Table

11 shows the results. Combining the two responses that indicate an implemented EMR,

regardless of how well it works, suggests that approximately 25% (15 of 61) of hospitals have

implemented an EMR.

Table 11: Degree of EMR implementation

Considering an EMR, but no specific plans. 14 22.95%

Making plans and preparing to purchase. 14 22.95%

Not considering EMR implementation. 1 1.64%


Purchased and beginning to implement. 17 27.87%

Implemented but not working as expected. 6 9.84%

Implemented and works well. 9 14.75%

Respondents 61 100%

Current EMR Vendors

Respondents were asked to select the product name and version number of their current EMR

vendor. Results are listed in Table 12.

Table 12: Current EMR vendors

CPSI System 16 5 16.67%

Healthland, Inc. Clinical Information Systems (CIS) 9.0.0 5 16.67%

MEDITECH Advanced Clinical Systems Client Server 5.6 3 10%

Cerner Corporation Millennium PowerChart 2007 2 6.67%

Healthcare Management Systems, Inc. Version 7.0 2 6.67%

McKesson Provider Technologies Horizon Clinicals Suite ER 7.8.2 2 6.67%

Epic Systems Corporation Inpatient Clinical System Spring 2008 1 3.3%

Meditech Client Server 6.0 1 3.3%

MEDITECH Magic 5.6 1 3.3%

McKesson Horizon Patient Folder, Paragon Clinical Care Station, and Paragon Physician Portal 1 3.3%

McKesson Horizon Patient Folder 13.0 & Paragon Community 9.3 1 3.3%

McKesson Provider Technologies Horizon v. 10.1 1 3.3%

Medsphere OpenVistA 1 3.3%

Self-developed 1 3.3%

Siemens Invision with McKesson Pharmacy 1 3.3%

Siemens Medical INVISION Clinicals w/ Siemens Pharmacy and MAK v. 27.0/v24.0 1 3.3%

Siemens Medical MedSeries (MS4) Clinical Suite w/ Siemens Pharmacy 1 3.3%

Respondents 30 ≈100%

Status of recommended objectives

Respondents were asked to indicate their readiness to meet the EHR objectives issued by CMS

as a proposed set of final requirements in December 2009. If the requirements are adopted as

proposed, hospitals will be required to meet all of the objectives listed in the below matrix by the

end of 2012 in order to qualify for Phase 1 Medicare and Medicaid HIT incentive payments.


Respondents were instructed that meaningful use will require data associated with the objectives

to be in machine readable electronic form as discrete (or structured) data elements and that

scanned or dictated information is generally not machine readable. Table 13 summarizes the

results.


Table 13: Status of recommended meaningful use objectives.

Completely

implemented by

2011

Completely

implemented by

2012

Do not have resources

but considering after

2012

Unsure /

Don’t know

10% of all orders (any type) directly

entered by authorized provider (MD, DO, RN, PA, NP) through CPOE. (n = 30)

19 (63%) 9 (30%) 0 (0%) 2 (7%)

Implementation of drug-drug, drug-

allergy, and drug- formulary checks. (n = 30)

26 (87%) 1 (3%) 1 (3%) 2 (7%)

Maintain an up-to-date problem list of

current and active diagnoses based on ICD-9 or SNOMED. (n = 30)

19 (63.3%) 7 (23.3%) 1 (3.3%) 3 (10%)

Maintain active medication list (n = 30) 29 (97%) 1 (3%) 0 (0%) 0 (0%)

Maintain active medication allergy list. (n

= 30) 30 (100%) 0 (0%) 0 (0%) 0 (0%)

Record the following demographics

(preferred language, insurance type,

gender, race, ethnicity, date of birth, date

and cause of death in the event of mortality). (n = 30)

29 (97%) 1 (3%) 0 (0%) 0 (0%)

Record and chart the following vital signs

(height, weight, blood pressure, calculate

and display BMI, plot and display growth

charts for children 2-20 years, including

BMI). (n = 30)

25 (83.3%) 4 (13.3%) 1 (3.3%) 0 (0%)

Record smoking status for patients 13

years old or older. (n = 30) 25 (83.3%) 4 (13.3%) 1 (3.3%) 0 (0%)

Incorporate clinical lab test results into

EHR as structured data. (n = 30) 26 (87%) 2 (7%) 1 (3%) 1 (3%)

Generate lists of patients by specific

condition. (n = 29) 21 (72%) 3 (10%) 0 (0%) 5 (17%)

Report hospital quality measures to CMS

or the States. (n = 29) 22 (76%) 4 (14%) 0 (0%) 3 (10%)

Implement five clinical decision support

rules related to a high priority hospital

condition, including diagnostic test

ordering, along with the ability to track compliance of those rules. (n = 29)

10 (34%) 8 (28%) 5 (17%) 6 (21%)

Check insurance eligibility electronically

from public and private payers. (n = 30) 26 (87%) 2 (7%) 0 (0%) 2 (7%)

Submit claims electronically to public and

private payers. (n = 30) 28 (93.3%) 1 (3.3%) 0 (0%) 1 (3.3%)


Provide patients with an electronic copy of

their health information (including

diagnostic test results, problem list,

medication lists, allergies, discharge

summary, procedures), upon request. (n = 30)

14 (47%) 6 (20%) 4 (13%) 6 (20%)

Provide patients with an electronic copy of

their discharge instructions and procedures

at time of discharge, upon request. (n = 30)

16 (53%) 5 (17%) 4 (13%) 5 (17%)

Table 13: Status of recommended meaningful use objectives.

Completely

implemented by

2011

Completely

implemented by

2012

Do not have resources

but considering after

2012

Unsure /

Don’t know

Have capability to exchange key clinical

information (for example, discharge

summary, procedures, problem list,

medication list, allergies, diagnostic test

results), among providers of care and

patient authorized entities electronically.

(n = 30)

15 (50%) 6 (20%) 6 (20%) 3 (10%)

Perform medication reconciliation at

relevant encounters and each transition of care. (n = 30)

25 (83%) 2 (7%) 1 (3%) 2 (7%)

Provide summary care record of care and

referral. (n = 30) 19 (63%) 6 (20%) 2 (7%) 3 (10%)

Have the capability to submit electronic

data to immunization registries and

perform actual submission where required and accepted. (n = 30)

12 (40%) 5 (17%) 6 (20%) 7 (23%)

Have the capability to provide electronic

submission of reportable lab results (as

required by state and local law) to public

health agencies and actual submission where it can be received. (n = 30)

16 (53%) 5 (17%) 3 (10%) 6 (20%)

Have the capability to provide electronic

syndromic surveillance data to public

health agencies and actual transmission

according to applicable law and practice.

(n = 30)

10 (33.3%) 7 (23.3%) 4 (13.3%) 9 (30%)

Protect electronic health information

created or maintained by the certified EHR

technology through the implementation of appropriate technical capabilities. (n = 30)

25 (83%) 2 (7%) 0 (0%) 3 (10%)

Health Information Exchange Participation


Respondents were asked if they participated in any regional arrangements to share electronic

patient level clinical data through an electronic health information exchange. The responses are

summarized in Table 14.

Table 14: Health information exchange participation

Participate and exchange data with organizations within Louisiana 12 40%

Participate and exchange data with organizations within Louisiana and external to Louisiana 1 3%

Participate, but we DO NOT exchange data 3 10%

We do not participate in any regional arrangements for electronic health information exchange 14 47%

Respondents 30 100%


Type of HIE participation

Respondents that indicated they participated in HIE were asked to provide additional information

on the types of data and the types of organizations they exchanged with.

Table 15: HIE participation. # exchange partners Other hospitals Physicians Pharmacy Laboratory Other

0 1 2

Patient demographics (n=68) 58 7 3 7 (10%) 5 (7%) 0 0 1 (1%)

Clinical care record (n=68) 59 7 2 6 (9%) 4 (6%) 0 0 1 (1%)

Laboratory results (n=68) 59 7 2 7 (10%) 8 (12%) 0 0 1 (1%)

Medication history (n=68) 59 7 2 6 (9%) 4 (6%) 0 0 1 (1%)

Radiology reports (n=68) 59 7 2 6 (9%) 4 (6%) 0 0 1 (1%)

Other responses

One facility indicated that they exchanged data with outside clinics and one exchanged data with

LaRHIX.

Financial burden of upgrading EMR system

Respondents were asked to estimate the degree of financial burden upgrading an existing EMR

system would be to the hospital, factoring in the ability to access incentive payments.

Table 16: Financial burden of upgrading and EMR

Major burden 19 63.3%

Minor burden 9 30%

Unsure 1 3.3%

Will not upgrade 1 3.3%

Respondents 30 100%

Preparation for purchase of an EMR upgrade

Respondents were asked how they would prepare for the purchase of an EMR upgrade. Table 17

represents the number of respondents that indicated the respective approaches to preparing for

EMR upgrades. Respondents were allowed to choose multiple approaches. The results indicate

that 43 (61%) of respondent hospitals were not considering any of these approaches to prepare

for an EMR upgrade.

Table 17: Number of approaches for preparing for an EMR upgrade

Number of approaches Number of Hospitals Percent

0 41 60%


1 12 18%

2 5 7%

3 8 12%

4 2 3%

Responses 68 99%

Table 18 represents the number of responses for each specific approach.

Table 18: Preparation for EMR upgrade

Method Number Percent*

Loan 8 12%

Outright purchase 21 31%

Grant 11 16%

Medicare incentives 14 21%

* Percentages do not equal 100% because respondents were allowed to choose multiple

responses.

Barriers to EMR implementation

Respondents were asked to indicate barriers to adoption of an EMR in their hospital. Table 19

gives the responses.

Table 19: Barriers to EMR implementation

Yes No Unsure

Initial cost of the EMR installation (n = 30) 23 (77%) 6 (20%) 1 (3%)

Recurring costs of the EMR (n = 31) 24 (77%) 5 (16%) 2 (6%)

Unsure of what system to purchase (n = 29) 13 (45%) 14 (48%) 2 (7%)

No EMR product that meets our organization’s patient care needs (n = 28) 3 (11%) 20 (71%) 5 (18%)

Staff’s expertise with EMRs (n = 30) 20 (67%) 7 (23%) 3 (10%)

Staff’s expertise with computers (n = 29) 12 (41%) 17 (59%) 0 (0%)

Disruption in organizations productivity due to EMR learning curve (n = 30) 17 (57%) 13 (43%) 0 (0%)

Lack of EMR interoperability with other information systems in your organization (n=29) 9 (31%) 15 (52%) 5 (17%)

Meeting HIPAA compliance standards (n = 28) 6 (21%) 21 (75%) 1 (4%)

Financial burden of upgrading EMR system


Respondents were asked to rate the degree of financial burden they believed upgrading their

EMR system would be, factoring in the ability to access incentive payments. Responses are

shown in Table 20.

Table 20: Financial burden of upgrading and EMR

Major burden 19 61%

Minor burden 8 26%

Unsure 4 13%

Will not upgrade 0 -

Respondents 31 100%


Preparation for purchase of EMR

Respondents were asked how they would prepare for the purchase of an EMR. Table 21

represents the number of respondents that indicated the respective approaches to preparing for an

EMR purchase. Respondents were allowed to choose multiple approaches. The results indicate

that 40 (59%) of respondent hospitals were not considering any of these approaches to prepare

for an EMR purchase.

Table 21: Number of approaches for preparing for an EMR upgrade

Number of approaches Number of Hospitals Percent

0 40 59%

1 19 28%

2 4 6%

3 4 6%

4 1 1%

Responses 68 100%

Table 22 represents the number of responses for each specific approach.

Table 22: Preparation for EMR purchase

Method Number Percent*

Loan. 6 9%

Outright purchase. 4 6%

Grant. 8 12%

Medicare and Medicaid incentives. 8 12%

Medicaid incentives. 1 1%

Unsure. 12 18%

Other. 4 6%

* Percentages do not equal 100% because respondents were allowed to choose multiple

responses.

Other responses

Two hospitals indicated that they were bound by the decision the parent system made regarding

an EMR purchase. Two hospitals indicated they were working with vendors to arrange financing

for an EMR purchase. One hospital indicated they were waiting for a clearer definition of

meaningful use.


APPENDIX B: Louisiana Provider Information Technology Survey 2010

June 18, 2010

Prepared for:

The Louisiana Health Care Quality Forum

Prepared by:

Mark L. Diana, MBA, MSIS, PhD

Introduction

The Louisiana Health Care Quality Forum (LHCQF), as the state designated entity for Louisiana

for activities of the HITECH Act provisions of the American Recovery and Reinvestment Act

(ARRA), is in the strategic planning stages of the Health Information Exchange cooperative

agreement with the Office of the National Coordinator (ONC). A key piece of the strategic

planning process is an environmental scan, which is a comprehensive collection of information

about the current state of health information exchange in Louisiana. This survey was conducted

as part of the overall environmental scan and is specifically focused on providers in the

ambulatory setting. The survey collected information on provider’s information technology

environment, including the status of adoption of electronic records, awareness of the HITECH

provisions, preparation for receipt of incentive payments, and of participation in health

information exchange.

Survey Methodology

The Louisiana Health Care Quality Forum (LHCQF) in cooperation with the State Medicaid

Office developed an online survey of provider’s information technology environment. The

survey targeted primarily areas impacted by the American Recovery and Reinvestment Act

(ARRA) and its HITECH provisions. A copy of the full survey is provided in the appendix to

this report.

The LHCQF developed the survey in both an online survey tool and in a paper version, fielded

the survey, and collected responses. The survey was fielded over a period of several months.

The LHCQF sent initial notices of the survey and follow-up notices in an attempt to achieve a

high response rate.


The unit of analysis is the provider practice facility, not individual providers. The sample

consisted of the universe of the LHCQF list of provider facilities, derived from three primary

data sources: the Blue Cross/Blue Shield provider list, the Louisiana State Board of Medical

Examiners provider list, and the State Medicaid Office provider list. Provider practice facilities

were determined using a variety of criteria, including practice name, business addresses, and

phone numbers. This process resulted in the identification of 3,227 practice facilities with

verifiable addresses in the state.

There were 500 valid surveys returned, for an overall response rate of 15%. Response rates vary

by individual survey item, as not all respondents answered every question. Individual response

rates are noted in each items result. Only descriptive analyses are presented in this report.

Type of facility

The following table lists the type of facility responding.

Table 1: Types of facility

Type of facility Number Percent*

Freestanding medical office or group medical practice 398 81%

Federally Qualified Health Center 12 2%

Community Health Center or

Federally Qualified Health Center Look-Alike

9 2%

Hospital outpatient department 13 3%

Federal government facility 0 0%

State or local government facility 22 4%

Rural health clinic 34 7%

Total 488 100%

Number of sites

Respondents were asked how many sites their practice had. The responses ranged from one to

40 sites, with an average of 1.75, and a median of one. Seventy-seven percent of respondents

(314) indicated they had one site.

Table 2: Number of sites


Sites (n = 410) 1.7 1 2.8 1 40


Type of practice

The following table lists the type of practice.

Table 3: Type of practice

Types of practice Number Percent

Solo practice 193 47%

Single-specialty 169 42%

Multi-specialty 44 11%

Responses 406 100%

Specialties represented

The following table lists the specialties represented at the facility. The “other” response included

a wide range of specialties. There were 498 responses to this question.

Table 4: Specialties

Specialty Number Percent*

Family practice 100 20%

Primary care – internal medicine 71 14%

Primary care – pediatrics 53 14%

Obstetrics and gynecology 40 8%

Other medical subspecialties 70 14%

Pediatric subspecialties 18 4%

Other 154 31%

* Percentages may not equal 100% because respondents were allowed to choose multiple

responses.

Impact of the ARRA incentives

Respondents were asked if they had assessed the impact and value of ARRA incentives. Table 5

shows the results.

Table 5: Assessed impact of ARRA incentives

No 133 54%

Yes 53 22%

Don’t know 58 24%

Responses 244 100%


Pursuit of an EMR implementation

Incentive Providers were asked if they were pursuing one or more EMR implementation

incentives. Table 6 shows the results. This question was only asked on the paper version of the

survey.

Table 6: Pursuing ARRA incentives


Yes from Medicaid 130 26%

Yes from Medicare 28 6%

No 55 11%

Don’t know 46 9%


responses.

When providers will be ready to apply for Medicaid incentive payments

Table 7 indicates the dates that the 109 respondents to this question indicated that they would be

ready to apply for Medicaid incentive payments.

Table 7: Date ready to apply for Medicaid incentives

Now 6 5%

Don’t know 91 83%

Q3 2010 2 2%

Q4 2010 4 4%

Q1 2011 2 2%

Q2 2011 2 2%

Q3 2011 1 1%

Q3 2014 1 1%

Respondents 109 100%

Payer mix

Table 8: Average payer mix (%)


Medicare (n = 445) 31 30 21 0 95


Medicaid (n = 450) 20 10 24 0 100

Workers compensation (n = 395) 3 1 7.5 0 99

Commercial insurance (n = 449) 36 35 22 0 99

Uninsured/Private pay (n = 432) 8 5 13 0 100

Recognized patient-centered medical homes (PCMH)

Table 9: Patient-centered medical homes

Response Number Percent

No 364 77%

Yes 6 1%

Pursuing 25 5%

Don’t know 77 16%

Responses 472 99%


Interest in PCMH transformation assistance

Table 10: Interest in PCMH


No 64 38%

Yes 52 31%

Don’t know 53 31%

Responses 169 100%

Ownership

Table 11: Ownership


No 432 91%

Yes 40 8%

Don’t know 2 1%

Responses 474 100%

Facility size

Table 12: Average facility size


Physicians (n = 462) 7.5 2 45 0 800

Mid-level providers (n = 460) 2 0 12 0 200

IT support staff (n = 449) 2 1 9 0 175

Total (n = 458) 62 8 538 1 11,000

Type of Internet Access

Respondents were asked what type of Internet access they have. Table 13 indicates the specific

types of Internet access hospitals have.

Table 13: Types of Internet access

Type of Access Number of Hospitals Percent

None 11 2%

Dial-up 4 1%

High-speed (DSL, cable, T-1/T-3, Fiber) 447 97%


Responses 463 100%

Use of technologies

Respondents indicated the type of technology used at the facility on a daily or frequent basis.

There were 498 responses. Results are in Table 14.

Table 14: Use of technologies


E-mail 414 83%

Scanner 269 54%

Smart phones or PDAs 187 38%

Don’t know 19 4%


responses.

Electronic Claims

Respondents were asked if they submitted claims electronically.

Table 15: Electronic claims submission


No 28 6%

Yes 426 93%

Don’t know 4 1%

Responses 458 100%

Electronic Practice Management System (PMS)

Respondents were asked if they had an electronic practice management system at their facility.

Table 16: Electronic practice management



No 122 27%

Yes 306 67%

Don’t know 29 6%

Responses 457 100%


Electronic Medical Records (EMR)

Respondents were asked if they had an electronic medical record (EMR) system.

Table 17: Electronic medical records


All electronic 84 18%

Part electronic, part paper 95 21%

No 274 59%

Don’t know 7 2%

Responses 460 100%

Plans for installing or upgrading an EMR

Respondents were asked to indicate if they had plans to install new or replace a current EMR

system within the next three years.

Table 18: EMR installation or upgrade


No 190 27%

Yes 185 67%

Don’t know 83 6%

Responses 458 100%

Timeframe for installing or upgrading an EMR

Respondents were asked to indicate the timeframe for the installation or upgrade of an EMR

system.

Table 19: Timeframe for installing or upgrading EMR


0 – 6 months 42 17%

7 – 12 months 40 17%

13 – 24 months 43 18%

> 24 months 25 10%

Don’t know 91 38%


Responses 241 100%

Freestanding e-prescribing systems

Respondents were asked to provide information on the capabilities of existing freestanding e-

prescribing systems at their facility.

Table 20: Freestanding e-prescribing systems

Yes and used Yes and not used No Don’t know

Does your facility location have an e-Prescribing system, either

separate from or integrated with your EMR system? (n = 455) 158(35%) 51 (11%) 227 (50%) 19 (4%)

Does it offer warnings of drug interactions or contraindications?

(n=415) 159 (38%) 28 (7%) 159 (38%) 69 (17%)

Can prescriptions be checked electronically against an insurance-

specific formulary? (n = 412) 84 (20%) 23 (6%) 195 (47%) 110 (27%)

Can prescriptions be sent electronically to pharmacies? (n = 420) 160 (38%) 42 (10%) 175 (42%) 43(10%)

Can the e-Prescribing tool provide a medication history? (n = 416) 128 (31%) 22 (5%) 172 (41%) 94 (23%)

Can the e-Prescription tool provide a prescription history for

patients from other providers? (n = 414) 59 (14%) 12 (3%) 216 (52%) 127 (31%)

Health information exchange

Respondents were asked to identify organizations types they were currently exchanging

electronic patient data with (not including by facsimile or telephone), and the priority they placed

on being able to do so. Results are in Table 21.

Table 21: Health information exchange

Currently

Exchanging

Priority

Low High

1 2 3 4 5

Other practices within your system (n=227) 74 (33%) 87 (38%) 8 (4%) 33 (15%) 23 (10%) 76 (33%)

Hospitals within your system (n=251) 93 (37%) 61 (24%) 8 (3%) 37 (15%) 37 (15%) 108 (43%)

Pharmacies within your system (n=221) 78 (35%) 62 (28%) 12 (5%) 24 (11%) 25 (11%) 98 (44%)

Laboratories within your system (n=238) 120 (50%) 57 (24%) 9 (4%) 27 (11%) 22 (9%) 123 (52%)

Imaging providers within your system (n=238) 78 (33%) 58 (24%) 14 (6%) 23 (10%) 34 (14%) 109 (46%)

Practices outside your system (n=236) 33 (14%) 75 (32%) 20 (8%) 54 (23%) 32 (14%) 55 (23%)


Table 21: Health information exchange

Currently

Exchanging

Priority

Hospitals outside your system (n=245) 58 (24%) 73 (30%) 16 (6%) 42 (17%) 41 (17%) 73 (29.5%)

Pharmacies outside your system (n=232) 66 (28%) 63 (27%) 17 (7%) 44 (19%) 38 (16%) 70 (30%)

Laboratories outside your system (n=237) 73 (31%) 62 (26%) 21 (9%) 43 (18%) 38 (16%) 73 (31%)

Imaging providers outside your system (n=234) 52 (22%) 69 (29%) 14 (6%) 48 (21%) 40 (17%) 63 (27%)

Regional or community health information exchanges (n= 228) 24 (11%) 92 (40%) 16 (7%) 58 (25%) 27 (12%) 35 (15%)

Public health or vital statistics agencies (n=226) 23 (10%) 83 (37%) 31 (13.5%) 52 (23%) 29 (13%) 31 (13.5%)

Independent Provider Association or similar organization (n=229) 19 (8%) 108 (47%) 34 (15%) 45 (20%) 15 (6%) 27 (12%)

Quality collaborative or initiative (n=227) 31 (14%) 80 (35%) 24 (10%) 56 (25%) 31 (14%) 36 (16%)

Safety collaborative or initiative (n=229) 22 (10%) 82 (36%) 21 (9%) 58 (25%) 3 (15%) 34 (15%)

Patients (n=233) 40 (17%) 63 (27%) 34 (15%) 50 (21%) 31 (13%) 55 (24%)

Researchers (n=229) 21 (9%) 127 (55%) 24 (10%) 42 (18%) 15 (7%) 21 (9%)

Claims clearinghouse (n=239) 173 (72%) 32 (13%) 9 (4%) 17 (7%) 18 (8%) 163 (68%)

Patient registries (e.g., chronic disease, immunization) (n 241) 42 (17%) 65 (27%) 30 (12%) 48 (20%) 29 (12%) 69 (29%)

Interested in providing technical assistance

Respondents were asked if they would be interested in providing technical assistance to others on

the adoption or upgrade of EMR systems.

Table 22: Providing technical assistance


No 280 64%

Yes 67 15%

Don’t know 89 20%

Responses 438 99%

Interested in receiving technical assistance

Respondents were asked if they would be interested in receiving technical assistance from others

on the adoption or upgrade of EMR systems.

Table 23: Receiving technical assistance


No 151 34%

Yes 207 47%

Don’t know 81 18%


Responses 439 99%

Optional technical section EMR model

This is the first of a series of optional questions on the survey that attempted to gather more

detail about the technology environment of providers. Respondents were asked if their EMR

was client-based or an Application Service Provider (ASP) model.

Table 24: EMR Model


Client-based 89 65%

ASP 37 27%

Don’t know 11 8%

Responses 137 100%

EMR functionality

Respondents were asked to indicate the presence and use of the following EMR functions.

Table 25: EMR Functionality

Yes and used Yes and not used No Don’t know

Patient demographic information (n = 134) 125 (93%) 7 (5%) 1 (1%) 1 (1%)

Computerized orders for prescriptions (n = 135) 96 (71%) 22 (16%) 15 (12%) 2 (1%)

Alerts of drug interactions or contraindications (n = 132) 86 (65%) 11 (8%) 23 (17%) 12 (9%)

Prescriptions sent electronically to the pharmacy (n = 135) 71 (53%) 25 (19%) 33 (24%) 6 (4%)

Prescriptions checked against formularies (n = 134) 48 (36%) 14 (10%) 40 (30%) 32 (24%)

Computerized orders for tests (n = 133) 69 (52%) 28 (21%) 26 (20%) 10 (7%)

Orders sent electronically to other departments (n = 133) 45 (34%) 31 (23%) 45 (34%) 12 (9%)

Out of range lab values highlighted (n = 134) 69 (51%) 8 (6%) 35 (26%) 22 (16%)

Imaging results (n = 134) 48 (36%) 19 (14%) 46 (34%) 21 (16%)

Electronic images through a PACS system (n = 132) 33 (25%) 9 (7%) 54 (41%) 36 (27%)

Clinical notes (n= 133) 118 (89.72%) 13 (9.77%) 1 (0.75%) 1 (0.75%)

Medical history and follow-up notes (n = 133) 113 (85%) 13 (10%) 6 (4%) 1 (1%)

Reminders for guideline-based interventions (n = 135) 51 (37%) 28 (21%) 33 (24%) 24 (18%)

Continuity of Care Record (CCR) creation (n = 134) 37 (28%) 15 (11%) 28 (21%) 54 (40%)

Chronic disease management (n = 135) 39 (29%) 26 (19%) 34 (25%) 36 (27%)

Referral tracking (n = 134) 52 (39%) 19 (14%) 38 (28%) 25 (19%)

Communications to and from patients (n = 135) 52 (38%) 19 (14%) 44 (33%) 20 (15%)


Automated disease tracking and reporting

Respondents were asked of their EMR included automated disease tracking and reporting

capabilities, either as a standard function or through customized templates.

Table 26: Automated disease tracking and reporting


Tracking 14 11%

Reporting 24 19%

Don’t know 91 70%

Responses 129 100%

Access to EMR offsite

Respondents were asked if physicians had access to the EMR when they were away from the

practice site.

Table 27: EMR model


No 23 17%

Yes 109 79%

Don’t know 5 4%

Responses 137 100%

EMR and electronic billing or management systems integration

Respondents were asked if their EMR system shared information electronically with internal

billing or practice management systems.

Table 28: EMR and billing system integration


No 26 19%

Yes 107 78%

know 4 3%

Responses 137 100%


Barriers to EMR implementation

Respondents were asked to rate the significance of each of the following as barriers to their

existing EMR implementation.

Table 29: Barriers to EMR implementation

Not a barrier Minor Major Extreme

Concern about loss of productivity during implementation (n = 147) 38 (26%) 57 (39%) 30 (20%) 22 (15%)

Lack of acceptance by administration (n = 147) 118 (80%) 17 (12%) 5 (3%) 7 (5%)

Lack of acceptance by clinicians (n = 148) 76 (51%) 41 (28%) 19 (13%) 12 (8%)

Lack of acceptance by staff (n = 146) 76 (52%) 55 (38%) 9 (6%) 6 (4%)

Lack of capital (n = 147) 56 (38%) 27 (18%) 24 (16%) 40 (27%)

Insufficient knowledge to evaluate, compare and select an appropriate EMR (n=145) 82 (56%) 37 (26%) 14 (10%) 12 (8%)

Insufficient time to select, contract, install and implement the EMR (n = 146) 77 (53%) 33 (23%) 21 (14%) 15 (10%)

Lack of EMR certification or standardization (n = 146) 84 (57%) 22 (15%) 20 (14%) 20 (14%)

Security or privacy concerns (n = 148) 95 (64%) 37 (25%) 9 (6%) 7 (5%)

Overall projected return-on-investment (n= 148) 69 (47%) 32 (21%) 18 (12%) 29 (20%)

Electronic access to external data

Respondents were asked to indicate which of the following information, which originates from

exchange with external organizations, clinicians could access electronically during patient care.

Table 30: Electronic access to external data

Yes - Used Yes - Not Used No Don’t know

Patient demographics (n = 141) 50 (35%) 6 (4%) 71 (50%) 14 (10%)

List of past visits and procedures (n = 141) 48 (34%) 7 (5%) 72 (51%) 14 (10%)

List of past diagnoses (from claims) (n = 140) 44 (31%) 6 (4%) 73 (52%) 17 (12%)

Medications dispensed (n = 142) 46 (32%) 7 (5%) 74 (52%) 15 (11%)

Medications prescribed (n = 140) 50 (36%) 4 (3%) 71 (50%) 15 (11%)

Immunizations (n = 139) 43 (31%) 9 (6%) 72 (52%) 15 (11%)

Allergies (n = 138) 43 (31%) 5 (4%) 75 (54%) 15 (11%)

Laboratory results (n = 143) 68 (48%) 10 (7%) 55 (38%) 10 (7%)

Imaging results (n = 141) 58 (41%) 9 (6%) 63 (45%) 11 (8%)

Discharge summaries from hospitals or emergency rooms (n = 143) 57 (40%) 8 (6%) 68 (47%) 10 (7%)

Clinic notes or records (n = 139) 47 (34%) 7 (5%) 73 (52%) 12 (9%)

Patient advance directives (n = 140) 24 (17%) 6 (4%) 85 (61%) 25 (18%)

Implantable medical devices (n = 140) 15 (11%) 6 (4%) 87 (62%) 32 (23%)

Health plan coverage and service eligibility (n = 141) 64 (45%) 12 (9%) 49 (35%) 16 (11%)


Internet use for patient communication

Table 31: Internet for patient communication

Activity Number Percent*

Patient education materials 74 27%

Patient data entry 34 13%

E-mail correspondence to or from clinicians (e-Visits) 37 14%

Providing patients with test results 19 7%

Medication refill management 49 18%

Patient alerts or reminders 24 9%

None 72 27%


responses.

Barriers to future EMR implementation or upgrade

Respondents were asked to rate the significance of each of the following as barriers to a future

EMR implementation or upgrade in their facility.

Table 32: Barriers to future EMR implementation or upgrade

No Barrier Minor Major Extreme

Concern about loss of productivity during implementation (n= 277) 66 (24%) 95 (34%) 70 (25%) 46 (17%)

Lack of acceptance by administration (n=276) 184 (67%) 57 (21%) 23 (8%) 12 (4%)

Lack of acceptance by clinicians (n=277) 127 (46%) 87 (31%) 43 (16%) 20 (7%)

Lack of acceptance by staff (n= 277) 130 (47%) 91 (33%) 39 (14%) 17 (6%)

Lack of capital (n=278) 56 (20%) 51 (18%) 71 (26%) 100 (36%)

Insufficient knowledge to evaluate, compare and select an appropriate EMR (n=276) 119 (43%) 67 (24%) 43 (16%) 47 (17%)

Insufficient time to select, contract, install and implement the EMR (n=277) 97 (35%) 83 (30%) 56 (20%) 41 (15%)

Lack of EMR certification or standardization (n=275) 107 (39%) 66 (24%) 50 (18%) 52 (19%)

Security or privacy concerns (n=277) 127 (46%) 86 (31%) 37 (13%) 27 (10%)

Overall projected return-on-investment (n=278) 83 (30%) 59 (21%) 69 (25%) 67 (24%)

Optional Loan Program Section

This section included a series of questions designed to determine the level of interest in

participation in a loan program that may be offered in the future from a combination of grants

from the HITECH program and the state legislature.


Interest in applying for a loan to purchase or upgrade an EMR

Respondents were asked if they were interested in applying for a loan to purchase or upgrade and

EMR system.

Table 33: Interest in applying for a loan


No 197 62%

Yes 48 15%

Don’t know 75 23%

Responses 320 100%

Consider a loan if it were available (through the EHR loan fund*)

Respondents were asked if they would consider applying for a loan to assist for the purchase of

their EMR if it were available to them.

Table 34: Consider a loan


No 70 50%

Yes 41 29%

Don’t know 30 21%

Responses 141 100%

Estimated funding required

Respondents were asked to estimate the amount of funding they would require. Results are

reported as thousands of dollars. Responses ranged from a low of $2,000 to a high of

$1,000,000. The results are skewed, with an average amount of $284,000 and a median amount

of $40,000.

Table 35: Estimated funding (thousands of $)


Estimated funding (n = 56) 283.97 40.00 1,345.82 2.00 10,000.00

Considering financing from other sources


Respondents were asked if they were considering obtaining financing from other sources they

knew were currently available.

Table 36: Other financing sources


No 134 42%

Yes 79 25%

Don’t know 104 33%

Responses 317 100%

Already applied for funds

Respondents were asked if they had already applied for loan funds to support the purchase of an

EMR.

Table 37: Already applied for funds


No 270 85%

Yes 25 8%

Don’t know 23 7%

Responses 318 100%

Disease Registry

Respondents were asked if their practice used a disease registry.

Table 38: Disease registry


All electronic 8 3%

Part electronic, part paper 16 5%

No 242 76%

Don’t know 52 16%

Responses 318 100%


APPENDIX F: Addressing CMS Comments

Answers to the general CMS comments from SMHP Version 1.2:

1. Outstanding questions from the SMHP Template

Please refer to the SMHP template available at:

http://www.cms.gov/EHRIncentivePrograms/91_Information_for_States.asp#TopOfPage

The State should be sure to address each item in the template. If there are items in the

template in which it is noted that the State may defer the item, and the State chooses to

continue to defer that item, the State should indicate its estimated timeframe for when the

item will be addressed in a future SMHP version.

Appendix G addresses these questions.

2. The State should provide additional details of the baseline HIT assessment.

The HIT baseline has been addressed on Section 2.0: State “As Is” HIT Landscape.

3. The State should provide additional details of the State’s “to be” HIT environment and the

road map for getting from “as is” to “to be” to the extent that it is known by the time of the

next SMHP submission.

The HIT “To-Be” Vision and Roadmap will be addressed on the SMHP v2.0.

4. The State should provide details about its plans for developing an EHR incentive payment

process, addressing the items identified in the specific comments below.

The EHR Incentive Payment plan and process have been addressed on Section 4.3:

Medicaid’s EHR Incentive Payment System.

5. The State should address any comments that were previously made on version 1.1 of the

SMHP that have not been fully resolved.

The state has addressed all CMS comments from the submission of version 1.1 in this

appendix and Appendix G.

6. The State should remove the watermarked DRAFT from this document so that it is clear that

this is a final, though iterative, document.

The watermark “DRAFT” has been removed.

7. If the State intends to receive incentive payment program registrations in January, 2011,

http://www.cms.gov/EHRIncentivePrograms/91_Information_for_States.asp#TopOfPage


please clarify when the State will accept provider attestations and make payments. Please

provide an example use case.

The state intends to receive incentive payment program registrations and attestations

starting in January 15, 2010. Payments will commence during the week of January 22,

2010. Below are two examples of use cases, both of which have been added to Section

4.3.12 Attestation Use Cases.

Scenario A: EP successfully registers and receives payments.


1 EH registers with the NLR. NLR sends the state a B6 file via

ConnectDirect notifying LA

Medicaid of EP or EH

registration.

2 EH is notified by the NLR with login

information.

EH downloads and completes the EP &

EH Patient Volume WS and the EH

Incentive Payment WS.

Registrant data in the B6 will be

verified.

A B7 will be generated with

validation results and sent to

CMS via ConnectDirect.

3 EH registers on the LA Medicaid Incentive

Program website.

Completes state-side application and

attests to the accuracy of the information

provided.

EH is automatically notified via e-mail

confirming the application submission.

They are notified of the 10 business day

application processing.

Program monitor is notified via e-

mail.

4 EP waits maximum of 10 business

days.

Program monitor verifies the

EP’s information and approves

the application.

5 EP is notified of application

acceptance.

D16 is automatically generated

and sent to CMS.

6 CMS verifies information in the

D16.

7 EHR incentive system will



generate a payment file.

8 Payment file is posted weekly on

Fridays to an FTP site dedicated

to DHH’s Standard Payment

System.

9 The DHH SPS processes the

payment file and creates an

export file that contains check

register information.

10 EP receives payment. The file is processed and the

check is submitted

11 A D18 verification file is

automatically generated and sent

to CMS

Scenario B: EP is denied and submits deficient information.


1-3 Add steps from scenario A. Add steps from Scenario A.

4 EH waits maximum of 10 business

days.

Program monitor reviews the

EH’s information and denies the

application due to deficient

information.

5 EH automatically notified of

application denial.

EH is instructed to return to the EHR

incentive payment website for denial

reason and instructions for further

steps.

Provider decides to appeal.

6 Within 15 days, EH submits written

request for an informal hearing.

State reviews the request for

consideration and determines

whether a hearing is necessary.

7 EH receives an e-mail with date, The State approves the EH’s



time, and location of the informal

hearing.

request and notifies the EH.

8 EH attends hearing. Case is reviewed.

9 EH receives notification of hearing

results in writing. EH is denied and

decides to request an administrative

appeal.

10 Within 30 days, EH submits an

administrative appeal request.

State reviews the case and

determines whether or not the EH

request will be accepted.

8. Please indicate which file transfer software the State will use to transfer files to and from the

NLR.

The software to transfer files to and from NLR is Connect Direct; notation is made in

Section 4.3; 4.3.1; and 4.3.12.

9. While not required as part of the SMHP, please clarify whether the State has considered the

relationship of their Emergency Management Plan and electronic reporting by the hospitals

as a requirement of this plan, e.g., reporting bed capacity, prevalence of disease incidence

(like H1N1), etc. It appears that most of these systems do not offer interoperability and

require manual input of data.

Having been through devastating hurricanes such as Katrina and outbreaks such as

West Nile and H1N1 viruses, the state of Louisiana understands the importance of

electronic reporting capabilities by the hospitals and providers as a requirement of the

Emergency Management Plan that includes Syndromic Surveillance, reporting bed

capacity to deal with displaced persons, and the reporting of critical information such

as immunization data. For this reason, the state intends to submit an I-APD

requesting enhanced funding for the assessment of the capabilities and potential

upgrade of our public health infrastructure in terms of Syndromic Surveillance and

Immunizations registry capabilities to interact with a future HIE and enable

meaningful use.

APPENDIX G: Outstanding CMS Template Questions

Below is our response to the outstanding CMS Template Questions that were not yet addressed on Version 1.3 of the LaSMHP.

CMS Question Section/Answer

The State’s “As-Is” HIT Landscape:

1. Does the SMA have data or estimates on eligible providers

broken out by types of provider?

No. The Provider survey, prepared for the LHCQF by Dr. Diana of

Tulane University in June 2010 and included in this document under

Appendix B, does not break down the results by types of Provider.

This survey was designed to gain general insight about provider

participation in the EHR incentive program and HIE. Unfortunately,

the response rates were 27% or 68 hospitals and 15% or 498

providers.

This small sample size will not allow us to infer significant

information about EHR adoption or the Incentive Program. The data

acquisition and analysis of EHR adoption by Provider type as well as

other outstanding questions will be performed by Louisiana

Medicaid. This analysis will be based on information gained from

Provider participation in the EHR Incentive Payment Program as

well as Provider outreach and feedback.

The current data is included on Section 2.1 Current EHR Status

1. Does the SMA have data on EHR adoption by types of provider

(e.g. children’s hospitals, acute care hospitals, pediatricians, nurse

practitioners, etc.)?

No. The Provider survey, prepared for the LHCQF by Dr. Diana of

Tulane University in June 2010 and included in this document under

Appendix B, does not break down the results by types of Provider.

As mentioned in the previous question, the data acquisition and

analysis of EHR adoption by Provider type as well as other

outstanding questions will be performed by Louisiana Medicaid.

This analysis will be based on information gained from Provider

participation in the EHR Incentive Payment Program as well as

Provider outreach and feedback.

The current data is included on Section 2.1 Current EHR Status



7. Specifically, if there are health information exchange

organizations in the State, what is their governance structure and is

the SMA involved? ** How extensive is their geographic reach and

scope of participation?

Sections 2.6.2

8. Please describe the role of the MMIS in the SMA’s current

HIT/E environment. Has the State coordinated their HIT Plan with

their MITA transition plans and if so, briefly describe how.

The MMIS is the entity responsible for maintaining and updating the

MITA SS-A ongoing. Policy has been established that requires all

MITA Business Processes to be reviewed for possible updates,

acceptance, and approval by MMIS. Reviews shall occur whenever

procurements are needed, new contracts are established, new

processes implemented, etc. For more information on LMMIS and

MITA, please see Section 2.2.1 (LMMIS/MITA).

9. What State activities are currently underway or in the planning

phase to facilitate HIE and EHR adoption? What role does the

SMA play? Who else is currently involved? For example, how are

the regional extension centers (RECs) assisting Medicaid eligible

providers to implement EHR systems and achieve meaningful use?

Section 3.1 and. 3.4, and 3.4.1

10. Explain the SMA’s relationship to the State HIT Coordinator

and how the activities planned under the ONC-funded HIE

cooperative agreement and the Regional Extension Centers (and

Local Extension Centers, if applicable) would help support the

administration of the EHR Incentive Program.

Section 1.6

11. What other activities does the SMA currently have underway

that will likely influence the direction of the EHR Incentive

Program over the next five years?

There are no other activities currently underway that will influence

the direction of the EHR Incentive Program over the next five years.

Please see Section 2.7.4



12. Have there been any recent changes (of a significant degree) to

State laws or regulations that might affect the implementation of the

EHR Incentive Program? Please describe.

At this time, there have not been any recent changes to state laws or

regulations that might affect the implementation of the EHR

Incentive Program.


13. Are there any HIT/E activities that cross State borders? Is there

significant crossing of State lines for accessing health care services

by Medicaid beneficiaries? Please describe.

Louisiana Medicaid will work closely with our federal and state

partners to ensure the Medicaid EHR Incentive Payment Program, as

well as related HIT initiatives, follows national standards and fits into

the overall strategic plan for the Louisiana State Medicaid HIE Plan.

Louisiana Medicaid’s current efforts will focus primarily on

supporting local EPs and EHs, but such work will expand to

supporting HIT/HIE activities across State borders and beyond as the

capabilities arise.


14. What is the current interoperability status of the State

Immunization registry and Public Health Surveillance reporting

database(s)?

Louisiana Immunization Network for Kids Statewide (LINKS) is a

State immunization registry implemented by OPH. This web-based

system allows Medicaid enrolled providers to search and view

patient’s vaccination records, and provides read-write access or data

exchanges to WIC Clinics, STD Clinics, Hospitals, Health Plans,

Correctional Facilities, Elementary Schools and Head Start and

Military. Moreover, LINKS serves as a part of the EHR for one of

the largest hospital systems in the state (Ochsner Health System) and

has real time interface with all LSU Hospital Systems.

Currently, LINKS does not interface with Louisiana Public Health

Information Exchange (LAPHIE), our Public Surveillance Health

System. Louisiana Medicaid’s efforts will expand to supporting the

LINKS and LAPHIE interface as the State HIE capabilities mature.




The State’s “To-Be” HIT Landscape:

All requirements Section 3.0

The State’s Implementation Plan:

8. Will the SMA be proposing any changes to the MU definition as

permissible per rule-making? If so, please provide details on the

expected benefit to the Medicaid population as well as how the

SMA assessed the issue of additional provider reporting and

financial burden.

Louisiana Medicaid will not be proposing any changes to the MU

definition.


10. How will the SMA collect providers’ meaningful use data,

including the reporting of clinical quality measures? Does the State

envision different approaches for the short-term and a different

approach for the longer-term?

Section 4.3.7

11. * How will this data collection and analysis process align with

the collection of other clinical quality measures data, such as

CHIPRA

Louisiana Medicaid does not currently have in place methods for

collecting meaningful use or clinical quality measures data, but we

intend to align this process with the collection of other clinical

quality measures data.


21. What will be the process to assure that all Federal funding, both

for the 100 percent incentive payments, as well as the 90 percent

HIT Administrative match, are accounted for separately for the

HITECH provisions and not reported in a commingled manner with

the enhanced MMIS FFP?

Separate cost center accounts have been established for the ARRA

provider incentive payments (100% FFP) and the administrative

functions associated with developing the programs such as planning,

development, implementation, and outreach (90% FFP).

Please see Section 4.5



22. What will be the process to assure that Medicaid provider

payments are paid directly to the provider (or an employer or

facility to which the provider has assigned payments) without any

deduction or rebate?

Please see the answer to question 23 below.



23. What will be the process to assure that Medicaid payments go to

an entity promoting the adoption of certified EHR technology, as

designated by the state and approved by the US DHHS Secretary,

are made only if participation in such a payment arrangement is

voluntary by the EP and that no more than 5 percent of such

payments is retained for costs unrelated to EHR technology

adoption?

Through an aggressive provider outreach and education program, the

state of Louisiana is encouraging Medicaid Providers and Hospitals

to participate in the Incentive Payment Program, with the overall

State goal of adopting and meaningfully using certified EHR

technology. Those interested EPs and EHs adopting certified EHR

technology will register with the NLR voluntarily to participate in

Louisiana’s Medicaid Incentive Program.

In order to ensure the legitimacy of Providers, the application process

also involves:

Cross-checking Provider information between state and federal

data bases to ensure applicants are currently active and not

under any sanction

Obtaining relevant information to verify applicant eligibility

such as a patient encounters, EHR system description, etc. – all

of which will be submitted through applicable spreadsheets and

supporting documentation

Online attestation of the accuracy and validity of the

information submitted

Regular auditing to ensure the accuracy of the payments and

applicants’ information. This will entail reviews of attestation

and payments in place that will be processed out of a random set

of Providers.

Louisiana Medicaid has stated that those qualifying EPs will receive

85% of the Net Average Allowable Cost (NAAC) which totals

$21,250. Louisiana Medicaid has relayed the payment methodology

information to the Providers through the State by the web, forums

and collaborative outreach with the REC.



24. What will be the process to assure that there are fiscal

arrangements with providers to disburse incentive payments

through Medicaid managed care plans does not exceed 105 percent

of the capitation rate per 42 CFR Part 438.6, as well as a

methodology for verifying such information?

This requirement does not apply because LA Medicaid plans to pay

managed care providers directly , the same for providers not in

managed care. Managed care providers will need to enroll with LA

Medicaid in order to participate in the LA EHR Program

Please see section 4.3.10

25. What will be the process to assure that all hospital calculations

and EP payment incentives (including tracking EPs’ 15% of the net

average allowable costs of certified EHR technology) are made

consistent with the Statute and regulation?

With the exception of pediatricians, all EPs who meet the 30%

Medicaid patient volume requirement and other criteria will be

eligible to receive 85% of the maximum Net Average Allowable

Cost. All hospital incentive payment calculations are determined

using the EH Incentive Payment worksheet, which uses expense

information entered by the EH to calculate the incentive payment

amount. To ensure that payments are made consistent with the

Statute and regulation, the formulas in the worksheet have been

created in accordance with regulations established by CMS in 42

CFR Parts 412, 413, 422, and 495. For more information on the

payment calculation, see Section 4.3.9 (Calculating EP Payments)

and 4.3.11 (Calculating EH Payments).



27. States should explicitly describe what their assumptions are, and

where the path and timing of their plans have dependencies based

upon:

The role of CMS (e.g. the development and support of the

National Level Repository; provider outreach/help desk

support)

The status/availability of certified EHR technology

The role, approved plans and status of the Regional Extension

Centers

The role, approved plans and status of the HIE cooperative

agreements

State-specific readiness factors

Section 4.0

The State’s Audit Strategy

All requirements The updated Audit Strategy will be submitted for CMS review as a

separate document

The State’s HIT Roadmap

All requirements Addressed in 6.0.

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