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
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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
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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:
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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
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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.
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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
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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
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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.
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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.
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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.
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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
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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
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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
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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
Page 22 January 2015
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
Page 23 January 2015
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
Page 24 January 2015
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-
Page 25 January 2015
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
Page 26 January 2015
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.
Page 27 January 2015
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
Page 28 January 2015
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
Page 29 January 2015
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.
Page 30 January 2015
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.
Page 31 January 2015
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
Page 32 January 2015
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
Page 33 January 2015
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
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 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
Page 34 January 2015
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).
Page 35 January 2015
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
Page 36 January 2015
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.
Page 37 January 2015
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.
Page 38 January 2015
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.
Page 39 January 2015
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
Page 40 January 2015
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
participating in Incentive
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
participating in Incentive
Payment Program
Percent of hospitals
participating in Incentive
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
Page 41 January 2015
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
in the Incentive Payment
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
in the Incentive Payment
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
Page 42 January 2015
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
Page 43 January 2015
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.
Page 44 January 2015
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.
Page 45 January 2015
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.
Page 46 January 2015
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.
Page 47 January 2015
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.
Page 48 January 2015
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/)
Page 49 January 2015
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
Page 50 January 2015
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.
To increase provider participation in the Louisiana Health Information Exchange (LaHIE),
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
Page 51 January 2015
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.
Page 52 January 2015
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.
Page 53 January 2015
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
Page 54 January 2015
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.
Page 55 January 2015
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
Page 56 January 2015
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.
Page 57 January 2015
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
Page 58 January 2015
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
Page 59 January 2015
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
Page 60 January 2015
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
Page 61 January 2015
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
Page 62 January 2015
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
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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.
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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
Total Discharges Previous Year (PY) 2
WS S-3, Part
1, Column 15,
Line 14
Total Discharges Previous Year (PY) 3
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
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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%
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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
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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
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Step 8 Calculate Annual Incentive Payment Amount
Percentage Payment
Year 1 Payment 50% $0.00
Year 2 Payment 30% $0.00
Year 3 Payment 10% $0.00
Year 4 Payment 10% $0.00
Prepared by:
Signature:
Date:
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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.
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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
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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:
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If the provider did not pass the B6 NLR review, the following will be displayed:
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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:
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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
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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.
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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
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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. .
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The following “Tool Tips” can be viewed from the Practice Characteristics screen by clicking on
the underlined links:
90% Tool Tip:
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Practice Predominantly Tool Tip:
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FQHC or RHC Tool Tip:
Physician Assistant Tool Tip:
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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
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CMS EHR Certification ID Tool Tip:
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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
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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.
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90 Day Reporting Tool Tip
Medical and Needy Encounters Tool Tip
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Group Practice/Clinic Tool Tip:
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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:
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This screen should be used by an EP attesting to their 3rd
payment year after April 1, 2014:
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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:
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MU Attestation Period Tool Tip
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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.
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EP Stage 1 Core Measures
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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
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EP Stage 1 Menu Measures
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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
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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
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EP Stage 1 Clinical Quality Measures – Alternate CQMs
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EP Stage 1 Clinical Quality Measures – Additional CQMs
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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
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Stage 2 Meaningful Use Measures required of Eligible Professionals
For eligible professionals the following Stage 2 criteria must be met:
All 17 required core objectives
3 objectives chosen from a list of 6 menu set objectives.
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.
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EP Stage 2 Core Measures
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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.
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EP Stage 2 Menu Measures
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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
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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.
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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
CMS Measure ID 137 Status
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.
National Quality Strategy
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
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3
CMS Measure ID 165 Status
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.
National Quality Strategy
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
period. A positive whole number.
Percentage
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4
CMS Measure ID 156 Status
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.
National Quality Strategy
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
period. A positive whole number.
*Denominator 2: Patients 66 years and older who had a visit
during the measurement period. A
positive whole number.
Percentage
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5
CMS Measure ID 155 Status
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.
National Quality Strategy
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
period. A positive whole number.
Percentage
*Numerator 2: Patients who had counseling for nutrition during
the measurement period. A
positive whole number.
*Denominator2: Same as above.
Percentage
*Numerator 3: Patients who had counseling for physical activity
during the measurement period. A positive whole number.
*Denominator2: Same as above. Percentage
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6
CMS Measure ID 138 Status
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..
National Quality Strategy
Domain Population/Public Health
7
CMS Measure ID 125 Status
Title Breast Cancer Screenings Not Completed
Description
Percentage of women 40-69 years of age who had a mammogram to screen
for breast cancer
National Quality Strategy
Domain Clinical Process/Effectiveness
*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
measurement period. A positive whole number.
*Denominator: Women 42-69 years of age with a
visit during the measurement period. A positive whole
number.
Percentage
*Exclusion: A positive whole number.
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8
CMS Measure ID 124 Status
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.
National Quality Strategy
Domain
Clinical Process/Effectiveness
*Numerator: Women with one or more Pap tests during the
measurement period or the two years prior to the
measurement period. A positive whole number.
*Denominator: Women 24–64 years of age with a visit during
the measurement
Percentage
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9
CMS Measure ID 153 Status
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.
National Quality Strategy
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
positive whole number.
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
positive whole number.
Percentage
*Numerator 3: Total women with at least one chlamydia test
during the measurement period. A positive whole number.
*Denominator 3: Total women who are sexually active and
who had a visit in the measurement period. A positive whole
number.
Percentage
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10
CMS Measure ID 130 Status
Title Colorectal Cancer Screening Not Completed
Description
Percentage of adults 50-75 years of age who had appropriate screening for
colorectal cancer.
National Quality Strategy
Domain
Clinical Process/Effectiveness
*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
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11
CMS Measure ID 126 Status
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.
National Quality Strategy
Domain
Clinical Process/Effectiveness
*Numerator 1: Patients 5 – 11 years of age who were dispensed
at least one prescription for a preferred therapy during the
measurement period. A positive whole number.
*Denominator 1 : Patients 5-11 years of age with
persistent asthma and a visit during the
measurement period. A positive whole number.
Percentage
*Numerator 2 : Patients 12 – 18 years of age who were
dispensed at least one prescription for a preferred therapy
during the measurement period. A positive whole number.
*Denominator 2: Patients 12 – 18 years of age with
persistent asthma and a visit during the
measurement period. A positive whole number.
Percentage
*Numerator 3: Patients 19 – 50 years of age years of age who
were dispensed at least one prescription for a preferred therapy
during the measurement period. A positive whole number.
*Denominator 3: Patients 19 - 50 years of age with
persistent asthma and a visit during the
measurement period. A positive whole number.
Percentage
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12
CMS Measure ID 117 Status
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
National Quality Strategy
Domain
Population/Public Health
*Numerator 4: Patients 51 – 64 years of age who were
dispensed at least one prescription for a preferred therapy
during the measurement period. A positive whole number.
*Denominator 4: Patients 51-64 years of age with
persistent asthma and a visit during the
measurement period. A positive whole number.
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
measurement period. A positive whole number.
Percentage
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13
CMS Measure ID 147 Status
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.
National Quality Strategy
Domain
Population/Public Health
14
CMS Measure ID 127 Status
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
National Quality Strategy
Domain
Clinical Process/Effectiveness
*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.
A positive whole number.
Percentage
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15
CMS Measure ID 166 Status
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.
National Quality Strategy
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
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16
CMS Measure ID 131 Status
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
National Quality Strategy
Domain
Clinical Process/Effectiveness
17
CMS Measure ID 123 Status
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.
National Quality Strategy
Domain
Clinical Process/Effectiveness
*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.
A positive whole number.
Percentage
*Numerator: Patients who received a foot exam (visual
inspection with either a sensory exam or pulse exam) during the
measurement period. A positive whole number.
*Denominator: Patients 18-75 years of age with
diabetes with a visit during the measurement period.
A positive whole number.
Percentage
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18
CMS Measure ID 122 Status
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.
National Quality Strategy
Domain
Clinical Process/Effectiveness
19
CMS Measure ID 148 Status
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
National Quality Strategy
Domain
Clinical Process/Effectiveness
*Numerator: Patients whose most recent HbA1c level
(performed during the measurement period) is >9.0%. A
positive whole number.
*Denominator: Patients 18-75 years of age with
diabetes with a visit during the measurement period.
A positive whole number.
Percentage
*Numerator: Patients with documentation of date and
result for a HbA1c test during the measurement period. A
positive whole number.
*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
Page 154 January 2015
20
CMS Measure ID 134 Status
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.
National Quality Strategy
Domain
Clinical Process/Effectiveness
21
CMS Measure ID 163 Status
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.
National Quality Strategy
Domain
Clinical Process/Effectiveness
*Numerator: Patients with a screening for nephropathy or
evidence of nephropathy during the measurement period. A
positive whole number.
*Denominator: Patients 18-75 years of age with
diabetes with a visit during the measurement period.
A positive whole number.
Percentage
*Numerator: Patients whose most recent LDL-C level
performed during the measurement period is < 100 mg/dL. A
positive whole number.
*Denominator: Patients 18-75 years of age with
diabetes with a visit during the measurement period.
A positive whole number.
Percentage
Page 155 January 2015
22
CMS Measure ID 164 Status
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..
National Quality Strategy
Domain
Clinical Process/Effectiveness
23
CMS Measure ID 154 Status
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
National Quality Strategy
Domain
Efficient Use of Healthcare Resources
*Numerator: Patients who have documentation of use of
aspirin or another antithrombotic during the measurement
period. A positive whole number.
*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
Page 156 January 2015
24
CMS Measure ID 145 Status
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.
National Quality Strategy
Domain
Clinical Process/Effectiveness
*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.
*Denominator: All patients aged 18 years and older with a
diagnosis of coronary artery disease seen within a 12 month
period who also have LVEF <40% .A positive whole number.
Percentage
Page 157 January 2015
25
CMS Measure ID 182 Status
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)..
National Quality Strategy
Domain
Clinical Process/Effectiveness
*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
Page 158 January 2015
26
CMS Measure ID 135 Status
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.
National Quality Strategy
Domain
Clinical Process/Effectiveness
27
CMS Measure ID 144 Status
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
National Quality Strategy
Domain
Clinical Process/Effectiveness
*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
Page 159 January 2015
28
CMS Measure ID 143 Status
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
National Quality Strategy
Domain
Clinical Process/Effectiveness
29
CMS Measure ID 167 Status
Title
Diabetic Retinopathy: Documentation of Presence or Absence of Macular
Edema and Level of Severity of Retinopathy Not Completed
Description
Percentage of patients aged 18 years and older with a diagnosis of
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
National Quality Strategy
Domain
Clinical Process/Effectiveness
*Numerator Patients who have an optic nerve head
evaluation during one or more office visits within 12 months
*Denominator All patients aged 18 years and older
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
*Denominator All patients aged 18 years and older
with a diagnosis of diabetic retinopathy
Percentage
Page 160 January 2015
30
CMS Measure ID 142 Status
Title
Diabetic Retinopathy: Communication with the Physician Managing Ongoing
Diabetes Care Not Completed
Description
Percentage of patients aged 18 years and older with a diagnosis of
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
National Quality Strategy
Domain
Clinical Process/Effectiveness
31
CMS Measure ID 139 Status
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
National Quality Strategy
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
*Denominator All patients aged 18 years and older
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
Page 161 January 2015
32
CMS Measure ID 161 Status
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
National Quality Strategy
Domain
Clinical Process/ Effectiveness
*Numerator Patients who had suicide risk assessment
completed at each visit
*Denominator All patients aged 18 years and older
with a new diagnosis or recurrent episode of MDD
Percentage
Page 162 January 2015
33
CMS Measure ID 128 Status
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.
National Quality Strategy
Domain
Clinical Process/ Effectiveness
*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
Page 163 January 2015
34
CMS Measure ID 136 Status
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.
National Quality Strategy
Domain
Clinical Process/ Effectiveness
*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
measurement period. A positive whole number.
Percentage
Page 164 January 2015
35
CMS Measure ID 169 Status
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
National Quality Strategy
Domain
Clinical Process/ Effectiveness
*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
Page 165 January 2015
36
CMS Measure ID 157 Status
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
National Quality Strategy
Domain
Patient and Family Engagement
37
CMS Measure ID 141 Status
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.
National Quality Strategy
Domain
Clinical Process/Effectiveness
*Numerator: Patient visits in which pain intensity is quantified.
A positive whole number.
*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
Page 166 January 2015
38
CMS Measure ID 140 Status
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
National Quality Strategy
Domain
Clinical Process/Effectiveness
*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
Page 167 January 2015
39
CMS Measure ID 129 Status
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
National Quality Strategy
Domain
Efficient Use of Healthcare Resources
40
CMS Measure ID 62 Status
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
National Quality Strategy
Domain
Clinical Process/Effectiveness
*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
positive whole number.
Percentage
Page 168 January 2015
41
CMS Measure ID 52 Status
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
National Quality Strategy
Domain
Clinical Process/Effectiveness
*Numerator 1: Patients who were prescribed pneumocystis
jiroveci pneumonia (PCP)
prophylaxis within 3 months of CD4 count below 200c ells/mm3.
A positive whole number.
*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
jiroveci pneumonia (PCP)
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
visit. A positive whole number.
Percentage
Page 169 January 2015
*Numerator 3: Patients who were prescribed Pneumocystic
jiroveci pneumonia (PCP)
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
visit. A positive whole number.
Percentage
Page 170 January 2015
42
CMS Measure ID 77 Status
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
National Quality Strategy
Domain
Clinical Process/Effectiveness
43
CMS Measure ID 2 Status
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
National Quality Strategy
Domain
Population/ Public Health
*Numerator: Patients whose most recent HIV RNA level is
<200 copies/mL. A positive whole number.
*Denominator: All patients aged 13 years and older with a
diagnosis of HIV/AIDS with at least two visits during the
measurement year, with at least 90 days between each visit. A
positive whole number.
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
Page 171 January 2015
44
CMS Measure ID 68 Status
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
National Quality Strategy
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
Page 172 January 2015
45
CMS Measure ID 69 Status
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
National Quality Strategy
Domain
Population/ Public Health
*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
Page 173 January 2015
46
CMS Measure ID 132 Status
Title
Cataracts: Complications within 30 Days Following Cataract Surgery Requiring
Additional Surgical Procedures Not Completed
Description
Percentage of patients aged 18 years and older with a diagnosis of
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.
National Quality Strategy
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
Page 174 January 2015
47
CMS Measure ID 133 Status
Title
Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract
Surgery Not Completed
Description
Percentage of patients aged 18 years and older with a diagnosis of
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.
National Quality Strategy
Domain
Clinical Process/Effectiveness
48
CMS Measure ID 158 Status
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.
National Quality Strategy
Domain
Clinical Process/Effectiveness
*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
positive whole number.
Percentage
Page 175 January 2015
49
CMS Measure ID 159 Status
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.
National Quality Strategy
Domain
Clinical Process/Effectiveness
*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
Page 176 January 2015
50
CMS Measure ID 160 Status
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..
National Quality Strategy
Domain
Clinical Process/Effectiveness
*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
*Numerator 2: Adult patients diagnosed during the months of
May through August.
*Denominator 2: Adult patients age 18 and older with an
office visit and the diagnosis of major depression or dysthymia
during May through August . A positive whole number.
Percentage
*Numerator 3: Adult patients diagnosed during the months of
September through December.
*Denominator 3: Adult patients age 18 and older with an
office visit and the diagnosis of major depression or dysthymia
during September through December . A positive whole
number.
Percentage
Page 177 January 2015
51
CMS Measure ID 75 Status
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
during the measurement period.
National Quality Strategy
Domain
Clinical Process/Effectiveness
52
CMS Measure ID 177 Status
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.
National Quality Strategy
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.
A positive whole number.
*Denominator: All patient visits for those patients aged 6
through 17 years with a diagnosis of major depressive
disorder. A positive whole number.
Percentage
Page 178 January 2015
53
CMS Measure ID 82 Status
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.
National Quality Strategy
Domain
Population/ Public Health
*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
positive whole number.
Percentage
Page 179 January 2015
54
CMS Measure ID 74 Status
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.
National Quality Strategy
Domain
Clinical Process/Effectiveness
*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
*Numerator: Children age 6 – 12 who receive a fluoride
varnish application .
*Denominator: Children, age 6 - 12 years, with a visit during the
measurement period .
Percentage
*Numerator: Children age 13 – 20 who receive a fluoride
varnish application .
*Denominator: Children, age 13-20 years, with a visit during
the measurement period .
Percentage
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55
CMS Measure ID 61 Status
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.
National Quality Strategy
Domain
Clinical Process/Effectiveness
*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
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*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
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56
CMS Measure ID 64 Status
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.
National Quality Strategy
Domain
Clinical Process/Effectiveness
*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.)
Percentage
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57
CMS Measure ID 149 Status
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
National Quality Strategy
Domain
Clinical Process/Effectiveness
*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
*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
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58
CMS Measure ID 65 Status
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
National Quality Strategy
Domain
Clinical Process/Effectiveness
59
CMS Measure ID 50 Status
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
National Quality Strategy
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
positive whole number.
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
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60
CMS Measure ID 66 Status
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.
National Quality Strategy
Domain
Patient and Family Engagement
*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
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61
CMS Measure ID 56 Status
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
National Quality Strategy
Domain
Patient and Family Engagement
62
CMS Measure ID 90 Status
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
National Quality Strategy
Domain
Patient and Family Engagement
*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
positive whole number.
*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
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63
CMS Measure ID 179 Status
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)
during the measurement period.
National Quality Strategy
Domain
Patient Safety
64
CMS Measure ID 22 Status
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.
National Quality Strategy
Domain
Population/ Public Health
*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
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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
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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
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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
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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.
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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.
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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
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CMS Certification ID Tool Tip
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EH Payment Calculation -
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EH Meaningful Use –
This screen is for an EH submitting for the 3rd
payment year prior to 1/1/14:
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This screen is for an EH submitting for the 3rd
payment year on or after 1/1/14:
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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.
:
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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 13 required core objectives
5 objectives chosen from a list of 10 menu set objectives.
All 15 CQM’s
The attesting provider selects the core, menu, and CQMs by selecting the appropriate link.
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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:
All 13 required core objectives
5 objectives chosen from a list of 10 menu set objectives.
16 out of 29 total 2014 CQMs
The attesting provider selects the core, menu, and CQM by selecting the appropriate link.
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EH Stage 1 Core Measures
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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
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EH Stage 1 Menu Measures
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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
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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
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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
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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
the EHR reporting period.
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
the EHR reporting period.
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# Measure Information Measure Value
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.
# Measure Information Measure Value
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
# Measure Information Measure Value
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.
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# Measure Information Measure Value
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
# Measure Information Measure Value
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
the EHR reporting period.
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
the EHR reporting period.
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# Measure Information Measure Value
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.
Numerator: N/A. Yes No
Denominator N/A
# Measure Information Measure Value
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.
# Measure Information Measure Value
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
Numerator: N/A. Yes No
Denominator N/A
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# Measure Information Measure Value
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.
# Measure Information Measure Value
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.
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# Measure Information Measure Value
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.
Exclusion: No exclusion
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
Page 229 January 2015
# Measure Information Measure Value
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
# Measure Information Measure Value
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.
Does any of these exclusion apply to you? Yes No
Measure 14 Yes No
Page 230 January 2015
# Measure Information Measure Value
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.
Does any of these exclusion apply to you? Yes No
Measure 15 Yes No
# Measure Information Measure Value
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.
Does this exclusion apply to you? Yes No
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.
Page 231 January 2015
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
Page 232 January 2015
EH Stage 2 Menu Measures
Meaningful Use Menu Measures - Eligible hospitals and CAHs must fill out 3 out of 6
menu measures
# Measure Information Measure Value
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
Does this exclusion apply to you? Yes No
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.
# Measure Information Measure Value
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.
Page 233 January 2015
# Measure Information Measure Value
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.
# Measure Information Measure Value
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.
# Measure Information Measure Value
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
Does this exclusion apply to you? Yes No
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.
Page 234 January 2015
# Measure Information Measure Value
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.
Exclusion: No exclusion
Numerator: The number of structured clinical lab results
sent to the ordering provider.
Denominator: The number of electronic lab orders received.
Page 235 January 2015
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
Page 236 January 2015
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.
Page 237 January 2015
1
CMS Measure ID 55 Status
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.
National Quality Strategy
Domain Patient and Family Engagement
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
Page 238 January 2015
2
CMS Measure ID 111 Status
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.
National Quality Strategy
Domain Patient and Family Engagement
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 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
Page 239 January 2015
3
CMS Measure ID 104 Status
Title Discharged on anti-thrombotic therapy Not Completed
Description
Ischemic stroke patients prescribed antithrombotic therapy at hospital
discharge
National Quality Strategy
Domain Clinical Process/Effectiveness
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: Ischemic stroke patients prescribed
antithrombotic therapy at hospital discharge .
*Denominator: Ischemic stroke patients.
Percentage
Page 240 January 2015
4
CMS Measure ID 71 Status
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.
National Quality Strategy
Domain Clinical Process/ Effectiveness
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: Ischemic stroke patients prescribed
anticoagulation therapy at hospital discharge.
*Denominator: Ischemic stroke patients with documented
atrial fibrillation/flutter.
Percentage
Page 241 January 2015
5
CMS Measure ID 91 Status
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.
National Quality Strategy
Domain Clinical Process/ Effectiveness
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 : 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
Page 242 January 2015
6
CMS Measure ID 72 Status
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
National Quality Strategy
Domain Clinical Process/ Effectiveness
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: Ischemic stroke patients who had
antithrombotic therapy administered by end of hospital day
two.
*Denominator: Ischemic stroke patients.
Percentage
Page 243 January 2015
7
CMS Measure ID 105 Status
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
National Quality Strategy
Domain Clinical Process/Effectiveness
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: 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
Page 244 January 2015
8
CMS Measure ID 107 Status
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
National Quality Strategy
Domain
Patient and Family Engagement
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: 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
Page 245 January 2015
9
CMS Measure ID 102 Status
Title
Stroke-10 Ischemic or hemorrhagic stroke – Assessed for
Rehabilitation Not Completed
Description
Ischemic or hemorrhagic stroke patients who were assessed for
rehabilitation services.
National Quality Strategy
Domain
Care Coordination
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: 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
Page 246 January 2015
10
CMS Measure ID 108 Status
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.
National Quality Strategy
Domain
Patient Safety
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: 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
Page 247 January 2015
11
CMS Measure ID 190 Status
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).
National Quality Strategy
Domain
Patient Safety
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: 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
Page 248 January 2015
12
CMS Measure ID 73 Status
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
National Quality Strategy
Domain
Clinical Process/Effectiveness
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: 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
Page 249 January 2015
13
CMS Measure ID 109 Status
Title
VTE-4 VTE Patients Receiving Unfractionated Heparin (UFH) with
Dosages/Platelet Count Monitoring by Protocol (or Nomogram) Not Completed
Description
This measure assesses the number of patients diagnosed with
confirmed VTE who received intravenous (IV) UFH therapy dosages
AND had their platelet counts monitored using defined parameters
such as a nomogram or protocol.
National Quality Strategy
Domain
Clinical Process/Effectiveness
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 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
Page 250 January 2015
14
CMS Measure ID 110 Status
Title VTE-5 VTE discharge instructions Not Completed
Description
This measure assesses the number of patients diagnosed with
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
National Quality Strategy
Domain
Patient and Family Engagement
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: 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
Page 251 January 2015
15
CMS Measure ID 114 Status
Title VTE-6 Incidence of potentially preventable VTE Not Completed
Description
This measure assesses the number of patients diagnosed with
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.
National Quality Strategy
Domain
Patient Safety
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: Patients who received no VTE prophylaxis
prior to the VTE diagnostic test order date.
*Denominator: Patients who developed confirmed
VTE during hospitalization.
Percentage
Page 252 January 2015
16
CMS Measure ID 100 Status
Title AMI-2-Aspirin Prescribed at Discharge for AMI Not Completed
Description AMI patients who are prescribed aspirin at hospital discharge
National Quality Strategy
Domain
Clinical Process/Effectiveness
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: 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
Page 253 January 2015
17
CMS Measure ID 113 Status
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.
National Quality Strategy
Domain
Clinical Process/Effectiveness
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: Patients with elective deliveries.
*Denominator: Patients delivering newborns
with >= 37 and < 39 weeks of gestation
completed
Percentage
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18
CMS Measure ID 60 Status
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.
National Quality Strategy
Domain
Clinical Process/Effectiveness
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 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
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19
CMS Measure ID 53 Status
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
National Quality Strategy
Domain
Clinical Process/Effectiveness
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: 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
Page 256 January 2015
20
CMS Measure ID 30 Status
Title AMI-10 Statin Prescribed at Discharge Not Completed
Description Acute Myocardial Infarction (AMI) patients who are prescribed a
statin at hospital discharge.
National Quality Strategy
Domain
Clinical Process/Effectiveness
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: AMI patients who are prescribed a statin
medication at hospital discharge .
*Denominator: AMI patients .
Percentage
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21
CMS Measure ID 188 Status
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.
National Quality Strategy
Domain
Efficient Use of Healthcare Resources
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 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
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22
CMS Measure ID 171 Status
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
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: 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
Denominator 3: 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 Hip arthroplasty.
Percentage
Denominator 4: 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 knee arthroplasty.
Page 259 January 2015
Percentage
Denominator 5: 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 colon surgery.
Percentage
Denominator 6: 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 Abdominal
hysterectomy.
Percentage
Denominator 7: 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 Vaginal
hysterectomy.
Denominator 8: 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 Vascular surgery.
Percentage
Page 260 January 2015
23
CMS Measure ID 172 Status
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
National Quality Strategy
Domain
Efficient Use of Healthcare Resources
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: 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
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
Denominator 3: 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 Hip arthroplasty.
Percentage
Denominator 4: 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 knee arthroplasty.
Percentage
Denominator 5: 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 colon surgery.
Page 261 January 2015
Percentage
Denominator 6: 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 Abdominal
hysterectomy.
Percentage
Denominator 7: 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 Vaginal
hysterectomy.
Percentage
Denominator 8: 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 Vascular surgery.
Percentage
Page 262 January 2015
24
CMS Measure ID 178 Status
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.
National Quality Strategy
Domain
Patient Safety
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: 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
Page 263 January 2015
25
CMS Measure ID 32 Status
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
National Quality Strategy
Domain
Care Coordination
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 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
*Numerator 2: Median time (in minutes) from ED arrival
to ED departure for patients discharged from the
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
*Numerator 3: Median time (in minutes) from ED arrival
to ED departure for patients discharged from the
emergency department to another Acute Care Hospital.
*Denominator 3 : All patients discharged from the to
another Acute Care Hospital.
Percentage
Page 264 January 2015
26
CMS Measure ID 26 Status
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.
National Quality Strategy
Domain
Patient and Family Engagement
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: 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
Page 265 January 2015
27
CMS Measure ID 9 Status
Title Exclusive Breast Milk Feeding Not Completed
Description Exclusive breast milk feeding during the newborn's entire
hospitalization
National Quality Strategy
Domain
Clinical Process/Effectiveness
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 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
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28
CMS Measure ID 185 Status
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
National Quality Strategy
Domain
Patient Safety
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 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
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29
CMS Measure ID 31 Status
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
National Quality Strategy
Domain
Clinical Process/Effectiveness
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 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
Page 268 January 2015
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.
Page 269 January 2015
EH Review and Attestation
Page 270 January 2015
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
Page 271 January 2015
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.
Page 272 January 2015
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.
Page 273 January 2015
Page 274 January 2015
Main Menu:
Clicking on EHR Case Inquiry displays this screen:
Page 275 January 2015
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.
Page 276 January 2015
Steps Provider Back End
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
Page 277 January 2015
Steps Provider Back End
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.
Page 278 January 2015
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.
Page 279 January 2015
Figure 4.3-1. Conceptual diagram of the EHR Incentive Payment System
Page 280 January 2015
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
Page 281 January 2015
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”
Page 282 January 2015
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.
Page 283 January 2015
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).
Page 284 January 2015
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
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token account (provider ID, login, and password) to secure individual provider access. DHH
will use the secured intranet LMMIS Inquiry web site.
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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,
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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
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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
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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-
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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
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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;
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• 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.
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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
Page 294 January 2015
relevant value-added expertise required to supplement resource gaps, validate and document the
artifacts required to advance completion of the proposed procurement roadmap.
Page 295 January 2015
Page 296 January 2015
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.
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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.
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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.
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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.
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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%
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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%
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* 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 $)
Mean Median SD Min Max
Medicaid share (n = 8) 59.27 7.88 90.68 1.74 240
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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%
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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.
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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.
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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%)
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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
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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%
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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%
Page 310 January 2015
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
Page 311 January 2015
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%
Page 312 January 2015
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.
Page 313 January 2015
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.
Page 314 January 2015
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
Mean Median SD Min Max
Sites (n = 410) 1.7 1 2.8 1 40
Page 315 January 2015
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%
Page 316 January 2015
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
Response Number Percent*
Yes from Medicaid 130 26%
Yes from Medicare 28 6%
No 55 11%
Don’t know 46 9%
* Percentages may not equal 100% because respondents were allowed to choose multiple
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 (%)
Mean Median SD Min Max
Medicare (n = 445) 31 30 21 0 95
Page 317 January 2015
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%
Page 318 January 2015
Interest in PCMH transformation assistance
Table 10: Interest in PCMH
Response Number Percent
No 64 38%
Yes 52 31%
Don’t know 53 31%
Responses 169 100%
Ownership
Table 11: Ownership
Response Number Percent
No 432 91%
Yes 40 8%
Don’t know 2 1%
Responses 474 100%
Facility size
Table 12: Average facility size
Mean Median SD Min Max
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%
Page 319 January 2015
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
Response Number Percent*
E-mail 414 83%
Scanner 269 54%
Smart phones or PDAs 187 38%
Don’t know 19 4%
* Percentages may not equal 100% because respondents were allowed to choose multiple
responses.
Electronic Claims
Respondents were asked if they submitted claims electronically.
Table 15: Electronic claims submission
Response Number Percent
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
Response Number Percent
Page 320 January 2015
No 122 27%
Yes 306 67%
Don’t know 29 6%
Responses 457 100%
Page 321 January 2015
Electronic Medical Records (EMR)
Respondents were asked if they had an electronic medical record (EMR) system.
Table 17: Electronic medical records
Response Number Percent
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
Response Number Percent
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
Response Number Percent
0 – 6 months 42 17%
7 – 12 months 40 17%
13 – 24 months 43 18%
> 24 months 25 10%
Don’t know 91 38%
Page 322 January 2015
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%)
Page 323 January 2015
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
Response Number Percent
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
Response Number Percent
No 151 34%
Yes 207 47%
Don’t know 81 18%
Page 324 January 2015
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
Response Number Percent
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%)
Page 325 January 2015
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
Response Number Percent
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
Response Number Percent
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
Response Number Percent
No 26 19%
Yes 107 78%
know 4 3%
Responses 137 100%
Page 326 January 2015
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%)
Page 327 January 2015
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%
* Percentages may not equal 100% because respondents were allowed to choose multiple
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.
Page 328 January 2015
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
Response Number Percent
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
Response Number Percent
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 $)
Mean Median SD Min Max
Estimated funding (n = 56) 283.97 40.00 1,345.82 2.00 10,000.00
Considering financing from other sources
Page 329 January 2015
Respondents were asked if they were considering obtaining financing from other sources they
knew were currently available.
Table 36: Other financing sources
Response Number Percent
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
Response Number Percent
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
Response Number Percent
All electronic 8 3%
Part electronic, part paper 16 5%
No 242 76%
Don’t know 52 16%
Responses 318 100%
Page 330 January 2015
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,
Page 331 January 2015
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.
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
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Steps Provider Back End
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, The State approves the EH’s
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Step Provider Back-End
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
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CMS Question Section/Answer
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
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CMS Question Section/Answer
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.
Please see Section 2.7.5
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.
Please see Section 2.7.6
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.
Please see Section 2.3.1
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CMS Question Section/Answer
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.
Please see Section 2.4.3
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.
Please see Section 4.3.7
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
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CMS Question Section/Answer
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.
Page 339 January 2015
CMS Question Section/Answer
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.
Page 340 January 2015
CMS Question Section/Answer
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).
Page 341 January 2015
CMS Question Section/Answer
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.