Oregon Medicaid Electronic Health Record (Ehr) Incentive Program

Link to law: http://arcweb.sos.state.or.us/pages/rules/oars_400/oar_410/410_165.html
Published: 2015

The Oregon Administrative Rules contain OARs filed through November 15, 2015

 

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OREGON HEALTH AUTHORITY, DIVISION OF MEDICAL ASSISTANCE PROGRAMS




 

DIVISION 165
OREGON MEDICAID ELECTRONIC HEALTH RECORD (EHR) INCENTIVE PROGRAM

410-165-0000
Basis
and Purpose
(1) These rules (OAR chapter 410, division
165) govern the Oregon Health Authority (Authority), Division of Medical Assistance
Programs (Division), Medicaid Electronic Health Record (EHR) Incentive Program.
The Medicaid EHR Incentive Program provides incentive payments consistent with federal
law concerning such payments to eligible providers participating in the Medicaid
program who adopt, implement, upgrade, or successfully demonstrate meaningful use
of certified EHR technology and who are qualified by the program.
(2) The Medicaid EHR Incentive
Program is implemented pursuant to:
(a) The American Reinvestment
and Recovery Act of 2009, Pub. L. No. 111-5, section 4201;
(b) The Centers for Medicare
and Medicaid Services (CMS) federal regulation 42 CFR Part 495 (2010, 2012, &
2014) pursuant to the Social Security Act sections 1903(a)(3)(F) and 1903(t);
(c) The Division’s
General Rules program, OAR chapter 410, division 120;
(d) The Authority’s
Provider Rules, OAR chapter 943, division 120.
(3) The following retroactive
effective dates apply to these rules:
(a) For all sections and
references in this rule that refer to CMS federal regulation 42 CFR Part 495 (2014),
the effective date is October 1, 2014;
(b) For eligible hospitals,
except for sections and references in the rule applicable under section (3)(a) above,
the effective date is October 1, 2013, which is also the start date for program
year 2014.
(c) For eligible professionals,
except for sections and references in the rule applicable under section (3)(a) above,
the effective date is January 1, 2014, which is also the start date for program
year 2014.
Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 413.042
& 414.033
Hist.: DMAP 13-2011, f. 6-29-11,
cert. ef. 7-1-11; DMAP 20-2013(Temp), f. & cert. ef. 4-26-13 thru 10-23-13;
DMAP 56-2013, f. & cert. ef. 10-22-13; DMAP 2-2015(Temp), f. 1-30-15, cert.
ef. 2-3-15 thru 8-1-15; DMAP 20-2015, f. & cert. ef. 4-8-15
410-165-0020
Definitions
The following definitions apply to OAR
410-165-0010 through 410-165-0140:
(1) Acceptance documents
means written evidence supplied by a provider demonstrating that the provider met
Medicaid EHR Incentive Program eligibility criteria or participation requirements
according to standards specified by the Oregon Health Authority’s (Authority),
Division of Medical Assistance Programs.
(2) Acute care hospital means
a healthcare facility including but not limited to a critical access hospital with
a Centers for Medicare and Medicaid Services’ (CMS) certification number (CCN)
that ends in 0001-0879 or 1300-1399; and where the average length of patient stay
is 25 days or fewer.
(3) Adopt, implement, or
upgrade:
(a) Acquire, purchase, or
secure access to Certified EHR Technology capable of meeting meaningful use requirements;
(b) Install or commence utilization
of Certified EHR Technology capable of meeting meaningful use requirements; or
(c) Expand the available
functionality of Certified EHR Technology capable of meeting meaningful use requirements
at the practice site, including staffing, maintenance, and training or upgrade from
existing EHR technology to Certified EHR Technology.
(4) Attestation means a statement
that:
(a) Is made by an eligible
provider or preparer during the application process;
(b) Represents that the eligible
provider met the thresholds and requirements of the Medicaid EHR Incentive Program;
and
(c) Is made under penalty
of prosecution for falsification or concealment of a material fact.
(5) Certified EHR Technology
as defined in 42 CFR 495.302 (2010, 2012, and 2014), 42 CFR 495.4 (2010 and 2012),
42 CFR 495.6 (2014) and 45 CFR 170.102 (2010, 2011, 2012, and 2014) per the Office
of the National Coordinator for Health Information Technology EHR certification
criteria.
(6) Children’s hospital
means a separately certified hospital, either freestanding or hospital-within a
hospital that predominantly treats individuals under 21 years of age and that either:
(a) Has a CMS Certification
Number (CCN) that ends in 3300–3399; or
(b) Does not have a CCN but
has been provided an alternative number by CMS for purposes of enrollment in the
Medicaid EHR Incentive Program as a children’s hospital.
(7) Dentist has the meaning
given that term in in OAR 410-120-0000 and 42 CFR 440.100.
(8) Eligible hospital means
an acute care hospital with at least 10 percent Medicaid patient volume or a children’s
hospital.
(9) Eligible professional
means a professional who:
(a) Is a physician; a dentist;
a nurse practitioner, including a nurse-midwife nurse practitioner; or a physician
assistant practicing in a Federally Qualified Health Center (FQHC) or a Rural Health
Clinic (RHC) that is so led by a physician assistant;
(b) Meets patient volume
requirements described in OAR 410-165-0060; and
(c) Is not a hospital-based
professional.
(10) Eligible provider means
an eligible hospital or eligible professional.
(11) Encounter means:
(a) For an eligible hospital,
either:
(A) Services rendered to
an individual per inpatient discharge; or
(B) Services rendered to
an individual in an emergency department on any one day.
(b) For an eligible professional,
services rendered to an individual on any one day.
(12) Enrolled provider means
a hospital or health care practitioner who is actively registered with the Authority
pursuant to OAR 943-120-0320.
(13) Entity promoting the
adoption of Certified EHR Technology means an entity designated by the Authority
that promotes the adoption of Certified EHR Technology by enabling:
(a) Oversight of the business
and operational and legal issues involved in the adoption and implementation of
Certified EHR Technology; or
(b) The exchange and use
of electronic clinical and administrative data between participating providers in
a secure manner, including but not limited to maintaining the physical and organizational
relationship integral to the adoption of Certified EHR Technology by eligible providers.
(14) Federal fiscal year
(FFY) means October 1 to September 30.
(15) Federally Qualified
Health Center (FQHC) has the meaning given that term in OAR 410-120-0000.
(16) Grace period means a
period of time or specified date following the end of a program year when an eligible
provider may submit an application to the Medicaid EHR Incentive Program for that
program year:
(a) For program years 2011
and 2012, the following applies:
(A) For a first year application,
the grace period is 60 days;
(B) For all subsequent years,
the grace period is 90 days.
(b) For program year 2013,
the grace period is 90 days;
(c) For program year 2014,
the following applies:
(A) For eligible hospitals,
the grace period ends on January 31, 2015;
(B) For eligible professionals,
the grace period ends on May 31, 2015;
(d) For program year 2015
and later, the grace period is 90 days.
(17) Group has the meaning
given that term in OAR 410-120-0100.
(18) Hospital-based professional
means a professional who furnishes 90 percent or more of Medicaid-covered services
in a hospital emergency room (place of service code 23) or inpatient hospital (place
of service code 21) in the calendar year (CY) preceding the program year, except
that hospital-based professional does not include a professional practicing predominantly
at a Federally Qualified Health Center (FQHC) or a Rural Health Clinic (RHC).
(19) Individuals receiving
Medicaid means individuals served by an eligible provider where the services rendered
would qualify under the Medicaid encounter definition.
(20) Meaningful EHR user
means an eligible provider that, for an EHR reporting period for a program year,
demonstrates in accordance with 42 CFR 495.4 (2010 and 2012) and 42 CFR 495.8 (2010,
2012, and 2014), meaningful use of Certified EHR Technology by meeting the applicable
objectives and associated measures in 42 CFR 495.6 (2010, 2012, and 2014) and as
prescribed by 42 CFR Part 495.
(21) Medicaid encounter means:
(a) For an eligible hospital
applying for program year 2011 or 2012, either:
(A) Services rendered to
an individual per inpatient discharge where Medicaid (or a Medicaid demonstration
project approved under the Social Security Act section 1115) paid for part or all
of the service; or Medicaid (or a Medicaid demonstration project approved under
the Social Security Act section 1115) paid all or part of the individual’s
premiums, copayments, or cost-sharing; or
(B) Services rendered in
an emergency department on any one day where Medicaid (or a Medicaid demonstration
project approved under the Social Security Act section 1115) paid for part or all
of the service; or Medicaid (or a Medicaid demonstration project approved under
the Social Security Act section 1115) paid all or part of the individual’s
premiums, copayments, and cost-sharing.
(b) For an eligible hospital
applying for program year 2013 or later, either:
(A) Services rendered to
an individual per inpatient discharge where the individual was enrolled in Medicaid
(or a Medicaid demonstration project approved under the Social Security Act section
1115) or Children’s Health Insurance Program (CHIP) if part of a state’s
Medicaid expansion (does not apply to Oregon’s as it is designated as a separate
CHIP state) at the time the billable service was provided; or
(B) Services rendered in
an emergency department on any one day where the individual was enrolled in Medicaid
(or a Medicaid demonstration project approved under the Social Security Act section
1115) or Children’s Health Insurance Program (CHIP) if part of a state’s
Medicaid expansion (does not apply to Oregon’s as it is designated as a separate
CHIP state) at the time the billable service was provided;
(c) For an eligible professional
applying for program year 2011 or 2012, either:
(A) Services rendered to
an individual on any one day where Medicaid (or a Medicaid demonstration project
approved under the Social Security Act section 1115) paid for part or all of the
service; or
(B) Medicaid (or a Medicaid
demonstration project approved under the Social Security Act section 1115) paid
all or part of the individual’s premiums, copayments, and cost-sharing;
(d) For an eligible professional
applying for program year 2013 or later, services rendered to an individual on any
one day where the individual was enrolled in a Medicaid program (or a Medicaid demonstration
project approved under the Social Security Act section 1115) or Children’s
Health Insurance Program (CHIP) if part of a state’s Medicaid expansion (does
not apply to Oregon’s as it is designated as a separate CHIP state) at the
time the billable service was provided.
(22) National Provider Identifier
has the meaning given that term in 45 CFR Part 160 and OAR 410-120-0000.
(23) Needy individual means
individuals served by an eligible professional where the services rendered qualify
under the needy individual encounter definition.
(24) Needy individual encounter
means:
(a) For an eligible professional
applying for program year 2011 or 2012, services rendered to an individual on any
one day where:
(A) Medicaid or CHIP (or
a Medicaid or CHIP demonstration project approved under the Social Security Act
section 1115) paid for part or all of the service;
(B) Medicaid or CHIP (or
a Medicaid or CHIP demonstration project approved under the Social Security Act
section 1115) paid all or part of the individual’s premiums, copayments, or
cost-sharing;
(C) The services were furnished
at no cost and calculated consistent with 42 CFR 495.310(h) (2010); or
(D) The services were paid
for at a reduced cost based on a sliding scale determined by the individual’s
ability to pay;
(b) For an eligible professional
applying for program year 2013 or later, services rendered to an individual on any
one day where:
(A) The services were rendered
to an individual enrolled in a Medicaid program (or a Medicaid demonstration project
approved under the Social Security Act section 1115) or CHIP at the time the billable
service was provided;
(B) The services were furnished
at no cost and calculated consistently with 42 CFR 495.310(h) (2010); or
(C) The services were paid
for at a reduced cost based on a sliding scale determined by the individual’s
ability to pay.
(25) Nurse practitioner has
the meaning given that term in OAR 410-120-0000 and 42 CFR 440.166.
(26) Panel means a managed
care panel, medical or health home program panel, or similar provider structure
with capitation or case assignment that assigns patients to providers.
(27) Patient volume means:
(a) For eligible hospitals,
the proportion of Medicaid encounters to total encounters expressed as a percentage;
(b) For eligible professionals
who do not meet the definition of “practices predominantly”: The proportion
of Medicaid encounters to total encounters expressed as a percentage;
(c) For eligible professionals
who meet the definition of “practices predominantly”: The proportion
of Needy Individual encounters to total encounters expressed as a percentage.
(28) Pediatrician means a
physician who predominantly treats individuals under 21.
(29) Physician has the meaning
given that term in OAR 410-120-0000 and 42 CFR 440.50.
(30) Physician assistant
has the meaning given that term in OAR 410-120-0000 and 42 CFR 440.60.
(31) Practices predominantly
mean an eligibility criterion to permit use of needy individual patient volume.
An eligible professional “practices predominantly” if:
(a) For program year 2011
or 2012, more than 50 percent of an eligible professional’s total patient
encounters over a period of six months in the calendar year preceding the program
year occur at an FQHC or RHC;
(b) For program year 2013
and later, more than 50 percent of an eligible professional’s total patient
encounters occur at an FQHC or RHC:
(A) During a six-month period
in the calendar year preceding the program year; or
(B) During a six-month period
in the most recent 12 months prior to attestation.
(32) Preparer means an individual
authorized by an eligible provider to act on behalf of the provider to complete
an application for a Medicaid EHR incentive via an electronic media connection with
the Authority.
(33) Program year means:
(a) The calendar year (CY)
for an eligible professional; or
(b) The federal fiscal year
(FFY) for an eligible hospital.
(34) Provider Web Portal
means the Authority’s website that provides a secure gateway for eligible
providers or preparers to apply for the Medicaid EHR Incentive Program.
(35) Qualify means to meet
the eligibility criteria and participation requirements to receive a Medicaid EHR
incentive payment for the program year. The Medicaid EHR Incentive Program (Program)
makes the determination as to whether an eligible provider qualifies.
(36) Rural Health Clinic
(RHC) means a clinic located in a rural and medically underserved community designated
as an RHC by CMS. Payment by Medicare and Medicaid to an RHC is on a cost-related
basis for outpatient physician and certain non-physician services.
(37) So led means when an
FQHC or RHC has a physician assistant who is:
(a) The primary provider
in the clinic;
(b) A clinical or medical
director at the clinical site of practice; or
(c) An owner of the RHC.
Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 413.042
& 414.033
Hist.: DMAP 13-2011, f. 6-29-11,
cert. ef. 7-1-11; DMAP 20-2013(Temp), f. & cert. ef. 4-26-13 thru 10-23-13;
DMAP 56-2013, f. & cert. ef. 10-22-13; DMAP 2-2015(Temp), f. 1-30-15, cert.
ef. 2-3-15 thru 8-1-15; DMAP 20-2015, f. & cert. ef. 4-8-15
410-165-0040
Application
(1) An eligible provider must apply
to the Medicaid Electronic Health Record (EHR) Incentive Program (Program) each
program year that the eligible provider seeks an incentive payment. In order to
apply, an eligible provider or a preparer acting on behalf of an eligible provider
must:
(a) Register with the Centers
for Medicare and Medicaid Services (CMS);
(b) Apply to the Program
after registering with CMS for each program year; and
(c) Attest that:
(A) The information submitted
is true, accurate, and complete; and
(B) Any falsification or
concealment of a material fact may be prosecuted under federal and state laws;
(d) Maintain for a period
of no less than seven years from the date of completed application complete, accurate,
and unaltered copies of all acceptance documents associated with all data transmissions
and attestations. The information maintained must include at a minimum documentation
to support:
(A) The financial or legal
obligation for the adoption, implementation, or upgrade of certified EHR technology
including, but not limited to, the purchase agreement or contract;
(B) Demonstration of meaningful
use for the year corresponding to the program year;
(C) Patient volume for the
year corresponding to the program year; and
(D) The eligible hospital’s
payment calculation data including, but not limited to, Medicare cost reports.
(2) An eligible provider
must submit the acceptance documents referred to above in section (1)(d)(A) when
the eligible provider is attesting for a payment for the adoption, implementation,
or upgrade to certified EHR technology or when new Certified EHR Technology is acquired.
If the eligible provider is an eligible hospital seeking its first year payment,
it must submit the acceptance documents referred to in section (1)(d)(D).
(3) The Program reviews the
completed application and the acceptance documents to determine if the eligible
provider qualifies for an incentive payment:
(a) The Program verifies
the information in the application;
(b) The Program determines
if the eligible provider’s information complies with the eligibility criteria
and participation requirements;
(c) The Program notifies
the eligible provider about the incentive payment determination;
(d) The Authority may reduce
the incentive payment to pay off debt if an eligible provider or incentive payment
recipient owes a debt under a collection mandate to the State of Oregon. The incentive
payment is considered paid to the eligible provider even when part or all of the
incentive may offset the debt. The Authority may not reduce the incentive payment
amount for any other purpose unless permitted or required by federal or state law;
and
(e) The Authority distributes
1099 forms to the tax identification number designated to receive the Medicaid EHR
incentive payment.
Stat. Auth.: ORS 413.042
Stats. Implemented: ORS,
413.042 & 414.033
Hist.: DMAP 13-2011, f. 6-29-11,
cert. ef. 7-1-11; DMAP 20-2013(Temp), f. & cert. ef. 4-26-13 thru 10-23-13;
Administrative correction, 11-22-13; DMAP 2-2015(Temp), f. 1-30-15, cert. ef. 2-3-15
thru 8-1-15; DMAP 20-2015, f. & cert. ef. 4-8-15
410-165-0060
Eligibility
(1) For the purposes of the Medicaid
Electronic Health Record (EHR) Incentive Program, there are three categories of
eligibility criteria: criteria for an eligible professional, criteria for an eligible
professional practicing predominately in a Federally Qualified Health Center (FQHC)
or a Rural Health Clinic (RHC), and criteria for an eligible hospital.
(2) To be eligible for a
Medicaid EHR incentive payment for the program year, an eligible professional as
listed in Table 165-0060-1 must meet the Medicaid EHR Incentive Program criteria
each year:
(a) To be eligible for an
incentive payment, an eligible professional must at a minimum:
(A) Meet and follow the scope
of practice regulations as applicable for each professional as defined in 42 CFR
Part 440;
(B) Meet the following certified
EHR technology and meaningful use requirements for the corresponding year of participation:
(i) First year of participation:
(I) Adopt, implement, or
upgrade certified EHR technology; or
(II) Demonstrate meaningful
use as prescribed by 42 CFR 495.4 (2010 and 2012) and 42 CFR 495.8 (2010, 2012,
and 2014) and meet the corresponding meaningful use criteria as prescribed by 42
CFR 495.6 (2010, 2012, and 2014).
(ii) Subsequent years of
participation, demonstrate meaningful use as prescribed by 42 CFR 495.4 (2010 and
2012) and 42 CFR 495.8 (2010, 2012, and 2014) and meet the corresponding meaningful
use criteria as prescribed by 42 CFR 495.6 (2010, 2012, and 2014).
(C) Either not be a hospital-based
professional or for program year 2013 or later meet the requirements that allow
a reversal of a hospital-based determination. To be considered non-hospital-based
in future program years after an initial reversal determination, the professional
must attest in each subsequent program year that the professional continues to meet
the requirements. To meet the requirements, the professional must do all of the
following:
(i) Fund the acquisition,
implementation, and maintenance of Certified EHR Technology, including supporting
hardware and interfaces needed for meaningful use without reimbursement from an
eligible hospital and use such Certified EHR Technology in the inpatient or emergency
department of a hospital;
(ii) Provide documentation
to the Program for review and approval for the program year and in accordance with
the program application rules in OAR 410-165-0040;
(iii) Meet all applicable
requirements to receive an incentive payment; and
(iv) If attesting to meaningful
use, demonstrate using all encounters at all locations equipped with Certified EHR
Technology, including those in the inpatient and emergency departments of the hospital.
(D) Meet one of the following
criteria:
(i) Have a minimum of 30
percent patient volume attributable to individuals receiving Medicaid; or
(ii) Be a pediatrician who
has a minimum of 20 percent patient volume attributable to individuals receiving
Medicaid;
(b) An eligible professional
must calculate patient volume, as listed in Table 165-0060-2, by using the patient
volume calculation method either of patient encounter or of patient panel. The patient
panel volume calculation method may be used only when all of the following apply:
(A) The patient panel is
appropriate as a patient volume calculation method for the eligible professional;
and
(B) There is an auditable
data source to support the patient panel data;
(c) An eligible professional
must calculate patient volume as listed in Table 165-0060-2 by using either the
patient volume of the eligible professional or the patient volume of the group.
The patient volume of the group may be used only when all of the following apply:
(A) The group’s patient
volume is appropriate as a patient volume methodology calculation for the eligible
professional;
(B) There is an auditable
data source to support the group’s patient volume determination;
(C) All eligible professionals
in the group must use the same patient volume calculation method for the program
year;
(D) The group uses the entire
practice or clinic’s patient volume and does not limit patient volume in any
way; and
(E) If an eligible professional
works inside and outside of the group, then the patient volume calculation includes
only those encounters associated with the group and not the eligible professional’s
outside encounters.
(d) An eligible professional’s
patient volume must be calculated using one of the following methods:
(A) The patient encounter
calculation method based on the patient volume of the eligible professional requires
that:
(i) For program year 2011
or 2012, the eligible professional must divide the total Medicaid encounters by
the total patient encounters that were rendered by the eligible professional in
any representative, continuous 90-day period in the preceding calendar year; or
(ii) For program year 2013
and later, the eligible professional must divide the total Medicaid encounters by
the total patient encounters that were rendered by the eligible professional in
any representative, continuous 90-day period either in the preceding calendar year
or in the twelve month timeframe preceding the date of attestation. The eligible
professional may not use the same 90-day timeframe to calculate patient volume in
different program years.
(B) The patient encounter
calculation method based on the patient volume of the group requires that:
(i) For program year 2011
or 2012, the eligible professional must divide the group’s total Medicaid
encounters by the group’s total patient encounters in any representative,
continuous 90-day period in the preceding calendar year;
(ii) For program year 2013
and later, the eligible professional must divide the group’s total Medicaid
encounters by the group’s total patient encounters in any representative,
continuous 90-day period either in the preceding calendar year or in the twelve-month
timeframe preceding the date of attestation. The eligible professional may not use
the same 90-day timeframe to calculate patient volume in different program years.
(C) The patient panel calculation
method based on the patient volume of the eligible professional requires that:
(i) For program year 2011
or 2012, the eligible professional must:
(I) Add the total Medicaid
patients assigned to the eligible professional’s panel in any representative
90-day period in the prior calendar year, provided at least one Medicaid encounter
took place with the patient in the preceding calendar year, to the eligible professional’s
unduplicated Medicaid encounters rendered in the same 90-day period; and
(II) Divide the result calculated
above in (1)(d)(C)(i)(I) by the sum of the total patients assigned to the eligible
professional’s panel in the same 90-day period, provided at least one encounter
took place with the patient during the preceding calendar year, plus all of the
unduplicated patient encounters in the same 90-day period;
(ii) For program year 2013
and later, the eligible professional must:
(I) Add the total Medicaid
patients assigned to the eligible professional’s panel in any representative
90-day period in either the preceding calendar year or during the 12-month timeframe
preceding the attestation date, provided at least one Medicaid encounter took place
with the individual during the 24 months before the beginning of the 90-day period,
to the eligible professional’s unduplicated Medicaid encounters rendered same
90-day period; and
(II) Divide the result calculated
above in section (2)(d)(C)(ii)(I) by the sum of the total patients assigned to the
eligible professional’s panel in the same 90-day period, provided at least
one encounter took place with the patient during the 24 months before the beginning
of the 90-day period, plus all of the unduplicated patient encounters in the same
90-day period; and
(III) Not use the same 90-day
timeframe to calculate patient volume in different program years;
(D) The patient panel calculation
method based on the patient volume of the group requires that:
(i) For program year 2011
or 2012, the eligible professional must:
(I) Add the total Medicaid
patients assigned to the group’s panel in any representative 90-day period
in the prior calendar year, provided at least one Medicaid encounter took place
with the patient in the preceding calendar year, to the group’s unduplicated
Medicaid encounters in the same 90-day period; and
(II) Divide the result calculated
above in (1)(d)(D)(i)(I) by the sum of the total patients assigned to the group’s
panel in the same 90-day period, provided at least one encounter took place with
the patient during the preceding calendar year, plus all of the unduplicated patient
encounters in the same 90-day period.
(ii) For program year 2013
and later, the eligible professional must:
(I) Add the total Medicaid
patients assigned to the group’s panel in any representative 90-day period
in either the preceding calendar year or during the 12-month timeframe preceding
the attestation date, provided at least one Medicaid encounter took place with the
individual during the 24 months before the beginning of the 90-day period, to the
group’s unduplicated Medicaid encounters that same 90-day period;
(II) Divide the result calculated
above in (1)(d)(D)(ii)(I) by the sum of the total patients assigned to the group’s
panel in the same 90-day period, provided at least one encounter took place with
the patient during the 24 months before the beginning of the 90-day period, plus
all of the unduplicated patient encounters in the same 90-day period; and
(III) Not use the same 90-day
timeframe to calculate patient volume in different program years.
(3) To be eligible for a
Medicaid EHR incentive payment for the program year, an eligible professional practicing
predominantly in an FQHC or an RHC, as listed in Table 165-0060-1, must meet the
Medicaid EHR Incentive Program professional eligibility criteria each year by meeting
either the above section (2) of this rule or by meeting the following FQHC- and
RHC-specific criteria:
(a) To be eligible for an
incentive payment, an eligible professional must at a minimum:
(A) Meet and follow the scope
of practice regulations as applicable for each professional as prescribed by 42
CFR Part 440;
(B) Meet the following certified
EHR technology and meaningful use requirements for the corresponding year of participation:
(i) First year of participation:
(I) Adopt, implement, or
upgrade Certified EHR Technology; or
(II) Demonstrate meaningful
use as prescribed by 42 CFR 495.4 (2010 and 2012) and 42 CFR 495.8 (2010, 2012,
and 2014) and meet the corresponding meaningful use criteria as prescribed by 42
CFR 495.6 (2010, 2012, and 2014).
(ii) Subsequent years of
participation demonstrate meaningful use as prescribed by 42 CFR 495.4 (2010 and
2012) and 42 CFR 495.8 (2010, 2012, and 2014) and meet the corresponding meaningful
use criteria as prescribed by 42 CFR 495.6 (2010, 2012, and 2014).
(C) Have a minimum of 30
percent patient volume attributable to needy individuals.
(b) An eligible professional
must calculate patient volume, as listed in Table 165-0060-3, by using the patient
volume calculation method either of patient encounter or of patient panel. The patient
panel volume calculation method may be used only when all of the following apply:
(A) The patient panel is
appropriate as a patient volume calculation method for the eligible professional;
and
(B) There is an auditable
data source to support the patient panel data;
(c) An eligible professional
must calculate patient volume, as listed in Table 165-0060-3, by using either the
patient volume of the eligible professional or the patient volume of the group.
The group’s patient volume may be used only when all of the following apply:
(A) The group’s patient
volume is appropriate as a patient volume methodology calculation for the eligible
professional;
(B) There is an auditable
data source to support the group’s patient volume determination;
(C) All eligible professionals
in the group must use the same patient volume calculation method for the program
year;
(D) The group uses the entire
practice or clinic’s patient volume and does not limit patient volume in any
way; and
(E) If an eligible professional
works inside and outside of the group, then the patient volume calculation includes
only those encounters associated with the group and not the eligible professional’s
outside encounters.
(d) An eligible professional’s
needy individual patient volume must be calculated using one of the following methods:
(A) The patient encounter
calculation method based on the patient volume of the eligible professional:
(i) For program year 2011
or 2012, the eligible professional must divide the total needy individual encounters
by the total patient encounters that were rendered by the eligible professional
in any representative, continuous 90-day period in the preceding calendar year;
(ii) For program year 2013
and later, the eligible professional must divide the total needy individual encounters
by the total patient encounters that were rendered by the eligible professional
in any representative, continuous 90-day period either in the preceding calendar
year or in the12-month timeframe preceding the date of attestation. The eligible
professional may not use the same 90-day timeframe to calculate patient volume in
different program years;
(B) The patient encounter
calculation method based on the patient volume of the group requires that:
(i) For program year 2011
or 2012, the eligible professional must divide the group’s total needy individual
encounters by the group’s total patient encounters in any representative,
continuous 90-day period in the preceding calendar year;
(ii) For program year 2013
and later, the eligible professional must divide the group’s total needy individual
encounters by the group’s total patient encounters in any representative,
continuous 90-day period either in the preceding calendar year or in the 12-month
timeframe preceding the date of attestation. The eligible professional may not use
the same 90-day timeframe to calculate patient volume in different program years;
(C) The patient panel calculation
method based on the patient volume of the eligible professional requires that:
(i) For program year 2011
or 2012, the eligible professional must:
(I) Add the total needy individual
patients assigned to the eligible professional’s panel in any representative,
90-day period in the prior calendar year, provided at least one Medicaid encounter
took place with the patient in the preceding calendar year, to the eligible professional’s
unduplicated needy individual encounters rendered in the same 90-day period; and
(II) Divide the result calculated
above in section (2)(d)(C)(i)(I) by the sum of the total patients assigned to the
eligible professional’s panel in the same 90-day period, provided at least
one encounter took place with the patient during the preceding calendar year, plus
all of the unduplicated patient encounters in the same 90-day period;
(ii) For program year 2013
and later, the eligible professional must:
(I) Add the total needy individual
patients assigned to the eligible professional’s panel in any representative,
90-day period either in the preceding calendar year or during the twelve month timeframe
preceding the attestation date, provided at least one Medicaid encounter took place
with the individual during the 24 months before the beginning of the 90-day period,
to the eligible professional’s unduplicated needy individual encounters rendered
same 90-day period;
(II) Divide the result calculated
above in section (2)(d)(C)(ii)(I) by the sum of the total patients assigned to the
eligible professional’s panel in the same 90-day period, provided at least
one encounter took place with the patient during the 24 months before the beginning
of the 90-day period, plus all of the unduplicated patient encounters in the same
90-day period; and
(III) Not use the same 90-day
timeframe to calculate patient volume in different program years;
(D) The patient panel calculation
method based on the patient volume of the group requires that:
(i) For program year 2011
or 2012, the eligible professional must:
(I) Add the total needy individual
patients assigned to the group’s panel in any representative 90-day period
in the prior calendar year, provided at least one needy individual encounter took
place with the patient in the preceding calendar year, to the group’s unduplicated
Medicaid encounters in the same 90-day period; and
(II) Divide the result calculated
above in section (2)(d)(D)(i)(I) by the sum of the total patients assigned to the
group’s panel in the same 90-day period, provided at least one encounter took
place with the patient during the preceding calendar year, plus all of the unduplicated
patient encounters in the same 90-day period;
(ii) For program year 2013
and later, the eligible professional must:
(I) Add the total needy individual
patients assigned to the group’s panel in any representative, 90-day period
either in the preceding calendar year or during the 12-month timeframe preceding
the attestation date, provided at least one needy individual encounter took place
with the individual during the 24 months before the beginning of the 90-day period,
to the group’s unduplicated Medicaid encounters that same 90-day period;
(II) Divide the result calculated
above in section (2)(d)(D)(ii)(I) by the sum of the total patients assigned to the
group’s panel in the same 90-day period, provided at least one encounter took
place with the patient during the 24 months before the beginning of the 90-day period,
plus all of the unduplicated patient encounters in the same 90-day period; and
(III) Not use the same 90-day
timeframe to calculate patient volume in different program years.
(4) To be eligible for a
Medicaid EHR incentive payment for the program year, an eligible hospital must meet
the Medicaid EHR Incentive Program criteria each year:
(a) To be eligible for an
incentive payment, an eligible hospital must, at a minimum, meet the Certified EHR
Technology and meaningful use requirements for the corresponding year of participation:
(A) First year of participation:
(i) Adopt, implement, or
upgrade Certified EHR Technology;
(ii) For eligible hospitals
that participate in the Medicaid EHR Incentive Program only, demonstrate meaningful
use as prescribed by 42 CFR 495.4 (2010 and 2012) and 42 CFR 495.8 (2010, 2012,
and 2014) and meet the corresponding meaningful use criteria as prescribed by 42
CFR 495.6 (2010, 2012, and 2014); or
(iii) For eligible hospitals
that participate in both the Medicare and Medicaid EHR Incentive Programs, demonstrate
meaningful use under the Medicare EHR Incentive Program to Centers for Medicare
and Medicaid Services (CMS) and be deemed a meaningful EHR user for the program
year, as prescribed by 42 CFR 495.4 (2010 and 2012), 42 CFR 495.6 (2010, 2012, and
2014), and 42 CFR 495.8 (2010, 2012, and 2014);
(B) Subsequent years of participation:
(i) For eligible hospitals
that participate in both the Medicare and Medicaid EHR Incentive Programs, demonstrate
meaningful use under the Medicare EHR Incentive Program to Centers for Medicare
and Medicaid Services (CMS) and be deemed a meaningful EHR user for the program
year as prescribed by 42 CFR 495.4 (2010 and 2012), 42 CFR 495.6 (2010, 2012, and
2014), and 42 CFR 495.8 (2010, 2012, and 2014); or
(ii) For eligible hospitals
that participate in the Medicaid EHR Incentive Program only, demonstrate meaningful
use as prescribed by 42 CFR 495.4 (2010 and 2012) and 42 CFR 495.8 (2010, 2012,
and 2014) and meet the corresponding meaningful use criteria as prescribed by 42
CFR 495.6 (2010, 2012, and 2014);
(b) If an eligible hospital
is an acute care hospital, it must calculate patient volume by dividing the total
eligible hospital Medicaid encounters by the total encounters in any representative,
continuous 90-day period:
(A) For program year 2011
and 2012, in the preceding federal fiscal year;
(B) For program year 2013
and later, either in the preceding federal fiscal year or in the 12-month timeframe
preceding the attestation date. The eligible hospital may not use the same 90-day
timeframe to calculate patient volume in different program years.
(5) Table 165-0060-1. [Table
not included. See ED. NOTE.]
(6) Table 165-0060-2. [Table
not included. See ED. NOTE.]
(7) Table 165-0060-3. [Table
not included. See ED. NOTE.]
[ED. NOTE:
Tables referenced are not included in rule text. Click here for PDF copy of table(s).]
Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 413.042
& 414.033
Hist.: DMAP 20-2011, f. 7-21-11,
cert. ef. 7-22-11; DMAP 20-2013(Temp), f. & cert. ef. 4-26-13 thru 10-23-13;
DMAP 56-2013, f. & cert. ef. 10-22-13; DMAP 2-2015(Temp), f. 1-30-15, cert.
ef. 2-3-15 thru 8-1-15; DMAP 20-2015, f. & cert. ef. 4-8-15
410-165-0080
Meaningful Use
(1) An eligible provider must demonstrate
being a meaningful Electronic Health Record (EHR) user as prescribed by 42 CFR 495.4
(2010 and 2012), 42 CFR 495.6 (2010, 2012, and 2014), and 42 CFR 495.8 (2010, 2012,
and 2014):
(a) For eligible providers
that are demonstrating meaningful use under the Medicaid EHR Incentive Program in
Stage 1 to comply with 42 CFR 495.8, the state of Oregon requires an eligible provider
to satisfy the objective “Capability to submit electronic data to immunization
registries or immunization information systems and actual submission in accordance
with applicable law and practice”;
(b) For eligible hospitals:
(A) If CMS deems an eligible
hospital to be a meaningful EHR user for the Medicare EHR Incentive Program for
a program year, then the eligible hospital is automatically deemed to be a meaningful
EHR user for the Medicaid EHR Incentive Program for the same program year;
(B) An eligible hospital
deemed to be a meaningful EHR user by Medicare for a program year does not have
to also meet Oregon’s Stage 1 requirement to satisfy the objective “Capability
to submit electronic data to immunization registries or immunization information
systems and actual submission in accordance with applicable law and practice”
for the Medicaid EHR incentive payment for the same program year.
(2) As prescribed by 42 CFR
495.4 (2010 and 2012), the following meaningful use EHR reporting periods must be
used by eligible providers that are demonstrating meaningful use to the Medicaid
EHR Incentive Program:
(a) For program year 2014
only:
(A) For eligible professionals,
either:
(i) Any continuous 90-day
period in calendar year 2014; or
(ii) Any of the following
3-month periods:
(I) January 1, 2014 through
March 31, 2014;
(II) April 1, 2014 through
June 30, 2014;
(III) July 1, 2014 through
September 30, 2014; or
(IV) October 1, 2014 through
December 31, 2014;
(B) For eligible hospitals,
either:
(i) Any continuous 90-day
period in federal fiscal year 2014; or
(ii) Any of the following
3-month periods:
(I) October 1, 2013 through
December 31, 2013;
(II) January 1, 2014 through
March 31, 2014;
(III) April 1, 2014 through
June 30, 2014; or
(IV) July 1, 2014 through
September 30, 2014;
(b) For Program years other
than 2014:
(A) For eligible professionals
demonstrating meaningful use:
(i) For the first time, either:
(I) Any continuous 90-day
period in the calendar year; or
(II) The calendar year.
(ii) For a subsequent time:
the calendar year;
(B) For eligible hospitals
demonstrating meaningful use:
(i) For the first time, either:
(I) Any continuous 90-day
period in the federal fiscal year; or
(II) The federal fiscal year.
(ii) For a subsequent time,
the federal fiscal year.
Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 413.042
& 414.033
Hist.: DMAP 13-2011, f. 6-29-11,
cert. ef. 7-1-11; DMAP 20-2013(Temp), f. & cert. ef. 4-26-13 thru 10-23-13;
DMAP 56-2013, f. & cert. ef. 10-22-13; DMAP 2-2015(Temp), f. 1-30-15, cert.
ef. 2-3-15 thru 8-1-15; DMAP 20-2015, f. & cert. ef. 4-8-15
410-165-0100
Participation and Incentive Payments
(1) To qualify for an incentive payment,
an eligible provider applying for a Medicaid Electronic Health Record (EHR) incentive
payment must meet the Medicaid EHR Incentive Program eligibility criteria and participation
requirements for each year that the eligible provider applies:
(a) An eligible provider
must meet the eligibility criteria for each program year of:
(A) Type of eligible provider;
(B) Patient volume minimum;
and
(C) Certified EHR Technology
adoption, implementation, or upgrade requirements in the first year of participation
and meaningful use requirements in subsequent years, or meaningful use requirements
in all years of participation;
(b) An eligible provider
must meet the participation requirements for each program year including:
(A) Be an enrolled Medicaid
provider with the Oregon Health Authority’s (Authority) Division of Medical
Assistance Programs (Division);
(B) Maintain current provider
information with the Division;
(C) Possess an active professional
license and comply with all licensing statutes and regulations within the state
where the eligible provider practices;
(D) Have an active Provider
Web Portal account;
(E) Ensure the designated
payee is able to receive electronic funds transfer from the Authority; and
(F) Comply with all applicable
Oregon Administrative Rules (OAR), including chapter 410, division 120, and chapter
943, division 120;
(c) An eligible professional
may reassign the entire amount of the incentive payment to:
(A) The eligible professional’s
employer with which the eligible professional has a contractual arrangement allowing
the employer to bill and receive payments for the eligible professional’s
covered professional services;
(B) An entity with which
the eligible professional has a contractual arrangement allowing the entity to bill
and receive payments for the eligible professional’s covered professional
services; or
(C) An entity promoting the
adoption of certified EHR technology.
(2) An eligible professional
must follow the Medicaid EHR Incentive Program participation conditions including
requirements that an eligible professional must:
(a) Receive an incentive
payment from only one state for a program year;
(b) Only receive an incentive
payment from either Medicare or Medicaid for a program year, but not both;
(c) Not receive more than
the maximum incentive amount of $63,750 over a six-year period or the maximum incentive
of $42,500 over a six-year period if the eligible professional qualifies as a pediatrician
who meets the 20 percent patient volume minimum and less than the 30 percent patient
volume;
(d) Participate in the Medicaid
EHR Incentive Program:
(A) Starting as early as
calendar year (CY) 2011 but no later than CY 2016;
(B) Ending no later than
CY 2021;
(C) For a maximum of six
years; and
(D) On a consecutive or non-consecutive
annual basis;
(e) Be allowed to switch
between the Medicare and Medicaid EHR Incentive Program only one time after receiving
at least one incentive payment and only for a program year before 2015.
(3) Payments are disbursed
to an eligible professional following verification of eligibility for the program
year:
(a) An eligible professional
is paid an incentive amount for the corresponding program year for each year of
qualified participation in the Medicaid EHR Incentive Program;
(b) The payment structure
is as follows for:
(A) An eligible professional
qualifying with 30 percent minimum patient volume:
(i) The first payment incentive
amount is $21,250; and
(ii) The second, third, fourth,
fifth, or sixth payment incentive amount is $8,500; or
(B) An eligible pediatrician
qualifying with 20 percent but less than 30 percent minimum patient volume:
(i) The first payment incentive
amount is $14,167; and
(ii) The second, third, fourth,
fifth, or sixth payment incentive amount is $5,667.
(4) An eligible hospital
must follow the Medicaid EHR Incentive Program participation conditions including
requirements that the eligible hospital:
(a) Receives a Medicaid EHR
incentive payment from only one state for a program year;
(b) May participate in both
the Medicare and Medicaid EHR Incentive Programs only if the eligible hospital meets
all eligibility criteria for the program year for both programs;
(c) Participates in the Medicaid
EHR Incentive Program:
(A) Starting as early as
Federal Fiscal Year (FFY) 2011 but no later than FFY 2016;
(B) Ending no later than
FFY 2021;
(C) For a maximum of three
years;
(D) On a consecutive or non-consecutive
annual basis for federal fiscal years prior to FFY 2016; and
(E) On a consecutive annual
basis for federal fiscal years starting in FFY 2016;
(d) A multi-site hospital
with one Centers for Medicare and Medicaid Services’ Certification Number
(CCN) is considered one hospital for purposes of calculating payment.
(5) Payments are disbursed
to an eligible hospital following verification of eligibility for the program year.
An eligible hospital is paid the aggregate incentive amount over three years of
qualified participation in the Medicaid EHR Incentive Program:
(a) The payment structure
as listed in Table 165-0100-1 is as follows:
(A) The first payment incentive
amount is equal to 50 percent of the aggregate EHR amount;
(B) The second payment incentive
amount is equal to 40 percent of the aggregate EHR amount; and
(C) The third payment incentive
amount is equal to 10 percent of the aggregate EHR amount;
(b) The aggregate EHR amount
is calculated as the product of the “overall EHR amount” times the “Medicaid
Share” as listed in Table 165-00100-2. The aggregate EHR amount is calculated
once for the first year participation and then paid over three years according to
the payment schedule:
(A) The overall EHR amount
for an eligible hospital is based upon a theoretical four years of payment the hospital
would receive and is the sum of the following calculation performed for each of
such four years. For each year, the overall EHR amount is the product of the initial
amount, the Medicare share, and the transition factor:
(i) The initial amount as
listed in Table 165-0100-3 is equal to the sum of the base amount, which is set
at $2,000,000 for each of the theoretical four years plus the discharge-related
amount that is calculated for each of the theoretical four years:
(I) For initial amounts calculated
in program years 2011 or 2012, the discharge-related amount is $200 per discharge
for the 1,150th through the 23,000th discharge, based upon the total discharges
for the eligible hospital (regardless of source of payment) from the hospital fiscal
year that ends during the federal fiscal year (FFY) prior to the FFY year that serves
as the first payment year. No discharge-related amount is added for discharges prior
to the 1,150th or any discharges after the 23,000th;
(II) For initial amounts
calculated in program year 2013 or later, the discharge-related amount is $200 per
discharge for the 1,150th through the 23,000th discharge, based upon the total discharges
for the eligible hospital (regardless of source of payment) from the hospital fiscal
year that ends before the FFY that serves as the first payment year. No discharge-related
amount is added for discharges prior to the 1,150th or any discharges after the
23,000th;
(III) For purposes of calculating
the discharge-related amount for the last three of the theoretical four years of
payment, discharges are assumed to increase each year by the hospital’s average
annual rate of growth; negative rates of growth must also be applied. Average annual
rate of growth is calculated as the average of the annual rate of growth in total
discharges for the most recent three years for which data are available per year.
(ii) The Medicare share that
equals 1;
(iii) The transition factor
that equals:
(I) 1 for the first of the
theoretical four years;
(II) 0.75 for the second
of the theoretical four years;
(III) 0.5 for the third of
the theoretical four years; and
(IV) 0.25 for the fourth
of the theoretical four years;
(B) The Medicaid share for
an eligible hospital is equal to a fraction:
(i) The numerator for the
FFY and with respect to the eligible hospital is the sum of:
(I) The estimated number
of inpatient-bed-days that are attributable to Medicaid individuals; and
(II) The estimated number
of inpatient-bed-days that are attributable to individuals who are enrolled in a
managed or coordinated care organization, a pre-paid inpatient health plan, or a
pre-paid ambulatory health plan administered under 42 CFR Part 438;
(ii) The denominator is the
product of:
(I) The estimated total number
of inpatient-bed-days with respect to the eligible hospital during such period;
and
(II) The estimated total
amount of the eligible hospital’s charges during such period, not including
any charges that are attributable to charity care, divided by the estimated total
amount of the hospital’s charges during such period;
(iii) In computing inpatient-bed-days
for the Medicaid share, an eligible hospital may not include either of the following:
(I) Estimated inpatient-bed-days
attributable to individuals that may be made under Medicare Part A; or
(II) Inpatient-bed-days attributable
to individuals who are enrolled with a Medicare Advantage organization under Medicare
Part C;
(iv) If an eligible hospital’s
charity care data necessary to calculate the portion of the formula for the Medicaid
share are not available, the eligible hospital’s data on uncompensated care
may be used to determine an appropriate proxy for charity care but must include
a downward adjustment to eliminate bad debt from uncompensated care data if bad
debt is not otherwise differentiated from uncompensated care. Auditable data sources
must be used; and
(v) If an eligible hospital’s
data necessary to determine the inpatient bed-days attributable to Medicaid managed
care patients are not available, that amount is deemed to equal 0. In the absence
of an eligible hospital’s data necessary to compute the percentage of inpatient
bed days that are not charity care as described under subparagraph (B)(ii)(II) in
this section, that amount is deemed to be 1.
(6) The aggregate EHR amount
is determined by the state from which the eligible hospital receives its first incentive
payment. If a hospital receives incentive payments from other states in subsequent
years, total incentive payments received over all payment years of the program can
be no greater than the aggregate EHR amount calculated by the state from which the
eligible hospital received its first incentive payment.
(7) Table 165-0100-1. [Table
not included. See ED. NOTE.]
(8) Table 165-0100-2. [Table
not included. See ED. NOTE.]
(9) Table 165-0100-3. [Table
not included. See ED. NOTE.]
[ED. NOTE: Tables referenced are available
from the agency.]
Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 413.042
& 414.033
Hist.: DMAP 13-2011, f. 6-29-11,
cert. ef. 7-1-11; DMAP 20-2013(Temp), f. & cert. ef. 4-26-13 thru 10-23-13;
DMAP 56-2013, f. & cert. ef. 10-22-13; DMAP 2-2015(Temp), f. 1-30-15, cert.
ef. 2-3-15 thru 8-1-15; DMAP 20-2015, f. & cert. ef. 4-8-15
410-165-0120
Appeals
(1) The appeals process for the Medicaid
Electronic Health Record (EHR) Incentive Program is pursuant to 42 CFR 495.370 and
the Oregon Health Authority’s (Authority) Provider Appeals Rules in the Oregon
Administrative Rules (OAR) chapter 410, division 120.
(2) The Authority exercises
its option, pursuant to 42 CFR 495.312 and 42 CFR 495.370, to have the Centers for
Medicare and Medicaid Services (CMS) conduct the audits and handle any subsequent
appeals, of whether eligible hospitals are meaningful EHR users.
(3) For purposes of OAR chapter
410, division 165, a provider who applies for a Medicaid EHR incentive payment may
appeal a decision by the Medicaid EHR Incentive Program as outlined in the Authority’s
Division of Medical Assistance Programs’ Provider Appeal Rules (OAR chapter
410, division 120). The provider’s appeal must note the specific reason for
the appeal, which must be due to one or more of the following issues:
(a) An incentive payment;
(b) An incentive payment
amount;
(c) A provider eligibility
determination;
(d) The demonstration of
adopting, implementing or upgrading; or
(e) Meaningful use eligibility
other than a meaningful use eligibility issue where CMS handles the appeal, as provided
in section (2) of this section.
Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 413.042
& 414.033
Hist.: DMAP 13-2011, f. 6-29-11,
cert. ef. 7-1-11; DMAP 20-2013(Temp), f. & cert. ef. 4-26-13 thru 10-23-13;
DMAP 56-2013, f. & cert. ef. 10-22-13
410-165-0140
Oversight
and Audits
(1) A provider who qualifies for a Medicaid
Electronic Health Record (EHR) incentive payment under the Medicaid (EHR) Incentive
Program is subject to audit or other post-payment review procedures as authorized
in Oregon Administrative Rule (OAR) 943-120-1505.
(2) The Oregon Health Authority
and the Department of Human Services have the authority to recover overpayments
from the person or entity who received an incentive payment from the Medicaid EHR
Incentive Program.
(3) As authorized in 42 CFR
495.312, the Oregon Health Authority and the Department of Human Services designate
Centers for Medicare and Medicaid Services (CMS) to conduct audits on Eligible Hospitals
Meaningful Use attestations.
(4) The person or entity
who received a Medicaid EHR incentive overpayment must repay the amount specified
within 30 calendar days from the mailing date of written notification of the overpayment
as prescribed by OAR 943-120-1505.
[ED. NOTE:
Tables referenced are not included in rule text. Click here for PDF copy of table(s).]
Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 413.042
& 414.033
Hist.: DMAP 13-2011, f. 6-29-11,
cert. ef. 7-1-11; DMAP 20-2013(Temp), f. & cert. ef. 4-26-13 thru 10-23-13;
DMAP 56-2013, f. & cert. ef. 10-22-13

The official copy of an Oregon Administrative Rule is
contained in the Administrative Order filed at the Archives Division,
800 Summer St. NE, Salem, Oregon 97310. Any discrepancies with the
published version are satisfied in favor of the Administrative Order.
The Oregon Administrative Rules and the Oregon Bulletin are
copyrighted by the Oregon Secretary of State. Terms
and Conditions of Use
Read Entire Law on arcweb.sos.state.or.us