Medicaid EHR Incentives for Children's Hospitals Under the HITECH Act

1. Medicaid EHR Incentives for Children's Hospitals Under the HITECH Act Friday, February 4, 2011 · 12:00-1:00 pm Eastern This brown bag is brought to you by the Children's Hospital Affinity Group (CHAG) of the In-House Counsel Practice Group Presenter: Joseph E. Lynch, Esquire Partner King & Spalding LLP, Washington, DC jlynch@kslaw.com Co-Chairs of CHAG: Stephanie Webster Partner, King & Spalding LLP, Washington DC swebster@kslaw.com Rhonda L. ComerGeneral Counsel, Nationwide Children’s Hospital, Columbus, Ohio rhonda.comer@nationwidechildrens.org 1

2. Overview • H.R. 408 – Spending Reduction Act of 2011 • Medicaid EHR incentives issues concerning: • Children’s Hospitals and Their EPs • Children’s Hospitals • EPs • Questions 2

3. Issues for Children’s Hospitals and EPs • EHR certification – complete functionality is required • Timing of Medicaid EHR incentives • CMS must approve each State’s HIT Plan • States likely to pay Medicaid EHR incentives over 3 years • Qualifying under the “Adopt, Implement, Upgrade” option • Minimum requirement – contract to acquire or have access to certified EHR technology (all functionality) • EPs must also meet the Medicaid population requirement 3

4. Issues for Children’s Hospitals • Assignment of EPs’ EHR incentives • EPs’ 15% cost sharing obligation • Qualifying for Medicaid EHR incentives in non-consecutive years prior to FY 2016 (important concerning “adopt, implement, upgrade” qualification option) 4

5. Issues for EPs • Medicaid patient volume • State HIT Plan specifies measurement methodology • CMS-approved measurement methodologies • Encounters paid at least in part under Medicaid • “Panel” option • Clinic/group patient volume • Used by all EPs in the clinic/group • Can include part-time EPs • When is the clinic/group volume an “appropriate” surrogate for an EP’s volume? • What constitutes a “clinic” or “group”? • “Pediatrician” definition/pediatric subspecialists 5

6. Questions 6

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