Eligible Hospitals

The Promoting Interoperability (PI) Program (formerly the Medicaid EHR Incentiv Program) is limited to Eligible Professionals (EPs) for six years of participation, and Eligible Hospitals (EHs) for three years. The program provides incentive payments to EPs and EHs as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology. According to the Stage 1 Final Rule, EHs wishing to participate in the PI Program must begin receiving payments for Program Year (PY) 2016 or an earlier program year. Additionally, they must receive a PY 2016 payment and will not receive payments after PY 2021. After PY 2016, EHs must have participated in the previous year to receive payments.

Eligibility

Defined as:

  • Acute care hospitals (including critical access hospitals) must meet a 10 percent minimum Medicaid patient volume
  • Children’s hospitals (cannot be pediatric wings of larger hospitals) are not required to meet patient volume thresholds
Requirements

Acute care, critical access and children’s hospitals are the only hospital types that are eligible for the PI Program. Acute care and critical access hospitals must have a Medicaid (Title XIX) patient volume of at least 10 percent of their total volume to be eligible to receive incentive payments. Patient volume is defined by CMS as the percent of Medicaid Title XIX encounters to total hospital encounters for the same 90-day period. Children’s hospitals do not have to meet Medicaid patient volume requirements to receive incentive payments. Click here for more information about eligibility for hospitals.

Adopt, Implement, Upgrade & Meaningful Use

Meaningful use Eligible Hospital participants must adopt (acquire and install), implement (training), upgrade (expand functionality with new version, etc.) or demonstrate meaningful use of certified EHR technology during Year 1 of their program participation. In the two remaining years of their program participation, Eligible Hospitals must demonstrate meaningful use (i.e., how the technology moves beyond being a digital medical chart to a valuable tool to transform health care service delivery and improve health outcomes).

Certified EHR Technology

The PI Program requires that all EHR products and systems must be certified by the Office of the National Coordinator for Health Information Technology (ONC). For more information, visit the ONC website at https://chpl.healthit.gov/#/search.

Incentive Payments

By meeting all program requirements, Eligible Hospitals may earn an incentive payment based on a formula that includes an annual EHR base amount; a per-discharge amount and a transition factor for each year; a Medicaid share based on inpatient, non-charity care days; and an aggregate EHR payment amount. The aggregate EHR payment estimate, when approved by DCH, is the total incentive payment that will be paid out during three years of participation.

Eligible Hospitals may receive payments from both Medicare and Medicaid PI Programs. The exceptions are children's hospitals, which will qualify for Medicaid incentive payments only.

Patient Volume Calculator

For assistance calculating the Medicaid patient volume, contact DXC Technology Contact Center at HP.mapir.outreach@dcx.com or call 800-766-4456 and choose prompt 4 for the PI Program Support Team.

Getting Started

Step One: Register with CMS. Eligible Hospitals must first register on the CMS Registration and Attestation System website at https://ehrincentives.cms.gov/hitech/login.action.

Step Two: Contact DXC Technology Contact Center at HP.mapir.outreach@dxc.com or call 800-766-4456 and choose prompt 4 for the PI Program Support Team.

QualityNet Secure Portal

Beginning January 2, 2018, dually eligible hospitals and critical access hospitals (CAHs) attesting to CMS will submit their 2017 Meaningful Use attestations in the QualityNet Secure Portal (QNet). The Registration and Attestation System will continue to be available for Medicaid-only hospitals and CAHs after December 31, 2017. Click here for additional information or here for the QNet Secure Portal Enrollment and Login User Guide.

2018 CAH Hardship Exception Submission Deadline

In 2018, the Centers for Medicare & Medicaid Services (CMS) required that all critical access hospitals (CAHs) use either the 2014 or 2015 Edition certified electronic health record technology (CEHRT) to meet the reporting requirements of the Medicare Promoting Interoperability Program and successfully demonstrate meaningful use. The law requires that downward payment adjustments be applied to CAHs that are not meaningful users of CEHRT.

CAHs may avoid the Medicare downward payment adjustments if they can show that meeting the requirements for being a meaningful EHR user would result in a significant hardship. To be considered for an exception, CAHs must complete a hardship exception application and select the reason for the hardship.

Hardship Exception Application Details

  • You may now submit hardship applications electronically here.

  • If an electronic submission is not possible, you may verbally submit your application over the phone by calling the QualityNet Help Desk at (866) 288-8912.

  • The deadline for CAHs to submit an application is December 2, 2019, at 11:59 p.m. ET.

For more information about payment adjustments and hardship information, click here. For more information on the Promoting Interoperability Programs, visit the Promoting Interoperability Programs website.

Additional Resources

EHR Fact Sheet for Eligible Hospitals

EHR FAQs for Eligible Hospitals

Medicaid PI Program Toolkit for Eligible Hospitals

EH Hardship and Adjustment Tip Sheet