Medicaid State Information
Beginning in 2019, all eligible professionals (EPs), eligible hospitals, dual-eligible hospitals, and critical access hospitals (CAHs) are required to use 2015 edition certified electronic health record technology (CEHRT) to meet the requirements of the Promoting Interoperability Program. Note that the requirements for eligible hospitals, dual-eligible hospitals, and CAHs that submit an attestation to CMS under the Medicare Promoting Interoperability Program were updated in the 2019 IPPS final rule.
In 2019, all Medicaid eligible hospitals and EPs must adhere to the requirements of their state’s Medicaid Promoting Interoperability Program and attest directly to their state. Visit the 2019 Promoting Interoperability Medicaid page for more information.
All states and territories offer the Medicaid Promoting Interoperability voluntarily, and determine program specifics, such as attestation timelines and eCQM reporting methods. For information on specific Medicaid state/territory programs, a list of state websites and contact e-mail addresses can be found here (PDF).
The last year that an EP or eligible hospital could begin participation was 2016. The last year to receive incentive payments is 2021.
EPs and eligible hospitals could have received an incentive payment for adopting, implementing, or upgrading CEHRT in their first year of participation. In subsequent years, EPs and eligible hospitals can receive incentive payments for successfully demonstrating meaningful use and attesting to their State Medicaid Agency. The requirements for meaningful use can be found here. EPs and eligible hospitals must also submit electronic clinical quality measures (eCQMs). The requirements for eCQM reporting can be found here.
- EPs in the Medicaid Promoting Interoperability Program include:
- Physicians (primarily Doctors of Medicine and Doctors of Osteopathy)
- Nurse Practitioner
- Certified Nurse-Midwives
- Physician Assistant who provide services in a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) led by a Physician Assistant.
In certain states, Optometrists are eligible for the Medicaid Promoting Interoperability Program. For an Optometrist to be eligible, the state Medicaid program must cover adult Optometry services under physician services in the Medicaid State Plan. Please check with your state Medicaid agency for more information
- To qualify for a Medicaid Incentive Payment, an EP must also meet one of the following criteria:
- Have a minimum 30 percent Medicaid patient volume
- Be a pediatrician and have a minimum 20 percent Medicaid patient volume, or
- Practice predominantly in a FQHC or RHC and have a minimum 30 percent patient volume attributable to needy individuals.
- EPs are eligible for incentive payments for up to 6 years, and participation years do not have to be consecutive.
- Incentive payments for EPs under the Medicaid Promoting Interoperability Program can amount to up to $63,750 over 6 years.
- EPs will receive $21,250 for their first year of participation in the program and $8,500 for each subsequent year. Pediatricians who have more than 20%, but less than 30% Medicaid patient volume, will receive ⅔ the full incentive payment.
- EPs who also treat Medicare patients may also be required to participate in the CMS Quality Payment Program, which is separate from the Medicaid Promoting Interoperability. For more information, visit qpp.cms.gov.
- More information on which hospitals eligibility requirements to receive a Medicaid incentive payment can be found here.
- Hospitals that are eligible for both the Medicare Promoting Interoperability Program and the Medicaid Promoting Interoperability Program should attest to CMS under the Medicare requirements. They should then contact their state Medicaid agency for any additional requirements to receive an incentive payment.
- Hospitals that are only eligible for the Medicaid Promoting Interoperability Program should attest to their state Medicaid agency directly.