Sec. 10.25.16.04. Participation Requirements

A. To be eligible for an EHR adoption incentive under this chapter, a primary care practice shall:

(1) Adopt a certified EHR;

(2) Complete and submit an EHR adoption incentive request to each appropriate payor from which the practice desires an incentive award; and

(3) Demonstrate that the primary care practice has either:

(a) Attested to the current meaningful use requirements under the Medicare or Medicaid EHR Incentive Program; or

(b) Participates in any MHCC approved patient-centered medical home program and has achieved NCQA level two recognition.

B. An EHR adoption incentive request shall include the following:

(1) Practice specific information:

(a) Name;

(b) Address;

(c) Specialty;

(d) Organizational national provider identifier number; and

(e) Tax identification number;

(2) The individual NPIs of each provider within the primary care practice;

(3) The estimated total number of patients on the practice panel, if available;

(4) The name and version of the certified EHR system implemented by the primary care practice;

(5) Documentation that the primary care practice meets the criteria for the EHR adoption incentive including:

(a) A copy of the confirmation received from CMS or Medicaid of acceptance of attestation to meaningful use by at least one physician or nurse practitioner within the practice; or

(b) A copy of the NCQA level two recognition letter; and

(6) An attestation signed by an authorized member of the primary care practice that:

(a) The information contained in the request is accurate;

(b) If the practice is led by a physician, all the physicians within the primary care practice are using the certified EHR system; and

(c) If the practice is led by a nurse practitioner, all the nurse practitioners within the primary care practice are using the certified EHR system

C. A payor shall issue an EHR adoption incentive request acknowledgement letter as soon as is reasonably possible and no later than 45 days after receipt of an EHR adoption incentive request.

D. The meaningful use attestation of a physician or nurse practitioner may only be included in a single EHR adoption incentive request to a payor.

E. A payor may request additional information as necessary to determine the validity of an EHR adoption incentive request.

F. A payor shall process and pay in full the adoption incentive within 75 days of receiving a complete EHR adoption incentive request.

G. A payor shall provide each primary care practice requesting an EHR adoption incentive with a written notification regarding:

(1) The amount of the EHR adoption incentive awarded to the primary care practice;

(2) The method of distribution of the EHR adoption incentive; and

(3) The time period over which the incentive will be distributed.

H. A primary care practice that provided an attestation to meaningful use must give written notice within 90 days to each payor that awarded an EHR adoption incentive to the practice under the following circumstances in the event that the CMS, Medicaid, or its designated entity:

(1) Conducted a prepayment or post-payment audit of compliance with the participation requirements of the Medicare or Medicaid EHR Incentive Program regarding the physician or nurse practitioner identified by the primary care practice as part of its EHR adoption incentive request; and

(2) Determined that the physician or nurse practitioner had not met the requirements under the Medicare or Medicaid EHR Incentive Program.

I. Payors may request reimbursement of the incentive payments made under this chapter to the primary care practice in the event of notice provided by the primary care practice under §H of this regulation.

J. Nothing in this chapter shall require a group model health maintenance organization to provide an incentive to a health care provider who is employed by a multispecialty group of physicians or nurse practitioners under contract with the group model health maintenance organization.