Sec. 10.25.16.07. Incentive Program Transition

A. A payor has until the end of the implementation period to implement this chapter’s requirements.

B. Except as provided in §E of this regulation, a primary care practice that received an incentive under earlier incentive program requirements is not eligible to receive an incentive under the requirements of this replacement chapter.

C. A primary care practice may be eligible to receive an incentive provided under the requirements of an earlier EHR adoption incentive regulation if the practice, under an earlier EHR adoption incentive regulation:

(1) Did not receive an incentive payment; and

(2) Prior to the effective date of this chapter:

(a) Submitted an incentive application and payment request; or

(b) Submitted an incentive application but not an incentive payment request.

D. A primary care practice in §C(1) and (2)(b) of this regulation shall have 60 days after the effective date of this replacement chapter to submit a payment request to the payor for a base and additional incentive, as provided in earlier regulations.

E. Within 90 days after the effective date of this replacement chapter, a primary care practice that received an additional incentive that was less than or equal to the base incentive under earlier incentive program requirements may request that the payor award the difference between the previously received incentive payment and the incentive payment calculated under this replacement chapter based on the practice’s eligible patient enrollment with the payor at the time of the original payment.

F. A payor shall process a payment request within 75 days of receiving a complete EHR incentive request from a primary care practice submitted under §§C-E of this regulation.