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EHs must meet the following criteria for the EHR Incentive Payment program. Please note that criteria have been updated to reflect changes to eligibility as stated in the CMS Stage 2 Final Rule (2012).

5.2.1.1 EH Provider Type

To be eligible for the MPIP, EHs must fall into one of the following hospital types: • Acute Care Hospital:

o The CCN has the last four digits in the series 0001 – 0879; and o The average length of patient stay is 25 days or fewer; or • Critical Access Hospital (CAH):

o The CCN has the last four digits in the series 1300 – 1399; and o The average length of patient stay is 25 days or fewer; or • Children’s Hospital: (None in Mississippi)

o The hospital is separately certified as a children’s hospital - either

freestanding or a hospital within hospital and the CCN has the last four digits in the series 3300-3399; or

o The hospital is separately certified, either freestanding or hospital

within a hospital, which predominately treats individuals 21 years of age or younger and does not have a CCN because they do not serve any Medicare beneficiaries but has been provided an alternative number by CMS for purposes of enrollment in the Medicaid EHR Incentive Program.

5.2.1.2 EH Eligibility Period

For the purposes of calculating hospital patient volume the eligibility period is defined as: • A representative, continuous 90-day, 3-month, 6-month or full year period from

• A representative, continuous 90-day period in the 12-month period directly preceding the attestation date.

DOM requires that the eligibility period start on the first day of the month to ensure that patient volume data self-reported in the eligibility period selected by the provider aligns with the reporting periods of the data available in the MMIS. Once an eligibility period is used for the purposes of calculating Medicaid patient volume, the same eligibility period may not be used in subsequent attestation years for the purposes of proving Medicaid patient volume.

5.2.1.3 EH Patient Volume

Acute Care and CAHs must have at least a 10 percent Medicaid patient volume based on both the inpatient and emergency room discharges. Children’s hospitals are not required to meet a minimum Medicaid patient volume. To calculate Medicaid patient volume, an EH must divide total Medicaid encounters (numerator) by total patient encounters (denominator) using the same eligibility period for both numerator and denominator.

For purposes of calculating hospital patient volume, a Medicaid encounter means services rendered to an individual per inpatient discharge and/or in an emergency department on any one day where:

• Medicaid (or a Medicaid demonstration project approved under section 1115 of the Act) paid for part or all of the service; or

• Medicaid (or a Medicaid demonstration project approved under section 1115 of the Act) paid for all or part of the individual’s premiums, co-payments, and/or cost sharing; or

• The individual was enrolled in a Medicaid (or a Medicaid demonstration project approved under section 1115 of the Act), regardless of payment liability, in accordance with CFR §495.306.

As noted above, the optional EHR Hospital Patient Volume Calculator can be found at http://www.medicaid.ms.gov. Also, see Appendix G attached hereto. Hospitals may use the EHR Hospital Patient Volume Calculator as a worksheet; however it will no longer be required for submission with the attestation.

Hospitals are allowed to count a maximum of one encounter per patient per day. Hospitals will be required to use their discharges from both the inpatient facility (POS 21) and the emergency room (POS 23) to determine their patient volumes.

The authorized data source documents (detailed below) are required documentation to be submitted with EH attestations. Only MS DOM authorized data sources as described below will be used to calculate the Medicaid share percentage.

• The authorized data source for the total Inpatient Discharges (POS 21) will be the annual cost report for the hospital's fiscal year ending in the prior federal fiscal year.

• The authorized data source for the total Medicaid Primary Inpatient Discharges (POS 21) will be the annual cost report for the hospital's fiscal year ending in the prior federal fiscal year.

• The authorized data source for the total Medicaid Secondary Payer Inpatient Discharges will be the hospital's inpatient accounting/billing system. Only Medicare and Third party claims with Medicaid as the secondary payer showing that the individual was enrolled in Medicaid (or a Medicaid demonstration project approved under section 1115 of the Act) will be used to determine the Medicaid Secondary Payer Inpatient Discharges, regardless of payment liability by Medicaid. Summary data supporting each discharge amount will be attached to the hospital's application. Upon request, the hospital may be required to provide detailed reports including the payer (primary and secondary), patient ID, claim number, date, revenue and procedure codes, and paid amounts. • The authorized data source for the total Medicaid Primary Payer Emergency

Room Discharges will be the hospital's inpatient accounting/billing system. Summary data supporting each discharge amount will be attached to the hospital's application. Each emergency room visit will be considered a single discharge. Emergency room visits that result in transfer to the inpatient unit for other than observation will not be included in the emergency room discharges. Upon request, the hospital may be required to provide detailed reports including the payer (primary and secondary), patient ID, claim number, date, revenue and procedure codes, and paid amounts.

• The authorized data source for the total Medicaid Secondary Payer Emergency Room Discharges will be the hospital's emergency room accounting/billing system. Only Medicare and Third party claims with Medicaid as the secondary payer showing that the individual was enrolled in Medicaid (or a Medicaid demonstration project approved under section 1115 of the Act) will be used to determine the Medicaid Secondary Payer Emergency Room Discharges, regardless of payment liability by Medicaid. Medicare and Third party claims will be reported separately. Summary data supporting each discharge amount will be attached to the hospital's application. Upon request, the hospital may be required to provide detailed reports including the payer (primary and secondary), patient ID, claim number, date revenue and procedure codes, and paid amounts. Each emergency room visit will be considered a single discharge. Emergency room visits that result in transfer to the inpatient unit for other than observation will not be included in the emergency room discharges.

As noted above, hospitals have the option to complete the EHR Hospital Patient Volume Calculator. The EHR Hospital Patient Volume Calculator will no longer be required for a

all other authorized data sources must be attached to the hospital’s attestation as supporting documentation.