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N.H. won't be ready for Medicaid meaningful use until 2012

New Hampshire probably won't be the only state unable to process meaningful use reporting data from Medicaid providers immediately. But it's the first state to say so publicly.

Within the last few months, the state of New Hampshire has made it clear to health care providers that it won't be ready to handle Medicaid meaningful use quality-reporting and syndromic-surveillance data until at least 2012, according to Sandy Pardus, CIO for the New Hampshire-based Lamprey Health Care and Community Health Access Network.

Providers need not worry who see enough Medicaid patients to qualify for the state-administered Medicaid portion of the Electronic Health Records Incentive Program (EHRIP) and aim to receive incentive payments for 2011. They just might not get their money, however, until 2012, after the state builds -- and brings online -- its EHRIP support systems.

The Medicaid incentive program differs from its federally administered Medicare counterpart in that it doesn't require qualified providers to report on required core meaningful use criteria until 2012. The requirements for 2011 mandate these providers only to adopt, implement and upgrade certified EHR systems, which the state verifies via an audit. The 90-day meaningful use reporting period the Medicare incentive program requires for 2011 does not start until 2012 for providers qualified under the Medicaid EHRIP.

"There is an option, we've been told, to start with Medicare and move to Medicaid if we qualify for sboth," Pardus said in a recent webinar sponsored by the Health Information and Management Systems Society. She helps support EHR systems, and is spearheading a meaningful use program for providers spread across 24 sites in New Hampshire."Some health centers will qualify for both, but I'm not sure ours do. We tend to deal with folks who are younger."

Andrew Chalsma, administrator of the Data and Systems Management Bureau at the New Hampshire Department of Health and Human Services' Office of Medicaid Business and Policy, has not yet heard of a single Medicaid-eligible applicant that will be affected by the delay, he said. Further, he doesn't think that the delay will affect many providers anyway -- 30% of physicians' patients and 20% of pediatricians' patients must be on Medicaid for them to qualify for the incentive program, but only 9% of New Hampshire residents are on Medicaid.

"Many [providers] are simply not going to qualify for the Medicaid side of things," Chalsma said. "A large majority of them are going to qualify for Medicare, because you just have to be a Medicare provider to qualify for Medicare. There isn't that threshold."

Chalsma's state is lagging behind early-adopter states for several reasons: First, New Hampshire had not funded health IT programs previously or given private care providers and payers incentives for using them before the Office of the National Coordinator for Health Information Technology made that a priority over the last few years. The handful of forward-thinking states that did are more likely to be on time putting together the meaningful use jigsaw puzzle for next year, he said.

Second, with no state sales or income taxes, and a budget that depends on revenue from travelers and businesses, New Hampshire has very limited resources beyond federal grants to build its state health IT infrastructure. It had to come up with 10% of the $350,000 in planning funds, with the federal government providing the rest.

We're just trying to tell the truth to providers.

Andrew Chalsma, administrator, Data and Systems Management Bureau, N.H. Department of HHS, Office of Medicaid Business and Policy

"Early on, there were plenty of states -- our state included -- [that were saying], 'Where are we even going to get 10%, because of the budget situation?'" Chalsma said. "We're going on with our planning but, because our funds are not an enormous amount of money, we can't contract out to Arthur Andersen or something, and get an expensive, short-term planning process in place to get it done. We're going about it in kind of a measured way."

Third, although the state received a federal Health IT Planning Advance Planning Document process grant last June to lay the groundwork for building its EHR support network, the Centers for Medicare & Medicaid Services (CMS) need to approve the plan at various stages of development, which takes time, Chalsma said. He anticipates the state will wrap up its plan by the middle of 2011, put the implementation together by 2012 and disburse Medicaid incentive program payments shortly after that

"We're just trying to tell the truth to providers," Chalsma said. He thinks the 2012 target will not make New Hampshire an outlier, because other states will be in the same boat. "We have to go through a process, and that process is pretty complex, and we have just started. We don't know until we've gone through the planning process what it will take to implement the plan."

Lastly, CMS is building a system called the National Level Repository (NLR) to verify provider eligibility for EHRIP payments. It will eventually be able to confirm that a physician is neither double-dipping into both the Medicare and Medicaid programs, nor trying to get Medicaid incentives from two different states. To get that system running, CMS has to finish building and testing it, and individual states need to plug into it successfully and identify who's who among providers in their EHRIP programs.

That hasn't happened yet, although CMS indicated in a recent frequently asked questions document that it would provide support for states that cannot connect to the NLR by May 2011.

All this having been said, Chalsma remains upbeat about building the Medicaid EHRIP support system, and gives CMS high marks for its support throughout the process.

"CMS has been fabulous about how they've laid this out, and the information they've provided to sates has been great," Chalsma said, likening it to a cookbook with recipes each state will have to customize.

Let us know what you think about the story; email Don Fluckinger, Features Writer.

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