D.C. Mun. Regs. r. 29-8902

Current through Register Vol. 71, No. 33, August 16, 2024

Rule 29-8902 - PROVIDER INCENTIVE PAYMENTS

8902.1

For all payment years, MEIP incentive payments for each eligible provider shall be subject to all of the following conditions:

(a) Incentive payments shall be calculated pursuant to 42 C.F.R. § 495.310;

(b) An eligible provider may receive a MEIP incentive payment so long as the eligible provider meets all MEIP requirements as set forth in this chapter; and

(c) No eligible provider shall receive an incentive payment after payment year 2021.

8902.2

In the first payment year, to receive an incentive payment, an eligible professional shall meet all eligibility and volume requirements in accordance with Sections 8900, "Provider Eligibility" and 8901, "Methodology for Volume Requirements;" and satisfy one (1) of the following conditions:

(a) Demonstrate and attest to adopting, implementing or upgrading EHR technology as defined in 42 C.F.R. § 495.302 that has been certified by the Office of the National Coordinator for Health Information Technology; or

(b) Demonstrate that it is a meaningful EHR user as defined in 42 C.F.R. § 495.4.

8902.3

Incentive payments to an eligible professional in the first payment year shall meet the following requirements:

(a) An initial incentive payment shall not be dispersed after CY 2016;

(b) An incentive payment shall not exceed twenty-one thousand two hundred fifty dollars ($21,250);

(c) Incentive payments cannot be received from more than one State or Medicaid incentive payment program in a payment year;

(d) Incentive payments to pediatricians shall be subject to the limitations of 42 C.F.R. § 495.310(a)(4); and

(e) Incentive payments to professionals that are Medicaid and Medicare eligible shall be subject to the limitations set forth in 42 C.F.R. § 495.10(e).

8902.4

In the second, third, fourth, fifth, and sixth payment year, to receive an incentive payment, an eligible professional shall meet all eligibility requirements in accordance with Sections 8900, "Provider Eligibility" and 8901, "Methodology for Volume Requirements;" and demonstrate that it is a meaningful EHR user as defined in 42 C.F.R. § 495.4.

8902.5

Incentive payments to an eligible professional in subsequent payment years shall meet the following requirements:

(a) Incentive payments shall be disbursed consistent with the CY on a non-consecutive, annual basis, following verification of eligibility for the payment year;

(b) A single incentive payment may not exceed eight thousand five hundred dollars ($8,500);

(c) An eligible professional shall not participate in MEIP for more than a total of six (6) years. Incentive payments shall not exceed sixty-three thousand seven hundred and fifty dollars ($63,750) over a six (6) year period;

(d) Incentive payments to pediatricians shall be subject to the limitations of 42 C.F.R § 495.310(a)(4); and

(e) Incentive payments to professionals that are Medicaid and Medicare eligible shall be subject to the limitations set forth in 42 C.F.R. § 495.10(e).

8902.6

In the first payment year, to receive an incentive payment, an eligible hospital shall meet all eligibility requirements in accordance with Sections 8900, "Provider Eligibility" and 8901, "Methodology for Volume Requirements;" and satisfy one (1) of the following conditions:

(a) Demonstrate and attest to adopting, implementing or upgrading EHR technology as defined in 42 C.F.R. § 495.302 that has been certified by the Office of the National Coordinator for Health Information Technology; or

(b) Demonstrate that it is a meaningful EHR user as defined in 42 C.F.R. § 495.4.

8902.7

Incentive payments to an eligible hospital in the first payment year shall meet the following requirements:

(a) Incentive payments shall be disbursed consistent with the Federal FY on a rolling basis following verification of eligibility for the payment year;

(b) An initial incentive payment shall not be dispersed after FY 2016; and

(c) An eligible hospital shall receive an incentive payment from only one State or Medicaid incentive payment program in a payment year.

8902.8

In the second, third, fourth, fifth, and sixth payment year, to receive an incentive payment, an eligible hospital shall meet all eligibility requirements in accordance with Sections 8900, "Provider Eligibility" and 8901, "Methodology for Volume Requirements;" and demonstrate that it is a meaningful EHR user as defined in 42 C.F.R. § 495.4.

8902.9

Incentive payments to an eligible hospital in subsequent payment years shall meet the following requirements:

(a) Incentive payments shall be disbursed consistent with the Federal FY on a rolling basis following verification of eligibility for the payment year;

(b) Prior to FY 2016, incentive payments may be disbursed on a non-consecutive, annual basis for the fiscal year;

(c) After 2016, incentive payments shall be dispersed only to an eligible hospital that received an incentive payment in the prior FY;

(d) Incentive payments shall be dispersed over a minimum of a three (3) year period and a maximum of a six (6) year period;

(e) An eligible hospital shall receive an incentive payment from only one State or Medicaid incentive payment program in a payment year;

(f) No single incentive payment may exceed fifty percent (50%) of the aggregate EHR incentive amount as calculated under 42 C.F.R. § 495.310(g);

(g) The total incentive payment received over all payment years of the program shall be no greater than the aggregate EHR incentive amount as calculated under 42 C.F.R.§ 495.310(g); and

(h) No incentive payments over a two (2) year period may exceed ninety percent (90%) of the aggregate EHR hospital incentive amount as calculated in 42 C.F.R.§ 495.310(g).

8902.10

Incentive payments, identified in Subsections 8902.1 through 8902.9, may be assigned to a third party employer or to an entity under the following conditions:

(a) The third party must have a contractual arrangement with the eligible hospital that allows the third party to bill and receive payment for the eligible hospital's covered professional services;

(b) Assignments in Medicare must be consistent with § 1842(b)(6)(A) of the Social Security Act and 42 C.F.R. §§ 424.70 - 424.90;

(c) Medicaid eligible providers may also assign their incentive payments to a Taxpayer Identification Number (TIN) for an entity promoting the adoption of EHR technology, consistent with 42 C.F.R. §§ 495.300 - 495.370; and

(d) Each eligible provider may reassign the entire amount of the incentive payment to only one employer or entity.

8902.11

Incentive payments, identified in Subsections 8902.1 through 8902.9, that are disbursed through Medicaid managed care plans shall not exceed one hundred and five percent (105%) of the capitation rate pursuant to 42 C.F.R. § 438.6(c)(5)(iii).

8902.12

Incentive payments assigned to third party employers and other entities as described in Subsection 8902.10 shall not be implemented until on or after November 1, 2013.

D.C. Mun. Regs. r. 29-8902

Final Rulemaking published at 61 DCR 237 (January 10, 2014)

Authority: An Act to enable the District of Columbia to receive Federal financial assistance under Title XIX of the Social Security Act for a medical assistance program, and for other purposes, approved December 27, 1967 (81 Stat.744; D.C. Official Code § 1-307.02 (2013 Supp.)), and Section 6(6) of the Department of Health Care Finance Establishment Act of 2007, effective February 27, 2008 (D.C. Law 17-109; D.C. Official Code § 7-771.05(6) (2012 Repl.)).