States can offer ODs Medicaid EHR incentives, CMS confirms

September 25, 2012

While the vast majority of the more than 6,900 U.S. optometrists who have so far registered for federal Health Information Technology for Economic and Clinical Health (HITECH) incentives programs are enrolled in the Medicare Electronic Health Records (EHR) Incentive Program, many could qualify for substantially higher incentive payments under the Medicaid EHR Incentive Program – provided state officials take appropriate administrative action to allow it, the U.S. Centers for Medicare & Medicaid Services (CMS) confirmed during a review teleconference.

During its June 7 “Registration and Attestation for the Medicare & Medicaid EHR Incentive Programs for Eligible Professionals” teleconference, CMS officials acknowledged optometrists in selected states are already taking part in the Medicaid EHR program and Medicaid administrators in virtually all other states could bring optometrists into the program with a relatively simple change in the state Medicaid plan.

The AOA Advocacy Group says the teleconference provided a long-overdue, clear public indication that the U.S. Department of Health & Human Services (HHS) intends for optometrists to be involved in the Medicare EHR incentive programs across the nation, according to the AOA Advocacy Group.

HHS Secretary Kathleen Sebelius and other federal officials have confirmed during meetings with AOA or state optometric association representatives their intent that Medicaid EHR Incentive programs involve optometrists in all states (see AOA News, April).

Optometrists in only eight states are actively participating in Medicaid EHR incentive programs – with up to a half dozen additional states possibly opening their Medicaid EHR incentive programs to optometrists in the near future, according to the AOA Advocacy Group.

The AOA Advocacy Group attributes the limited participation by optometrists in the Medicaid EHR incentive program to previously issued inaccurate CMS public documents and presentations that incorrectly indicated optometrists across the nation were ineligible for the program.

Under the Medicaid EHR Incentive Program, health care practitioners who demonstrate that they have billed at least 30 percent of their insurance claims to Medicaid during a 90-day reporting period can qualify for up to $63,750 in incentives over the six-year life of the program.

The Medicare EHR Incentive Program, by comparison, offers up to $44,000 ($48,400 in federally designated Health Professional Shortage Areas).

Medicaid is a federally funded program, administered by states within federal guidelines. HHS regulations implementing the incentive program stipulate that optometrists can qualify for Medicaid EHR in any state that recognizes optometrists as providers of adult physician services within the scope of optometric practice.

Since the Medicaid EHR Incentive Program was created under the American Recovery and Reinvestment Act (ARRA) of 2009, Alabama, Illinois, Kentucky, Louisiana, Michigan, Ohio, South Carolina and Virginia have all amended their Medicaid State Plans to allow optometrists to qualify for EHR incentives.

The entry of optometrists into state Medicaid EHR Incentive Programs comes as the result of lobbying efforts by the AOA to get the CMS to clarify incentive program rules, as well as successful efforts by state optometric associations to assist state Medicaid departments in filing necessary state Medicaid plan amendments with the CMS to allow participation by optometrists in their incentive programs.

For more information, see “Five states now offer Medicaid EHR incentives to ODs” in the April edition of AOA News or contact Brian Reuwer in the AOA Washington office at 800-365-2219, ext.1343 or BReuwer@aoa.org.

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