The calculation of Medicaid patient volume (to meet the 30% Medicaid volume threshold required for eligible professionals) should include all encounters under Title XIX (Medicaid) and exclude all Medicaid encounters under Title XXI (Children’s Health Insurance Program or CHIP). Encounters under Title XXI can be included in the “medically needy” count allowed for RHCs and FQHCs.

Missouri has a combination Children’s Health Insurance Program (CHIP). The following methodology has been approved by CMS for purposes of reporting and meeting Medicaid patient volume thresholds for Missouri’s Medicaid EHR incentive program.

Providers whose data systems cannot separate Title XXI (CHIP) patients from Title XIX (Medicaid) patients, can use Medicaid Eligibles & CHIP by County (with estimates by county of Title XXI eligibles) to estimate their Title XXI patient volume.

The source for these averages is MO HealthNet’s Monthly Management Reports which are based on eligibility data – it includes counts for Medicaid eligibles by county and separate counts eligibles by Title XIX and Title XXI.

The Medicaid Eligibles & CHIP by County file shows the yearly average percentage of Title XXI patients per county during CY 2010, the year for which the Medicaid volume thresholds are calculated for applications in CY 2011. County averages for CY 2011 will be posted in February 2012, the year for which volume thresholds are calculated for applications in CY 2012. Applications for 2012 submitted prior to the new posting can use CY 2010 data.

Providers can use the county average for the location of their office or practice (or a weighted average of counties from which they draw patients) to estimate the number of Medicaid patients that were covered under Title XXI (CHIP). The average estimate (for CHIP Title XXI patients) should be subtracted from total Medicaid counts. And in the case of FQHCs and RHCs, that estimate should be included as a discrete subgroup of “needy individuals”.

Providers who believe that county estimates do not accurately represent their patient population can send a description of their patient base as the basis for an alternate calculation for their practice.

If you have questions, please send to MHD.EHRincentives@dss.mo.gov.