Frequently Asked Questions

How can I obtain a copy of the Eligible Hospital User Guide?

The User Guide is available within the SLR application once logged into the SLR. To obtain a copy of the User Guide without registering, email our Help Desk at SLRHelpdesk@acs-inc.com. A copy is also posted on the MHD webpage http://dss.mo.gov/mhd/ehr/.

How can I ensure the data from CMS (National Level Registry or NLR) matches the State Level Registry data with MO HealthNet so we don’t experience any delays?

Once you have registered with CMS check your NPI number under the “Status” tab in the CMS Registration and Attestation System to verify it is accurate and the same NPI you will use when registering with MO HealthNet. If the NPI is incorrect you will need to work with CMS's technical support at 888-734-6433 to change the NPI in CMS's database.

Please clarify how ED visits are used in calculating eligibility?

The ED visits can be used in calculating Medicaid eligibility – both ED visits with inpatient admissions and non-inpatient admissions are requested and documented in different fields within the SLR solution as described below.

MO HealthNet Volumes section

Both ED visits with inpatient admissions and outpatient ED visits should be included in the MO HealthNet Volumes section. The ED visits should be included only in the volumes for the 90-day representative period and must be included in both the Medicaid discharges and total discharges.

Hospital Demographics section

ED visits with inpatient admissions can be included in the total discharges, which is used to calculate the Medicaid patient volume threshold. ED outpatient visits cannot be included in any of the data in this section.  The data used to calculate the hospital incentive payment amounts are based on inpatient data only, which eliminates outpatient visits from the total. New language to explain this will be added to the Help Text displayed when the "more" button is chosen.

Here is wording from the final ruling:

  • 2) For purposes of calculating hospital patient volume, both of the following definitions in paragraphs (e)(2)(i) and (e)(2)(ii) of this section may apply:
    • (i)  A Medicaid encounter means services rendered to an individual per inpatient discharge where—(A) Medicaid (or a Medicaid demonstration project approved under section 1115 of the Act) paid for part or all of the service; or (B) Medicaid (or a Medicaid demonstration project approved under section 1115 of the Act) paid all or part of the individual’s premiums, copayments, and/or cost-sharing.
    • (ii) A Medicaid encounter means services rendered in an emergency department on any one day where—(A) Medicaid (or a Medicaid demonstration project approved under section 1115 of the Act) paid for part or all of the service; or (B) Medicaid (or a Medicaid demonstration project approved under section 1115 of the Act) paid all or part of the individual’s premiums, copayments, and cost-sharing.
Are nursery days and nursery discharges (for newborns) included as acute-inpatient services in the calculation of hospital incentives for the Medicare and Medicaid EHR Incentive Programs?

No, nursery days and discharges are not included in inpatient bed-day or discharge counts in calculating hospital incentives. Nursery days and discharges are not considered acute inpatient services based on the level of care provided during a normal nursery stay. The hospital worksheet has been updated (as of June 22) to indicate that these should be excluded.

Pages 44450 and 44453 of the final rule preamble explain that for the Medicare calculation, the statutory language clearly restricts discharges and inpatient bed-days to those from the acute care portion of a hospital.  This is because of the definition of "eligible hospital" in section 1886(n)(6)(B) of the Social Security Act.

Page 44497 of the final rule explains that statutory parameters placed on Medicaid incentive payments to hospitals are largely based on the methodology applied to Medicare incentive payments.  Therefore, as Medicaid is held to the same parameters as Medicare, the same limitations on counting inpatient bed-days and total discharges apply to Medicaid hospital incentive calculations.

Are NICU days treated the same as nursery bed days, as an exclusion?

No, NICUs are not excluded – these discharges can be counted as inpatient bed-days in the hospital incentive calculation.

Can Medicaid secondary claims (for dual eligibles) be counted in the encounter volume?

Yes, dual eligibles can be counted in the encounter volume for the 10% test to qualify for Medicaid volume threshold, but not in the calculation of the amount of the Medicaid incentive to be paid.

What year should be used for providing hospital data?

Hospitals should use the federal fiscal year. The EH workbook is being updated to reflect "Federal Fiscal year" instead of "Calendar year". For historical trend data use 2006 – 2009; for most recent year, use 2010.

Should cost reports be attached?

The SLR requests specific data from the eligible hospital cost report to populate the eligibility data fields. To document the cost reports, attach Worksheet S-3 for 2006 – 2009 and Worksheets S-3, S-10 and C for 2010. The system will be updated to request attachments of these worksheets.

If there is an amended Cost Report, should that info be updated in the SLR?

Amended cost reports will be considered during submission of information in the subsequent year.

Clarify what information is required in the Contract attachment?

The following components must be included in the Contract attachment: 1) signature page, 2) name of EHR product that has been Adopted, Implemented, or Upgraded and 3) date. Contract documents can be redacted by the marking out proprietary and confidential information such as pricing arrangements, etc.

The required attachments for eligible hospitals are EHR documentation including a signed contract/agreement for the EHR (Step 3) and the signed attestation agreement (Step 4). For submissions that select the "Upgrade" methodology of attestation, the State also requests a vendor letter indicating the ONC certification number of the EHR.

Are there limitations on the size of the attachments?

The file size limit is 10 megabytes per attachment; up to 10 attachments are allowed. There is not a page limit on the documents.

Can data or attachments be changed?

Yes, as long as the changes are made prior to finishing and submitting Step 5.

Who has visibility to the attestation information and attachments?

Authorized MO HealthNet staff and ACS staff (the SLR vendor) assigned to support Missouri’s program. Confidential and proprietary information can be redacted in attachments.

Who should sign the EH attestation agreement?

A person who is authorized to sign a legally binding agreement on behalf of the hospital.

Will payment be a one-time payment or in multiple payments?

The total hospital payment will be made spread over 3 years; annual amounts will be made in one payment following review of attestation submissions and approval of CMS.

Clarify how the aggregate payment amount over 3 yrs is calculated and when distributed, and where does it show what the EH payments will be?

The Eligibility workbook posted on MO’s provider outreach page details the calculation, and indicates the payment schedule over the 3 years at the bottom: 50% in year 1 – 35% in year 2 – 15% in year 3.

When are payments expected to be made for Missouri’s Medicaid EHR Incentive Program?

The goal is to be able to make initial payments in July. Given the schedule for review and approval of submitted attestations is 3 to 6 weeks, late August or early September is a realistic time to expect receipt of payments. A process for direct deposit will be used for incentive payments and information specifically for these payments will be requested prior to payment. We will provide updated information as soon as it is available.

Can hospitals skip years for Medicaid incentives program (as EPs) can? For example, perform AIU in year 1 now and wait a year for M/U?

Yes. Hospitals can skip years.