37.85.1121    ELIGIBLE PROVIDER INCENTIVE PAYMENT SCHEDULE

(1) The department adopts and incorporates by reference the EP incentive payment schedule specified in 42 CFR 495.310 (2011), a copy of which is posted at www.medicaidprovider.hhs.mt.gov/providerpages/ehrincentives.shtml and may also be obtained by writing DPHHS Director's Office, PO Box 4210, Helena, MT 59604.

(2) Pediatricians who do not meet the 30% threshold, but meet the 20% threshold will receive reduced payments as specified in 42 CFR 495.310 (2011). Also, an EP's payment may be adjusted downward depending on net average allowable costs.

(3) Each year the EP will attest to the receipt of funds from sources other than state or local government to offset the cost of the certified electronic health record. If the EP received funds from other sources, the EP must identify the calendar year of receipt, the amount, and the source. For the first year, any amount over $29,000 will reduce the payment by a like amount. For years two through six any amount over $10,610 will reduce the payment by a like amount.

(4) Assignment of payment - EPs must choose either direct payment or may assign payment to the provider's group practice or clinic. If the EP is a member of a group and chooses to assign the incentive payment to the group, payment will be made to a group consistent with existing MMIS capabilities. If a member of a group chooses to retain the incentive payment, the payment will be made directly to the EP through an existing process in the MMIS. Due to existing MMIS limitations, Montana Medicaid will not make direct incentive payments to any entity (individual, group, or clinic) that is not recognized as a Montana Medicaid provider. For example, EHR system vendors are not recognized as Montana Medicaid providers, and as such cannot be assigned payment.

History: 53-6-113, MCA; IMP, 53-6-111, MCA; NEW, 2011 MAR p. 1374, Eff. 7/29/11.