Meaningful Use Toolkit

Eligible Professionals (EPs) and Eligible Hospitals (EHs) have been able to earn incentives from the Medicaid EHR Incentive Program to Adopt, Implement, or Upgrade (AIU) to Certified EHR Technology (CEHRT) and demonstrate Meaningful Use (MU):

• MU-based incentives were available up to and including Program Year 2021 for EPs, and Program Year 2018 for EHs. From Program Year 2017 onward, this was restricted to returning participants who had been paid AIU and/or MU incentives in prior program year(s).
• The last year to initiate first-time participation and to earn incentives for AIU was Program Year 2016.

Eligible Professionals (EPs) were required to register through the CMS Registration and Attestation System (R&A). EPs could register and attest themselves and/or could authorize a designee to act on their behalf. To register, EPs needed to have a National Provider Identifier (NPI), Identify and Access (I&A) Id and Password, Payee Tax Identification Number (TIN), and an EHR Certification Number. 

Likewise, EHs needed to be registered in the CMS Registration and Attestation system (R&A). The Authorized Official of an EH had to authorize a designee to register and attest on its behalf. The data entered included the CCN and NPI and other identification information.

The registration data was matched against MMIS, MassHealth's Medicaid Management Information System. To participate in the EHR Incentive Program, the EP or EH had to be recognized in the MMIS. A successful registration resulted in a “Welcome to MAPIR” email notification with instructions on how to access MAPIR to begin the attestation process.

Annual attestations were completed by the designee assigned to attest on behalf of the EP or EH. To attest, they had to use MAPIR, the state's attestation system, which is accessible via the Provider Online Service Center on the MassHealth website. This required login into MAPIR using the Virtual Gateway username and password provided during registration. MAPIR guided the user in entering the data required to demonstrate an EP or EH met the program requirements.

The attestation included the upload of supporting documentation to the MAPIR application prior to submittal for review as per the Supporting Documentation Guides provided below. EP attestations ended with Program Year 2021, and EH attestations with Program Year 2018.

Up to and including Program Year 2016, EPs and EHs could earn incentives for Adopting, Implementing or Upgrading (AIU) to Certified EHR Technology (CEHRT). This was required for, and only available to, first year participants. To qualify for AIU, the new participants had to attest that they met the program's eligibility criteria, and they had to either:
•   Adopt:          Acquire, purchase or secure access to CEHRT
•   Implement:   Install or initiate the use of CEHRT
•   Upgrade:      Expand existing EHR functionality to CEHRT

As of Program Year 2014, first year participants had the option to immediately attest to Meaningful Use in the first year, skipping AIU attestation.

AUI Implementation Tips

When participating in the Medicaid EHR Incentive Program, take the following tips in mind when implementing your CEHRT. 

Realize EHR Implementation is a Process

The goal of AIU is not to the EHR implementation, and the goal is not even successful attestation to Meaningful Use. The goal is to provide more effective and safer care for patients, better workflow for staff, and better quality of life for physicians.

Choosing an EHR

See it from a user perspective, not a vendor perspective. It’s better to see a practice similar in size and specialty using it in a patient encounter.

Certified EHRs

Before buying an EHR, ask whether it is certified by one of the approved certifying agencies for Meaningful Use. Also, choose a vendor that is financially stable, committed to upgrading its product to meet Meaningful Use requirements, and will be around for years to come

Make Sure you know how the EHR System Operates

Ask potential vendors about issues and the ability to modify the EHR software as needed. Also ask vendors if they’ll be able to provide support, such as coming onsite to correct a software problem, should a compliance issue arise.

Consider the Full Costs

The number the EHR rep throws out at first may actually be about one-third of the true overall costs of implementation. In addition to the technology costs, there are other costs to consider, such as training the staff and reduced productivity for the first few weeks of implementation.

Prepare yourself and Your Staff for Change

Successful implementation means opening up yourself and your staff to changing the way you do things at your practice.

Know your Starting Point

You’ll need to have an honest assessment of your staff and providers’ computer literacy level, workflow issues, clinical needs, budget, and office layout before determining what software and hardware are right for your practice.

Find your Champions

A practice identifies champions on both the clinical and the administrative side, who foster the enthusiasm of those people so that they naturally step into leadership roles.

Starting with Program Year 2019, all participating EPs needed to attest to Stage 3. Stage 3 had only 8 objectives that further consolidated the objectives and measures of Modified Stage 2. An EP also needed to meet the Clinical Quality Measures (CQMs) requirements.​ Stage 3 required a 2015 Edition CEHRT.

The EP or appointed designee must upload supporting documentation to the EP’s MAPIR application prior to submittal for review.  Please review the Attestation tab for the Supporting Documentation Guides. Additional information specific to the MU measures is provided below.

MU Modified Stage 2 and Stage 3 required EPs to attest to the Public Health Reporting objective, which required using Certified EHR Technology (CEHRT) to submit data to public health and/or specialized registries. The Public Health Reporting objective required active engagement with two or more of the following:

1. Immunization Registry
2. Syndromic Surveillance Registry
3. Electronic Case Reporting
4. Public Health Registry
5. Clinical Data Registry

Requirements for Final EP Program Year 2021

The sections below describe how the Meaningful Use requirements were addressed in Program Year 2021, which was the final year of EP attestations.

MIIS, the Massachusetts Immunization Information System, is a web-based registry that collects patient immunization data. MIIS accepts electronic immunization messages (VXU) from CEHRT systems in the HL7 2.5.1 format. This satisfies Meaningful Use purposes. Technical specifications can be found on the MIIS Providers webpage. 

Immunization Registry (Measure 1)

Note that pursuant to M.G.L. Chapter 111, Section 24M, all licensed health care providers who administer immunizations are required to report immunization data to MIIS. EPs can claim an exclusion for the MU measure if they do not administer immunizations to any of the populations for which data is collected during the EHR reporting period.

For more information, and to register intent to submit immunization data, contact the MIIS Help Desk at 617-983-4335 or miishelpdesk@state.ma.us.
The MDPH also holds weekly MIIS Technical Support calls:
When: Every Thursday from 10:BAM to 11:00 AM EST
Phone: (605) 562-3000. Enter Access Code: 580574#

Syndromic Surveillance (Measure 2)

MDPH accepts syndromic surveillance data from EPs who practice in a freestanding urgent care facility. All other EPs can claim an exclusion for this measure. Save or print a screenshot of the MDPH Meaningful Use and Public Health Reporting webpage to document the reason for claiming the exclusion. 

Electronic Case Reporting (Measure 3)

Electronic Case Reporting is a new Stage 3 requirement. It is available since Program Year 2019 and is reported as Stage 3 Measure 3.

Note: Prior to Program Year 2019, Public Health Registries and Specialized / Clinical Data Registries were reported as part of Modified Stage 2 Measure 3.

Public Health Registry (Measure 4)

EPs who do not collect data relevant to a Public Health Registry within their "jurisdiction" may claim an exclusion for this measure, since there is no registry available relevant to their scope of practice. However, the definition of “jurisdiction” is dependent on the type of registry, and the scope of "jurisdiction" may be local, state, regional or national.

The Commonwealth of Massachusetts offers two options for Public Health Registry Reporting:

1. The Massachusetts Cancer Registry (MCR) supports electronic reporting from CEHRT systems. If you are an EP who treats cancer patients and are interested in reporting to the MCR, contact Susan T. Gershman at susan.gershman@state.ma.us. 
    
2. The Bureau of Infectious Disease Prevention at the MDPH has implemented electronic infectious disease case reporting into a specialized registry, the Massachusetts Virtual Epidemiologic Network (MAVEN). The registry accepts electronic medical case reports for acute hepatitis, active tuberculosis, and sexually-transmitted diseases. As onboarding participants is resource intensive, MDPH limits participation via a threshold based on incidence of reportable conditions seen by providers over a 12-month period. For EPs, the combined number of cases of syphilis, gonorrhea, chlamydia, acute hepatitis, and active tuberculosis seen at your facility must be greater than 1,000 in the most recent 12-month period. If your facility meets the threshold and you are interested in reporting data to this registry, contact Sita C. Smith at sita.c.smith@state.ma.us.

At this time, the MDPH has not declared the Prescription Drug Monitoring Program (PDMP) a Specialized Registry.

Clinical Data Registry (Measure 5)

EPs can meet this measure by reporting to a clinical data registry. Some national professional associations, such as the American College of Cardiology, American Academy of Ophthalmology, and American College of Rheumatology have made clinical data registries available to their members. Other non-public registries may be available as well.

Reporting Requirements

MU Modified Stage 2 and Stage 3 required EHs to attest to the Public Health Reporting objective, which requires using Certified EHR Technology (CEHRT) to submit data to public health and/or specialized registries. The Public Health Reporting objective required active engagement with one of more of the following:

1. Immunization Registry
2. Syndromic Surveillance Registry
3. Specialized / Public Health Registry
4. Electronic Lab Reporting (ELR)

   Stage 3 program years:

5. Electronic Case Reporting
6. Clinical Data Registry Immunization Registry (Measure 1)

Requirements for Final EH Program Year 2018

The sections below describe how the Meaningful Use requirements were addressed in Program Year 2018, which was the final year of EH attestations.

MIIS, the Massachusetts Immunization Information System, is a web-based registry that collects patient immunization data. MIIS accepts electronic immunization messages (VXU) from CEHRT systems in the HL7 2.5.1 format. This satisfies Meaningful Use purposes. Technical specifications can be found on the MIIS Providers webpage.

Note that pursuant to M.G.L. Chapter 111, Section 24M, all licensed health care providers who administer immunizations are required to report immunization data to MIIS. An EH can claim an exclusion for the MU measure if it does not administer immunizations to any of the populations for which data is collected during the EHR reporting period.

For more information, and to register intent to submit immunization data, contact the MIIS Help Desk at 617-983-4335 or miishelpdesk@state.ma.us.
The MDPH also holds weekly MIIS Technical Support calls:
When: Every Thursday from 10:00AM to 11:00 AM EST
Phone: (605) 562-3000. Enter Access Code: 580574#

Syndromic Surveillance (Measure 2)

MDPH accepts syndromic surveillance data from hospital emergency departments only. Other EHs can claim an exclusion for this measure. Save or print a screenshot of the MDPH Meaningful Use and Public Health Reporting webpage to document the reason for claiming the exclusion. 

Specialized Registry / Public Health Registry (Modified Stage 2 Measure 3 / Stage 3 Measure 4)

Specialized Registry Reporting is a Modified Stage 2 measure. In Stage 3, this measure is renamed to Public Health Reporting, but the requirements stay the same.

EHs who do not collect data relevant to a Specialized / Public Health Registry within their "jurisdiction" may claim an exclusion for this measure, since there is no registry available relevant to their scope of practice. However, the definition of “jurisdiction” is dependent on the type of registry, and the scope of "jurisdiction" may be local, state, regional or national.

EHs may be able to meet the Specialized / Public Health Registry measure by reporting to a national clinical data registry:

• Some national professional associations, such as the American College of Cardiology, American Academy of Ophthalmology, and American College of Rheumatology have made clinical data registries available to their members.

EHs that do not collect data relevant to a Specialized Registry within their "jurisdiction" may claim an exclusion for this measure, since there is no Specialized Registry available relevant to their scope of practice. However, the definition of “jurisdiction” is dependent on the type of registry, and the scope of "jurisdiction" may be local, state, regional or national.

The Commonwealth of Massachusetts offers two options for Specialized / Public Health Registry Reporting:

1. The Massachusetts Cancer Registry (MCR) supports electronic reporting from CEHRT systems. If your EH treats cancer patients and are interested in reporting to the MCR, contact Susan T. Gershman at susan.gershman@state.ma.us.
    
2. The Bureau of Infectious Disease Prevention at the MDPH has implemented electronic infectious disease case reporting into a specialized registry, the Massachusetts Virtual Epidemiologic Network (MAVEN). The registry accepts electronic medical case reports for acute hepatitis, active tuberculosis, and sexually-transmitted diseases. As onboarding participants is resource intensive, MDPH limits participation via a threshold based on incidence of reportable conditions seen by providers over a 12-month period. For EHs, the combined number of cases of syphilis, gonorrhea, chlamydia, acute hepatitis, and active tuberculosis seen at the facility must be greater than 1,000 in the most recent 12-month period. If your facility meets the threshold and you are interested in reporting data to this registry, contact Sita C. Smith at sita.c.smith@state.ma.us.

At this time, the MDPH has not declared the Prescription Drug Monitoring Program (PDMP) a Specialized Registry.

Electronic Laboratory Reporting (Modified Stage 2 Measure 4 / Stage 3 Measure 6)

Electronic Laboratory Reporting is a secure, automated mechanism for the reporting of laboratory and patient information by hospitals. MDPH is able to transform messages currently sent from hospitals (in HL7 2.3.1 or SMF formats) to HL7 2.5.1 format. MDPH also accepts HL7 2.5.1 messages. A copy of the Meaningful Use certificate and a letter stating that the hospital routinely sends electronic laboratory reports to MDPH will be provided to all data providers upon request.

MDPH offers umbrella certification for all EHs that submit electronic laboratory reports. These EHs will be viewed as having formally registered intent to submit ELR for the purposes of Meaningful Use. For more information please contact ELR.CDSupport@state.ma.us.

Electronic Case Reporting (Stage 3 Measure 3 - future program years)

Electronic Case Reporting is a new Stage 3 requirement, but is not yet available in Program Year 2018.

Clinical Data Registry (Stage 3 Measure 5 - future program years)

Clinical Data Registry is a new Stage 3 requirement, but is not yet available in Massachusetts in Program Year 2018.

Reporting Requirements

To qualify, EPs had to meet a 30% Medicaid Patient Volume Threshold (20% for Board-Certified Pediatricians) over a 90-day reporting period. For an overview of available PVT calculation methods, click here (i.e. Paid claims vs Enrollee; FQHC/RHC vs non-FQHC; and Individual vs Group Proxy).

PVT Calculator

Failure to properly calculate PVT was the main reason why EHR Incentive applications cycled through resubmissions. To make it easier, MeHI created the PVT Calculator to automatically calculate your PVT from claims data. To learn more about how it works, click here.

To download the PVT Calculator, click on the links below. The Instructions and Overview are also embedded on tabs within the PVT Calculator. Read the instructions to get started and then follow the onscreen instructions as you go.

PVT Calculator (Version 2/19/2019)  - Download to use the PVT Calculator
Instructions (Version 2/19/2019)        - Download to get started
Overview (Version 2/19/2019)              - Download if you are interested to learn how the PVT Calculator works

2021 CHIP Factors for Eligible Professionals (Children's Health Insurance Program)

2020 CHIP Factors for Eligible Professionals (Children's Health Insurance Program)

2018 CHIP Factors for Eligible Professionals

For non-FQHC/RHC, the following CHIP factor must be applied to the in-state numerator to exclude CHIP patients.
 If you selected a 90 day PVT reporting period in:
 - 2017: use the 2017 Calendar Year factor listed below.
 - 2018: use the 2018 factor corresponding to the last day of the period. 

2017 CHIP Factors for Eligible Professionals

For non-FQHC/RHC, the following CHIP factor must be applied to the in-state numerator to exclude CHIP patients.
 If you selected a 90 day PVT reporting period in:
 - 2016: use the 2016 Calendar Year factor listed below.
 - 2017: use the 2017 factor corresponding to the last day of the period. 

2016 CHIP Factors for Eligible Professionals

For non-FQHC/RHC, the following CHIP factor must be applied to the in-state numerator to exclude CHIP patients.
 If you selected a 90 day PVT reporting period in:
 - 2015: use the 2015 Calendar Year factor listed below.
 - 2016: use the 2016 factor corresponding to the last day of the period. 

2015 CHIP Factors for Eligible Professionals

For non-FQHC/RHC, the following CHIP factor must be applied to the in-state numerator to exclude CHIP patients.
 If you selected a 90 day PVT reporting period in:
 - 2014: use the 2014 Calendar Year factor listed below.
 - 2015: use the 2015 factor corresponding to the last day of the period. 

Table notes:
*    Q1-Q2 factors changed as of 7/8/16. If you submitted before 7/8/16, you will only need to update your application if we ask you to do so.
**  Q3-Q4 factors are new as of 7/8/16. If you submitted before 7/8/16 using an estimated factor, you will be asked to update the application.

To qualify, an EH's Medicaid Patient Volume had to meet a 10% Patient Volume Threshold during a 90-day reporting period. Children's Hospitals were exempt from this threshold requirement. 

2018 CHIP Factors for Eligible Hospitals (Children's Health Insurance Program)

 The following CHIP factor must be applied to the in-state numerator to exclude CHIP patients:
 If you selected a 90 day PVT reporting period in:
 - 2017: use the 2017 Calendar Year factor listed below.
 - 2018: use the 2018 factor corresponding to the last day of the period. 

2017 CHIP Factors for Eligible Hospitals (Children's Health Insurance Program)

 The following CHIP factor must be applied to the in-state numerator to exclude CHIP patients:
 If you selected a 90 day PVT reporting period in:
 - 2016: use the 2016 Calendar Year factor listed below.
 - 2017: use the 2017 factor corresponding to the last day of the period. 

2016 CHIP Factors for Eligible Hospitals (Children's Health Insurance Program)

 The following CHIP factor must be applied to the in-state numerator to exclude CHIP patients:
 If you selected a 90 day PVT reporting period in:
 - 2015: use the 2015 Calendar Year factor listed below.
 - 2016: use the 2016 factor corresponding to the last day of the period. 

2015 CHIP Factors for Eligible Hospitals (Children's Health Insurance Program)

 The following CHIP factor must be applied to the in-state numerator to exclude CHIP patients:
 If you selected a 90 day PVT reporting period in:
 - 2014: use the 2014 Calendar Year factor listed below.
 - 2015: use the 2015 factor corresponding to the last day of the period. 

Table notes:
*   2015 Q1-Q2 factors changed as of 7/8/16. If you submitted before 7/8/16, you will only need to update your application if we ask you to do so.
**  2015 Q3-Q4 factors are new as of 7/8/16. If you submitted before 7/8/16 using an estimated factor, you will be asked to update the application.
*** 2016 Q1-Q2 factors are new as of 10/17/16. If you submitted before 10/17/16 using an estimated factor, you will be asked to update the application.

All Medicaid EHR Incentive Program applications went through a pre-payment validation process. After the incentives had been paid, some provider were also selected for a post-payment audit. The audits were performed by EOHHS, or their contractors. For audit purposes, all supporting documentation must be retained for at least six years after attestation.