Eligible Hospitals
The final rule identifies acute care and children's hospitals as the only two types of institutional providers potentially eligible for Medicaid incentive payments. Acute care hospitals are defined as hospitals with an average patient length of stay of 25 days or fewer, and with a CCN that falls in the range 0001-0879 or 1300-1399.
Children's hospitals are defined as hospital that is separately certified as a children's hospital, with a CCN in the 3300-3399 series and predominantly treats individuals under the age of 21.
Acute care hospitals must also meet a 10% Medicaid patient volume threshold requirement. Children's hospitals do not have patient volume requirements for Medicaid incentive program participation.
Incentive payments to eligible hospitals are based on a complex formula in which a base incentive amount for all hospitals is modified by the number of Medicaid patient discharges as well as other factors.
Aggregate EHR Incentive Payment = Overall EHR Amount * Medicaid Share
| Overall EHR Amount = | Sum of Y1-Y4 Initial amounts | |
| Initial Amount = | Base amount + discharge-related amount X transition factor | |
| Base Amount (B) $2M | ||
|
Discharge related-amount (D) |
$200 per number of discharges >1,150 and <23,000 e.g. first 1149 discharges are not counted and are subtracted from total discharges |
|
| Transition Factor (T) | Y1 1 | |
| Y2 0.75 | ||
| Y3 0.5 | ||
| Y4 0.25 | ||
| Add avg. annual growth rate to discharges for Y2, Y3, Y4 based on prior 3 year reporting (G) | ||
| Y1 = (B) + (D*200) *1 | ||
| Y2 = (B) + [(D +D*G)*200]*.75 | ||
| Y3 = (B) + [(D +D*G)*200]*.5 | ||
| YY4 = (B) + [(D +D*G)*200]*.25 | ||
| Y1+Y2+Y3+Y4 | ||
| Medicaid Share = /td> | Medicaid inpatient-bed days | |
| total inpatient-bed days * [(total charges - charity care) ÷ total charges] | ||
Sample incentive payment calculations for three hospital types
http://www.cms.gov/EHRIncentivePrograms/40_Eligibility_Eligible_Hospitals.asp