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PDFWAC 182-502-0025

Electronic health records (EHR) incentive program.

The purpose of this section is to establish the medicaid electronic health records (EHR) incentive program under the American Recovery and Reinvestment Act of 2009 (ARRA). The medicaid EHR incentive program promotes the adoption and meaningful use of certified EHR technology by offering financial incentives to eligible professionals and hospitals. This program is administered by the medicaid agency.
(1) The agency provides incentive payments to eligible providers and hospitals that adopt and meaningfully use certified EHR technology under 42 C.F.R. Parts 412, 413, 422, and any other federal regulations that apply.
(2) Providers and hospitals eligible to participate in EHR incentive program are identified in 42 C.F.R. Part 495.304 and other applicable rules.
(3) As authorized by 42 C.F.R. Parts 412, 413, 422, chapters 43.20B and 74.09 RCW, and any other federal or state rules that apply, the agency monitors and reviews all providers and hospitals participating in the EHR incentive program. By the same authority, the agency reviews all practices, documentation, and data related to EHR technology to determine whether professionals and hospitals participating in the EHR incentive program are eligible and complying with state and federal rules and regulations.
(4) The agency may determine that a participating professional or hospital has not met the eligibility or performance requirements to receive an EHR incentive payment, or should receive an incentive payment in an amount less than the amount anticipated by the provider or hospital. Areas of possible dispute in the EHR incentive program include, at a minimum, any of the following:
(a) Patient volume thresholds and calculations, as outlined in 42 C.F.R. Parts 495.304 and 495.306.
(b) Eligibility criteria and payment limitations, as outlined in 42 C.F.R. Parts 495.10, 495.304, 495.306, and 495.310.
(c) Attestations and compliance demonstrations including, at a minimum:
(i) Attestations that certified EHR technology has been adopted, implemented, or upgraded; and
(ii) Demonstrations of meaningful use, as outlined in 42 C.F.R. Parts 495.6, 495.8, 495.306, 495.310, and in any future published federal regulations and requirements, as applicable.
(d) The payment process and incentive payment amounts, as outlined in 42 C.F.R. Parts 495.310, 495.312, and 495.314.
(e) Additional issues regarding EHR incentive program eligibility, participation, documentation, and compliance as outlined in 42 C.F.R. Parts 412, 413, 422, and in any future published federal regulations and requirements, as applicable.
(5) All matters of dispute are subject to the Administrative Procedure Act (APA) appeal process under chapter 34.05 RCW. A provider who disagrees with an agency action under this section may request a hearing. The hearing request must:
(a) Be in writing;
(b) Be received by the agency, at the address identified in the notice of action, within twenty-eight days of the date of the notice of action by certified mail (return receipt); and
(c) State the reason or reasons why the provider thinks the action is incorrect.
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 15-14-039, § 182-502-0025, filed 6/24/15, effective 7/25/15. WSR 11-14-075, recodified as § 182-502-0025, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090. WSR 11-13-053, § 388-502-0025, filed 6/10/11, effective 7/11/11.]
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