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ILHIE Medicaid Work Group Minutes - February 7 2011 

February 7, 2011

Attendees (phone and in-person):

  • Steve Bradley, Department of Healthcare and Family Services (HFS)
  • Dave Barnes, HFS
  • Julie Bonello, Access Community Health Network
  • Patricia Borrowdale, Pediatric Health Associates
  • Kelly Carter, Illinois Primary Health Care Association
  • Connie Christen, HFS
  • Andrew Garrett, HFS
  • Ivan Handler, HFS
  • Jill Hayden, Illinois Primary Health Care Association
  • Joe Holler, HFS
  • Roger Holloway, Illinois Health Information Technology Regional Extension Center (IL-HITREC)
  • Peter Ingram, Sinai Health System
  • Vince Keenan, Illinois Academy of Family Physicians
  • Mike Koetting, HFS
  • Frank Kopel, HFS
  • Stan Krok, Children's Memorial Hospital
  • John Lekich, HFS
  • Michael McCabe, UnitedHealthcare
  • Mary McGinnis, Office of Health Information Technology (OHIT)
  • Susan Melczer, Metropolitan Chicago Healthcare Council
  • Pat Merryweather, Illinois Hospital Association
  • Jim Parker, HFS
  • Renee Perry, HFS
  • Mary Ring, Illinois Critical Access Network
  • Ken Ryan, Illinois State Medical Society
  • Dr. Silva
  • Gwen Smith, HFS
  • Cory Verblen, OHIT
  • Theresa Walunas, Chicago Health Information Technology Regional Extension Center (CHITREC)
  • Matthew Werner, Consultant
  • Laura Zaremba, OHIT

Review Minutes of Previous Meeting

The meeting minutes from the January 24, 2011, meeting were approved.

Proposed Hospital Electronic Health Record Payment Incentive Schedule

Peter Ingram provided an overview to the group saying that the proposed payment schedule discussed at the February 3, 2011, meeting was based on whether hospitals have a contract with a Medicaid managed care company. It was also noted that the ARRA guidelines allow the states administrative flexibility in determining the schedule of the provider incentive payments.

Peter asked for more information about the areas of the state that are presenting managed care contracting challenges. Jim Parker explained that the greatest contracting impediment has occurred in the Cook County collar counties. The recently enacted Health Care Reform bill requires that HFS have 50 percent of its clients in coordinated care by January 1, 2015. HFS has been working to contract with additional hospitals for this initiative and has met with significant resistance from many of the suburban Chicago hospitals. HFS is looking for innovative methods to incent providers and hospitals to participate in more complex care coordination models. Jim indicated one of the barriers to this contracting effort is that hospitals have a negative perception of managed care based on past history. Jim said that the managed care companies have assured HFS that the reimbursement rate will not be lower than the Medicaid rate and, in some cases the rate will be higher than the Medicaid rate. Jim is planning to add language to the managed care contracts to ensure that the reimbursement rate to providers is not below the Medicaid rate.

Peter indicated that the role of the Medicaid Work Group is to advise HFS and OHIT, and should provide the best counsel. He asked if the managed care plans are required to contract with all hospitals. Jim indicated that there are hospitals that want to be in an HMO network, and the HMOs have told them they did not want to sign them up. Jim indicated that HFS will address this scenario. Peter suggested that HFS provide a more complete definition of "contract." Peter asked what will happen if in year one the payment schedule is accelerated for a hospital and in year two the hospital, doesn't have a contract. This will also be addressed by HFS.

Pat Borrowdale stated that the doctors in the practice she works with are very concerned about joining an HMO, and have a great concern about the potential for lost revenue. Jim stated that it will be in the HMOs contract that they cannot pay less than the Medicaid rate.

Stan Krok inquired if the payment schedule proposal will slow the submission of the State Medicaid HIT Plan (SMHP). Frank Kopel replied that the rate structure has to be specified in the SMHP. Renee Perry said that this may hold up the SMHP in the short term but HFS is also addressing other issues with the SMHP.

Hospital-Based Eligible Provider (EP) Calculation

Renee Perry provided answers to a previous question about patient volume calculations. She learned that if an EP is not hospital based then their patient volume is based on total patient encounters. The place of service does not come into play for the calculation.

Review of Draft SMHP

Renee Perry indicated that the draft SMHP is not yet available. There are a number of internal decisions that have to be made, but the goal is to have the SMHP completed by the end of February. HFS is taking into consideration the lessons learned, and best practices, from other states that have already submitted their SMHP.

Provider Information Notice

Renee reported that the provider Web site is now up, and running, and is located at: www.hfs.illinois.gov/ehr. As questions are received on the Web site, a Frequently Asked Questions (FAQ) document will be created. Cory Verblen volunteered to assist with the FAQs.

Draft of Provider Volume Calculation Sheet

Frank Kopel indicated that the worksheet is not yet completed, but hopes to have it ready for review at the next meeting.

Multiple Practices

A link to the Centers for Medicare and Medicaid (CMS) Web site was distributed. The Web site includes the answer to the following question:

If an eligible professional (EP) in the Medicaid EHR Incentive Program wants to leverage a clinic or group practice's patient volume as a proxy for the individual EP, how should a clinic or group practice account for EPs practicing with them part-time and/or applying for the incentive through a different location (e.g., where an EP is practicing both inside and outside the clinic/group practice, such as part-time in two clinics)? This can be viewed on the Centers for Medicaid and Medicare Services Web site.

CHIPRA Update

Gwen Smith reported that since the last meeting she has received the final set of core measures with very detailed specifications. The chart will be updated to include this information and Gwen hopes to have it available at the next meeting.

Develop Agenda for Next Meeting

  1. Hospital Rates (Jim Parker)
  2. SMHP (Renee Perry)
  3. Provider Volume Calculation Worksheet (Frank Kopel)
  4. CHIPRA Update (Gwen Smith)

The next meeting is scheduled on Tuesday, February 22, 2011. Meeting adjourned.