Arizona Medicaid (AHCCCS) Promoting Interoperability (PI) Program for Eligible Professionals

If you have any questions about the AHCCCS Promoting Interoperability (PI) Program (formerly the Medicaid EHR Incentive Program), Health Current is available to provide educational assistance and support for the PI Program. Contact us at 602-688-7210 or via email at ehr@healthcurrent.org.

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The Medicaid Promoting Interoperability Program for Eligible Professionals (EPs) is an incentive program open to Arizona providers who meet eligibility requirements. Annually EPs may elect to participate in the program by submitting proof of their eligibility to AHCCCS and attesting through Arizona’s Electronic Provider Incentive Payment (ePIP) System to meeting the performance requirements for the program year. After eligibility and performance submissions are reviewed by AHCCCS, EPs who attest successfully and meet the program requirements receive a lump sum incentive payment.

The Medicaid Promoting Interoperability program began in 2011 as the Medicaid EHR Incentive Program and continues through 2021. EPs may claim a maximum of six incentive payments over the life of the program and must have received at least one payment during Program Years 2011 through 2016 to continue participation after 2016. Providers are not required to notify AHCCCS if they decide to skip a program year, as participation is optional and there is no penalty for non-participation.

The Arizona Medicaid Program does not allow third party attestation for Eligible Providers in the Electronic Provider Incentive Payment System (ePIP). Eligible Providers should actively participate in the ePIP attestation process and are responsible for the completeness and accuracy of the information in their attestation. Providers may claim eligibility either individually or as part of an organization, but all EPs attest individually to meeting performance requirements.

Eligible Professionals directing their incentive payment to their organization must be affiliated with that organization at the time of attestation.

Eligibility
Eligible Professionals (EPs) include Physicians, Nurse Practitioners, Certified Nurse-Midwives and Dentists. Physician Assistants who practice in a Federally Qualified Health Center or Rural Health Clinic led by a Physician Assistant are also eligible.

EPs applying for years two through six must meet one of the following criteria:

  • Have a minimum 30% Medicaid patient volume to claim an incentive payment of $8,500
  • Have a minimum 20% Medicaid patient volume and be credentialed as a pediatrician to claim an incentive payment of $5,667.
  • Practice predominately in a Federally Qualified Health Center or Rural Health Clinic and have a minimum 30% Medicaid/Needy patient volume to claim an incentive payment of $8,500.
  • Practice predominately in a Federally Qualified Health Center or Rural Health Clinic, have a minimum 20% Medicaid/Needy patient volume and be credentialed as a pediatrician to claim an incentive payment of $5,667.

In Arizona, encounter information from any consecutive 90 days in the calendar year prior to the program year is used to calculate the Medicaid or Needy Patient Volumes identified above. For example, providers attesting for program year 2020 would use encounter information from calendar year 2019 to prove eligibility.

EPs must already have received at least one incentive payment for a program year prior to 2017 to continue participation.

General Requirements
Beginning in 2019, all eligible professionals (EPs) are required to use 2015 edition certified electronic health record technology (CEHRT) to meet the requirements of the Promoting Interoperability (PI) Program. The 2015 Edition CEHRT does not have to be implemented on January 1st. However, the functionality must be in place by the first day of the Promoting Interoperability reporting period and the product must be certified to the 2015 Edition criteria by the last day of the reporting period. In some situations, the product may be deployed but pending certification.

Changes in Registration
CMS maintains a registration record for all Eligible Professionals participating in the program. EPs needing to change their program registration information may do so at https://ehrincentives.cms.gov/hitech/loginCredentials.action.

Reporting Period
In 2019, Eligible Professionals will attest to two categories of measures:

  1. Medicaid Promoting Interoperability Program Eligible Professionals Objectives and Measures (PI Measures). EPs report their performance on these measures for any consecutive 90 days in 2019.
  2. Electronic Clinical Quality Measures (eCQMs). Returning EPs who have previously attested to Meaningful Use have a one-year eCQM reporting period. First-time Meaningful Use attesters have a 90-day eCQM reporting period.

Attestation
Please consult the Attestation Deadline information on the AHCCCS web site for the latest information on the attestation period for Program Year 2019.

The attestation period takes place during the calendar year after the program year. EPs attesting for Program Year 2019 will submit their attestations during 2020.

Promoting Interoperability (PI) Objectives and Measure
The PI Objectives and Measures for 2019 are the previously established Meaningful Use Stage 3 Objectives and Measures as modified by the 2019 Medicare Physician Fee Schedule Final Rule. There are 8 Objectives containing 20 measures. For a listing of Objectives, see 2019 Objectives and Measures. Click on the Name of each Objective to retrieve the detailed specifications for each measure included in the Objective.

 Promoting Interoperability ObjectiveNumber of Measures
1Protect Patient Health Information1
2Electronic Prescribing (eRx)1
3Clinical Decision Support (CDS)2
4Computerized Provider Order Entry (CPOE)3
5Patient Electronic Access2
6Coordination of Care3
7Health Information Exchange3
8Public Health Reporting5

The documentation for each Objective specifies how many of the measures must be attested and which measures have exclusions available. Generally, EPs must either meet the threshold for passing the measure or qualify for an exclusion to attest successfully.

Electronic Clinical Quality Measures (eCQMs)
Eligible Professionals are required to report on any six eCQMs related to their scope of practice. At least one measure reported must be an outcome measure, if any are relevant. If no outcome measures are relevant to that EP, at least one measure reported must be a high-priority measure. If there are no outcome or high priority measures relevant to an EP’s scope of practice, they must report on any six relevant measures.

Outcome Measures for 2019

Measure TitleCMS eCQM IDeCQM NQFNQFQuality NumberMeasure TypeMIPS High Priority
Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)*CMS122v7None591Intermediate OutcomeX
Cataracts: Complications within 30 Days Following Cataract Surgery Requiring Additional Surgical ProceduresCMS132v7None564192OutcomeX
Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract SurgeryCMS133v7None565191OutcomeX
Controlling High Blood Pressure*CMS165v7None18236Intermediate OutcomeX
Depression Remission at Twelve MonthsCMS159v70710e710370OutcomeX
Children Who Have Dental Decay or CavitiesCMS75v7NoneNone378OutcomeX

*Included in the 2018 Medicaid and CHIP Core Measure Sets

All Outcome Measures are High Priority Measures. See the table below for the additional High Priority Measures not considered Outcome Measures. Measures may be designated as High Priority either by MIPS Quality Payment Program or by inclusion in the Medicaid and CHIP Core Measure Sets. Providers with both Medicare and Medicaid patient populations may prefer to choose measures considered High Priority by both programs.

Additional High Priority Measures for 2019

Measure TitleCMS eCQM IDeCQM NQFNQFQuality NumberMeasure TypeMIPS High Priority
Appropriate Testing for Children with PharyngitisCMS146v7NoneNone66ProcessX
Appropriate Treatment for Children with Upper Respiratory Infection (URI)CMS154v7None6965ProcessX
Appropriate Use of DXA Scans in Women Under 65 Years Who Do Not Meet the Risk Factor Profile for Osteoporotic FractureCMS249v1NoneNone472ProcessX
Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk AssessmentCMS177v71365eNone382ProcessX
Closing the Referral Loop: Receipt of Specialist ReportCMS50v7NoneNone374ProcessX
Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes CareCMS142v7None8919ProcessX
Documentation of Current Medications in the Medical RecordCMS68v8None419130ProcessX
Falls: Screening for Future Fall RiskCMS139v7None101318ProcessX
Functional Status Assessment for Total Hip ReplacementCMS56v7NoneNone376ProcessX
Functional Status Assessment for Total Knee ReplacementCMS66v7NoneNone375ProcessX
Functional Status Assessments for Congestive Heart FailureCMS90v8NoneNone377ProcessX
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment*CMS137v7None4305ProcessX
Oncology: Medical and Radiation - Pain Intensity QuantifiedCMS157v7None384143ProcessX
Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer PatientsCMS129v8None389102ProcessX
Use of High-Risk Medications in the ElderlyCMS156v7None22238ProcessX
Breast Cancer Screening*CMS125v7None2372112Process
Anti-depressant Medication Management*CMS128v7None1059Process
Follow-up Care for Children Prescribed ADHD Medication (ADD)*CMS136v8None108366Process
Chlamydia Screening for Women*CMS153v7None33310Process
Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents*CMS155v7None24239Process
Preventive Care and Screening: Screening for Depression and Follow-up Plan*CMS2v8None418134Process

* Included in the 2018 Medicaid and CHIP Core Measure Sets

Eligible Professionals should review their CEHRT to verify which measures are available in their system. Not all systems can provide all measures and providers may need to work with their vendor to determine the best set of measures to report. If the CEHRT has a different version of the measure than is currently specified, EPs may still report the measure for the Medicaid PI Program if the reporting format of the measure has not changed. Because of variabilities in systems, measures and relevance to providers, it is a best practice to track all available measures and select six relevant measures for attestation in ePIP.

The list of available eCQMs for EPs in 2019 is aligned with the list of eCQMs for Eligible Clinicians participating in the Medicare Quality Payment Program MIPS and/or the e-specified measures included in the 2018 Medicaid and CHIP Core Measure Sets. A list of these eCQMs can be found at https://ecqi.healthit.gov/ep-ec-ecqms by selecting 2019 as the Performance/Reporting period and downloading the Eligible Clinicians and Eligible Professionals Table of eCQMs. All eCQMs in the Core Sets are considered high priority measures for the Medicaid Promoting Interoperability Program but may or may not also be considered high priority measures for MIPS.

Note: There is no performance scoring on eCQMs in the Medicaid program. While CMS advises reporting on measures containing numerators and denominators before reporting on measures containing zeros, zero is an acceptable result provided that this value was produced by certified EHR technology. CMS and AHCCCS strongly encourage providers to report CQMs relevant to their patient population.

Reporting Period
In 2020, Eligible Professionals will attest to two categories of measures:

  1. Medicaid Promoting Interoperability Program Eligible Professionals Objectives and Measures (PI Measures). EPs report their performance on these measures for any consecutive 90 days in 2020.
  2. Electronic Clinical Quality Measures (eCQMs). EPs report their performance on these measures for any consecutive 90 days in 2020. The reporting period is a minimum, and EPs are encouraged to report on a longer period if they can do so.
  3. Download the Arizona Medicaid Promoting Interoperability (PI) Program Eligible Professional Meaningful Use Checklist for Program Year 2020 Stage 3.

Attestation
Please consult the Attestation Deadline information on the AHCCCS web site for the latest information on the attestation period for Program Year 2020.

The attestation period takes place during the calendar year after the program year. EPs attesting for Program Year 2020 will submit their attestations during 2021.

Promoting Interoperability (PI) Objectives and Measures
The PI Objectives and Measures for 2020 are the previously established Meaningful Use Stage 3 Objectives and Measures as modified by the 2019 Medicare Physician Fee Schedule Final Rule. There are 8 Objectives containing 20 measures. For a listing of Objectives, see 2020 Objectives and Measures. Click on the Name of each Objective to retrieve the detailed specifications for each measure included in the Objective.

 Promoting Interoperability ObjectiveNumber of Measures
1Protect Patient Health Information1
2Electronic Prescribing (eRx)1
3Clinical Decision Support (CDS)2
4Computerized Provider Order Entry (CPOE)3
5Patient Electronic Access to Health Information2
6Coordination of Care through Patient Engagement3
7Health Information Exchange3
8Public Health and Clinical Data Registry Reporting5

The documentation for each Objective specifies how many of the measures must be attested and which measures have exclusions available. Generally, EPs must either meet the threshold for passing the measure or qualify for an exclusion to attest successfully.

Electronic Clinical Quality Measures (eCQMs)
Eligible Professionals are required to report on any six eCQMs related to their scope of practice. At least one measure reported must be an outcome measure, if any are relevant. If no outcome measures are relevant to that EP, at least one measure reported must be a high-priority measure. If there are no outcome or high priority measures relevant to an EP’s scope of practice, they must report on any six relevant measures.

Outcome Measures for 2020

Measure TitleCMS eCQM IDeCQM NQFNQFQuality NumberMeasure TypeMIPS High Priority
Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)*CMS122v8N/A591Intermediate OutcomeX
Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract SurgeryCMS133v80565e565191OutcomeX
Controlling High Blood Pressure*CMS165v8None18236Intermediate OutcomeX
Depression Remission at Twelve MonthsCMS159v80710e710370OutcomeX
Children Who Have Dental Decay or CavitiesCMS75v8NoneNone378OutcomeX
International Prostate Symptom Score (IPSS) or American Urological Association-Symptom Index (AUA-SI) Change 6-12 Months After Diagnosis of Benign Prostatic HyperplasiaCMS771v1NoneNone476Patient Reported OutcomeX

* Included in the 2019 Medicaid and CHIP Core Measure Sets

All Outcome Measures are High Priority Measures. See the table below for the additional High Priority Measures not considered Outcome Measures.

Additional High Priority Measures for 2020

Measure TitleCMS eCQM IDeCQM NQFNQFQuality NumberMeasure TypeMIPS High Priority
Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes CareCMS142v80089e8919ProcessX
Appropriate Treatment for Children with Upper Respiratory Infection (URI)CMS154v8None6965ProcessX
Appropriate Testing for Children with PharyngitisCMS146v8NoneNone66ProcessX
Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer PatientsCMS129v90389e389102ProcessX
Documentation of Current Medications in the Medical RecordCMS68v90419e419130ProcessX
Oncology: Medical and Radiation – Pain Intensity QuantifiedCMS157v80384e384143ProcessX
Use of High-Risk Medications in the ElderlyCMS156v8None22238ProcessX
Initiation and Engagement of Alcohol and Other Drug Dependence TreatmentCMS137v8NoneNone305ProcessX
Falls: Screening for Future Fall RiskCMS139v8None101318ProcessX
Closing the Referral Loop: Receipt of Specialist ReportCMS50v8NoneNone374ProcessX
Functional Status Assessment for Total Knee ReplacementCMS66v8NoneNone375ProcessX
Functional Status Assessment for Total Hip ReplacementCMS56v8NoneNone376ProcessX
Functional Status Assessments for Congestive Heart FailureCMS90v9NoneNone377ProcessX
Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk AssessmentCMS177v81365eNone382ProcessX
Appropriate Use of DXA Scans in Women Under 65 Years Who Do Not Meet the Risk Factor Profile for Osteoporotic FractureCMS249v2NoneNone472ProcessX
Breast Cancer Screening*CMS125v8None2372112Process
Cervical Cancer Screening*CMS124v8NoneNone309Process
Childhood Immunization Status*CMS117v8NoneNone240Process
Chlamydia Screening for WomenCMS153v8NoneNone310Process
Follow-Up Care for Children Prescribed ADHD Medication (ADD) *CMS136v9NoneNone366Process
Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents*CMS155v8NoneNone239Process

* Included in the 2019 Medicaid and CHIP Core Measure Sets

Eligible Professionals should review their CEHRT to verify which measures are available in their system. Not all systems can provide all measures and providers may need to work with their vendor to determine the best set of measures to report. If the CEHRT has a different version of the measure than is currently specified, EPs may still report the measure for the Medicaid PI Program if the reporting format of the measure has not changed. Because of variabilities in systems, measures and relevance to providers, it is a best practice to track all available measures and select six relevant measures for attestation in ePIP.

The list of available eCQMs for EPs in 2020 is aligned with the list of eCQMs for Eligible Clinicians participating in the Medicare Quality Payment Program MIPS and/or the e-specified measures included in the 2019 Medicaid and CHIP Core Measure Sets. A list of these eCQMs can be found at https://ecqi.healthit.gov/ep-ec-ecqms by selecting 2020 as the Performance/Reporting period and downloading the Eligible Clinicians and Eligible Professionals Table of eCQMs. All eCQMs in the Core Sets are considered high priority measures for the Medicaid Promoting Interoperability Program but may or may not also be considered high priority measures for MIPS.

Note: There is no performance scoring on eCQMs in the Medicaid program. While CMS advises reporting on measures containing numerators and denominators before reporting on measures containing zeros, zero is an acceptable result provided that this value was produced by certified EHR technology. CMS and AHCCCS strongly encourage providers to report CQMs relevant to their patient population.

The Promoting Interoperability and eCQM reporting periods for Medicaid EPs in 2021 will be a minimum of any continuous 90-day period within the 2021 Calendar Year (CY). Because all program payments are legislatively mandated to occur by 12/31/2021, the end date for an EP’s reporting period in 2021 must fall before October 31, 2021. This truncated reporting period is needed to facilitate payment processing by the end of 2021.

Medicaid EPs may conduct a security risk analysis at any time during CY 2021, even if the EP conducts the analysis after the EP attests to meaningful use of CEHRT to the state. A Medicaid EP who has not completed a security risk analysis for CY 2021 by the time he or she attests to meaningful use of CEHRT for CY 2021 will be required to attest that he or she will complete the required analysis by December 31, 2021. This allows for maximum flexibility for Medicaid EPs to attest before their state’s 2021 deadline, while maintaining their annual SRA schedule.

All Medicaid Promoting Interoperability payments to EPs must be issued by December 31, 2021.

Federal support to the states for administrative activities related to audits and appeals is available through September 30, 2023.

2021 PI Program Webinar Series

Open Forum Documentation Requirements Program Closure – September

Open Forum for Meaningful Use Focus: Electronic Prescribing, Clinical Decision Support, and Computerized Provider Order Entry – August

AHCCCS Open Forum Presentation – August 26 2021_Poll

Open Forum: Objective 5 Patient Electronic Access Objective 6 Coordination of Care – July

Open Forum: Objective 7 Health Information Exchange – June

PI Program Webinar: Open Forum: Objective 1 Patient Health Information & Objective 8 Public Health & Clinical Data – May

PI Program Webinar: Open Forum 2021 Checklist – April

PI Program: Documentation Retention – March

PI Program: Electronic Clinical Quality Measures (eCQMs) for Meaningful Use – February

PI Program Objective 7: Health Information Exchange – Summary of Care Instructions for Referrals/Transitions – February


Program Year 2021 Stage 3 Objectives for Meaningful Use – January

2020 PI Program Webinar Series

PI Program Webinar: Program Year 2020 Documentation Retention – November 2020

PI Program Webinar: PY2020: Electronic Clinical Quality Measures for MU (eCQMs) – October 2020

PI Program Webinar: Obj. 7: HIE Summary of Care Instructions for Referrals/Transitions – Sept. 2020

PI Program Webinar: Objective 8: Public Health and Clinical Data Registry Reporting – September 2020

PI Program Webinar: PY2020 Stage 3 Requirements Objective for Meaningful Use – August 2020

PI Program Webinar: Open Forum for Meaningful Use – August 2020

PI Program Webinar: PY 2020 Objective 5: Patient Electronic Access Objective for Meaningful Use – July 2020

PI Program Webinar: PY2020 Security Risk Analysis for Meaningful Use – July 2020

PI Program Webinar: Objective 7: Health Information Exchange – June 2020

PI Program Webinar: Objective 2: Electronic Prescribing, Objective 3: Clinical Decision Support and Objective 4: Computerized Provider Order Entry – June 2020

PI Program Webinar: Objective 6: Coordination of Care through Patient Engagement – May 2020

Objective 8: Public Health and Clinical Data Registry Reporting – May 2020

PI Program Webinar: Objective 8: Public Health and Clinical Data Registry Reporting – April 2020

PI Program Webinar: PY 2019: Stage 3 Objectives for Meaningful Use – March 2020

PI Program Webinar: Objective 5: Patient Electronic Access to Health Information – February 2020

PI Program Webinar: Clinical Quality Measures (eCQMs) for PI Program – January 2020