State of Nevada

1

State of Nevada

Department of Health and Human Services Division of Health Care Financing and Policy

State Medicaid Health Information Technology

Plan

April 12, 2017

State Medicaid Health Information Technology Plan (SMHP) 2017

Table of Contents

Table of Contents....................................................................................................................... 1 Table of Figures ......................................................................................................................... 3

Table of Tables........................................................................................................................... 4

Revision History......................................................................................................................... 5

Introduction and Overview ........................................................................................................ 6 Section A. Nevada's "As-Is" Landscape ................................................................................ 10

A.1. Extent of EHR Adoption by Practitioners and Hospitals ....................................................... 10 A.2. Broadband Internet Access Challenges to Rural Areas........................................................ 23 A.3. FQHC HIT/HIE HRSA Grant Funding ................................................................................... 32 A.4. Veterans Administration and Indian Health Services Providers ........................................... 36 A.5. Stakeholder Engagement in HIT/HIE Activity ....................................................................... 38 A.6. SMA HIT/HIE Relationship with Other Entities ..................................................................... 40 A.7. Health Information Exchange Governance Structure ........................................................... 48 A.8. The MMIS Role in the Current HIT/HIE Environment ........................................................... 50 A.9. State Activities Underway to Facilitate HIT/HIE Adoption ..................................................... 57 A.10. SMA's Relationship to the State HIT Coordinator ............................................................... 58 A.11. SMA Activities to Influence EHR Incentive Program and Use of Data ............................... 58 A.12. State Laws or Regulations Impacting the EHR Incentive Program .................................... 59 A.13. HIT/HIE Activities Crossing State Borders .......................................................................... 67 A.14. Current Interoperability of State Immunization/Public Health ............................................. 68 A.15. HIT Related Grant Awards to the State .............................................................................. 72

Section B. The State's "To-Be" HIT Landscapes ................................................................... 79

Overview ....................................................................................................................................... 79 B.1. SMA Five Year HIT/HIE Goals .............................................................................................. 79 B.2. Future of DHHS IT System Architecture ............................................................................... 86 B.3. How Medicaid Providers Interface with the SMA Related to the EHR Incentive Program . 102 B.4. HIE Governance Planning and SMA HIT/HIE Goals and Objectives ................................. 102 B.5. Provider EHR Adoption and Meaningful Use Advancement Strategies of the SMA .......... 108 B.6. SMA Encouragement of FQHC EHR Adoption ................................................................... 109 B.7. SMA Needs Assessment and Technical Assistance for Medicaid Providers ..................... 112 B.8. SMA Management of Populations with Unique Needs ....................................................... 115 B.9. Grant Leverage of the EHR Incentive Program .................................................................. 116 B.10. SMA Need for New or Changed State Laws..................................................................... 117 B.11. SMA Need for Issue Management and Other Institution Involvement for Five Year Goal

Realization ..................................................................................................................... 117

Section C. Activities Necessary to Administer and Oversee the EHR Incentive Program 118

Nevada Department of Health and Human Services Division of Health Care Financing and Policy | page 1

State Medicaid Health Information Technology Plan (SMHP) 2017

Program Overview ...................................................................................................................... 118 C.1. SMA Verification of Provider Sanction, License, Qualification Status ................................ 119 C.2. SMA Verification of Provider "Hospital-Based" Status........................................................ 122 C.3. SMA Verification of Provider Attestation ............................................................................. 122 C.4. SMA Communication with Providers Regarding Eligibility, Payment, Etc. ......................... 124 C.5. SMA Methodology for Patient Volume Calculation ............................................................. 124 C.6. SMA Verification of Eligible Professionals and Eligible Hospitals Patient Volumes ........... 128 C.7. SMA Verification of EP "Practices Predominantly" Requirement for FQHCs/RHCs .......... 131 C.8. SMA Verification of Adopt, Implement, Upgrade of CEHRT............................................... 131 C.9. SMA Verification of CEHRT for Second Year Meaningful Use ........................................... 132 C.10. SMA Proposal of Permissible Changes for Meaningful Use ............................................ 140 C.11. SMA Verification of Providers' Use of CEHRT ................................................................. 141 C.12. SMA Collection of Meaningful Use and ECQM Data ........................................................ 141 C.13. Data Collection Alignment with Other CQM Data ............................................................. 142 C.14. IT, Fiscal and Communication Systems That Will Support Implementation of the EHR

Implementation Program ............................................................................................... 142 C.15. SMA IT System Changes Needed to Implement the EHR Incentive Program ................. 143 C.16. SMA Timeframe for Systems Modifications ...................................................................... 143 C.17. Interface Testing with CMS National Level Repository..................................................... 143 C.18. SMA Acceptance of Medicaid Provider NRL Registration Data ....................................... 143 C.19. SMA Website Development for Medicaid Provider Engagement ..................................... 145 C.20. SMA Anticipation of Modifications to MMIS ...................................................................... 146 C.21. SMA Provision of a Help Desk .......................................................................................... 146 C.22. SMA Provision for Provider Appeal Regarding Eligibility, Payment, AIU ......................... 146 C.23. SMA Accounting for Separation of HITECH and FFS Funds ........................................... 147 C.24. SMA Anticipated Frequency of EHR Incentive Payments ................................................ 148 C.25. SMA Verification of Payment to Provider without Deduction or Rebate ........................... 154 C.26. SMA Verification Payments to Entities Supporting Adoption of CEHRT .......................... 155 C.27. SMA Process of Fiscal Arrangements for Payment Disbursement .................................. 155 C.28. SMA Verification of Calculation and Payment Incentives are Consistent with Statue and

Regulation ...................................................................................................................... 155 C.29. Role of SMA Contractors in Implementing the EHR Incentive Program........................... 155 C.30. Description of SMA Assumptions, Path, Training and Planning Dependencies............... 156

Section D. The State's Audit Strategy .................................................................................. 157

D.1. SMA Methods to Avoid Improper Payments ....................................................................... 157 D.2. SMA Methods Employed to Identify Fraud and Abuse ....................................................... 158 D.3. SMA Tracking of Overpayments ......................................................................................... 158 D.4. SMA Process for Managing Detection of Fraud and Abuse ............................................... 159 D.5. SMA Intent Regarding Leveraging Existing Data Sources for Verification of Meaningful Use

....................................................................................................................................... 159 D.6. SMA Use of Sampling as Part of Its Audit Strategy ............................................................ 159

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State Medicaid Health Information Technology Plan (SMHP) 2017

D.7. SMA Methods to Relieve Provider Burden and Maintain Integrity and Efficacy of the Oversight Process ......................................................................................................... 159

D.8. Program Integrity Operations Locations ............................................................................. 159

Section E. The State's HIT Roadmap .................................................................................... 160

E.1. SMA Graphical/Narrative Pathway from "As-Is" to "To-Be" ................................................ 160 E.2. SMA Expectations Regarding Provider EHR Technology Adoption over Time and Annual

Benchmarks ................................................................................................................... 164 E.3. Benchmarks for SMA Goals ................................................................................................ 164 E.4. Benchmarks for Audit and Oversight Activities ................................................................... 169

Appendix A. Nevada SMHP Addendum ? February 9, 2017............................................ 170 Appendix B. Nevada SMHP Addendum ? January 14, 2016 ........................................... 171 Appendix C. Nevada SMHP Addendum ? October 29, 2014 ........................................... 172 Appendix D. SLR Screen Designs .................................................................................... 173 Appendix E. Electronic Health Records Incentive Program Communication Plan ....... 174 Appendix F. Acronym List ................................................................................................ 175 Endnotes ................................................................................................................................ 182

Table of Figures

Figure 1. Nevada SIM Aims and Primary Drivers ........................................................................... 7 Figure 2. State of Nevada Health Care Centers............................................................................. 9 Figure 3. Broadband Service Inventory for the State of Nevada by Platform................................ 24 Figure 4. Selected Rural Health Care Facilities............................................................................ 35 Figure 5. Business Architecture ................................................................................................... 51 Figure 6. Information Architecture................................................................................................ 52 Figure 7. Technical Architecture .................................................................................................. 53 Figure 8. Core MMIS Modernization Project ................................................................................ 54 Figure 9. MITA Seven Standards and Conditions: Levels of Business Capability ........................ 55 Figure 10. CCBHC Grant Themes ............................................................................................... 73 Figure 11. NetSmart to HealtHIE Nevada Data Flow ................................................................... 78 Figure 12. SMA System Next Generation 20 ............................................................................... 87 Figure 13. Proposed Nevada HIT Infrastructure Model ................................................................ 97 Figure 14. Nevada's "TO-BE" Public Health HIT/HIE Environment .............................................. 98 Figure 15. DHCFP Master Data Management Solution.............................................................. 101 Figure 16. "TO-BE" HIE Infrastructure Model ............................................................................. 104 Figure 17. EHR Adoption Barriers.............................................................................................. 113

Nevada Department of Health and Human Services Division of Health Care Financing and Policy | page 3

State Medicaid Health Information Technology Plan (SMHP) 2017

Figure 18. EHR Usage Concerns............................................................................................... 114 Figure 19. State Personnel Organizational Chart ....................................................................... 119 Figure 20. EP Registration and Attestation Processes............................................................... 120 Figure 21. EP and EH/CAH Registration and Attestation Processes.......................................... 121 Figure 22. CMS Interfaces ......................................................................................................... 144 Figure 23. ONC/Certified HIT Product List Interface .................................................................. 145 Figure 24. Nevada's AS-IS to To-Be Pathway, 2017-2021 ........................................................ 161 Figure 25. Nevada's Health IT Development History and Planned Initiatives ............................. 162

Table of Tables

Table 1. Table A: Top EHRs in Use among Medicare and Medicaid EHR Incentive Program Participants.................................................................................................................................. 11 Table 2. Table B: Top 10 Vendors by Provider Type/Specialty among Medicare and Medicaid Program Participants ................................................................................................................... 12 Table 3. Nevada EHR Incentive Payments to Date...................................................................... 15 Table 4. Medicaid Program Data 2012-2016 ............................................................................... 16 Table 5. Organizations Interviewed.............................................................................................. 18 Table 6. Nevada Provider SMHP Survey: Provider Type Responses .......................................... 20 Table 7. EHR Systems in Use Among e-Scan Survey Respondents ........................................... 21 Table 8. PCMH-Recognized Clinics ............................................................................................. 34 Table 9. Health Information Technology and Data Task Force .................................................... 38 Table 10. Population Health Improvement Council Sub-committee Members .............................. 39 Table 11. HealtHIE Nevada HIE Connection Projects.................................................................. 41 Table 12. HealtHIE Nevada Board of Directors............................................................................ 48 Table 13. HealtHIE Nevada Fee Structure................................................................................... 49 Table 14. Current State Activities to Facilitate HIE/EHR Adoption ? Contracted Services............ 57 Table 15. Future Planned State Activities to Facilitate HIE/EHR Adoption ................................... 57 Table 16. Nevada Medicaid EHR Goals for Eligible Professionals ............................................... 82 Table 17. Nevada Medicaid EHR Goals for Eligible Hospitals...................................................... 83 Table 18. Planned HealtHIE Nevada HIE Connection Projects .................................................... 89 Table 19. EHR Incentive Program Attestations by Provider Type .............................................. 110 Table 20. Patient Volume Threshold Criteria ............................................................................. 125 Table 21. Stage of Meaningful Use Criterial by First Year.......................................................... 134 Table 22. Eligible Professionals Modifications to Meaningful Use .............................................. 135 Table 23. Eligible Hospitals Modifications to Meaningful Use..................................................... 137 Table 24. Supplemental Documentation Requirements ............................................................. 138

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