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Eligibility

2016 was the last year to begin participation in the Medicaid Promoting Interoperability Program

In order to qualify for incentives under the New Jersey Medicaid PI Program, providers must meet both a Medicaid provider type requirement and a Medicaid patient volume requirement. Additionally, the Medicaid provider cannot be “hospital based”, defined as 90% or more of the provider’s encounters taking place at an inpatient or emergency room place of service/practice location.

Provider Requirements

Provider Types:

  • Physicians, Nurse Practitioners, Dentists, FQHCs, Optometrists, and Pediatricians 

Patient Volume Requirements:

  • 30% Medicaid patient volume (20% minimum for Pediatricians)
  • Patient volume look-back period is the preceding calendar year
  • Volume may be established by individual provider or by the group

Active Enrollment:

  • Medicaid provider is active in NJMMIS
  • For more information on NJMMIS click here

Provider Level:

  • EPs attested through another organization, can  reassign incentives to current organization through CMS PI Program Incentive Program portal
  • EPs who began participation in CY 2016 or prior are eligible for remaining PI incentives through CY 2021
  • Payment may be made to the individual provider or the group

Additional information on provider eligibility  can be found here

EHR Requirements

Proof of a 2014 or 2015 Edition CEHRT

Modified Stage 2:

  • 2014 Edition CEHRT
  • 2014/2015 Edition CEHRT
  • 2015 Edition CEHRT
  • EHR technology must support the objectives and measures to which EP plans to attest

Stage 3

  • 2015 Edition CEHRT
  • 2014/2015 Edition CEHRT (CMS is adopting final policies to allow healthcare providers to use 2014 CEHRT, 2015 CEHRT or 2014-2015 combination CEHRT)
  • EHR technology must support the functionalities, objectives and measures for Stage 3

Click here for more information on certified EHR

50/80 Rule

All PI measures are based on encounters that occurred at locations where certified EHR technology is implemented.

At least 50% of a provider’s total patient encounters must occur at locations where there is certified EHR technology in order to be eligible for a Medicaid PI Program payment based on PI criteria.

Additionally, at least 80% of the attesting provider’s patients in the EHR Reporting Period must be included in the provider’s or group practice’s EHR system in order to be eligible for New Jersey Medicaid PI Program payments.

Multiple Locations – To be a meaningful EHR user, an EP must have 50% or more of their patient encounters during the EHR reporting period at a practice/location or practices/locations equipped with certified EHR technology. (There are additional considerations to determine eligibility for part-time employees for MU if working at multiple practices/locations. Click here for more information).

Click here for more information on PI requirements.

New Jersey Innovation Institute
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323 Dr Martin Luther King Jr Blvd
Newark, NJ 07102

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