Maryland is the first state to require State-regulated payors (payors) to provide incentives to select health care providers (practices) to promote the adoption of electronic health records (EHRs). The State-Regulated Payor EHR Adoption Incentive Program (incentive program) is a result of House Bill 706 Electronic Health Records Regulation and Reimbursement. The Maryland Health Care Commission (MHCC) worked with the six largest private payors in the State to establish the incentive program. The incentive program went into effect on April 21, 2011 and was amended on October 21, 2011 requiring that the incentive be paid in cash, unless a provider and payor agree on an incentive of equivalent value.
The incentive program was revised on June 9, 2014 in an effort to simplify some of the administrative requirements and to align with the federal EHR incentive programs. The incentive program was also amended on November 24, 2016 to extend the program two years until December 31, 2018. The information on this website reflects the current requirements that went into effect on November 24, 2016 under COMAR 10.25.16, Electronic Health Record Incentives. If your practice previously applied for or received an incentive prior to June 9, 2014, please review the instructions under the section titled: What If I Applied or Received an Incentive under the Earlier State-Regulated Payor EHR Adoption Incentive Program?.
Note: The incentive program is separate from the Medicaid and Medicare EHR Incentive Programs authorized under the American Recovery and Reinvestment Act of 2009. For more information about these programs, visit the Center for Medicare and Medicaid Services EHR Incentive Program web page here.
Who Qualifies for the Incentives?
Incentives are available to hospital owned and non-hospital owned primary care practices in Maryland who adopt an EHR that is certified by an Office of the National Coordinator (ONC) - Authorized Testing and Certification Body. To determine if your EHR system and version is certified, please visit ONC's Certified Health Information Technology Products List web site here.
Primary care practices include family, general, geriatric, internal medicine, pediatric, or gynecologic practices. Primary care practices can be led by a nurse practitioner providing health care services in family practice, general practice, geriatric, internal medicine, pediatric medicine, or gynecologic practice.
In order to qualify for the incentive, the primary care practice must also demonstrate that the practice has either:
- Attested to the current Meaningful Use requirements under the Medicare or Medicaid EHR Incentive Program; or
- Participates in any MHCC-approved patient centered medical home (PCMH) program and has achieved recognition from the National Committee for Quality Assurance (NCQA) for meeting NCQA’s 2011 or later standards for at least level two PCMH recognition
What Incentive is Available?
The incentive is a one-time cash incentive, or an incentive of equivalent value agreed upon by the primary care practice and payor. Incentives of equivalent value include: specific services; lump sum payments; gain-sharing arrangements; rewards for quality and efficiency; in-kind payments; or other items or services that can be assigned a specific monetary value. Practices are eligible to receive up to $15,000 per practice per payor.
The incentive is calculated at $25.00 for each patient who is a Maryland resident and enrolled in a fully insured health benefits plan assigned by the payor to a provider within the primary care practice at the time a practice makes a request for the incentive payment. In cases where the payor does not assign patients to a provider, the fully-insured patients enrolled with that payor who is a Maryland resident and has been treated by the practice in the last 24 months can be included in the incentive calculation. Payors may exclude patients from the incentive calculation who are enrolled in a self-insured health plan at the time of the payment request or who were previously included in another primary care practice’s EHR adoption incentive calculation. Please contact the payor for details regarding its calculation and determination process.
How do Practices Request the Incentive?
In order to request the incentive, eligible practices can submit the State-Regulated EHR Adoption Incentive Payment Request Form (payment request), including required documentation, to each payor with which it does business. Payors required to participate include: Aetna; CareFirst BlueCross BlueShield; Cigna HealthCare Mid-Atlantic; Coventry Health Care; Kaiser Permanente; and United Healthcare, Mid-Atlantic Region. The application may be submitted no later than December 31, 2018. To access the enterable payment request form, click on the link below.
State-Regulated Payor EHR Adoption Incentive Payment Request Form
Support Documentation Guidance
What Happens after I Request an Incentive?
The payor may request additional information as necessary to determine the validity of a payment request. Payors will issue a payment request acknowledgement letter no later than 45 days after receiving a complete payment request and must process and pay in full the adoption incentive within 75 days of receiving a complete payment request. Additionally, the payor will provide written notification to the primary care practice regarding: 1) the amount of the EHR adoption incentive awarded; 2) the method of distribution of the EHR adoption incentive; and 3) the time period over which the incentive will be distributed.
A practice may request an accounting of its EHR adoption incentive, including the names of each patient included in the EHR adoption incentive calculation. The payor must provide the requested accounting to the primary care practice in a timely manner.
A primary care practice that provided an attestation to meaningful use must give written notice within 90 days to each payor that awarded an EHR adoption incentive to the practice under the following circumstances in the event that the CMS, Medicaid, or its designated entity:
- Conducted a prepayment or post-payment audit of compliance with the participation requirements of the Medicare or Medicaid EHR Incentive Program regarding the physician or nurse practitioner identified by the primary care practice as part of its EHR adoption incentive request; and
- Determined that the physician or nurse practitioner had not met the requirements under the Medicare or Medicaid EHR Incentive Program.
Payors may request reimbursement of the incentive payments made under this incentive program to the primary care practice in the event that a notice is provided by the primary care practice.
What if I Applied or Received Payment under the Earlier Incentive Program?
Practices who submitted an incentive program application prior to June 9, 2014 but did not receive an incentive are able to submit a payment request under the revised incentive program beginning October 7, 2014, following the revised incentive program requirements as detailed above. To access the enterable payment request form, click on the link below.
State-Regulated Payor EHR Adoption Incentive Payment Request Form
Who Should I Contact if I Have Questions?
For more information about applying for the incentive program, please contact the payor to which you plan to apply or have applied using the information below. The following contact information was provided by each payor:
- Aetna, Inc.
Maryland EHR Incentives
Email Aetna: MarylandEHRIncentives@aetna.com
- CareFirst BlueCross BlueShield
External Mandates, Mailstop: OM3-800
10455 Mills Run Circle
Owings Mill, MD 21117
C/O EHR Incentive Coordinator
Email Carefirst: EHRIncentiveCoordinator@carefirst.com
- Cigna Health Care Mid-Atlantic Region
Contracting, Electronic Health Records
- Coventry Health Care
- Maryland EHR Incentives
Email Conventry: CoventryEHRRequest@cvty.com
- Kaiser Permanente
Provider Contracting and Network Management
2101 E. Jefferson St.
Rockville, MD 20852
Email Kaiser: provider.Relations@kp.org
- UnitedHealthcare, Mid-Atlantic Region
Attention: MD EHR- Lisa Kahl
800 King Farm Blvd, Suite 600
Rockville, MD 20850
Email United: email@example.com
State-Regulated Payor EHR Incentive Flyer
A brief, printable flyer summarizing the State-Regulated Payor EHR Adoption Incentive Program.
State-Regulated Payor EHR Adoption Incentive Program Presentation
A brief presentation about the State-Regulated Payor EHR Adoption Incentive Program. This presentation includes details regarding practice eligibility, incentive calculation, requesting the incentive, and key dates.
Maryland Meaningful Use Resource Center
The Medicare and Medicaid EHR Incentive Programs were created under the American Recovery and Reinvestment Act (ARRA) to provide financial incentives to Eligible Providers and Eligible Hospitals who adopt and demonstrate meaningful use of EHRs. Achieving Meaningful Use can be a confusing and challenging endeavor for providers and their staff. The Meaningful Use Resource Center was created to provide a single, comprehensive informational tool for Eligible Professionals and their staff as they work towards meeting the Meaningful Use requirements.
NCQA PCMH Recognition Program
The National Committee for Quality Assurance is a private, 501(c)(3) not-for-profit organization dedicated to improving health care quality through measurement, transparency and accountability. NCQA has created several recognition programs to empower employers, health plans, patients and consumers to make informed heath care decisions based on quality. The PCMH recognition program establishes standards and guidelines for practices to achieve in functioning as medical homes. The NCQA has developed nine practice standards that reflect a practice’s alignment with the Joint Principles of Patient-Centered Medical Home.
State Designated Management Organizations
Management Service Organizations (MSOs) offer services to practices to assist in implementing and maintaining an EHR system. State Designated MSOs have emerged as a way to address the challenges associated with provider adoption of EHRs. These challenges include the cost and maintenance of the technology, and the responsibilities of privacy and security that accompany the storage of electronic data. In addition, MSOs offer services that assist providers in areas of EHR planning, staff training, technical support, and becoming advanced EHR users.
Regional Extension Center
The Maryland Regional Extension Center (REC) is a resource for any Maryland provider needing technical assistance in adopting an EHR and qualifying for the Medicare and Medicaid EHR Incentive Program. For primary care providers that meet the eligibility requirements of this program, certain services are discounted. In order to deliver these services across the State, the REC is working with MSOs that have received State Designation from the MHCC or are in Candidacy Status.
The information contained on this webpage is provided for informational purposes only and does not constitute legal advice. Practices and payors are encouraged to consult with appropriate legal advisors regarding application of the law.