2020/2021 Program Requirements Medicaid

Electronic Health Record (EHR) Reporting Period in 2020 and 2021

For program years 2020 and 2021, the EHR reporting period for Medicaid eligible professionals (EPs) and eligible hospitals is a minimum of any continuous 90-day period within calendar (CY) 2020 or 2021, respectively. Please contact your State Medicaid Agency for information on the attestation period and deadline.

Electronic Clinical Quality Measures (eCQM) Policies for Program Years 2020 and 2021

 The 2020 Physician Fee Schedule (PFS) Final Rule established that in 2020, all Medicaid EPs must report on a 90-day eCQM reporting period. EPs are required to report on any six eCQMs related to their scope of practice. In addition, Medicaid EPs are required to report on at least one outcome measure. If no outcome measures are relevant to that EP, they must report on at least one other 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.

The list of available eCQMs for EPs in 2020 and 2021 is aligned with the list of eCQMs available for Eligible Clinicians under the Merit-based incentive Payment System (MIPS) in 2020 and 2021.  Those eCQMs can be found at https://ecqi.healthit.gov/eligible-professional-eligible-clinician-ecqms.

2015 Edition Certified EHR Technology

All participants in the Medicaid Promoting Interoperability Program are required to use 2015 Edition CEHRT. This requirement will benefit health care providers and patients by using the most up-to-date standards and functions to better support interoperable exchange of health information and improve clinical workflows. The 2015 Edition CEHRT did not have to be implemented on January 1, 2020. However, the functionality must be in place by the first day of the EHR reporting period and the product must be certified to the 2015 Edition criteria by the last day of the EHR reporting period. The EP, hospital or CAH must be using the 2015 Edition functionality for the full EHR reporting period.  In many situations the product may be deployed but pending certification.

Additional Resources

• 2020 and 2021 Medicaid EP Specification Sheets (PDF)
• 2020 Medicare Physician Fee Schedule (PFS) Final Rule

Contact Information

Medicaid EPs and hospitals participating in the Medicaid Promoting Interoperability Program with inquiries about their participation should contact their State Medicaid Agencies.