NH State Medicaid HIT Plan

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INFORMATION ON INTERNAL PROVIDER AUDITING PROCEDURES AND PROCESSES HAVE BEEN REMOVED FROM THIS DOCUMENT. NH State Medicaid HIT Plan June 30 2014 Describes how the New Hampshire Department of Health and Human Services Office of Medicaid Business and Policy (OMBP) will administer the Electronic Health Record (EHR) incentive payment program authorized under section 4201 of the American Reinvestment and Recovery Act and outlines the Health Information Technology initiatives that OMBP believes will encourage the adoption and meaningful use of certified EHR technology. SMHP Addendum Version 4 Authors: Andrew Chalsma (603) 271-4514; AChalsma@dhhs.state.nh.us New Hampshire Department of Health and Human Services Office of Medicaid Business and Policy Eve Fralick (603) 271-9440; Eve.Fralick@unh.edu New Hampshire Institute on Health Policy and Practice

Table of Contents Table of Contents... 2 Revision History... 3 Change Control Document... 4 SMHP Addendum Summary of Revisions... 5 Appendix C: Electronic Provider Incentive Payment System... 9 2013 SMHP v3 Table of Contents Page 2

Revision History SMHP Version New Hampshire Action Date Submitted to CMS CMS Action 1 Version 1 completed August 3, 2011 Comments received September 20, 2011 2 Responses to CMS Version 1 comments and Version 2 updates completed December 6, 2011 Approval received April 12, 2012 (Enclosure A questions to be addressed in next update) 3 Responses to CMS Enclosure A questions and Version 3 updates August 26, 2013 Approval received November 12, 2013 4 Version 4 completed June 30, 2014 2013 SMHP v3 Revision History Page 3

Change Control Document The New Hampshire State Medicaid Health Information Technology (SMHP) Addendum (Version 4) revises the New Hampshire SMHP and all prior versions. It includes the following sections: SMHP Addendum Summary of Revisions; and Appendix C (Stage 1 Meaningful Use for Eligible Professionals). The following table lists the revision topics and their corresponding page numbers in Version 4. Description SMHP Addendum Version 4 Page Number Policy Summary 5 6 Group Practice Definitions 6 Attestation Eligibility 6 7 2014 Attestation Reporting Period 7 Attestations Following Payment Recoupment 7 New Hampshire s Audit Strategy 7 8 Appendix C: Electronic Provider Incentive Payment System 8 111 2013 SMHP v3 Change Control Document Page 4

SMHP Addendum Summary of Revisions New Hampshire SMHP Addendum (Version 4) modifies information from prior versions of the New Hampshire SMHP. This section lists each topic that has been revised with a summary of the associated changes. Policy Summary New Hampshire has implemented the following policies and practices for Eligible Professional attestations. Patient Volume Criterion Eligible Professionals (EPs) may select one, or more, location(s) from which to report patient volume encounters. Reporting out of state encounters is optional. However, if included, out of state encounters must be reported in both the numerator and denominator. Group encounter reports must be submitted as supporting documentation; EPs attesting using individual patient volume are required to submit encounter reports upon request of the New Hampshire Medicaid EHR Office. Hospital Based Criterion EPs attesting to Medicaid patient volume are required to attest to Medicaid POS 21, Medicaid POS 23, and total Medicaid encounters during the reporting period. Out ofstate encounters must be included. Supporting documentation is required upon request of the New Hampshire Medicaid Office. Practice Predominantly Criterion EPs that attest to Needy Individual patient volume are required to have worked at a Federally Qualified Health Center (FQHC) or Rural Health Center (RHC) for a minimum of six months in order to be eligible to attest for a Medicaid EHR incentive payment. EPs attesting to Needy Individual patient volume that did not work at an FQHC/RHC at any time during the prior calendar year are not eligible to attest. EPs attesting to the Practice Predominantly criterion are required to attest to, and provide supporting documentation for, encounters worked within, and outside of, the FQHC/RHC during the reporting period. Out of state encounters must be included. 50% Rule EPs attesting to Meaningful Use (MU) are required to attest to every location at which services were provided during the MU reporting period. EPs must also attest to, and provide supporting documentation for, the number of Certified EHR Technology (CEHRT), and non CEHRT, encounters provided at each location during the 90 day MU reporting period. Meaningful Use Attestation 2013 SMHP v3 SMHP Addendum - Summary of Revisions Page 5

EPs are required to attest to, and provide supporting documentation for, MU measures based on every encounter at every location during the reporting period in which CEHRT was used with the exception of POS 21 and POS 23 encounters (which can be excluded from the calculation). EPs must sum the numerators and denominators calculated by each CEHRT system to obtain a total for the numerator and denominator of the Core and Menu measures and Clinical Quality Measures. However, if practicing locations choose different Menu measures or Clinical Quality Measures, EPs should only report on the encounters from the location with the highest number of encounters. Group Practice Definitions To promote, and facilitate, EP attestations, New Hampshire has taken a broad based approach in defining the criteria that constitutes a group. The following definitions have been authorized to date. Others will be considered on a case by case basis taking into consideration each group s unique characteristics. Group Definition 1 Hospital owned group is comprised of several multi specialty practices. The group uses one Tax Identification Number (TIN) and one EHR. The group combines the patient volume encounters from all providers in the multi specialty practices to calculate one group patient volume. Group Definition 2 Hospital owned specialty practices have separate TINs but shared a common EHR. Each specialty practice calculates patient volume based solely on the providers in its practice and each attests as a unique group. Group Definition 3 Hospital owned practice shares the hospital s TIN. The practice can attest as a unique group and calculate patient volume based solely on the providers in the practice. Attestation Eligibility The following are guidelines used to determine whether EPs are eligible to receive a Medicaid EHR Incentive Program payment. EPs using individual patient volume that wish to receive payment EPs must be actively enrolled in NH Medicaid as of the date of attestation in order to receive an incentive payment. EPs using group patient volume that wish to reassign payment 2013 SMHP v3 SMHP Addendum - Summary of Revisions Page 6

EPs that attest using group patient volume do not have to be actively enrolled in NH Medicaid or affiliated with the payee organization as of the attestation date as long as they were affiliated in the past during the applicable attestation reporting periods and meet other program criteria as of the last date of affiliation with the payee organization. Hence, EPs may authorize an organization to attest and receive payment even after they have retired; been fired; or moved to a different organization (as long as they are not reassigning an incentive payment to a new employer/organization). Additionally, new EPs, hired to directly replace EPs that have left an organization, may attest using the group patient volume methodology and reassign payment to the payee organization as long as program criteria have been met. In this situation, the payee organizations may receive reassigned incentive payments from both EPs that left the organization as well as newly hired EPs during the same payment year. 2014 Attestation Reporting Period EPs are required to select a 90 day reporting period in 2014 to attest for meaningful use measures (in lieu of a three month reporting period). Stage 1 Meaningful Use Menu Measures For the 2014 payment year, the New Hampshire Department of Public Health Services does not have the capability to accept EP data for either public health Menu measure (i.e., Immunization Registry or Syndromic Surveillance). As a result, in order to complete meaningful use attestations for Menu measures, EPs must select one public health Menu measure on which to claim exclusion; then complete five additional (non public health) Menu measures. Attestations Following Payment Recoupments An EP whose payment has been recouped in one payment year may attest during a subsequent year. However, the EP cannot re attest for the same payment year, but, rather, must attest to the next program year s criteria. Example An EP receives a year 1 payment for Adopting, Implementing, or Upgrading (AIU) CEHRT. During a post payment audit, the EP is found to be ineligible, and the payment is recouped. The provider may attest for the first year of Stage 1 MU during a subsequent year, however, the provider is not eligible to reattest for AIU again. New Hampshire s Audit Strategy 2013 SMHP v3 SMHP Addendum - Summary of Revisions Page 7

SECTION MODIFIED; SOME PARTS REMOVED Myers and Stauffer LC continue to serve as the vendor for conducting New Hampshire s Medicaid EHR Incentive Program post payment audits with oversight from the Department of Health and Human Services Office of Improvement and Integrity (OII). CMS approved New Hampshire s audit plan for payment years 1 and 2 on April 8, 2014. The plan calls for Myers and Stauffer to audit 5 Eligible Hospital (EH) and 30 EP Medicaid EHR Incentive Program attestations. The results of the audits will be used to inform future year audit plans (as applicable) to strengthen New Hampshire s audit program. Appendix C: Electronic Provider Incentive Payment System The New Hampshire SR&A provides modules in which EPs and EHs enter attestation data. For EPs, these modules include: Patient Volume; General Requirements; Meaningful Use Core Measures; Meaningful Use Menu Measures; and Clinical Quality Measures. Appendix C provides an overview of screens in each EP module. In 2014, per the Stage 2 Final Rule, updates were made to several Core and Menu criteria; CQMs were replaced with 64 new CQMs. 2013 SMHP v3 SMHP Addendum - Summary of Revisions Page 8

Appendix C: Electronic Provider Incentive Payment System To submit an attestation, EPs log on to the Electronic Provider Incentive Payment System (epip), the New Hampshire SR&A. epip allows EPs to manage their accounts; attest; review payment history; identify the status of an existing attestation; upload supporting documents; and validate CMS EHR Certification IDs prior to attesting. For Payment Years 2 and 3 (Stage 1 Meaningful Use), epip requires EPs to complete five modules and an attestation statement. This appendix provides an overview of the EP Payment Year 2 and 3 attestation process with applicable screen shots. Select A Payment Year To attest for a Medicaid EHR Incentive Program payment, EPs first select their payment year on the Select A Payment Year webpage. This tab also includes expandable tabs that provide information on a variety of attestation topics including patient volume; Adopt, Implement, and Upgrade; Stage 1 Meaningful Use; and supporting documentation requirements. The following are screens that EPs may view when initiating a Meaningful Use attestation for Payment Years 1, 2 or 3. Select A Payment Year 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use for Eligible Professionals Page 9

Select Attestation Type 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use for Eligible Professionals Page 10

Submit An Attestation Patient Volume Module EPs enter patient volume data and hospital based (or practice predominantly data) in this module. (Group patient volume is populated by Medicaid EHR staff and automatically populates in epip when an EP attesting to group patient volume logs on.) epip does not allow EPs to proceed to other modules if they do not meet the minimum criteria thresholds in this module. For simplicity purposes, the following screens reflect those of an EP attesting to the individual Medicaid patient volume methodology. 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use for Eligible Professionals Page 11

Patient Volume Type 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use for Eligible Professionals Page 12

Patient Volume Attestation Medicaid Patient Encounters 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use for Eligible Professionals Page 13

Hospital-based Attestation 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use for Eligible Professionals Page 14

Patient Volume Eligibility Results General Requirements Module In this module, EPs enter their CMS EHR Certification ID; meaningful use reporting period dates (which are auto verified by epip); practice location information; and encounter data within, and/or outside of, CEHRT. epip auto calculates the percentage of CEHRT encounters. The system will not allow EPs that do not meet a minimum 50 percent threshold to proceed with their attestations. 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use for Eligible Professionals Page 15

General Requirements (continued on next page) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use for Eligible Professionals Page 16

General Requirements (continued on next page) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use for Eligible Professionals Page 17

General Requirements 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use for Eligible Professionals Page 18

General Requirements Eligibility Results Meaningful Use Core Measures Module epip requires EPs to complete 13 Stage 1 Meaningful Use Core measures in order to proceed with their attestations. The following reflect the Stage 1 Meaningful Use Core Measures screens. 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use for Eligible Professionals Page 19

Original Core Measure 1: Use computerized provider order entry (CPOE) for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines. 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use for Eligible Professionals Page 20

Optional Core Measure 1: Use computerized provider order entry (CPOE) for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines. 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use for Eligible Professionals Page 21

Core Measure 2: Implement drug-drug and drug-allergy interaction checks 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use for Eligible Professionals Page 22

Core Measure 3: Maintain an up-to-date problem list of current and active diagnoses 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use for Eligible Professionals Page 23

Core Measure 4: Generate and transmit permissible prescriptions electronically (erx) (continued on next page) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use for Eligible Professionals Page 24

Core Measure 4: Generate and transmit permissible prescriptions electronically (erx) (continued) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use for Eligible Professionals Page 25

Core Measure 5: Maintain Active Medication List 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use for Eligible Professionals Page 26

Core Measure 6: Maintain Active Medication Allergy List 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use for Eligible Professionals Page 27

Core Measure 7: Record all of the following demographics: (a) Preferred language (b) Gender (c) Race (d) Ethnicity (e) Date of birth 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use for Eligible Professionals Page 28

Core Measure 8: Record/chart vital signs: height, weight, blood pressure; calculate and display BMI; plot and display growth charts for children 0-20 years, including BMI (continued on next page) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use for Eligible Professionals Page 29

Core Measure 8: Record/chart vital signs: height, weight, blood pressure; calculate and display BMI; plot and display growth charts for children 0-20 years, including BMI (continued) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use for Eligible Professionals Page 30

Core Measure 9: Record smoking status for patients 13 years old or older 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use for Eligible Professionals Page 31

Core Measure 10: Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance with that rule 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use for Eligible Professionals Page 32

Core Measure 11: Provide patients the ability to view online, download, and transmit their health information within four business days of the information being available to the EP 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use for Eligible Professionals Page 33

Core Measure 12: Provide clinical summaries for patients for each office visit 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use for Eligible Professionals Page 34

Core Measure 13: Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities Meaningful Use Menu Measures Module epip requires EPs to claim exclusion on one Public Health Menu measure and complete five additional (non Public Health) Menu measures. The following reflect the Stage 1 Meaningful Use Menu Measures screens. 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use for Eligible Professionals Page 35

Menu Measure 1 (Implement Drug Formulary Checks) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use for Eligible Professionals Page 36

Menu Measure 2 (Incorporate clinical lab test results into EHR as structured data) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use for Eligible Professionals Page 37

Menu Measure 3 (Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use for Eligible Professionals Page 38

Menu Measure 4 (Send reminders to patients per patient preference for preventive/follow-up care) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use for Eligible Professionals Page 39

Menu Measure 5 (Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use for Eligible Professionals Page 40

Menu Measure 6 (The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 41

Menu Measure 7 (The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary care record for each transition of care or referral) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 42

Menu Measure 8 (Capability to submit electronic data to immunization registries or immunization information systems and actual submission according to applicable law and practice) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 43

Menu Measure 9 (Capability to submit electronic syndromic surveillance data to public health agencies and actual submission according to applicable law and practice) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 44

Clinical Quality Measures Module epip will offer providers the opportunity to select 9 Clinical Quality Measures (CQMs) from a total of 64 Clinical Quality Measures. Each CQM is categorized into a Domain (as EPs must include measures from at least 3 Domains). The following reflect the 2014 Stage 1 CQM screens. CMS50v2 (Closing the referral loop: receipt of specialist report) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 45

CMS137v2 (Initiation and Engagement of Alcohol and Other Drug Dependence Treatment) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 46

CMS165v2 (Controlling High Blood Pressure) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 47

CMS125v2 (Breast Cancer Screening) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 48

CMS124v2 (Cervical Cancer Screening) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 49

CMS130v2 (Colorectal Cancer Screening) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 50

CMS126v2 (Use of Appropriate Medications for Asthma) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 51

CMS127v2 (Pneumonia Vaccination Status for Older Adults 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 52

CMS131v2 (Diabetes: Eye Exam) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 53

CMS123v2 (Diabetes: Foot Exam) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 54

CMS122v2 (Diabetes: Hemoglobin A1c Poor Control) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 55

CMS148v2 (Hemoglobin A1c Test for Pediatric Patients) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 56

CMS134v2 (Diabetes: Urine protein Screening) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 57

CMS163v2 [Diabetes: Low Density Lipoprotein (LDL) Management] 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 58

CMS164v2 (Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 59

CMS145v2 [Coronary Artery Disease (CAD): Beta-Blocker Therapy Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF <40%)] 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 60

CMS182v2 (Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 61

CMS135v2 [Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)] 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 62

CMS1442v2 [Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)] 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 63

CMS143v2 [Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation] 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 64

CMS167v2 (Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 65

CMS142v2 (Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 66

CMS161v2 [Adult Major Depressive Disorder (MDD): Suicide Risk Assessment] 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 67

CMS128v2 (Anti-depressant Medication Management) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 68

CMS136v3 [ADHD: Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication] 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 69

CMS169v2 (Bipolar Disorder and Major Depression: Appraisal for alcohol or chemical substance use) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 70

CMS141v3 (Colon Cancer: Chemotherapy for AJCC Stage III Colon Cancer Patients) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 71

CMS140v2 (Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/ Progesterone Receptor (ER/PR) Positive Breast Cancer) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 72

CMS62v2 (HIV/AIDS: Medical Visit) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 73

CMS52v2 (HIV/AIDS: Pneumocystis jiroveci pneumonia (PCP) Prophylaxis) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 74

CMS77v2 (HIV/AIDS: RNA control for Patients with HIV 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 75

CMS133v2 (Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract Surgery) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 76

CMS158v2 (Pregnant women that had HBsAg testing) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 77

CMS159v2 (Depression Remission at Twelve Months) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 78

CMS160v2 (Depression Utilization of the PHQ-9 Tool) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 79

CMS75v2 (Children who have dental decay or cavities) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 80

CMS74v3 (Primary Caries Prevention Intervention as Offered by Primary Care Providers, including Dentists) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 81

CMS61v3 [Preventive Care and Screening: Cholesterol Fasting Low Density Lipoprotein (LDL-C) Test Performed] 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 82

CMS64v3 [Preventive Care and Screening: Risk-Stratified Cholesterol Fasting Low Density Lipoprotein (LDL-C)] 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 83

CMS149v2 (Dementia: Cognitive Assessment) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 84

CMS65v3 (Hypertension: Improvement in blood pressure) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 85

CMS146v2 (Appropriate Testing for Children with Pharyngitis) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 86

CMS166v3 (Use of Imaging Studies for Low Back Pain) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 87

CMS154v2 [Appropriate Treatment for Children with Upper Respiratory Infection (URI)] 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 88

CMS129v3 (Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 89

CMS157v2 (Oncology: Medical and Radiation Pain Intensity Quantified) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 90

CMS66v2 (Functional status assessment for knee replacement) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 91

CMS56v2 (Functional status assessment for hip replacement) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 92

CMS90v3 (Functional status assessment for complex chronic conditions) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 93

CMS156v2 (Use of High-Risk Medications in the Elderly) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 94

CMS139v2 (Falls: Screening for Future Fall Risk) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 95

CMS68v3 (Documentation of Current Medications in the Medical Record) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 96

CMS132v2 (Cataracts: Complications within 30 Days Following Cataract Surgery Requiring Additional Surgical Procedures) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 97

CMS177v2 [Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk Assessment] 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 98

CMS179v2 (ADE Prevention and Monitoring: Warfarin Time in Therapeutic Range) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 99

CMS155v2 (Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 100

CMS138v2 (Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 101

CMS153v2 (Chlamydia Screening for Women) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 102

CMS117v2 (Childhood Immunization Status) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 103

CMS147v2 (Preventive Care and Screening: Influenza Immunization) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 104

CMS2v3 (Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 105

CMS69v2 [Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up] 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 106

CMS82v1 (Maternal depression screening) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 107

CMS22v2 (Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented) 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 108

Submit an Attestation Webpage Once an EP has completed the applicable epip modules, he/she submits the attestation by verifying attestation data and agreeing to a disclaimer statement. epip will generate a submission tracking receipt and prompt the EP to upload supporting documentation to complete the attestation. Submission Process: Attestation Statements 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 109

Attestation Disclaimer 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 110

Submission Receipt 2013 SMHP v3 Appendix C: Stage 1 Meaningful Use Page 111