Public Health and Meaningful Use

Public Health and Meaningful Use

Medicaid and Medicare Electronic Health Record (EHR) Incentive Programs

As a part of the federally‐funded Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, $36 billion was budgeted for health information technology (HIT) infrastructure. Of that, $34 billion was allocated for the Medicare and Medicaid EHR Incentive Programs. The goal of these programs is to provide more effective health care by encouraging eligible professionals (EP), eligible hospitals (EH) and critical access hospitals (CAH) to adopt, implement, or upgrade (AIU) to an EHR technology certified by the Office of the National Coordinator for Health Information Technology (ONC), and then to demonstrate Meaningful Use (MU) of that technology.

There are two separate EHR Incentive Programs, Medicare and Medicaid. EPs in North Carolina may only participate in one of these programs and could switch between them one time between program years 2011 and 2014. EHs in North Carolina are considered dually eligible and may participate in both the Medicare and Medicaid EHR Incentive Programs.

The NC Medicaid EHR Incentive Program made its first incentive payment in 2011 and is slated to continue through 2021.

EPs participating in the NC Medicaid EHR Incentive Program may receive up to $63,750 in incentive payments over six years of program participation. Participation years do not need to be consecutive, but EPs need to begin participating by Program Year 2016 to have the opportunity to earn the full incentive payment.

For EPs who meet all program requirements, the first incentive payment is $21,250. Five additional payments of $8,500 are available for providers who successfully demonstrate MU every subsequent year of participation. For the first program year, EPs only need to attest that they adopted, implemented, or upgraded (AIU) to an ONC-certified EHR technology. EPscould elect to bypass AIU and attest to MU in their first year of program participation, but every participant will be required to attest to MU in participation years two through six. The last year an EP may attest to, and receive a payment for, AIU was Program Year 2016.

EHs and CAHs may participate with the NC Medicaid EHR Incentive Program for three years. EH and CAH incentive payments are based on a number of factors, including annual growth rates and projected discharges. Their incentive payment is calculated by starting with a base payment, then using a formula to adjust up or down, depending on specific hospital activity. The payment is then divided into three installments. The first installment is 50 percent, the second is 40 percent, and the third is 10 percent of the total payment amount.

The Medicare EHR Incentive Program gave EPs the opportunity to earn $44,000 over five years if they met all program requirements. There was an additional incentive for EPs who provide services in a Health Professional Shortage Area (HPSA). EH payments under Medicare’s EHR Incentive Program were based on a number of factors, but started at a $2 million base payment. The Medicare EHR Incentive Program for returning eligible professionals (EPs) ended with the 2016 reporting period. Starting in 2017, Medicare eligible clinicians report to the Quality Payment Program.

Beginning in 2015, Medicare EPs, EHs, and CAHs that do not successfully demonstrate MU are subject to payment adjustments in their Medicare reimbursement. There are no Medicaid payment adjustments tied to MU.


More information about the NC Medicaid EHR Incentive Program 
More information about the Medicare EHR Incentive Program and Quality Payment Program
CMS' Stage 1 Meaningful Use Final Rule
CMS' Stage 2 Meaningful Use Final Rule
Modified Stage 2 and Stage 3 Meaningful Use in 2015 Through 2017 Final Rule

FY 2018 Hospital Inpatient PPS Final Rule (including updates to Medicaid EHR Incentive Program 2017-2018)

Public Health

In North Carolina, the state Division of Public Health oversees five objectives of the public health meaningful use component of the state-level Health Information Technology for Economic and Clinical Health (HITECH) initiative.

  1. Electronic submission of Reportable Laboratory Results (for hospitals only)
  2. Electronic submission of Syndromic Surveillance Data (for hospitals only)
  3. Electronic submission of Cancer Registry Data (for eligible professionals only)
  4. Diabetes specialized public health registry (for eligible professionals and hospitals)


NC DPH Meaningful Use Reporting
NC DPH Specialized Registries
NC DPH Meaningful Use Site for Registration of Intent