Program Year 2021 Requirements

2015 Edition CEHRT Required

In order to qualify for a Medicaid EHR Incentive, your practice MUST be using a 2015 Edition Certified EHR System.  The EHR system 2015 Edition CEHRT ID will contain "15E" in the third through fifth digits.  Consult your EHR vendor if you are unsure of the certification standard of your system.

For your Meaningful Use and Clinical Quality Measure Reporting Period, you must be using a 2015 Edition CEHRT for the entire 90-day reporting period.

Security Risk Assessments in PY2021

Because of the earlier attestation window for PY2021, the requirement to complete a Security Risk Assessment (SRA) has been modified. Previously, a provider was required to attest to an SRA being completed during the PY for which they are attesting; the SRA had to already be completed prior to attestation and provide documentation of the SRA with the application.

When providers attest for PY2021, they will be asked if the measure (completing an SRA) has been completed prior to the date of attestation. If the response is "no", then they will be asked to attest that the SRA will be completed no later than December 31, 2021 and that they understand that their incentive payment will be subject to recoupment for failure to do so.

All attesting providers must upload a copy of their 2021 SRA to MAPIR by January 31, 2022, otherwise they will automatically be selected for audit.

MU and CQM Reporting Periods in Program Year 2021

As previously mentioned the Meaningful Use and Clinical Quality Measure Reporting Period is 90 days in 2021. Meanginful Use Stage 3 requirements  are organized into eight Objectives with a total of 20 Measures. The CMS Specification Sheets for the 2021 Medicaid Promoting Interoperability/EHR Incentive Program are posted at the CMS 2020/2021 Program Year webpage.

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 2021 is aligned with the list of eCQMs available for Eligible Clinicians under the Merit-based incentive Payment System (MIPS) in 2021. Those eCQMs can be found at 

Please note that important changes to the Public Health/Clinical Data Registry Reporting requirements (MU3 Objective 8) will affect how Eligible Professionals will select and complete the measures.  As noted from the CMS MU measure #8 specification sheet, an Eligible Provider must satisfy two measures for this objective.  If the EP cannot satisfy at least two measures, they must take exclusions from all measures they cannot meet.

Click here to learn about what public health measures Rhode Island's Department of Health Public Health Reporting is capable to accept.