Filing Instructions For The 2015 Mlr Reporting Year - Centers For Medicare & Medicaid Services (Cms) Page 22
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57• Actual rewards/incentives/bonuses/reductions in co-pays, etc. (not administration of
these programs) that are not already reflected in premiums or claims should be allowed
as QI activities for the group market to the extent permitted by section 2705 of the
PHSA
• Any quality reporting and related documentation in non-electronic form for wellness
and health promotion activities
• Coaching or education programs and health promotion activities designed to change
member behavior (e.g., smoking, obesity)
Line 4.5 – Health information technology (HIT) expenses related to improving health care quality
Report information technology expenses associated with the activities in Lines 4.1 through 4.4
for which expenses are reported. (45 CFR §158.151 allows “Health Information Technology”
expenses that are required to accomplish the activities allowed in 45 CFR §158.150.)
Include HIT expenses required to accomplish the activities reported in Lines 4.1 through 4.4
that are designed for use by health plans, health care providers, or enrollees for the electronic
creation, maintenance, access, or exchange of health information as well as activities that are
consistent with Medicare and/or Medicaid meaningful use requirements, and which may in
whole or in part improve quality of care, or provide the technological infrastructure to enhance
current quality improvement or make new quality improvement initiatives possible by doing
one or more of the following:
1. Making incentive payments to health care providers for the adoption of certified
electronic health record technologies and their ‘‘meaningful use’’ as defined by HHS to
the extent such payments are not included in reimbursement for clinical services as
defined in 45 CFR §158.140;
2. Implementing systems to track and verify the adoption and meaningful use of certified
electronic health records technologies by health care providers, including those not
eligible for Medicare and Medicaid incentive payments;
3. Providing technical assistance to support adoption and meaningful use of certified
electronic health records technologies;
4. Monitoring, measuring, or reporting clinical effectiveness, including reporting and
analysis of costs related to maintaining accreditation by nationally recognized
accrediting organizations such as NCQA or URAC, or costs for public reporting of
quality of care, including costs specifically required to make accurate determinations of
defined measures (e.g., CAHPS surveys or chart review of HEDIS measures and costs
for public reporting mandated or encouraged by law);
5. Advancing the ability of enrollees, providers, issuers or other systems to communicate
patient centered clinical or medical information rapidly, accurately, and efficiently to
determine patient status, avoid harmful drug interactions or direct appropriate care –
this may include electronic health records accessible by enrollees and appropriate
providers to monitor and document an individual patient’s medical history and to
support care management;
6. Tracking whether a specific class of medical interventions or a bundle of related
services leads to better patient outcomes;
7. Reformatting, transmitting or reporting data to national or international government-
based health organizations for the purposes of identifying or treating specific
conditions or controlling the spread of disease; or
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