Instructions for Eligible Hospitals

Eligible Hospitals (EHs): Prerequisites to Participate in the Texas Medicaid EHR Incentive Program in YEAR ONE
Step One: Registration with the Centers for Medicare & Medicaid Services (CMS)

A.Gather information needed for registration:

B.Register at CMS:

Step Two: Preparations Before Entering the Texas Medicaid EHR Incentive Program Portal

Before you begin entering your information into the Texas Medicaid EHR Incentive Program portal, be sure you have collected the required information described below:

A.Adopt, Implement, and Upgrade (AIU) certified technology:

  • You will need to enter the CMS EHR certification identification number in the AIU portion of the portal (see Step One - A, for instructions on obtaining the certification number).
  • Have documentation ready from a contract, subscription, or purchase order for your EHR.  You will be required to upload the documents in the AIU portion of the portal. You will only need to upload the pages that clearly identify the two parties in agreement, as well as the signature page of the contract.

B.Patient threshold volume

  • Reporting Period:  Determine your reporting period. You have the option to choose a reporting period of any 90-day or three full consecutive month period in the previous fiscal year OR any 90-day or three full consecutive month period in the most recent 12 months preceding attestation.
  • Patient Volume: Eligible critical access and acute care hospitals must demonstrate 10 percent Medicaid discharges during the 90-day or 3 month reporting period.
    • Children’s hospitals do not have a patient volume threshold requirement.
    • Hospital encounters include inpatient discharge and emergency room services to Medicaid-eligible patients on any one day.

Medicaid Discharges  +   Medicaid ED Encounters            X 100
Total Discharges      +  ED Encounters

  • The emergency department (ED) must be a part of the hospital under the qualifying CMS certification number (CCN).
  • Numerator and denominator must be derived from the same reporting period.

C.Payment Calculation

A multi-site hospital with one CMS Certification Number (CCN) is considered one hospital for purposes of payment.

The following steps outline the hospital payment calculation. Remember to use an auditable data source such as the Medicare cost report, as well as supplemental data that may be needed. To estimate your hospital payment calculation, you may use the hospital calculation tool found here: 

The following examples demonstrate the steps of the hospital payment calculation. The incentive amount will be calculated automatically based on the data you enter during attestation. Please note that federal regulations require hospitals to modify certain cost report data elements for purposes of the EHR incentive payment. Hospitals are responsible for correctly reporting information to calculate the incentive payments. Please see the EHR Incentive Program Final Rule (2010) for specific details on calculating hospital payments.

Step 1. Growth Rate

Calculate growth rate based on the average percent increase or decrease of discharges over a three year period.


Media Folder: 

Step 2. Overall EHR Amount

Calculate the overall EHR amount based upon a theoretical four years of payment the hospital would receive starting from the base amount of $2 million, plus the discharge related amount, multiplied by a transition factor.


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Step 3. Medicaid Share
  • Do not include any inpatient days paid in part by Medicare (i.e., dual-eligibles).
  • Calculate the Medicaid share based on estimated Medicaid inpatient bed days and total inpatient bed days.
  • Do not include nursery days in the inpatient days.
  • See the hospital payment calculation tool and the EHR Incentive Program Final Rule for additional details on adjusting cost report data elements for purposes of incentive payments.


    Media Folder: 


Step 4. Aggregate amount

Calculate the aggregate amount, which is the product of the overall EHR amount times the Medicaid share.


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Step 5. Payout Schedule

Apply the Texas hospital payout schedule:

  • Year One:              50 Percent
  • Year Two:             40 Percent
  • Year Three:           10 Percent                


Media Folder: 

D.Payment Assignment

The Hospital TIN and NPI entered into the CMS registration portal is sent to Texas Medicaid and will be automatically entered into the payment assignment page of the Texas portal.

Step Three:  Accessing the Texas Medicaid EHR Incentive Program Portal

Congratulations!  You are now ready to begin participating in the Texas Medicaid EHR Incentive Program.

Simply go to the following link:

  • “Log into my account.”
  • Scroll to “Manage Provider Account.”
  • Click on the “Texas Medicaid EHR Incentive Program.”

If the link is not available, the person trying to access the site is not designated as the hospital administrator in the TMHP portal system.

Additional Resources – Texas Medicaid EHR Incentive Program