MHSA Updates, timing, new forms

corrections/revisions posted in red
New Forms Posted:
Don't forget to check the LACDMH website for the updated forms and the new ones for Maintenance Only reimbursement. You only use these new Maintenance forms/process if you are ONLY seeking reimbursement for ongoing maintenance fees AND you already have EDI certification.

Timing:
Roughly, you should plan for:

• 2-3 months for EHR-S budgeting, selection, and contract negotiation
• 3 weeks to write-up the application
• 4-6 weeks for Level 1
• 4-6 weeks for Level 2 , i.e. MHSA application approval
• 4-5 weeks for TNFA (legal agreement) execution (sometimes less)
• 4 weeks to receive 20% start-up funds, if you requested this, which so far no one has; 4 weeks from the date DMH receives a properly completed Start-Up invoice - so submit this when you sign! 

(average total from initial MHSA submission to receive first check = 16 - 21 weeks / 4-5 months)

• 6-9 months to complete your EHR-S implementation

that could be 27-36 weeks (6-8+ months) to begin flow of reimbursements, if you are just getting started, so don't delay any further! If you are in this camp, you likley can't begin incurring project expenses (start your project work) until December , i.e. sign an EHR-S vendor contract requiring a payment, and can expect to be up and running around July 2011.
Note: these estimates at each step are very rough given the numerous variables that impact any given contractor’s timeline. They are provided to give you a sense of your overall timeline.

Maintenance Only Projects..............
Those who have already incurred the major expense of their EHR-S and plan to only submit for maintenance fees, don't wait too long to get your project in the queue. At some point you will run out of time to access all your allocated MHSA funds, since you can only seek reimbursement monthly for maintenance projects and no 20% start-up funds are applicable. I.e. divide the # of months left for MHSA reimbursement (you have 7.5 years remaining to access these funds, until 12/31/2017) into your total allocation and that is the minimum amount your maintenance fees would need to be to get your total allocation.

So, for example, you have 7.5 years left which gives you about 90 months remaining to spend the approved project funds. Assume it will take you 16 weeks to get through the MHSA/TNFA application process, that leaves you with 86 months of reimbursements. If your allocation was $100K then you need your monthly maintenance fees to be at least $1163/month to receive your entire allocation, if you start TODAY!

At one point the 10 year timeline sounded like forever for your MHSA reimbursements, but the clock is ticking.... tick tick tick.

Misc. Updates:

• The insurance requirements for 'subcontractors' does not apply to your COTS (off the shelf) EHR-S vendor. They are not considered a 'subcontractor'.
• any custom development is considered "high risk", regardless of the rating scale on the application.
• 23 applications in process at DMH now, 3 TNFA's signed and 2-3 in process so far; (6 have been cancelled to resubmit);
• Only 12 of 117 contract providers have indicated that they have not yet begun their selection process; 47 have indicated they plan to implement a basic product (i.e. low-end category) and based on DMH numbers and what I know, about 19 providers have plans to go with a mid-range product and I'd guess about 9-10 are either planning for or already have a high-end product, and 5-7 with their own custom product. Seems about 20 are unaccounted for here, so we'll see as time passes.
• Looking at the DMH EDI certifications, http://dmh.lacounty.gov/hipaa/downloads/EDI_Transition_Status.pdf , actual EDI progress can be seen like this:
• From the Vendors perspective, those either with EDI certification or in process:
• low-end = 4 vendors
• mid-range = 3 vendors
• high-end = 4 vendors
• clearinghouses = 2 vendors
• From the provider side, those that selected a:
• low-end product = 37
• mid-range product = 10
• high-end product = 6
• clearinghouse only = 4
• developed a custom product =  8

Keeping in mind that this is from the LACDMH EDI certification list, and some product trade-outs are taking place (which you can see there if you look closely) so its a moving measuring stick......

• The first MHSA allocation is not at risk due to state budget issues.
• The new MHSA application forms are in Adobe format and can be completed online and saved!
• Don't forget your Business Continuity and Operational Recovery plans are due 60 days after TNFA is signed if you have already implemented your EHR system, otherwise, these plans are due 60 days after your go-live date if you have not implemented your EHR system; and should absolutely be written and tested before your GO-LIVE! Let me know if I can help.