General Information

Medi-Cal Electronic Health Record Incentive Program

The following has been distributed through normal Medi-Cal communication channels to hospital Medi-Cal contact representatives; please note the due dates and links to assist you in determining your individual hospital eligibility for the EHR incentives.

Notice to Hospital Representatives,

The Department of Health Care Services (DHCS) anticipates the launch of the California electronic health record incentive registration site, State Level Registry (SLR), for eligible hospitals on October 3, 2011. In an effort to expedite hospital applications for electronic health record incentive dollars, DHCS is prepared to conduct a preliminary review of your hospital qualifications. This process will prequalify hospitals that have submitted all necessary information and met participation standards.

DHCS will begin accepting the following documents beginning September 6, 2011 to consider hospitals for qualification. You must submit all of the following items via the email address listed below:

  • Completed Hospital Workbook**
  • Name, address, email, and phone number of person submitting package and the key contact, if different 
  • Relevant pages of your four most recent (e.g. 2007, 2008, 2009, and 2010) Center for Medicare and Medicaid Services (CMS) cost reports
  • An electronic copy of the webpage that provides your CMS EHR Certification ID which can be found at
  • Documentation that demonstrates a legally or financially binding commitment for adopting, implementing, or upgrading (AIU) electronic health record systems/software

**The link to the workbook you must complete for prequalification:

The workbook has 2 tabbed pages:

  1. Workbook – this is the page that you will need to fill out and save
  2. Calculations – this page will show you what your hospital’s payment calculations are based on the information you input into the workbook page

You will need your hospital’s four most recent CMS Medicare cost reports (e.g. 2007, 2008, 2009, and 2010). If the requested information is not available on your CMS cost reports, you may use your most recent Hospital Annual Financial Disclosure Report or other auditable sources. Other auditable resources must be submitted and clearly labeled with source information.

Completed workbooks and support documentation should be emailed to DCHS prefers that all documents be submitted in PDF format. However, if this is not feasible, DCHS will also accept documents in Word, Excel and PowerPoint formats. The final date for submitting qualifications is 5:00 p.m. PST September 23, 2011. If you miss this deadline, you will have to wait until after October 3, 2011 to submit the necessary information requested by the state.

PLEASE NOTE: You will still need to register your hospital at the CMS Registration & Attestation Site at prior to registering for the SLR at Sending your information during this “prequalification” phase will expedite your final approval. DHCS will contact you regarding your package once your information has been reviewed.