Eligible Professionals
The final rule defines eligible professionals (EP), for purposes of the Medicaid EHR Incentive Program, as: physicians, dentists, certified nurse-midwives, nurse practitioners, and physician assistants practicing in an FQHC or RHC that is so led by a physician assistant. To qualify for Medicaid incentive payments, Medicaid eligible professionals must adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology in the first year of participation, and successfully demonstrate meaningful use in subsequent participation years. Additionally, to qualify for incentives, most Medicaid EPs cannot be "hospital-based." A Medicaid EP is considered hospital-based if 90% or more of his or her services are performed in a hospital inpatient (POS 21) or emergency room (POS 23) setting. The only exception to this rule is that Medicaid EPs practicing predominantly in an FQHC or RHC are not subject to the hospital-based exclusion.
The incentive payments for EPs are based on individual providers. If you are part of a practice, each EP may qualify for an incentive payment if each EP successfully demonstrates meaningful use of certified EHR technology. Each EP is only eligible for one incentive payment per year, regardless of how many practices or locations at which he or she provide services.
To qualify for an EHR incentive payment, Medicaid EPs must not be hospital-based and must meet one of the following criteria:
- Have a minimum 30% Medicaid patient volume
- Have a minimum 20% Medicaid patient volume, and be a pediatrician*
- Practice predominantly (more than 50% of clinical services) in a Federally Qualified Health Center (FQHC) or Rural Health Center (RHC) and have a minimum 30% patient volume attributable to needy individuals.
- A list of FQHCs by State and County can be found here:http://findahealthcenter.hrsa.gov/Search_HCC_byCounty.aspx
- For calendar years 2011-2021, participants can receive up to $63,750** over 6 years under the Medicaid EHR incentive program. EHR incentive payments are made by the state based on the calendar year. See payment table below.
| Medicaid EP Qualifies to Receive First Payment in 2011 | Medicaid EP Qualifies to Receive First Payment in 2012 | Medicaid EP Qualifies to Receive First Payment in 2013 | Medicaid EP Qualifies to Receive First Payment in 2014 | Medicaid EP Qualifies to Receive First Payment in 2015 | Medicaid EP Qualifies to Receive First Payment in 2016 | |
| Payment Amount in 2011 | $21,250.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Payment Amount in 2012 | $8,500.00 | $21,250.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Payment Amount in 2013 | $8,500.00 | $8,500.00 | $21,250.00 | $0.00 | $0.00 | $0.00 |
| Payment Amount in 2014 | $8,500.00 | $8,500.00 | $8,500.00 | $21,250.00 | $0.00 | $0.00 |
| Payment Amount in 2015 | $8,500.00 | $8,500.00 | $8,500.00 | $8,500.00 | $21,250.00 | $0.00 |
| Payment Amount in 2016 | $8,500.00 | $8,500.00 | $8,500.00 | $8,500.00 | $8,500.00 | $21,250.00 |
| Payment Amount in 2017 | $0.00 | $8,500.00 | $8,500.00 | $8,500.00 | $8,500.00 | $8,500.00 |
| Payment Amount in 2018 | $0.00 | $0.00 | $8,500.00 | $8,500.00 | $8,500.00 | $8,500.00 |
| Payment Amount in 2019 | $0.00 | $0.00 | $0.00 | $8,500.00 | $8,500.00 | $8,500.00 |
| Payment Amount in 2020 | $0.00 | $0.00 | $0.00 | $0.00 | $8,500.00 | $8,500.00 |
| Payment Amount in 2021 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $8,500.00 |
| TOTAL Incentive Payments | $63,750.00 | $63,750.00 | $63,750.00 | $63,750.00 | $63,750.00 | $63,750.00 |
|
* Pediatricians with under 30% Medicaid patient volume, whose caps are 2/3 of these
amounts ** Incentive payment is based on a % of net average allowable costs as defined by CMS. |
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