Non-hospital-based eligible professionals (EPs) who do not practice predominately at a Federally Qualified Health Center (FQHC) or a Rural Health Center (RHC) include the following types of providers:
  • physicians (doctors of medicine (MDs) and doctors of osteopathy (ODs));
  • dentists;
  • certified nurse midwives; and
  • nurse practitioners.

In order to qualify for Medicaid incentives, EPs who are not pediatricians must meet an annual 30% Medicaid Patient Volume threshold, while EPs who are pediatricians must meet an annual 20% Medicaid Patient Volume threshold.

Hospital Based EPs are excluded from receiving incentive payments. If 90% or more of an EP's services take place at a setting of "inpatient hospital" or "emergency room," the EP is not eligible for the incentive payments.

EPs must waive rights to Medicare EHR Incentive Payments in order to receive Medicaid Incentive Payments. EPs can receive Medicaid EHR Incentive Payment from only one state per year.

EPs who do practice predominately at a FQHC/RHC include the following types of providers:

  • physicians (doctors of medicine (MDs) and doctors of osteopathy (ODs));
  • dentists;
  • certified nurse midwives;
  • nurse practitioners; and
  • physician assistants who practice predominately at an FQHC/RHC that is also led by a physician assistant.

In order to qualify for the Medicaid Incentives, EPs who practice predominately at a FQHC/RHC must meet an annual 30% "Needy Individual " Patient Volume threshold. "Needy Individual" is defined as an individual receiving care from any of the following: (1) CHIP or Medicaid; (2) Uncompensated Care; or (3) no-cost or reduced-cost services on a sliding scale based on the individual's ability to pay.

"Practicing Predominately" at a FQHC/RHC is defined as 50% or more of the EP's patient encounters taking place at the FQHC or RHC.

EPs must waive rights to Medicare Incentive Payments in order to receive Medicaid Incentive Payments. EPs can receive Medicaid Incentive Payment from only one state per year.

For more information on EHR Incentive Program Eligibility Requirements for professionals, please go to http://www.cms.gov/EHRIncentivePrograms/15_Eligibility.asp#BOOKMARK1.

EPs can answer simple "yes or no" questions on the CMS Eligibility Wizard to find out which EHR Incentive Payment Programs they may qualify for:

http://www.cms.gov/EHRIncentivePrograms/15_Eligibility.asp#TopOfPage.


This information is provided by MassHealth .