Eligible Professionals
Eligible professionals (EPs) are non-hospital-based physicians, dentists, nurse practitioners, and certified nurse midwives that are fully enrolled Medicaid providers. Additionally, physician assistants practicing predominantly in a Federally Qualified Health Center (FQHC)
EPs can receive $63,750 over six years for adopting, implementing or upgrading and demonstrating meaningful use of certified EHR technology. Medicaid providers may opt out of the incentive program without their Medicaid reimbursements being affected. EPs can switch between the Medicare and Medicaid incentive programs one time. The last year for making an incentive program switch is 2014.
Eligible professionals must meet the following patient volume requirements.
| Non-Hospital-Based Eligible Professionals | Patient Volume Over 90-Day Period |
| Physician (MD, DO) | 30% Medicaid |
| Dentist | 30% Medicaid |
| Certified Nurse Midwife | 30% Medicaid |
| Nurse Practitioner | 30% Medicaid |
| Physician Assistant (PA) in a RHC or FQHC led by PA* | 30% Medicaid |
| Pediatrician** | 20% Medicaid |
* Eligible professionals that practice in a RHC or FQHC at least 50% of the time can count “needy individuals”1 to meet their patient volume threshold.
**Pediatricians, like other physicians, can be eligible for the full incentive payment ($63,750) if they meet the minimum 30% Medicaid patient volume requirements. However, Pediatricians only are also eligible if their Medicaid patient volume is between 20-29%. Pediatricians who qualify with a 20-29% Medicaid patient volume receive two-thirds of the maximum incentive payment, totaling $42,500.
*** Non-Hospital-Based is defined as not having 90% or more necounters in a hospital or emergency room setting.
1 Needy individuals are defined in Section 1903(t)(3)(F) of the Social Security Act as individuals meeting any of the following three criteria: (1) They are receiving medical assistance from Medicaid or the Children’s Health Insurance Program (CHIP); (2) they are furnished uncompensated care by the provider; or (3) they are furnished services at either no cost or reduced cost based on a sliding scale determined by the individual’s ability to pay.
