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CFR › Title 42 › Chapter IV › Subchapter G › Part 495 › Subpart D › Section 495.304

42 CFR 495.304 - Medicaid provider scope and eligibility.

There are 4 Updates appearing in the Federal Register for 42 CFR 495. Select the tab below to view, or View eCFR (GPOAccess)
§ 495.304
Medicaid provider scope and eligibility.
(a) General rule. The following Medicaid providers are eligible to participate in the HIT incentives program:
(1) Medicaid EPs.
(2) Acute care hospitals.
(3) Children's hospitals.
(b) Medicaid EP. The Medicaid professional eligible for an EHR incentive payment is limited to the following when consistent with the scope of practice regulations, as applicable for each professional ( §§ 440.50, 440.60, 440.100; §§ 440.165, and 440.166 ):
(1) A physician.
(2) A dentist.
(3) A certified nurse-midwife.
(4) A nurse practitioner.
(5) A physician assistant practicing in a Federally qualified health center (FQHC) led by a physician assistant or a rural health clinic (RHC), that is so led by a physician assistant.
(c) Additional requirements for the Medicaid EP. To qualify for an EHR incentive payment, a Medicaid EP must, for each year for which the EP seeks an EHR incentive payment, not be hospital-based as defined at § 495.4 of this subpart, and meet one of the following criteria:
(1) Have a minimum 30 percent patient volume attributable to individuals receiving Medicaid.
(2) Have a minimum 20 percent patient volume attributable to individuals receiving Medicaid, and be a pediatrician.
(3) Practice predominantly in a FQHC or RHC and have a minimum 30 percent patient volume attributable to needy individuals, as defined at § 495.302.
(d) Exception. The hospital-based exclusion in paragraph (c) of this section does not apply to the Medicaid-EP qualifying based on practicing predominantly at a FQHC or RHC.
(e) Additional requirement for the eligible hospital. To be eligible for an EHR incentive payment for each year for which the eligible hospital seeks an EHR incentive payment, the eligible hospital must meet the following criteria:
(1) An acute care hospital must have at least a 10 percent Medicaid patient volume for each year for which the hospital seeks an EHR incentive payment.
(2) A children's hospital is exempt from meeting a patient volume threshold.

Title 42 published on 2012-10-01

The following are only the Rules published in the Federal Register after the published date of Title 42.

For a complete list of all Rules, Proposed Rules, and Notices view the Rulemaking tab.

  • 2012-12-07; vol. 77 # 236 - Friday, December 7, 2012
    1. 77 FR 72985 - Health Information Technology: Revisions to the 2014 Edition Electronic Health Record Certification Criteria; and Medicare and Medicaid Programs; Revisions to the Electronic Health Record Incentive Program
      GPO FDSys XML | Text
      DEPARTMENT OF HEALTH AND HUMAN SERVICES, Office of the Secretary, Centers for Medicare & Medicaid Services
      Interim final rule with comment period.
      Effective Date: This interim final rule with comment period is effective January 7, 2013. The incorporation by reference of certain publications listed in the rule is approved by the Director of the Federal Register as of January 7, 2013. Comment Date: To be assured consideration, written or electronic comments must be received at one of the addresses provided below, no later than 5 p.m. on February 5, 2013.
      42 CFR Part 495

Title 42 published on 2012-10-01

The following are ALL rules, proposed rules, and notices (chronologically) published in the Federal Register relating to 42 CFR 495 after this date.

  • 2012-12-07; vol. 77 # 236 - Friday, December 7, 2012
    1. 77 FR 72985 - Health Information Technology: Revisions to the 2014 Edition Electronic Health Record Certification Criteria; and Medicare and Medicaid Programs; Revisions to the Electronic Health Record Incentive Program
      GPO FDSys XML | Text
      DEPARTMENT OF HEALTH AND HUMAN SERVICES, Office of the Secretary, Centers for Medicare & Medicaid Services
      Interim final rule with comment period.
      Effective Date: This interim final rule with comment period is effective January 7, 2013. The incorporation by reference of certain publications listed in the rule is approved by the Director of the Federal Register as of January 7, 2013. Comment Date: To be assured consideration, written or electronic comments must be received at one of the addresses provided below, no later than 5 p.m. on February 5, 2013.
      42 CFR Part 495