Ill. Admin. Code tit. 89, § 150.100 - Provider Eligibility
a)
General Requirements. A provider must:
1) Be
within one of the classes of eligible professionals enumerated in subsection
(b).
2) Be enrolled, and in good
standing, with the Department to participate in the Illinois Medical Assistance
Program.
3) Be a registered user of
the Department 's Medical Electronic Data Interchange System.
b) Eligible Professionals (EP).
1) The health practitioners that may be
eligible for incentive payments are limited to the following:
A) A certified nurse-midwife.
B) A dentist.
C) A nurse practitioner.
D) A physician.
E) An optometrist.
F) A physician assistant (PA) practicing in a
federally qualified health center (FQHC) or a rural health clinic (RHC) that is
led by a PA.
2) Eligible
Hospitals (EH). The hospitals that may be eligible for incentive payments are
limited to the following hospitals:
A) Acute
care hospitals.
B) Children's
hospitals.
c)
Eligibility Requirements for EP. For each year for which the practitioner seeks
an incentive payment, the practitioner must:
1) Have a minimum 30 percent patient volume
attributable to individuals receiving Medicaid , except in the instance of a
practitioner:
A) that is a pediatrician, with
a minimum 20 percent patient volume attributable to individuals receiving
Medicaid .
B) that practices
predominately in an FQHC or RHC with a minimum 30 percent patient volume
attributable to needy individuals, as defined at
42
CFR 495.302.
2) Not be a "hospital -based EP" as defined at
42
CFR 495.4, except this provision does not
apply to a practitioner practicing predominately at an FQHC or RHC.
d) Eligibility Requirements for
EH. For each year for which the hospital seeks an incentive payment, an acute
care hospital must have at least a 10 percent volume attributable to
individuals receiving Medicaid. A children's hospital is exempt from meeting a
patient volume threshold.
Notes
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