Eligible Professionals, Predominately FQHC/RHC

Eligible Professionals who Practice Predominately at an FQHC/RHCThe following are considered Eligible Professionals (EPs):

    • Non-hospital based Doctors of Medicine (MDs) and Doctors of Osteopathy (DOs)
    • Dentists
    • Nurse Practitioners
    • Certified Nurse Midwives
    • Physician Assistant that practices at an FQHC/RHC, so led by a physician’s assistant

Patient Threshold Requirements:

Eligible professionals that “practice predominately” at a Federally Qualified Health Center (FQHC)/Rural Health Clinic (RHC), meaning 50% or more of their encounters over a 6 month period in the current calendar year occur at an FQHC/RHC, must meet or exceed a 30% Needy Individual Patient Volume Threshold each year of participation.

A Needy Individual is defined as an individual receiving care from any of the following:

  • Medicaid, Medicaid 1115 Waiver Populations, CHIP, those dually eligible for Medicare and Medicaid
  • Uncompensated Care
  • No cost or reduced cost services on a sliding scale based on individuals ability to pay

Incentive Payments:

Eligible professionals may receive up to $63,750 in incentive payments over a 6 year period. In the first year of participation, eligible professionals may qualify for $21,250 in incentive payments. For each subsequent year of participation, they may receive up to $8,500. Pediatricians with a minimum 20% Medicaid Patient Volume Threshold may receive up to $42,500 in incentive payments over a 6 year period. In the first year of participation, eligible pediatricians may qualify for up to $14,167 in incentive payments. For each subsequent year of participation, they may receive up to $5,667.Pediatricians that meet or exceed the 30% Medicaid Patient Volume Threshold are eligible for the full incentive amount.

In order for eligible professionals to take advantage of the full incentive amount, they must register for the Medicaid EHR Incentive Payment Program no later than 2016.

For more helpful information regarding eligibility requirements for Eligible Professionals, please visit our Tools and Resources section of the website.