---
kind: "section"
citation: "42 C.F.R. § 495.202"
title: "42"
number: "495.202"
heading: "Identification of qualifying MA organizations, MA-EPs and MA-affiliated eligible hospitals."
url: "https://uscodex.org/cfr/42/495.202"
---

# §495.202. Identification of qualifying MA organizations, MA-EPs and MA-affiliated eligible hospitals.

- (a) **Identification of qualifying MA organizations.**
  - (1) Beginning with bids due in June 2011 (for plan year 2012), MA organizations seeking reimbursement for qualifying MA EPs and qualifying MA-affiliated eligible hospitals under the MA EHR incentive program are required to identify themselves to CMS in a form and manner specified by CMS, as part of submissions of initial bids under [section 1854(a)(1)(A)](/cfr/42/1854.md?p=a-1-A) of the Act.
  - (2) Qualifying MA organizations offering MA HMO plans, absent evidence to the contrary, are deemed to meet the definition of HMO in [42 U.S.C. 300gg-91(b)(3)](/usc/42/300gg-91.md?p=b-3)—[section 2791(b)(3)](/cfr/42/2791.md?p=b-3) of the PHS Act.
  - (3) Qualifying MA organizations offering MA plan types other than HMOs, must attest to the fact that they meet the definition of HMO in [42 U.S.C. 300gg-91(b)(3)](/usc/42/300gg-91.md?p=b-3)—[section 2791(b)(3)](/cfr/42/2791.md?p=b-3) of the PHS Act.
  - (4) Beginning with bids due in June 2014 (for plan year 2015), all MA organizations with potentially qualifying MA EPs or potentially qualifying MA-affiliated eligible hospitals under the MA EHR incentive program must identify themselves to CMS in a form and manner specified by CMS, as part of submissions of initial bids under [section 1854(a)(1)(A)](/cfr/42/1854.md?p=a-1-A) of the Act. “Potentially qualifying MA EPs” and “potentially qualifying MA-affiliated eligible hospitals” are those EPs and hospitals that meet the respective definitions of “qualifying MA EP” and “qualifying MA-affiliated eligible hospital” in [§ 495.200](/cfr/42/495.200.md) but who (or which) are not meaningful users of certified EHR technology.
- (b) **Identification of qualifying MA EPs and qualifying MA-affiliated eligible hospitals.**
  - (1) A qualifying MA organization, as part of its initial bid starting with plan year 2012, must make a preliminary identification of MA EPs and MA-affiliated eligible hospitals that the MA organization believes will be qualifying MA EPs and MA-affiliated eligible hospitals for which the organization is seeking incentive payments for the current plan year.
  - (2) A qualifying MA organization must provide CMS with the following for each MA EP or eligible hospital when reporting under either paragraph [(b)(1)](#b-1) or [(4)](#b-4) of this section:
    - (i) **The MA EP's or MA-affiliated eligible hospital's name.**
    - (ii) **The address of the MA EP's practice or MA-affiliated eligible hospital's location.**
    - (iii) **NPI or CCN.**
    - (iv) An attestation by MA organization specifying that the MA EP or MA-affiliated eligible hospital meets the eligibility criteria.
  - (3) When reporting under either paragraph [(b)(1)](#b-1) or [(4)](#b-4) of this section for purposes of receiving an incentive payment, a qualifying MA organization must also indicate whether more than 50 percent of the covered Medicare professional services being furnished by a qualifying MA EP to MA plan enrollees of the MA organization are being furnished in a designated geographic HPSA (as defined in [§ 495.100](/cfr/42/495.100.md) of this part).
  - (4) Final identification of qualifying and potentially qualifying, as applicable, MA EPs and MA-affiliated eligible hospitals must be made within 2 months of the close of the payment year or the EHR reporting period that applies to the payment adjustment year as defined in [§ 495.200](/cfr/42/495.200.md).
  - (5) Beginning plan year 2015 and for subsequent plan years, all qualifying MA organizations, as part of their initial bids in June for the following plan year must—
    - (i) Identify all MA EPs and MA-affiliated eligible hospitals of the MA organization that the MA organization believes will be either qualifying or potentially qualifying;
    - (ii) Include information specified in [paragraph (b)(2)(i) through (iii)](#b-2-i..b-2-iii) of this section for each professional or hospital; and
    - (iii) Include an attestation that each professional and hospital either meets or does not meet the EHR incentive payment eligibility criteria.

## Notes

### Amendments

[75 FR 44565, July 28, 2010, as amended at 77 FR 54158, Sept. 4, 2012]

### Authority

Authority: 42 U.S.C. 1302 and 1395hh.

### Source

Source: 75 FR 44565, July 28, 2010, unless otherwise noted.

### Amendments

[75 FR 44565, July 28, 2010, as amended at 77 FR 54158, Sept. 4, 2012]