---
kind: "section"
citation: "42 C.F.R. § 495.304"
title: "42"
number: "495.304"
heading: "Medicaid provider scope and eligibility."
url: "https://uscodex.org/cfr/42/495.304"
---

# §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](/cfr/42/440.50.md), [440.60](/cfr/42/440.60.md), [440.100](/cfr/42/440.100.md); §§ [440.165](/cfr/42/440.165.md), and [440.166](/cfr/42/440.166.md)):
  - (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](/cfr/42/495.4.md) of this subpart, and meet one of the following criteria:
  - (1) **Have a minimum 30 percent patient volume attributable to individuals enrolled in a Medicaid program.**
  - (2) Have a minimum 20 percent patient volume attributable to individuals enrolled in a Medicaid program, 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](/cfr/42/495.302.md).
- (d) **Exception.** The hospital-based exclusion in [paragraph (c)](#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.**
- (f) **Further patient volume requirements for the Medicaid EP.** For payment year 2013 and all subsequent payment years, at least one clinical location used in the calculation of patient volume must have Certified EHR Technology—
  - (1) During the payment year for which the EP attests to having adopted, implemented or upgraded Certified EHR Technology (for the first payment year); or
  - (2) **During the payment year for which the EP attests it is a meaningful EHR user.**

## Notes

### Amendments

[75 FR 44565, July 28, 2010, as amended at 77 FR 54160, 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 54160, Sept. 4, 2012]