La. Admin. Code tit. 50 § I-12503

Current through Register Vol. 50, No. 11, November 20, 2024

Section I-12503 - Qualifying Criteria for Professional Practitioners

A. Professional practitioners shall qualify for Medicaid incentive payments when:

1. services are rendered to the required number of patients based on the Medicaid patient volume threshold; and

2. the meaningful use requirements are met for EHR systems, based on the participation year of the program.

B. Professional practitioners shall be required to meet the minimum Medicaid patient volume threshold of 30 percent. This threshold shall be calculated as a ratio where the numerator is the total number of Medicaid patient encounters with needy individuals treated in any 90-day period in the previous calendar year and the denominator is all patient encounters over the same period of time.

1. Needy individuals shall include:

a. Medicaid recipients;

b. Children's Health Insurance Program recipients;

c. patients furnished uncompensated care by the provider; and

d. patients furnished services at no cost or on a sliding scale.

C. During the first year of program participation, the meaningful use requirements for an eligible provider are to adopt, implement, and upgrade a certified EHR system. In subsequent years' participation, providers must meet the meaningful use requirements defined by CMS at the stage that is in place at that time.

D. Incentive payments to eligible practitioners shall begin in state fiscal year (SFY) 2011 and will end in SFY 2021. The latest state fiscal year a Medicaid provider can begin the program is SFY 2016.

E. Eligible practitioners may receive incentive payments from the Medicaid Program or from the Medicare Program. Payments cannot be received from both entities simultaneously. After the initial program selection, eligible practitioners shall be allowed to change their selection only once during SFY 2012 through SFY 2014.

F. Payments are based on calendar year and may total up to $63,750 over six years of participation. To receive the maximum total payment amount, the provider would have to initiate the program by SFY 2016.

1. Pediatricians with more than 20 percent, but less than 30 percent Medicaid patient volume, will receive two-thirds of the maximum amount.

G. Medicaid EHR incentive payments shall not be available to a hospital-based provider who furnishes 90 percent or more of his/her services in a hospital setting. This includes services furnished on an inpatient or outpatient basis and in an emergency room setting.

La. Admin. Code tit. 50, § I-12503

Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 36:2866 (December 2010).

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.