Overview for Health Care Professionals

Through the Medicaid EHR Incentive Program, health care practitioners in New York can qualify for up to $63,750 in incentive payments over six years. These payments are above and beyond any Medicaid reimbursement or other incentives (including the NY Medicaid e-prescribing incentive). Participation in the NY Medicaid EHR Incentive Program will begin in late 2011.

The following practitioner types are eligible to receive incentive payments:

  • Physicians (doctors of medicine and osteopathy)
  • Dentists
  • Nurse Practitioners
  • Certified Nurse-Midwives
  • Physician Assistants practicing in a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) that is led by a Physician Assistant

Incentive payments to eligible professionals (EPs) are disbursed over the course of six program participation years, according to the following schedule:

Participation Year Incentive Payment Amount
Year 1 $21,250
Year 2 $8,500
Year 3 $8,500
Year 4 $8,500
Year 5 $8,500
Year 6 $8,500
Total $63,750

Note that participation years do not necessarily need to be sequential - participants may skip years without penalty, although the last year to receive incentive payments is 2021. The last year that a provider may begin receiving payments is 2016.

In order to be eligible for incentive payments, practitioners must not be hospital-based (meaning they must furnish more than 10% of their covered services outside the inpatient and emergency department settings) and they must demonstrate a minimum Medicaid patient volume as follows:

  • Most practitioners will need to demonstrate that at least 30% of their patient encounters were paid all or in part by Medicaid.
  • Pediatricians who do not meet the 30% Medicaid patient volume threshold may qualify if they demonstrate at least 20% Medicaid patient volume, although in this case the incentive amount is reduced by 1/3.
  • Providers who practice predominately in an FQHC or RHC may qualify if they demonstrate that at least 30% of their patient encounters were for "needy" patients, which includes Medicaid, Child Health Plus, uncompensated care, and services billed on a sliding scale based on the patient's ability to pay.

In order to receive an incentive payment in the first year of participation, an EP must demonstrate that he or she has adopted, implemented, or upgraded certified EHR technology. In subsequent years of participation, EPs must demonstrate that they are meaningfully using the certified EHR technology by satisfying a set of objectives, which become progressively more stringent as the program goes on.

Health care practitioners must choose to participate in either the Medicaid EHR Incentive Program or a similar EHR Incentive Program offered through the Medicare program. They may not participate in both programs simultaneously. Practitioners may elect to switch from one program to the other, but they may only do so one time. They enter the new program in the year they would have been in had they stayed in the old program (i.e., a provider who receives two annual payments from the Medicaid program and then switches to Medicare will begin with the third year Medicare payment amount).