§ 495.310 Medicaid provider incentive payments.
(a) Rules for Medicaid EPs. The Medicaid EP's incentive payments are subject to all of the following limitations:
(1) First payment year. (i) For the first payment year, payment under this subpart may not exceed 85 percent of the maximum threshold of $25,000, which equals $21,250.
(ii) [Reserved]
(iii) An EP may not begin receiving payments any later than CY 2016.
(2) Subsequent annual payment years.
(i) For subsequent payment years, payment may not exceed 85 percent of the maximum threshold of $10,000, which equals $8,500.
(ii) [Reserved]
(iii) Payments after the first payment year may continue for a maximum of 5 years.
(iv) Medicaid EPs may receive payments on a non-consecutive, annual basis.
(v) No payments may be made after CY 2021.
(3) Maximum incentives. In no case may a Medicaid EP participate for more than a total of 6 years, and in no case will the maximum incentive over a 6-year period exceed $63,750.
(4) Limitation. For a Medicaid EP who is a pediatrician described in paragraph (b) of this section payment is limited as follows:
(i) The maximum payment in the first payment year is further reduced by two-thirds, which equals $14,167.
(ii) The maximum payment in subsequent payment years is further reduced by two-thirds, which equals $5,667.
(iii) In no case will the maximum incentive payment to a pediatrician under this limitation exceed $42,500 over a 6-year period.
(b) Optional exception for pediatricians. A pediatrician described in this paragraph is a Medicaid EP who does not meet the 30 percent patient volume requirements described in §§ 495.304 and 495.306, but who meets the 20 percent patient volume requirements described in such sections.
(c) Limitation to only one EHR incentive program. An EP may only receive an incentive payment from either Medicare or Medicaid in a payment year, but not both.
(d) Exception for EPs to switch programs. An EP may change his or her EHR incentive payment program election once, consistent with § 495.60.