Eligibility & Volume: Eligible Professionals

Additional Requirements

Eligible Professional Volume Requirements

In addition to being an eligible provider type and having certified technology, EPs must meet a 30% Medicaid encounter volume threshold over 90 day period. Pediatricians can qualify for the program with 20% Medicaid encounter volume but it results in a maximum reduced payment of $42,500.

View our tip sheet [PDF 365 KB] for a quick reference on volume requirements.

  1. Must be working in a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) and the clinic must be led by a PA. The "Attestation for Physician Assistant Led" form must be complete.
  2. Needy individuals are defined in Section 1903(t)(3)(F) of the Social Security Act as individuals meeting any of the following three criteria: