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Needy Individual Patient Volume and Practice Predominantly Eligibility

Needy Individual Patient Volume
Eligible Professionals (EPs) that work in a Federally Qualified Health Center (FQHC) or Rural Health Center (RHC) may choose one (or more) clinical sites of practice to calculate patient volume (i.e., the calculation does not need to be across all of an EP's sites of practice). However, at least one site at which the EP is adopting or meaningfully using certified EHR technology must be included in the patient volume.

New Hampshire implemented Managed Care Organizations on December 1, 2013. Providers should include managed care encounters in their patient volume attestations. New Hampshire Managed Care Organizations include Well Sense; Meridian; and NH Healthy Families.

  • Patient Volume reporting period: any continuous 90-day period during the calendar year prior to the payment year.
  • Total encounters (denominator): all encounters that the EP provided during the Patient Volume reporting period.
  • Needy Individual encounters (numerator): all services (in the denominator) provided in a day by a specific provider to a Needy individual. This includes:
    • Services in which:
      • Medicaid or Medicaid Managed Care programs (including out-of-state programs) paid for part or all of the services (including premiums, co-payments, and/or cost sharing); or
      • Out-of-State CHIP paid for part or all of the services (including premiums, co-payments, and/or cost-sharing); or
      • Services were rendered to an individual on a sliding scale; or
      • Services were uncompensated;
    • Encounters where Medicaid paid zero dollars where Medicare (in the case of patients that are dually eligible for both Medicaid and Medicare) or another third party paid for the encounter; or
    • Encounters provided to Medicaid beneficiaries for which no payments were received; or
    • Medical services provided to Medicaid beneficiaries that were not covered under New Hampshire's Medicaid program.

Practice Predominantly Criterion

This criterion is applicable only to EPs that attest to Needy Individual patient volume. These EPs must attest that during a six-month reporting period during the prior calendar year, the clinical location for over 50 percent of their patient encounters occurred at the FQHC/RHC facility.

The practice predominantly criterion is based on each individual EP's encounters data. (EPs may not use group data to attest to this criterion.)

  • Practice predominantly reporting period: six months during the calendar year prior to the payment year.
  • Denominator: total encounters at all locations that the EP provided during the practice predominantly reporting period.
  • Numerator: the sum of the EP's FQHC/RHC encounters during the six-month prior year reporting period.

The practice predominantly criterion is not applicable to non-FQHC/RHC EPs that attest using Medicaid patient volume encounter data.

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