Hospital Eligibility
Eligible hospital types for the program include:
- Acute Care Hospitals (Including Critical Access Hospitals)
- An average length of patient stay of 25 days or fewer
- A minimum 10% Medicaid patient volume
- A CMS Certification Number that ends in the range of 0001-0879 or 1300-1399
- Children's Hospitals
- CCN that ends in the range of 3300-3300
Determining Medicaid Patient Volume:
Acute Care and Critical Access Hospitals must have at least 10% Medicaid patient volume. The method to calculate patient volume has changed for program years 2013 and beyond. Medicaid patient volume is calculated using the following formula:
Total Medicaid patient encounters*
Total patient encounters*
*In any representative 90-day period within either, the prior fiscal year or 12-month time frame directly preceding the application date.
A Medicaid encounter includes either of the following:
- Services rendered to an individual per inpatient discharge where the individual was enrolled in Medicaid (or a Medicaid demonstration project approved under the Social Security Act section 1115) or Children’s Health Insurance Program (CHIP) as part of a Medicaid expansion at the time the billable service was provided.
- Services rendered in an emergency department on any one day where the individual was enrolled in Medicaid (or a Medicaid demonstration project approved under the Social Security Act section 1115) or Children’s Health Insurance Program (CHIP) as part of a Medicaid expansion, at the time the billable service was provided;
Note: An eligible hospital may receive incentive payments from both Medicare and Medicaid if it meets all eligibility criteria. (e.g. Medicaid acute care hospital that is also a Medicare subsection (d) hospital). Hospitals must apply for the incentives with each program in each application year.