Safety Net Hospital definition – A hospital must meet one of three criteria to participate in a PPS:

  • A public hospital, critical access hospital or sole community hospital
  • At least 35% of their patient volume in outpatient lines and 30% of inpatient treatment must be associated with Medicaid, uninsured and dual eligible individuals.
  • Must serve at least 30% of all Medicaid, uninsured, and dual eligible members in the proposed county or multi-county community – state may increase this minimum percentage threshold on case-by-case basis to ensure that the needs of the community are met.

Safety Net Non-Hospital Provider definition – Not participating as part of a state-designated Health Home, must have at least 35% of all patient volume associated with Medicaid, uninsured and dual eligible individuals.

Vital Access Provider Exception – Exceptions to the safety net definitions will be considered on a case-by-case basis if it is deemed in the best interests of Medicaid members to included the providers organization in as PPS.

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