Provider Self-Attestation

Who is Eligible and Should Self-Attest

In order to receive the enhanced rate, providers must complete and submit the Self-Attestation Form. Enhanced payments are limited to the qualified physicians and advanced practice clinicians providing services within their state scope of practice under the supervision of an eligible physician. APRNs must attest that they are under the supervision of, or in a collaborative relationship with, a physician who has self-attested and qualifies for the enhanced rates. This rule refers to advanced practice professionals (APPs) which consists of APRNs and PAs. However, only APRNs and physicians are required to self-attest. PAs will be automatically eligible if their supervising physician self-attests and is found eligible.

All physicians (MDs, DOs) must self-attest to qualify for the enhanced rate. APRNs must attest that they are under the supervision of, or in a collaborative relationship with, a physician who has self-attested and qualifies for the enhanced rates. Physician Assistants do not need to complete a separate self-attestation form but should be listed on their supervising physician’s form. No self-attestation is required for providers in the Vaccines for Children (VFC ) program to receive the enhanced VFC rates. Tables 1 and 2 contain eligibility workflows for physicians and APRNs that further explain the self-attestation form criteria.
Qualifying Specialties and Subspecialties

The following specialties/subspecialties certified by each of the acceptable Boards qualify for the enhanced rates:

American Board of Medical Specialties

 Family Medicine – Adolescent Medicine; Geriatric Medicine; Hospice and Palliative Medicine; Sleep Medicine; Sports Medicine
 Internal Medicine – Adolescent Medicine; Advanced Heart Failure and Transplant Cardiology; Cardiovascular Disease; Clinical Cardiac Electrophysiology; Critical Care Medicine; Endocrinology, Diabetes, and Metabolism; Gastroenterology; Geriatric Medicine; Hematology; Hospice and Palliative Medicine; Infectious Disease; Interventional Cardiology; Medical Oncology; Nephrology; Pulmonary Disease; Rheumatology; Sleep Medicine; Sports Medicine; Transplant Hepatology
 Pediatrics – Adolescent Medicine; Child Abuse Pediatrics; Developmental-Behavioral Pediatrics; Hospice and Palliative Medicine; Medical Toxicology; Neonatal-Perinatal Medicine; Neurodevelopmental Disabilities; Pediatric Cardiology; Pediatric Critical Care Medicine; Pediatric Emergency Medicine; Pediatric Endocrinology; Pediatric Gastroenterology; Pediatric Hematology-Oncology; Pediatric Infectious Diseases; Pediatric Nephrology; Pediatric Pulmonology; Pediatric Rheumatology; Pediatric Transplant Hepatology; Sleep Medicine; Sports Medicine

American Osteopathic Association

 Family Physicians – No subspecialties

 Internal Medicine – Allergy/Immunology; Cardiology; Endocrinology; Gastroenterology; Hematology; Hematology/Oncology; Infectious Disease; Pulmonary Diseases; Nephrology; Oncology; Rheumatology

 Pediatrics – Adolescent and Young Adult Medicine; Neonatology; Pediatric Allergy /Immunology;
Pediatric Endocrinology; Pediatric Pulmonology


American Board of Physician Specialties

The ABPS does not certify subspecialists. Therefore, eligible certifications are:
 American Board of Family Medicine Obstetrics; Board Certification in Family Practice; and Board
Certification in Internal Medicine. There is no Board certification specific to Pediatrics.