New Incentives for NYS Patient-Centered Medical Home Providers: Enhance Patient Care and Earn Additional Payments
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Retroactive to April 1, 2024, primary care providers recognized under the NYS PCMH program are entitled to an incentive enhancement of $4.00/PMPM for MMC enrollees and CHPlus members under 21 years of age, and $2.00/PMPM for individuals 21 years of age and older, in addition to the current $6.00/PMPM payment.
MMC Plans will be expected to calculate retroactive payments and furnish these payments to NYS PCMH-recognized providers in their networks. In 2025, to receive this enhanced incentive payment (in addition to the $6.00/PMPM), providers will be required to develop a workflow to refer patients to a Social Care Network (SCN) and submit an attestation by March 31, 2025, confirming their SCN participation. From April 1, 2024 through March 31, 2025, all NYS PCMH providers will receive the incentive enhancement. Providers should refer to Column Bin the “NYS PCMH Payment” table below.
Effective April 1, 2025, NYS PCMH providers that submit SCN attestation by March 31, 2025, will continue to receive the incentive enhancement. Providers should refer to Column C in the “NYS PCMH Payment” table on the website. NYS PCMH providers that do not attest to participation in an SCN will receive the $6.00/PMPM NYS PCMH payment without the incentive enhancement. Providers should refer to Column D in the “NYS PCMH Payment” table on the website.
PCMH practices can submit attestations after the March 31, 2025 deadline and the PCMH practice will be included in the subsequent participation list for the additional $2.00 and $4.00 enhancement. PCMH practices that submit attestations after March 31, 2025 will forfeit the $2.00 and $4.00 enhancement beginning April 1, 2025 until the attestation is received. NYS DOH will release more details about the attestation form and process in the coming weeks. The attestation form will be available on the NYS Health Commerce System (HCS) website.
The attestation will be completed once, per physical site location, covering all recognized providers at that location. In preparation, practices should check access to their NYS Health Commerce website accounts. A link to the attestation form will be emailed to all NYS PCMH practices for completion using the NYS PCMH contact email address(es) on file with NCQA.
In order for MMC, HARP, HIV SNP, and CHPlus plans to calculate PCMH incentive enhancement payment, there will be an “SCN Indicator” on the monthly NYS PCMH file posted to the Health Commerce System that will track provider completion of the attestation. Plans will calculate provider payment based on the information corresponding to the “SCN Indicator”.
