New York State Patient Centered Medical Home (PCMH) Update

The New York State (NYS) 2017-2018 fiscal budget reduced/eliminated medical home incentive payments for practices with National Committee of Quality Assurance (NCQA) PCMH recognition. The changes include:

• Elimination of Medicaid Managed Care (MMC) and Medicaid fee-for-service (FFS) PCMH incentives for providers with PCMH recognition under 2011 standards  
• Reduction of Medicaid Managed Care per member per month (PMPM) incentive amounts for providers with PCMH recognition under 2014 Level 2 and 3 standards, as shown below

More changes include NCQA’s redesign of its PCMH recognition program based on feedback from key stakeholders to make its program more manageable as it continues to concentrate on performance and quality improvement. The redesign is aimed at reducing paperwork and increasing practice interaction with NCQA. One major change is to require yearly reporting and check-in for recognition status. This is a significant change from the current three-year recognition cycle. More information is accessible here.

What Does CohnReznick Think?

It is critical to understand the financial impact of the elimination/reduction of PCMH incentives. These changes impact determinations regarding continuation of program participation and minimizing a decrease in Centers’ incentive payments. In addition, it is important to reflect these changes in future budgets and financial projections.

Given the trend toward reduction in reimbursement, it is essential that organizations confirm their recognition status with NCQA and its assignment of all primary care providers and service sites, in order to ensure the correct reimbursement amount is received for all eligible patients/visits. Periodic review of PCMH incentive payments received can determine if the correct incentive payment amount was received or if additional payment is owed to the Center.   

Contact

For more information, please contact Peter Epp, Partner, Healthcare Industry Practice, at [email protected] or 646-254-7411 or Dolores Di Re, Senior Manager, at [email protected] or 646-625-5703. To learn more about CohnReznick’s Healthcare Industry practice, visit our webpage.

This has been prepared for information purposes and general guidance only and does not constitute professional advice. You should not act upon the information contained in this publication without obtaining specific professional advice. No representation or warranty (express or implied) is made as to the accuracy or completeness of the information contained in this publication, and CohnReznick LLP, its members, employees and agents accept no liability, and disclaim all responsibility, for the consequences of you or anyone else acting, or refraining to act, in reliance on the information contained in this publication or for any decision based on it.