Proposed NYSDOH Changes for PCMH-Recognized Practices

The New York State Department of Health (NYS DOH) has proposed the following changes for Patient-Centered Medical Home (PCMH)-recognized practices due to state-level fiscal constraints.  We will continue to update primary care partners as we receive information from NYS DOH.

For PCMH 2014 Level 2-recognized practices, Medicaid Managed Care (MMC) and fee-for-service PCMH incentive payments will be permanently eliminated starting May 1, 2018.

For PCMH 2014 Level 3 or PCMH 2017-recognized practices, the NYS DOH will temporarily (from May 1, 2018 – June 30, 2018) reduce MMC incentive payments. Please note, fee-for-service incentive add-on amounts will remain unchanged. The temporarily reduced MMC incentive payment will be $2 per member per month (PMPM) for the two months.

Beginning July 1, 2018, the PCMH incentive payments will be modified (increased from the temporary 2-month reduction) to align with the principles of Value-Based Payments (VBP). NYS Medicaid will engage key stakeholders to focus on making sustainable fiscal recommendations that are in line with the Medicaid global spending cap for the PCMH program, and to explore options to tie the incentive to VBP participation, and quality. The NYSDOH anticipates that later this year, the incentive will be tied to whether providers have a VBP contract (Level 1 or higher). Projected rates for the MMC PMPM range from $5.00-$6.00 for providers with a VBP contract, and around $2 for those without a VBP contract.

Should New York State pass these proposed changes, we recommend that affected partners contact the Managed Care Organizations (MCOs) that they are contracted with or New York State Medicaid program if they have a Medicaid fee-for-service contract, to discuss the specific impact, if any, on their respective contracts.

Please note, OneCity Health does not have authority to contract with MCOs on behalf of our partners, and none of the OneCity Health contracts qualify as a Level 1 VBP contract.

Please refer to January 2018 NYS DOH Medicaid Update for details: