Patient Centered Medical Home Program Provides Pathway for Enhanced Care for Your Patients and Increased Medicaid Payments
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Did you know that the 2024-25 New York State Budget passed earlier this year included $148 million to increase payment rates for primary care delivered to your patients through New York’s Patient-Centered Medical Homes (PCMH) model?
A PCMH is a model of care where each enrollee has an on-going relationship with a personal physician and a care team. The physician and care team, which can include nurse practitioners, physician assistants, registered nurses, social workers, and care coordinators, take collective responsibility for meeting all the enrollee’s health care needs. The PCMH model also emphasizes greater care through open scheduling, expanded hours, enhanced communication among all involved with an enrollee’s care, and any other means to ensure that an enrollee obtains proper care in a culturally and linguistically appropriate manner. NCQA’s PCMH recognition is awarded to practices and their providers that meet a set of predetermined standards for providing high quality primary care services.
As reported by the NYS Department of Health, New York State currently has the greatest number of practices with NCQA PCMH recognition compared to all other states in the country. As of June 2023, over 2,000 practices and nearly 9,000 physicians and other providers have achieved New York State PCMH-recognition. In fact, smaller practices with only one provider working at the site currently make up the largest portion of NYS PCMH-recognized practices (30%).
While MSSNY continues to press the NYSDOH and other state policymakers for substantial across the Board increases in Medicaid payments as essential to enhancing patient access to community-based physician care, participation in the PCMH program is one pathway to increase these payments.
More information from the NYSDOH about how a practice can become PCMH-certified is available here NYS PCMH Brochure, and here NYS PCMH: Process for Getting Recognized – NCQA.
