New York State Patient-Centered Medical Home Program
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Primary care providers who missed the March 31, 2025, deadline can still submit an attestation for the New York State Patient-Centered Medical Home Provider (NYS PCMH), Medicaid Managed Care (MMC) and Child Health Plus (CHPlus) incentive enhancement.
Effective April 1, 2025, primary care providers recognized under the NYS PCMH program are entitled to an incentive enhancement of $4.00/per member per month (PMPM) for MMC enrollees and CHPlus members under 21 years of age, and $2.00/PMPM for NYS Medicaid members 21 years of age and older, in addition to the current $6.00/PMPM payment.
To receive this enhanced incentive payment, in addition to the $6.00/PMPM, providers will be required to develop a workflow to refer NYS Medicaid members to a Social Care Network (SCN) and submit an attestation confirming their SCN participation. It is best practice for primary care providers to document their referral workflow and attestation survey response, for their own records.
The NYS PCMH incentive enhancement will be paid in addition to the current $6.00/PMPM payment. Additionally, NYS Medicaid health plans, Health and Recovery Plans, Human Immunodeficiency Virus-Special Needs Plans, and CHPlus Plans will be instructed to calculate and pay the NYS PCMH incentive enhancement. Practices submitting attestations after April 1, 2025, will forfeit monthly incentive enhancement payments until the attestation is received. Practices will continue to receive the current $6.00/PMPM.
Practice(s) must complete the NYS Department of Health (DOH) password protected attestation. All currently recognized NYS PCMH providers have received the link to the attestation using the email address(es) associated with recognized primary care providers and practices, as transmitted to the NYS DOH by the National Committee for Quality Assurance (NCQA). Primary care providers who have not received the password for the attestation should email [email protected].
SCN Program
The SCN program is part of the 1115 New York Health Equity Reform Waiver. SCNs will help address health disparities and social needs by connecting NYS Medicaid members to nutritional services, housing supports, transportation, and other social services that can impact the health of an individual. For individuals not enrolled in NYS Medicaid, and therefore, ineligible for the SCN program, including CHPlus members, the goal of NYS DOH is to provide these individuals with appropriate services to pre-existing state, federal, and local programs to address health-related social needs. When completing the attestation, providers are allowed to make more than one selection related to their practice workflow with designated SCNs, as shown below:
- Connect patients to the regional SCN for NYS Medicaid members via referral provided to the patient.
- Connect directly with the SCN platform or through a regional Qualified Entity to submit Accountable Health Communities Health-Related Social Needs (HRSN) screenings and referrals for NYS Medicaid members.
- Connect with the regional SCN in another agreed upon way.
Reminder
Only practices that complete the attestation survey will be eligible for the MMC and CHPlus NYS PCMH program incentive enhancement of $2.00/PMPM or $4.00/PMPM. The drop-down list of practices available on the attestation survey is updated monthly as new practices earn NYS PCMH recognition. All new practices must complete the attestation to be eligible for the $2.00/PMPM or $4.00/PMPM incentive enhancements.
Questions and Additional Information:
- Questions regarding the NYS PCMH attestation should be directed to [email protected].
- Questions related to SCNs should be directed to [email protected].
- Questions related to CHPlus should be directed to [email protected].
- Additional NYS Medicaid and CHPlus NYS PCMH incentive enhancement information can be found in the New York State Patient-Centered Medical Home Program article published in the October 2024 issue of the Medicaid Update.
- Providers should refer to the NYS DOH “PCMH Attestation: Frequently Asked Questions (FAQ’s)” web page regarding NYS PCMH.
Information regarding SCNs can be found on the NYS DOH “Social Care Networks (SCN)” web page.
