New York DOH Nudges Medicaid Providers Toward Patient-Centered Medical Home

On April 1, 2018 The New York State Department of Health (NYSDOH) released an innovative model for primary care transformation known as the New York State Patient-Centered Medical Home (NYS PCMH).

NYS PCMH is a care delivery model where the primary care team, with the involvement of the patient (and family, when appropriate), is responsible for managing the full spectrum of health care needs, and coordinating with clinicians in other settings when care cannot be provided in the primary care setting. 

As a “nudge” to get primary care providers working toward NYS PCMH recognition, NYSDOH providers practices with the following resources:

  • Recognition at no cost to practices: NYSDOH covers the first-year’s NYS PCMH Recognition fee or the first NYS PCMH Annual Reporting fee. The practice is responsible for paying their Annual Reporting fee each year after earning NYS PCMH Recognition.

  • Transformation assistance: New York State has contracted with 15 organizations that specialize in NYS PCMH transformation and are being made available at no cost to participating practices. These entities provide step-by-step assistance in managing the transformation process and support the efforts of improving the patient experience.

  • Enhanced reimbursement opportunities: Practices that participate in NYS PCMH transformation may be eligible to receive supplemental payments through state programs such as the Medicaid PCMH Incentive Program. In addition, NYSDOH is engaged regionally with commercial payers to implement voluntary, multi-payer value-based payment (VBP) arrangements to support practices that have not had these opportunities through previous transformation efforts. Many of these models and eligibility to participate will depend on practices achieving NYS PCMH Recognition.

While the enhanced reimbursement opportunities vary from carrier to carrier, the transition toward Value Based Care is a common requirement for all.

For more information about obtaining NYS PCMH recognition for your practice or the enhanced reimbursement opportunities available to your practice, contact us.