Effective July 1, 2013, New York State Medicaid Program is changing the reimbursement policy and billing requirements for providers recognized by the National Committee for Quality Assurance (NCQA) under the Physician Practice Connections-Patient Centered Medical Home (PPC®-PCMH™) program (2008 Standards). The new policy applies to both Medicaid Managed Care and Fee-for-Service (FFS).  Payments will be eliminated for those practices with level 2 recognition under the 2008 standards and reduced for Level 3 recognized practices for both managed care and Fee-For-Service patients.  Incentive payments for those who have achieved Level 2 or Level 3 recognition under the PCMH 2011 program will stay the same.


To review the details of the revised policy and billing requirements please refer to the official newsletter for the New York State Medicaid Program, Medicaid Update (April 2013). Click here to view it.

The revised policy is designed to incentivize providers to seek recognition under the more robust standards of the PCMH 2011 program, in an effort to meet the goals of the Medicaid Redesign Team’s Triple Aim goal of improved care, improved population health and reduced per capita cost. As such, in December 2012, NYS Medicaid Program also eliminated any incentives paid to Level 1 Recognized practices.

RMS Healthcare, a division of Research & Marketing Strategies (RMS),  is a leader in healthcare transformation services and has assisted more than 75 practices in their journey to PCMH recognition.  We can help your practice attain a higher level of recognition or recognition under the PCMH 2011 program in order to maximize your state incentive payments.  Please call Susan Maxsween, Director of Healthcare and Practice Transformation at (315) 635-9802 or e-mail her at SusanM@rmsresults.com.