PCMH Incentive Enhancement: Timeline, New Requirements, and Metrics
The New York State Department of Health has announced new changes to the Medicaid PCMH incentive program. To continue receiving the $2–$4 per member per month (PMPM) incentive payments for Medicaid and Child Health Plus members, PCMH-recognized practices will need to meet additional reporting and performance requirements over the next several years.
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Background and Timeline
April 1, 2024
New York State began offering an incentive enhancement to all providers recognized as a Patient-Centered Medical Home (PCMH) by the National Committee for Quality Assurance (NCQA). This enhancement is added on top of the existing $6 per member per month (PMPM) base payment for Medicaid managed care and Child Health Plus (CHPlus) members.
The enhanced rates are:
- An additional $2 PMPM for adult members (total of $8 PMPM)
- An additional $4 PMPM for pediatric members (total of $10 PMPM)
These incentive payments are available to all eligible PCMH practices from April 1, 2024, through March 31, 2025, regardless of whether a referral workflow to Social Care Networks (SCNs) is in place.
See the Medicaid Update for additional background.
April 1, 2025
To continue receiving the enhancement, providers must complete an attestation confirming a referral workflow to Social Care Networks (SCNs).
For more details on SCN attestation requirements, visit CHCANYS's PCMH Update on SCN Attestation Requirements..
April 1, 2026
Practices must begin reporting on select quality metrics as part of their annual PCMH reporting to NCQA (for Measure Year 2025).
The enhancement will only continue for those who complete the SCN attestation and report the required metrics.
While reporting is not required for practices applying or renewing in 2025, DOH encourages practices to begin reporting early using Measure Year 2024 data. This is optional but intended to help practices prepare for future requirements.
April 1, 2028
The Department of Health will implement performance thresholds. Only practices that:
- Complete the SCN attestation
- Report on the required quality metrics for Measure Year 2027
- Meet DOH-defined performance standards based on Measure Year 2026 data
will remain eligible for the incentive enhancement.
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Required Quality Metrics
Practices must report select measures from NCQA’s PCMH Standardized Measure Set through the NCQA PCMH Transformation or Annual Reporting process.
Measure | Required For | eCQM Link
Childhood Immunization Status: Combo 10 | Pediatric practices | CMS117v13
Colorectal Cancer Screening | Adult practices | CMS130v14
Diabetes HbA1c Poor Control (>9%) | Adult practices | CMS122v14
Depression Screening and Follow-Up Plan | All practices | CMS2v14
- Pediatric practices must report two of the four measures.
Adult practices must report three of the four.
Measures must be submitted as part of NCQA’s annual PCMH reporting process. Practices applying or renewing in 2026 must report for Measure Year 2025 to remain eligible for the incentive enhancement.
Notes
- The eCQM links above show how each measure is defined and calculated, based on national specifications.
- New York State has not yet announced the performance thresholds that practices must meet beginning in 2028. CHCANYS will share that information when it becomes available.
- Federal approval is still pending for some of these changes. CHCANYS will continue to provide updates as more guidance is released.
Links
- DOH Announcement: PCMH Incentive and Quality Metrics (PDF)
- Medicaid Update – October 2024: PCMH Section
- CHCANYS: PCMH Update on SCN Attestation Requirements