In the November 2018 Medicaid Update, the New York State (NYS) Department of Health (DOH) issued new billing guidance for the Patient-Centered Medical Home (PCMH) and Advanced Primary Care (APC) Incentive Payment Programs. Providers that achieve PCMH or APC recognition can receive Medicaid or Child Health Plus (CHP) incentive payments. Payments are provided in the form of either per member per month (PMPM) capitation payments for Medicaid Managed Care (MMC) and CHP members, or as a per-visit “add-on” payment for eligible claims billed for services provided to Medicaid fee-for-service (FFS) members.
Under the PCMH model, each patient in a primary care practice has an ongoing relationship with his or her personal physician as well as a team of providers who are responsible for care coordination. The APC model is a variation of the PCMH model in an all-payer setting that promotes integrated care and care coordination. In April 2018, NYS announced the transition of both the PCMH and APC programs into a new NYS PCMH model.
This guidance and additional information on the transition to NYS PCMH are available in the November 2018 Medicaid Update here. A summary of the current policy guidance is attached.