We need you to reach out immediately to your State legislators (Assembly and Senate) regarding the Department of Health’s recently announced rate changes for Patient Centered Medical Home (PCMH) recognition, set to go into effect on April 1, 2015.
DOH has reduced the rate add-on for PCMH recognition under the 2011 NCQA Standards and has implemented rate add-ons for PCMH recognition under the 2014 NCQA standards. However, no FQHCs have achieved the 2014 standards yet, while about 80% of PCMH providers have achieved the 2011 standards. These cuts would equal $30 million in lost funding for primary care providers. The new rate add-ons are as follows:
Effective April 1, 2015
NCQA Level 2 2011/2014 Standards
NCQA Level 3 2011/2014 Standards
Medicaid Managed Care Per Member Per Month
$2/$6
$4/$8
Medicaid Fee-for-Service Per Visit
$7.75/$23.25
$12.50/$25.25
The Medicaid Managed Care Per Member Per Month (PMPM) add-on for PCMH recognition under the 2011 standards has been reduced by $2 for Level 2 and Level 3.
The Medicaid Fee-for-Service per-visit add-on for PCMH recognition under the 2011 standards has been reduced by $3.50 for Level 2 recognition and by $4.25 for Level 3 recognition.
Effective April 1, 2015, rate add-ons for PCMH Recognition under the 2008 NCQA standards have been eliminated. For full details, see the February issue of Medicaid Update here.
CHCANYS needs your help to delay these changes until April 2016, which would allow providers the additional time needed to achieve recognition under the 2014 standards. In partnership with the Primary Care Development Corporation, CHCANYS has sent a letter to Health Commissioner Howard Zucker and the Governor to express our serious concerns about the potential impact of these changes. However, we have a limited window to ask the legislature to include a delay in the FY 2015-2016 budget. We need you to take action to ensure the legislature understands the impact these changes have on their communities.
Please send this letter, including the impact of the cuts on your health center, to your legislators immediately and keep us informed regarding your progress. If you have any questions, please e-mail Beverly Grossman at bgrossman@chcanys.org.