The 2024-2025 NYS budget includes an increase in PCMH incentive payments:
- $4 PMPM for children under 21
- $2 PMPM for adults
These increases are retroactive to April 1, 2024, and have now been approved by CMS. The state is working to distribute retroactive payments.
Starting April 2025, these increases will be tied to Social Care Networks (SCNs). To maintain the increased incentive, PCMH-recognized providers must attest to having a workflow in place for referring patients to SCNs.
- The process is straightforward: no submission or approval of workflows is required—providers simply attest that a workflow exists.
- SCNs will not validate referrals; the attestation alone is sufficient.
The state will send an email with a link to the attestation form to the NCQA contact on file for each health center. Now is a good time to ensure those contact details are accurate. The form will also be available on the Health Commerce System (HCS).
While attestations are required for each site, DOH has confirmed that submissions can be completed simultaneously for all sites.
Additionally, claims will now include patient ages, making it easier to verify that the correct payment amounts are being received. For more information, please review the October Medicaid Update.