Resource Directory of Incentives for NCQA Recognition
Updated August 2023
|Organization||Programs Supported||Type of Support||Program Description|
ACHN is a care management system that requires Primary Care Physicians to participate with an ACHN entity in the region where the PCP practices. PCP practices that achieve PCMH Recognition will receive a five percent bonus payment.
Program incentivizes care that improves both health outcomes and coordination in the health care delivery system. Recognized PCMH practices in the APM model will be awarded “credit.”
DSS PCMH program for practices serving Medicaid members
Available for FQHCs and private practices. Practices that receive the PCMH designation are eligible for enhanced reimbursements. Practices also receive state-funded practice transformation support.
DC has two Health Home Programs to serve populations with chronic conditions. PCMH Recognition is a requirement for practices to enroll in Health Home.
Providers paid at Medicare rate; many MMA plans use PCMH certification as a qualification for the Physician Incentive Program however plans can determine the model they want to use (state’s or their own).
Provider incentives available to support costs to transform and sustain PCMH recognition.
Recognized practices can be considered Tier 1 or Tier 2 PCMHs and plans develop a reimbursement methodology that provides higher payment to the more advanced Tier 2 PCMH.
Tiered payment structure where the higher tiered payment is based on various factors including a practice’s PCMH Recognition.
Chronic Condition Health Home Program focused on whole-person, patient-centered, coordinated care for all stages of life and transitions of care. NCQA PCMH is required to become a Health Home.
Health Homes are a partnership between an enhanced Health Home primary care practice and one of ten Community Care Teams around the state. Both organizations receive a PMPM payment for Health Home services provided to MaineCare members who have two chronic conditions, or one chronic condition and at risk for another. Health Home services include care coordination, case management, individual and family support, and health promotion/education.
As of 2019, the HPC adopted the NCQA Distinction in Behavioral Health Integration as the standard for certifying Massachusetts primary care practices as PCMHs.
Participants will receive quarterly payments for attributed eligible Medicaid beneficiaries; two types of payments are available – Care Management and Coordination and Performance Incentive Plan
Provides intensive care coordination and care management as well as addresses social determinants of health for a medically complex population. NCQA PCMH Recognition is required to receive financial incentives.
Practices receive an enhanced PMPM for receiving national recognition
Practices that participate in NYS PCMH transformation may be eligible to receive supplemental payments ($6 PMPM payment for eligible clinicians) through State Medicaid PCMH Incentive Program.
PCPCH deems NCQA PCMH for select requirements.
Supplemental PMPM payments designed to drive practice transformation and quality improvement, and apply for national PCMH recognition.
Increased PMPM provided for PCMH recognition
Providers are compensated for supporting the initial start-up requirements of becoming a PCMH and for performing required new activities. Providers are also eligible for bonus payments for improvements in the quality and efficiency of the care they provide.
Texas Healthcare Transformation and Quality Improvement Program (aka Texas DSRIP)
Provides incentive payments to hospitals, physician practices, community mental health centers and local health departments to support their efforts to enhance access to health care, the quality of care, and the health of patients and families served. The waiver extended through September 2022. NCQA PCMH identified as desired model.
Eligibility requirements include achieving NCQA PCMH recognition; enhanced PMPM is tied to actual NCQA PCMH Recognition scores.
Pays an additional PMPM case management fee to primary care practitioners that meet certain requirements including NCQA PCMH Recognition.