Payer Support (Federal, State and Commercial)

Public and commercial payers offer incentives and support for NCQA PCMH Recognition. For a list of initiatives that require or recognize NCQA PCMH Recognition, please refer to NCQA’s Resource Directory of Incentives.  

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) 

MACRA replaces the Sustainable Growth Rate (SGR) formula for how the Centers for Medicare & Medicaid Services (CMS) pays clinicians caring for Medicare beneficiaries in the traditional Medicare program. 

MIPS and NCQA Recognition
Becoming an NCQA-Recognized PCMH or PCSP directly increases clinician payments through the Merit-Based Incentive Payment System (MIPS). 

• Clinicians in NCQA-Recognized PCMHs/PCSPs receive automatic full credit in the MIPS Improvement Activities category. 
• Clinicians in NCQA-Recognized PCMH and PCSP practices will likely do well in other MIPS categories. 
• NCQA Recognition can also benefit practices in APMs. 

Learn more about how NCQA Recognition can help you achieve your goals for MACRA. 

Public Sector Initiatives 

States continue to use the medical home model to promote primary care through various public sector programs, including federally-run initiatives such as Comprehensive Primary Care Plus, State Innovation Models, health homes and Delivery System Reform Incentive Payment Programs. As of March 2017, more than 20 public sector initiatives require or recognize NCQA PCMH Recognition. 

• 12 states mandate NCQA PCMH for participation in their programs. 
• 10 states require PCMH recognition – NCQA PCMH is accepted as meeting this requirement.