New York

New York State has been a national leader in medical home activity and currently has the largest number of regional, multi-payer PCMH initiatives. In 2009, the New York State Assembly authorized two medical home demonstration projects - a multi-payer Medical Home Demonstration in the Adirondack region and a statewide Medicaid PCMH demonstration. In July 2010, Article 5, Title 11 of the New York State Social Services Law, Section 364-m gave the Commissioner of Health the authority to establish a Statewide PCMH program whereby providers who are recognized by the NCQA are eligible to receive additional payments for services provided to Medicaid FFS and managed care enrollees. Preliminary analyses conducted by the NYSDOH indicate that MMC enrollees assigned to a provider within a PCMH have higher quality of care and outcomes as defined by standardized measures of quality. In addition, clinical areas where PCMH providers were initially underperforming such as appropriate antibiotic prescribing, have improved from 2010 to 2011. The Commissioner of Health has the authority to continue the Adirondack program until March 31, 2014. A recent budget request will extend the statewide program until March 31, 2016. 

Primary Care Innovations and PCMH Activity

Dual Eligible 2703 SPA CPC CPC+ PCMH QHP PCMH Legislation Private Payer

Multi-Payer Programs

Program Name Payer Type Coverage Area Parent Program Outcomes
Adirondack Medical Home Pilot Multi-Payer Clinton, Essex, Frankling, and Hamilton counties Multi-Payer Advanced Primary Care Practice (MAPCP)
Hudson Valley Comprehensive Primary Care Initiative Multi-Payer Capital District - Hudson Valley CMS Comprehensive Primary Care Initiative
Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration - New York Multi-Payer Adirondack region Multi-Payer Advanced Primary Care Practice (MAPCP)
North Hudson-Capital Region (NY) Comprehensive Primary Care Plus Multi-Payer Albany County, Columbia County, Dutchess County, Greene County, Montgomery County, Orange County, Rensselaer County, Saratoga County, Schenectady County, Schoharie County, Sullivan County, Ulster County, Warren County, Washington County CMS Comprehensive Primary Care Plus (CPC+)

Public Payer Programs

Program Name Payer Type Coverage Area Parent Program Outcomes
Bronx Behavioral Health Integration Project (Bronx-BHIP) Grant CMS Health Care Innovation Award (Round 2)
CMS State Innovation Model (SIM) Test Award - New York Grant Statewide CMS State Innovation Model (SIM)
Fully Integrated Dual Advantage (FIDA) Medicare, Medicaid Bronx, Kings, Nassau, New York, Queens, Richmond, Suffolk, Westchester Counties CMS Dual Eligible Demonstration
Hospital-Medical Home (H-MH) Demonstration Program Medicaid Statewide Medicaid Section 1115 Waiver
Institute for Family Health PCMH Program Medicaid Manhattan and Hudson Valley, NY
Medicaid Redesign Team (MRT) reforms Medicaid Statewide Medicaid Section 1115 Waiver
Montefiore ACO - CMS Pioneer ACO Medicare New York City Area CMS Pioneer ACO
New York Delivery System Reform Incentive Payment (DSRIP) Program Medicaid Medicaid Section 1115 Waiver
New York Health Homes Medicaid Statewide ACA Section 2703 Health Homes
NewYork-Presbyterian Regional Health Collaborative Medicaid, Other Manhattan and Hudson Valley, NY
P2 Collaborative Grant Western New York Aligning Forces for Quality
Parachute NYC: Mental Health Treatment - Fund for Public Health in New York, Inc Grant New York City CMS Health Care Innovation Award (Round 1)
Primary Care Information Project (PCIP) Medicaid
PTN - New York State Practice Transformation Network (NYSPTN) Grant Transforming Clinical Practices Initiative (TCPI)
Transforming Primary Care Delivery Project - Finger Lakes Health System Grant Rochester Area CMS Health Care Innovation Award (Round 1)

State Legislation

Legislation Status Year
Article 5, Title 11 of the New York State Social Services Law, Section 364-m

The law gave the Commissioner of Health the authority to establish a Statewide PCMH program whereby providers who are recognized by the NCQA are eligible to receive additional payments for services provided to Medicaid FFS and managed care enrollees.

Active 2010

State Facts:

Population:
19,518,100
Uninsured Population:
9%
Total Medicaid Spending FY 2013: 
$54.4 Billion 
Overweight/Obese Adults:
61.3%
Poor Mental Health among Adults: 
35.1%
Medicaid Expansion: 
Yes 

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