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
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
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)

Private Payer Programs

Program Name	Payer Type	Coverage Area	Parent Program
Aetna Patient-Centered Medical Home (PCMH) - New York	Commercial	Statewide	Aetna Patient-Centered Medical Home Program
Cigna Collaborative Accountable Care - Mt. Kisco Medical Group	Commercial	Westchester, Putnam and Dutchess counties	Cigna Collaborative Care Program
Cigna Collaborative Accountable Care - NYUPN Clinically Integrated Network, LLC	Commercial	New York City Area	Cigna Collaborative Care Program
Cigna Collaborative Accountable Care - Weill Cornell Physician Organization	Commercial		Cigna Collaborative Care Program
EmblemHealth Medical Home High Value Network Project	Commercial	32 New York practices
Enhanced Personal Health Care Program - New York	Commercial	All counties statewide where Anthem operates	Anthem - Enhanced Personal Health Care
Rochester Medical Home Initiative (RMHI)	Commercial	Rochester area
UnitedHealthcare Patient-Centered Medical Home Program- New York	Commercial		UnitedHealthcare PCMH Program

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.	Enacted	2010
A 7230b Establishes the primary care reform commission to review, examine and make findings on the level of primary care spending by all payers in the context of all health care spending in the state and publish an annual report on the findings, and also make recommendations to increase and strengthen spending on primary care in the state and improve primary care infrastructure, taking care to avoid increasing costs to patients or the total cost of health care.	Vetoed	2022
S. 1197 Establishes the primary care reform commission to review, examine, and make findings on the level of primary care spending by all payers in the context of all health care spending in the state and publish an annual report on the findings, and also make recommendations to increase and strengthen spending on primary care in the state and improve primary care infrastructure, taking care to avoid increasing costs to patients or the total cost of health care.	Pending	2023
S.B. 1127B The bill proposes amendments to the NY State Insurance and Social Services Law, requiring plans and payors to annually report the percentage of overall healthcare spending allocated to primary care. Plans or payors reporting less than 12.5% on primary care services would need to submit plans to increase spending by 1% annually until meeting or exceeding the threshold to address underinvestment in primary care and improve overall health outcomes in New York.	Pending	2024