Effective July 1, 2010, the New York State Department of Health (DOH) implements its Patient-Centered Medical Home Incentive Program, an initiative to incentivize the development of health care settings that facilitate partnerships between patients and their physicians. The program's overall goal is to increase quality and improve health outcomes for persons enrolled in New York Medicaid.

To qualify, providers must be recognized by the National Committee for Quality Assurance (NCQA) as a patient-centered medical home. The NCQA has established three levels of recognition. The level at which the provider is recognized depends upon their ability to meet standards set forth by NCQA's Physician Practice Connections - Patient-Centered Medical Home Program (PPC-PCMH). These standards, which promote improved coordination of care and communication between patients, providers, and staff, include:
  - Access and Communication
  - Patient Tracking and Registry Functions
  - Care Management
  - Patient Self-Management Support
  - Electronic Prescribing
  - Test Tracking
  - Referral Tacking
  - Performance Reporting and Improvement
  - Advanced Electronic Communications

Fidelis Care primary care providers who are recognized by the NCQA as a patient-centered medical home will be eligible for a per member, per month (PMPM) enhanced payment.
  - Providers recognized as Level 1 will receive an enhanced payment of $2 PMPM.
  - Providers recognized as Level 2 will receive an enhanced payment of $4 PMPM.
  - Providers recognized as Level 3 will receive an enhanced payment of $6 PMPM.

It is not necessary to notify Fidelis Care of your NCQA recognition status since that will be provided directly to Fidelis Care by the Department of Health through the NCQA on a monthly basis.

All enhanced payments by Fidelis Care will be made as a pass through payment on a quarterly basis, funded by the State of New York. Initial payments and continued enhanced reimbursement are strictly predicated upon the receipt of funding from the State. Once funding is received, payments will be retroactive to July 1, 2010. Fidelis Care providers not recognized by the NCQA or not listed by the Department of Health on the monthly listing of recognized providers will not receive an enhanced payment for that month.

For information about the patient-centered medical home recognition process, visit the NCQA Web site at NCQA.org, or contact NCQA Customer Support at 1-888-275-7585. For information about Fidelis Care's participation in the program, call the Provider Call Center at 1-888-FIDELIS (1-888-343-3547).