Medicaid Primary Care Rate Increase (PCRI)
Final Managed Care Primary Care Rate Increase Payment
Please be advised that the Medicaid Primary Care Rate Increase (PCRI) program ended December 31, 2014. A final PCRI Physician's Attestation List has been updated to the Department of Health website and should be used by plans and providers to complete a final Managed Care reconciliation for any outstanding claims from January 2013 - December 2014. Medicaid Managed Care plans will have until June 30, 2015 to submit a final reconciliation to the Department. Final reconciliations should be submitted electronically to the following address bmcr@health.ny.gov. Any reconciliations received after this date will not be processed. Thank you.
Provider List
In order to receive the PCRI, qualified providers must attest that they meet the requirements of the regulation. The attestation instructions and enrollment forms for physicians, nurse practitioners, and midwives can be found at www.emedny.org/info/ProviderEnrollment.
As provider attestations are filed and approved, updates will be posted to this site. If you would like to be notified of these updates, please sign up for the Listserv below.
April 2015 final update list of providers
Additional Information
- PCRI PowerPoint: Qualification, Attestation and Payment (PDF, 1MB)
- Frequently Asked Questions (FAQs) (PDF)
- CMS Rule (released November 2012)
- 3/31/14 CMS Q&A´s
- Additional Questions and Answers on §1202 Primary Care Payments
- Listserv (information updates)
- Managed Care
- Policy & Procedure Documentation
- NYSDOH PCRI Quarterly Submission Revised 2014 (EXCEL, 130KB)
- Schedule for PCRI Final Rev. 9-17-14
January 23, 2014
Updated Managed Care Payment Schedule
The managed care payment schedule has been updated to reflect a delay in PCRI funding for managed care plans. The delay is due to the Department working with CMS to secure federal funding and our actuary to set the base rates. The Department´s anticipated payment date for Q1-Q3 2013 is May 30, 2014. Any questions can be addressed to the Bureau of Acute Care and Rate Setting at BMCR@health.state.ny.us. We appreciate your patience as this process has been met with unanticipated delays.
December 16, 2013
Primary Care Rate Increase Retroactive Payments Now Available
Fee for service payment of the Primary Care Rate Increase began within payment cycle 1872 (July 4, 2013). Fee for service retroactive payment of the Primary Care Rate increase will begin with payment cycle 1893 (November 21, 2013). eMedNY will reprocess fee for service claims for dates of service on and after January 1, 2013 at the increased rate to providers who submitted complete attestations.
July 15, 2013
Medicaid Primary Care Rate Increase is Here!
New York State received State Plan Amendment (SPA #13-04) approval on May 30, 2013 from CMS to implement the PCRI. Fee for service payment began within payment cycle 1872 (July 4, 2013).
Further information on managed care implementation will be forthcoming.
Additional Resources:
- PCRI Fee Schedules
- PCRI FAQ´s, webinar presentation and attestation form
- Fee-for-service Medicaid billing assistance: CSC, (800) 343-9000.
