New York State Department of Health (DOH) Released Updated Billing Guidance for the New York State Patient Centered Medical Home (NYS PCMH) Program

The New York State Department of Health (DOH) released updated billing guidance for the New York State Patient Centered Medical Home (NYS PCMH) program as part of the March 2026 Medicaid Update. The updated  2026 NYS PCMH Billing Guidance (Version 1) consolidates current Medicaid Managed Care (MMC) billing and payment requirements for NCQA-recognized PCMH providers, effective January 1, 2026.

Effective in 2026, NYS PCMH practices can earn the incentive enhancement by:

• Completing the SCN Referral Attestation (newly recognized PCMH practices and practices who have not completed the attestation), and
• Reporting on prescribed quality metrics for Measurement Year (MY) 2025 (1/1/2025-12/31/2025). 

For details and FAQs, please read the NYS Medicaid PCMH Billing Guidance and Policy Manual updated as of February 2026.

> View & Download the Guide