ABOUT THE DEPARTMENT
We ensure that New Mexicans attain their highest level of health by providing whole-person, cost-effective, accessible, and high-quality health care and safety-net services.
Medicaid Primary Care Payment Reform
Eligibility screening and registration for New Mexico’s Medicaid Primary Care Payment Reform Value-Based Payment (PCPR VBP) Program is open! Please visit this page to complete the eligibility screen: https://nmpcpr.nethealth.com/screening-eligibility. Read all instructions carefully; the option you select from the initial drop-down menu should reflect your Medicaid billing provider type. Supported browsers for eligibility screening and registration are Microsoft Edge and Google Chrome.
Eligible practices will be directed to next steps for registration (you may review here prior to beginning registration).
In-state and Border primary care clinicians and practices (PCP) providing services that are rendered within 100 miles of the New Mexico state border (Mexico excluded) are eligible to participate in the NM PCPR VBP Program. Out-of-state PCP services that are rendered in an area more than 100 miles from the New Mexico border (Mexico excluded) are not eligible to participate.
It is expected that all primary care practices in the state participate. Practices that register by December 31, 2025 at 9:59pm are considered participating, and eligible for the incentive bonus payments, as of January 1, 2026.
This is a great opportunity for practices to receive additional reimbursement for serving your Medicaid patients!
Helpful Resources:
- PCPR VBP Program Provider Guidebook
- PCPR VBP Program MCO Guidebook
- Join the New Mexico PCPR Contact List
- New Mexico PCPR Provider FAQ
- New Mexico PCPR MCO FAQ
- New Mexico PCPR VBP Program – Provider One-Pager
- PCPR VBP Program Eligibility Criteria
- PCPR Implementation Checklist
Contact Trisstin Maroney, M.D., Innovation Program Manager (trisstin.maroney@hca.nm.gov) or Health Management Associates (NewMexicoPCPR@healthmanagement.com) if you have questions regarding the Medicaid PCPR VBP Program, including questions related to quality reporting and data submission.
Submit feedback or questions related to the design of the Primary Care Payment Reform HERE.
Primary Care Payment Reform Trainings and Events
Primary Care Payment Reform Trainings and Events
UPCOMING EVENTS:
Webinar: Preparing for the New PCPR VBP Program Year – Panel Discussion
A panel of practices will discuss what they are doing to prepare for PCPR VBP Program changes beginning in January.
- Thursday, December 11 at 2:00 p.m.
- Register HERE!
Webinar: Continuous Quality Improvement – How to Improve Performance and Receive the Maximum Bonus Payment
- Wednesday, January 21 at 2:00 p.m.
- Register HERE!
*Please note: Webinar dates and topics are subject to change as program priorities and timelines evolve.
Office Hours:
Virtual Office Hours take place every other Wednesday at noon. This is a great opportunity to get your questions answered by the PCPR VBP Program team Register Here!
NM PCPR Information and Resources for Data Collection and Reporting
Please note: Materials in this section contain the most current guidance for PCPR VBP Program data collection, submission, and analysis. As the program continues to evolve, documents in this section will be updated and should be considered your source of truth for the payment model. Information shared in previous presentations and materials was considered preliminary and subject to change.
Net Health Reporting Portal: https://nmpcpr.nethealth.com/
The PCPR VBP Program quality measure set was recently finalized. See below for a measure rollout timeline and more details on the measure set.
PCPR VBP Program Quality Measure Timeline
|
Started July 2024 Access and Reporting Measures: · Third Next Available Appointment · Patient Experience of Care · Screening, Brief Intervention, and Referral to Treatment · Encounter Acceptance Rate · Encounter Completion Rate |
January 2026 – December 2026 · 2 new structural measures · 10 new clinical quality and utilization measures – monitoring only in 2026 |
January 2027 and Beyond · Pay for performance |
PCPR VBP Program Quality Measure Set
Clinical Quality and Utilization Measures (monitoring begins in 2026)
| Measure Name | Patient Population | Clinical Relevance |
| Follow-Up After Hospitalization for Mental Illness (FUH) NCQA (HEDIS) |
Adult, Child (6+) | Behavioral health |
|
Pharmacotherapy for Opioid Use Disorder (POD) NCQA (HEDIS) |
Adult, Child (16+) | Behavioral health |
|
Controlling High Blood Pressure (CBP) NCQA (HEDIS) |
Adult | Chronic diseases |
|
Breast Cancer Screening State-defined |
Adult | Women’s health |
|
Contraceptive Care (CCW) HHS OPA |
Adult | Women’s health |
|
Adult Well-Care Visit State-defined |
Adult | Utilization |
|
30-Day All-Cause Readmission State-defined |
Adult |
Utilization
|
|
Well-Child Visits in the First 30 Months of Life (W30) NCQA (HEDIS) |
Child | Pediatric, Utilization |
|
Child and Adolescent Well-Care Visits (WCV) NCQA (HEDIS) |
Child | Pediatric, Utilization |
|
Lead Screening in Children NCQA (HEDIS) |
Child | Pediatric |
New Structural Measures (beginning 2026)
- Use of certified EHR technology and interoperability
- Quality improvement processes
Access and Reporting Measures (began 2024)
- Encounter Acceptance Rate (nothing for providers to submit)
- Encounter Completion Rate (providers submit patient visits data)
- Patient Experience of Care structural measure (will transition to outcome measure)
- Screening, Brief Intervention, and Referral to Treatment (SBIRT) structural measure (will transition to process measure)
- Third Next Available Appointment
Note: This is the final measure set as of 9/18/2025 and subject to CMS approval. Quality measures may be adjusted over time depending on performance and other programmatic considerations.
SBIRT Structural Measure Updates
The PCPR VBP Program SBIRT quality measure will be calculated with claims data using two Healthcare Common Procedure Coding System (HCPCS) procedure codes:
- Screen using Healthy Lifestyle Questionnaire: H0049
- Brief Intervention: H0050
*New Mexico Medicaid reimburses these procedure codes at a higher rate than other screening codes.
We’re aware of current challenges related to scheduling training and obtaining SBIRT certification. As a result, we’ve decided to suspend the requirement to complete SBIRT training and begin implementation
We will share additional information as it becomes available regarding updates to SBIRT training expectations and future quarterly requirements, in light of the current challenges.
The Healthy Lifestyle Questionnaire (HLQ) is available here: https://www.hca.nm.gov/wp-content/uploads/APPENDIX-Y.pdf
Materials, Recordings & Resources
Please note: The PCPR VBP Program has evolved over the past two years as a result of provider input, legislative and regulatory requirements and changes, and implementation logistics. As a result, information included in some of the recordings and materials below may be outdated.
November 5, 2025 Office Hours
Video Coming Soon !
October 28 & 29, 2025 In Person Workshops
October 15, 2025 Webinar: Understanding and Implementing Quality Measures in the PCPR VBP Program: Part 2
Video Coming Soon !
September 22, 2025 Webinar: Understanding and Implementing Quality Measures in the PCPR VBP Program: Part 1
September 3, 2025 Webinar: Attribution and Managing Your Panel
Video pending
August 21, 2025 Webinar: NM PCPR VBP Program Tier Selection and Contracting - What You Need to Know!
Office Hours June 25, 2025
June 2025 Workshop Content
Patient Experience of Care Webinar
The patient experience of care measures for the Primary Care Payment Reform Value-Based Payment Program have been announced. The program will be using a single straightforward question, with an option for additional follow up, to assess patient experience for adult and pediatric patients. View this webinar to learn more about the measure, how the data will be collected and reported, the timeline for implementation, and how you can use the data to improve your patient satisfaction scores.
Office Hours June 11, 2025
Office Hours May 28, 2025
Office Hours May 14, 2025
Office Hours April 30, 2025
Office Hours April 16, 2025
April 2025 Workshop Content
Office Hours March 19, 2025
Q1 2025 Structural Measure Planning Meeting
Office Hours March 5, 2025
SBIRT Structural Measure Webinar with Life Link Training Institute
Office Hours February 19, 2025
Office Hours February 5, 2025- SBIRT Timeline Update
Office Hours January 22, 2025- PCPR VBP Program Payment Update
Q4 2024 Structural Measure Planning Meetings
Office Hours, October 2, 2024- Eligibility Screening & Registration Demonstration
Q3 2024 Structural Measure Planning Meetings
Office Hours, October 9, 2024- Eligibility & Registration Process
Office Hours, November 20, 2024- New SBIRT Structural Measure Update!
Slide Deck – coming soon
Office Hours, October 30, 2024- Recap of data received during Q1 PE & SBIRT Planning Meetings
Office Hours, September 18, 2024- Registration Launch
Office Hours, September 25, 2024- Registration and FAQs
Office Hours, November 6, 2024- Data Reporting Reminders
Office Hours, October 23, 2024- Overview of Q2 Structural Planning Meetings
Office Hours, October 16, 2024- Q1 & Q2 Reporting
Office Hours, August 14, 2024 – Q1 Data Collection & Submission
Office Hours, August 28, 2024 – Frequently Asked Questions
Office Hours, September 11, 2024
Office Hours, July 24, 2024 – Patient Experience Planning Meetings
Report: New Mexico PCPR Provider Workshops Summary
Office Hours, July 17, 2024 - SBIRT
Office Hours, September 4, 2024
Office Hours, August 21, 2024 – Payment Calculation Plan Overview
Office Hours, July 31, 2024 – Patient Visits Data Collection
New Mexico PCPR: Virtual Provider Readiness Workshop
Net Health Portal Demonstration and Q&A Session- July 26, 2024
Updated Eligibility, Intake, and Onboarding Process & Patient Experience Measure Update
Report: New Mexico Primary Care Payment Reform Provider and Clinician Readiness Assessment
Office Hours, June 12, 2024 Slide Deck
Provider Readiness Webinar: Preparing your Practice for Redesigning Your Workflows for Value-Based Care
Primary Care Practice: Criteria for Inclusion in the PCPR
Primary Care Practice- Criteria for Inclusion in the Primary Care Model for Incentive Payments
Primary Care Provider Webinar: PCPR - Collecting and Reporting Quality Data Part 2 (5.1.24)
Office Hours, August 7, 2024 – Readiness Checklist & PCC Website Guide
Primary Care Provider Webinar: PCPR - Collecting and Reporting Quality Data Part 1 (3.20.24)
Primary Care Provider Webinar: PCPR - Internal Reporting Infrastructure (2.21.24)
- Recording of 2/21/24 webinar: Internal Reporting Infrastructure
Primary Care Provider Webinar: PCPR - Measurement Framework in Depth (1.18.24)
- Recording of 1/18/24 webinar titled Measurement Framework in Depth: Measurement Framework in Depth
Webinar Recording: - Data Collection, Analysis, and Reporting (7.2.23)
Recording of 7/20/23 webinar titled Data Collection, Analysis, and Reporting: Data Collection, Analysis, and Reporting Capabilities