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).
It is expected that all primary care practices in the state participate. Practices that registered by December 31, 2024 at 9:59pm are considered participating, and eligible for the incentive bonus payments, as of January 1st, 2025. Practices that register by March 31, 2025 at 9:59 pm will begin participation as of April 1, 2025.
This is a great opportunity for practices to receive additional reimbursement for serving your Medicaid patients!
Helpful Resources:
- 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 Joshua Nelson (joshua.nelson@hca.nm.gov) Strategic Operations Manager, or Health Management Associates (NewMexicoPCPR@healthmanagement.com) if you have questions regarding the Medicaid PCPR VBP Program that are specific to your primary care practice, 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
UPCOMING EVENTS:
Structural Measure Planning Meetings
Quarter 1 2025 Virtual Structural Measure Planning Meetings:
As part of the criteria to qualify for the quarter 1 2025 bonus payment, a representative from each primary care practice must attend ONE Structural Measure Planning Meeting.
These are focus group-style convenings to solicit provider feedback as we design the Patient Experience of Care and SBIRT measures to be applicable to primary care practices in New Mexico.
All sessions will cover the same material and practices only need to attend one virtual session.
Register Now! Quarter 1 2025 Virtual Structural Measure Planning Meetings:
The January 23rd planning meeting is cancelled.
February 18, 2025, 12:30 p.m.- 2:00 p.m. – Register Here
Webinars
NM PCPR VBP Program: SBIRT Quality Measure Webinar
February 13, 2025, 2:00-3:00 p.m. – Register Here
Join us for an SBIRT Quality Measure webinar, where we will discuss the SBIRT quality measure and learn from the Life Link Training Institute about training and certification. This session is designed to support providers in meeting quality goals and enhancing SBIRT delivery in practice.
NM PCPR VBP Program: Patient Experience of Care Quality Measure Webinar
Postponed – New date and registration link coming soon
NEW! In-Person Workshops
Save these dates for upcoming in-person workshops:
- April 1-3: Succeeding in Tier 1 (emphasis on SBIRT and Patient Experience of Care)
- April 1 in Las Cruces
- April 2 in Albuquerque
- April 3 in Santa Fe
- May 20-22: Looking Ahead to Tiers 2 and 3 (all practices encouraged to join, even those who wish to remain in Tier 1)
- May 20 in Las Cruces
- May 21 in Albuquerque
- May 22 in Santa Fe
Detailed agendas and registration information coming soon!
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/
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. Each site must become trained and certified by Life Link Training Institute to bill New Mexico Medicaid with these two codes. Practices will receive a $7,500 incentive payment once certified in SBIRT (through June 2025).
More information about training and certification is available here: https://sbirt.lltraininginstitute.org/
The Healthy Lifestyle Questionnaire (HLQ) is available here: https://www.hca.nm.gov/wp-content/uploads/APPENDIX-Y.pdf
HCA has selected UNM to develop an adolescent SBIRT training program; launch date is not yet known. Life Link Training Institute has been approved to certify practices in SBIRT for patients ages 11-17 until the UNM certification process is implemented. The certification process is as follows:
- Attend all existing required training modules for adult certification.
- Attend an additional training module for pediatric and adolescent providers – Life Link estimates this will be available by the end of February.
Practices will not need to be re-certified by UNM, so this interim process allows providers who see patients 11+ to get adolescent and adult certification through one streamlined process.
Additionally, the SBIRT operationalization timeline has been extended based on provider feedback. The updated timeline is below.
Video: Overview of the NM Primary Care Payment Model
Presented by HCA and hosted by the New Mexico Medical Society
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 the recording below may be outdated. Please refer to materials in the “NM PCPR Information and Resources for Data Collection and Reporting″ section for the most current information on data submission.
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. Please refer to materials in the “NM PCPR Information and Resources for Data Collection and Reporting″ section for the most current information on data submission.
Q4 2024 Structural Measure Planning Meetings
Q3 2024 Structural Measure Planning Meetings
Office Hours, November 6, 2024- Data Reporting Reminders
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, October 2, 2024- Eligibility Screening & Registration Demonstration
Office Hours, October 23, 2024- Overview of Q2 Structural Planning Meetings
Office Hours, October 9, 2024- Eligibility & Registration Process
Office Hours, September 25, 2024- Registration and FAQs
Office Hours, October 16, 2024- Q1 & Q2 Reporting
Office Hours, September 4, 2024
Office Hours, September 18, 2024- Registration Launch
Office Hours, September 11, 2024
Office Hours, August 28, 2024 – Frequently Asked Questions
Office Hours, August 21, 2024 – Payment Calculation Plan Overview
Office Hours, August 14, 2024 – Q1 Data Collection & Submission
Office Hours, July 31, 2024 – Patient Visits Data Collection
Office Hours, July 24, 2024 – Patient Experience Planning Meetings
Net Health Portal Demonstration and Q&A Session- July 26, 2024
Report: New Mexico PCPR Provider Workshops Summary
Updated Eligibility, Intake, and Onboarding Process & Patient Experience Measure Update
Office Hours, July 17, 2024 - SBIRT
New Mexico PCPR: Virtual Provider Readiness Workshop
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