Posted Jun 22, 2026
PHSP and Medicare 2025 and 2026 changes
We encourage you to review each section carefully and explore the links provided for full details.
| Program Parameter | Change |
|---|---|
| Measure-Specific Incentives | |
| Tier 1 | Adjusted down by 75% |
| Tier 2 | Adjusted down by 25% |
| Overall Quality Score (OQS) | |
| 5 | No reduction |
| 4.5 | PMPM adjusted from $12.50 to $11.25 |
| 4 | PMPM adjusted from $6.50 to $5.50 |
| 3.5 | PMPM adjusted from $1.50 to $1.15 |
| 3 | PMPM adjusted from $0.50 to $0.40 |
| Program Parameter | Change |
|---|---|
| Cutpoints | |
| Follow-Up After Emergency Room Visit for Mental Health | 5 score increased from 69% to 79% |
| Follow-Up After Emergency Room Visit for Substance Abuse | 5 score increased from 48% to 56% |
| Eye Exam for Patients with Diabetes | 5 score increased from 70% to 72% |
| Glycemic Status Assessment for Patients with Diabetes | 5 score increased from 82% to 84% |
| Cervical Cancer Screening | 5 score increased from 74% to 79% |
| Well-Child Visit 0-30 Months | 5 score increased from 84% to 86% |
| Measure Weights | |
| Initiation and Engagement of Substance Use Disorder: Engagement | Weight increased from 1 to 2 |
| Breast Cancer Screening | Weight decreased from 1 to 0.5 |
| Colorectal Cancer Screening | Weight decreased from 1 to 0.5 |
| Chlamydia Screening | Weight decreased from 1 to 0.5 |
| Well-Child Visit 3-21 | Weight decreased from 1 to 0.5 |
| Overall Quality Score (OQS) | |
| 5 | PMPM adjusted from $18.00 to $15.30 |
| 4.5 | PMPM adjusted from $16.00 to $12.80 |
| 4 | PMPM adjusted from $9.00 to $6.30 |
| 3.5 | PMPM adjusted from $2.50 to $0.65 |
| 3 | PMPM adjusted from $0.50 to $0.10 |
| 2.5 | PMPM adjusted from $0.25 to $0.05 |
| Cutpoints Added | 2 Score | 3 Score | 4 Score | 5 Score |
|---|---|---|---|---|
| Adult Access to Care | 47% | 60% | 71% | 84% |
| Med Adherence – High Risk | Target Rate 1 | Target Rate 2 | Target Rate Payment 1 | Target Rate Payment 2 |
|---|---|---|---|---|
| Cholesterol | 79% | 84% | $75.00 | $100.00 |
| Diabetes | 81% | 86% | $75.00 | $100.00 |
| Hypertension | 76% | 82% | $75.00 | $100.00 |
| Cutpoints Added | 2 Score | 3 Score | 4 Score | 5 Score |
|---|---|---|---|---|
| Adult Access to Care | 82% | 89% | 93% | 95% |
