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 to 25% of original |
| Tier 2 | Adjusted to 75% of original |
| Overall Quality Score (OQS) | |
| 5 | No reduction |
| 4.5 | No reduction |
| 4 | PMPM adjusted from $9.00 to $7.65 |
| 3.5 | PMPM adjusted from $3.00 to $2.25 |
| 3 | PMPM adjusted from $0.75 to $0.25 |
| PHSP Quarterly Incentive | Target Rate | Quarterly Payment | Min Den |
|---|---|---|---|
| Controlling High Blood Pressure Q1 | 20% | $30.00 | 30 |
| Controlling High Blood Pressure Q2 | 40% | $15.00 | 30 |
| Controlling High Blood Pressure Q3 | 60% | $15.00 | 30 |
| Controlling High Blood Pressure Q4 | 76% | $30.00 | 30 |
| Glycemic Status Assessment for Patients with Diabetes Q1 | 20% | $30.00 | 30 |
| Glycemic Status Assessment for Patients with Diabetes Q2 | 40% | $15.00 | 30 |
| Glycemic Status Assessment for Patients with Diabetes Q3 | 60% | $15.00 | 30 |
| Glycemic Status Assessment for Patients with Diabetes Q4 | 76% | $30.00 | 30 |
| Program Parameter | Change |
|---|---|
| Cutpoints | |
| Follow-Up After Emergency Room Visit for Mental Illness | 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 76% 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 |
| Incentives | No changes |
| 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% | $150.00 | $200.00 |
| Diabetes | 81% | 86% | $150.00 | $200.00 |
| Hypertension | 76% | 82% | $150.00 | $200.00 |
| Cutpoints Added | 2 Score | 3 Score | 4 Score | 5 Score |
|---|---|---|---|---|
| Adult Access to Care | 82% | 89% | 93% | 95% |
