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Auto Credit: Patient-Centered Medical Home (PCMH) 2011/2014 to Patient-Centered Specialty Practice (PCSP) 2016 Policy, FAQs and Selected Elements and Factors

~ How can practices use PCMH Recognition toward PCSP Recognition? ~

POLICY

1. Organizations with both primary care and specialty practices and that have practices with PCMH Level 2 or Level 3 Recognition may use auto credit for selected elements in PCMH to streamline the Recognition process for PCSP 2016.  

2. To receive auto credit, PCMH and PCSP practices/clinicians within the same organization must share the same electronic systems and use the same policies and procedures or documented processes. 

 

Frequently Asked Questions (FAQs)

Question

Answer

1. If a practice is applying for PCSP 2016 Recognition and is in the same organization as a practice with already has PCMH Recognition, what auto-credit may be applied to PCSP? 

1. The practice is allowed to attest to a maximum seven (7) elements from PCMH (2011 or 2014) in PCSP 2016. However, several factors within these seventen elements are not available for auto credit because they are specific to PCSP, and not to PCMH, or they are required at the site level and must be reported for each practice site. 

(See the table below for details of the seven (7) elements and their associated factors.)    

2. Is there a time limit?

 

2. Attestation for auto credit in a second Recognition must occur within the 3-year Recognition period but not within the last three (3) months of their Recognition.

3. Which elements are eligible for auto credit?

3.Seven (7) PCMH elements are eligible to be used as auto credit in PCSP 2016:

  • For PCMH 2011, the elements are PCMH 1C, 1F, 2A, 2B, 3E, 5A, 6E.
  • For PCMH 2014, the elements are PCMH 1C, 2C, 3A, 3B, 4D, 5A, 6F.
  • Refer to the table below for a list of the elements that may be used for auto credit.
  • Please note that some factors within these elements cannot be used for auto credit.

4. What is the process for using the auto credit option?

4. The practice responds “yes” in the PCSP survey for the auto credit eligible factors and provides an attestation:

  • In the Organizational Background tab of the PCSP 2016 ISS survey tool, the practice will attest to the following for each eligible element:

“[Name of practice] previously achieved NCQA Level 2 or Level 3 Recognition as a patient-centered medical home and attests that the responses to the eligible factors for this element reflect the current operations of the practice site. Documentation to support these responses can be provided on request.”

  • · The practice must be able to provide documentation for the auto credit elements if it is selected for audit.

5. Can any data or documentation be transferred from a PCMH Survey Tool to the new application for PCSP 2016?

5. No, NCQA is not able to transfer data from one type of Survey Tool to the other because of the differences in the Standards, Elements and Factors.


[6 standards, 26 elements, 164 factors]

Multi-Site – Multi-Specialty

PCMH 2011

PCMH 2014

Available for Auto Credit in PCSP 2016

 

Auto Credit with Attestation

PCSP 1: Working With Primary Care and Other Referring Clinicians

 


Element A: Establishing Relationships with Primary Care and Other Referring Clinicians

 

 

 

Element B: Managing Initial Referrals (Must-Pass)

 

 

 

Element C: Assessing Initial Referral Content

 

 

 

Element D: Assessing Initial Referral Response (Must-Pass)

 

 

 

Element E: Transitions Back to Primary Care

 

 

 

Element F: Connecting Self-Referred Patients with Primary Care

 

 

 

PCSP 2: Provide Access and Communication

 


Element A: Access

 

 

 

Element B: Electronic Access


PCMH 1C

PCMH 1C

PCSP 2B

Element C: Specialty Practice Responsibilities

 

 

 

Element D: Culturally & Linguistically Appropriate Services (CLAS)

PCMH 1F

PCMH 2C

PCSP 2D

PCMH 2011: Factors 2-4

PCMH 2014: all factors

Element E: The Practice Team (Must-Pass)

 

 

 

PCSP 3: Identify and Coordinate Patient Populations

 


Element A: Patient Information

PCMH 2A

PCMH 3A

PCSP 3A

PCMH 2011: Factors 1-8,10-11

PCMH 2014: Factors 1-11, 13

Element B: Clinical Data

PCMH 2B

PCMH 3B

PCSP 3B

PCMH 2011: Factors 1-9
PCMH 2014: all Factors

Element C: Implement Evidence-Based Reminders for Specialty Care

 

 

 

Element D: Implement Evidence-Based Decision Support

 

 

 

PCSP 4: Plan and Manage Care

 


Element A: Care Planning and Support Self-Care

 

 

 

Element B: Medication Management (Must-Pass)

 

 

 

Element C: Use Electronic Prescribing

PCMH 3E

PCMH 4D

PCSP 4C
PCMH 2011: all factors
PCMH 2014: Factors 2-5

PCSP 5: Track and Coordinate Care



Element A: Test Tracking and Follow-up (Must-Pass)

PCMH 5A

PCMH 5A

PCSP 5A
PCMH 2011 & 2014: Factors 1, 3-11

No credit is given for this element without meeting Factor 2 as it is a

*critical factor*

Element B: Referral Tracking and Follow-up

 

 

 

Element C: Coordinate Care Transitions

 



 

PCSP 6: Measure and Improve Performance



Element A: Measure Performance

 

 

 

Element B: Measure Patient/Family Experience

 

 

 

Element C: Implement & Demonstrate Continuous QI (Must-Pass)

 

 

 

Element D: Report Performance

PCMH 6E

PCMH 6F

PCSP 6D

Element E: Use Certified EHR Technology

 

 

 


7 PCMH elements may be used for auto credit

Some elements will be limited to specified factors

 

Updated 10/11/2016