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Patient-Centered Specialty Practice (PCSP) Clinician Eligibility

Frequently Asked Questions

Q: Who is eligible for PCSP recognition?

A: All types of medical specialties or subspecialties are eligible, including specialists who see patients infrequently, those who see patients for a short episode of care and those who provide care for chronic diseases or extended illnesses.

  • Eligible clinicians who typically receive referrals from PCPs and other non-primary care specialists, and can demonstrate a capability to meet the standards, are eligible, including non-primary care specialty doctors of medicine, doctors of osteopathy, nurse practitioners, physician assistants, certified nurse midwives and the following behavioral healthcare practitioners:
    • Doctoral or master’s-level psychologists who are state certified or licensed
    • Doctoral or master’s-level clinical social workers who are state certified or licensed
    • Doctoral or master’s-level marriage and family counselors who are state certified, registered or licensed by the state to practice independently.
  • Physician assistants, certified nurse midwives and nurse practitioners are eligible to be listed on NCQA’s Web site as providers if they have their own panel of patients.

Q: Why doesn’t PCSP include other health care professionals?

A: NCQA’s research suggested a focus on medical specialty practices and clinicians, not the broader health care community. This decision was supported by the PCSP Advisory Committee, NCQA’s Leadership and Board of Directors.

  • Medical specialists were the original target of the program in alignment with both ACP’s and AHRQ’s whitepapers. ACP placed a strong emphasis on establishing PCP-specialist agreements and on identifying the types of relationships between primary care and specialists.
  • Some advisory committee members suggested beginning with a narrow focus for this program and possibly, at a later time, expanding or developing another program for the broader healthcare community.
  • Research suggests that payers are vitally interested in reducing the costs associated with over-use of services, unnecessary referrals to specialists, timely transitioning of patients back to the PCP and patient safety issues associated with medication management.
  • There is a strong imperative to link mental health with primary care and to encourage coordination of care and communication between primary care and mental health providers

Q: Are Doctors of Chiropractic (DCs), Doctors of Optometry (ODs) or Doctors of Podiatric Medicine (DPM) eligible?

A: No. Chiropractors, Optometrists, Podiatrists are not eligible for the PCSP program.

  • Only the above listed clinicians are eligible for PCSP.
  • NCQA has been encouraged to develop a program that evaluates the relationship between primary care and the broader healthcare community. The PCSP program requirements are specifically focused on the coordination of care and collaboration between primary care practices and specialty practices.
  • A program that allows an even broader range of health care professionals to apply would require significantly modified criteria.