PCMH PRIME Certification

For Massachusetts Practices That Demonstrate the Ability to Address Behavioral Health in Primary Care

Behavioral health issues can often first identified in a primary care setting, and there is growing consensus that behavioral health should be integrated into primary care. Behavioral health conditions (mental illnesses and substance use disorders) can be exacerbated by under-/delayed diagnosis and treatment. This is a serious public health problem nationally and across Massachusetts. 

The Massachusetts Health Policy Commission (HPC), in collaboration with NCQA, developed the PCMH PRIME Certification Program, which identifies criteria that are key to integrating behavioral health care into primary care and certifies practices that meet a majority of these criteria.

Benefits of PCMH PRIME Certification

PCMH PRIME promotes best practices for integrating behavioral health care into a patient-centered primary care setting. The program seeks to provide benefits to practices and their patients by:

  • Supporting the use of evidence-based guidelines in treating patients.
  • Helping increase patient access to behavioral healthcare services. 
  • Recognizing practices that deliver comprehensive care by addressing both physical and behavioral health in the practice setting. 
  • Providing opportunities for practices to receive technical assistance from the HPC. 
  • Helping practices identify behavioral health issues before they become acute, resulting in better outcomes and improved patient experience. 

Program Requirements

Practices meet PCMH PRIME criteria by demonstrating capabilities in a majority of the following areas: 

  • Behavioral Health Integration: Integration of behavioral health through formal agreements, co-location or provider integration. 
  • Comprehensive Health Assessment: Comprehensive health assessments that include screenings for behavioral health conditions, such as depression, post-partum depression, anxiety, developmental delays and substance use disorder. 
  • Identifying High-Risk Patients: IA system for identifying high-risk patients for targeted care management. 
  • Referral Tracking and Follow-Up: Tracking and following up on referrals to specialists, including behavioral healthcare providers. 
  • Evidence-Based Decision Support: Using evidence-based guidelines to make decisions about support for mental health and substance use disorders.
  • Addiction Treatment: Medication-assisted treatment for addiction. 

Practice Eligibility 

  • Practices must be located in the Commonwealth of Massachusetts. 
  • Practices must have NCQA PCMH Recognition (any year/level except PCMH 2011 Level 1).
  • Practices must complete and submit an application to the Massachusetts Health Policy Commission
  • Practices must submit documentation to NCQA for evaluation on the PCMH PRIME behavioral health criteria. Practices are not charged for PRIME review. 
  • Practices must meet at least 7 of 13 criteria to achieve PCMH PRIME certification.

Getting Started 

Interested in attaining PCMH PRIME Certification? Here’s how you get started: 

First, go to the HPC’s website to complete a short application indicating your practice’s intent to pursue PCMH PRIME. Practices can also request HPC technical assistance with building capabilities specific to the PCMH PRIME program. 

Once your practice has submitted the HPC application and is ready for next steps with NCQA, you can take one of two paths: 

  • If you are an NCQA PCMH Recognized Practice: Go to your Recognition Program (RP) Portal and select Request an Add-On. In the pop-up window, select the add on you want: 
    • NCQA PCMH upgrade + HPC PRIME (If you would like to submit an application for PCMH PRIME Certification and are a Level 1 PCMH, you must also upgrade to Level 2 or Level 3 in order to qualify for PMCH PRIME) 
    • HPC PRIME only (You may select this option if you are a Level 2 or Level 3 PCMH). 
  • Practices not currently recognized as an NCQA PCMH: You must attain NCQA PCMH Recognition (any year/level except PCMH 2011 Level 1).

PCMH PRIME Alignment with NCQA’s PCMH 2017 Program

The HPC is working with NCQA to determine the implications of the new 2017 PCMH Recognition program on PCMH PRIME.  Please see the HPC Website for  more information.

Questions? 

Have more questions? Check out additional PCMH PRIME resources: the Standards and Guidelines FAQs for more information on eligibility and getting started or visit my.ncqa.org to ask a question and a representative will get back to you shortly.

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