FAQ Directory

Yes, if the pediatric practice conducts postpartum depression screening during an infant care visit, the practice may receive credit for this diagnostic. The practice does not necessarily have to create a new patient record, nor store the results of the screening in the infant’s record, so long as it can provide the required documentation to NCQA. 

No, practices do not pay an additional fee for PCMH PRIME Certification.

Practices seeking NCQA PCMH 2017 Recognition and PCMH PRIME Certification concurrently are charged only the standard NCQA PCMH Recognition application fee. Applying to these programs concurrently may make your practice eligible for a discount on PCMH 2017 Recognition; please contact GRIP Staff, pcmh-grip@ncqa.org for more information. Practices seeking PCMH PRIME Certification only, to supplement a previously achieved PCMH Recognition, are not billed for the PCMH PRIME survey.

Note: If a practice fails to achieve PCMH PRIME in two attempts, the HPC reserves the right to require the practice to cover the cost of additional attempts.

• Accreditation Process and Timeline: Key steps, timing and resources for a successful accreditation.
• Standards and Guidelines: The complete standards and guidelines, including the intent and scope of review.
• Interactive Survey Tool: Contains the complete standards and guidelines; you can also determine your organization’s survey readiness—the tool calculates your potential survey score.

HP 2020

As practices obtain PCMH PRIME Certification, or make a commitment to doing so (thereby receiving “Pathway to PCMH PRIME” status), their names are posted on this website. 

The program is open to practices in Massachusetts currently recognized as: 

• NCQA PCMH 2011, Level 2 or 3. 
• NCQA PCMH 2014, Level 1, 2 or 3. 
• NCQA PCMH 2017

A practice that is working toward NCQA Recognition may apply for the PCMH PRIME program and NCQA PCMH recognition concurrently. 

PCMH PRIME is a site-specific certification program.  Unless otherwise noted in the PCMH PRIME Standards and Guidelines, practices must submit site-specific evidence.  For some of the PCMH PRIME criteria, practices that are part of a multi-site organization can share the same evidence.  Please see the PCMH PRIME Standards and Guidelines for specific details regarding which evidence can be shared across practice sites.  

Massachusetts practices may apply for PCMH PRIME Certification at any time; there is no application submission deadline. Practices may apply for PCMH PRIME Certification at the same time as they are renewing or sustaining their NCQA PCMH Recognition, or they may apply for PCMH PRIME as a separate program at any time. 

On September 30, 2017, the HPC released an updated set of PCMH PRIME standards with the aim of aligning with NCQA’s PCMH 2017 program. Beginning November 17, 2017, all practices seeking PCMH PRIME Certification will apply through a new NCQA survey platform (Q-PASS) and will be subject to these modified standards. The 2017 version of the PCMH PRIME standards can be found in the NCQA store and a summary of the differences between 2016 and 2017 PCMH PRIME standards can be found on the HPC website.

 
Additionally, practices that seek 2017 PCMH Recognition and PCMH PRIME concurrently will have an integrated review process with NCQA, which may include both submitting documentation to NCQA and going through their new “virtual review” process.  Practices that seek only PCMH PRIME Certification (after having already achieved PCMH Recognition) will upload all evidence to Q-PASS, with no virtual reviews. 

 
While NCQA PCMH 2017 Recognition requires an annual review process to maintain recognition, at this time, PCMH PRIME remains a 3-year certification.  

Behavioral health conditions (mental illnesses and substance use disorders) suffer from both under-diagnosis and delayed diagnosis. This is a serious public health problem nationally and across the Commonwealth. Untreated behavioral health conditions contribute to morbidity and increase the total cost of care. The gap in care and treatment for behavioral health conditions requires action and a coordinated effort by providers and payers to ensure that patients get the care they need, before illness is severe and results in a crisis situation (e.g., avoidable ED visit or inpatient admission). Integrating behavioral health—including appropriate screening for behavioral health conditions (and treatment, when appropriate)—is critical in the primary care setting.   

Practices seeking PCMH PRIME Certification must submit documentation to NCQA for review or participate in an NCQA virtual review.  NCQA reviewers evaluate the evidence to determine whether the practice has met the PCMH PRIME criteria.  NCQA provides its assessment to the HPC.  Based on this assessment, the HPC then scores the practice and determines whether it has met PCMH PRIME Certification requirements.

Some practices seeking PCMH PRIME Certification may be designated by the HPC as on the “Pathway to PCMH PRIME.”  Practices qualify for Pathway to PCMH PRIME status if they are currently NCQA PCMH Recognized (at any level except PCMH 2011 Level 1) and commit to applying to NCQA for PCMH PRIME Certification within 18 months of submitting a PCMH PRIME application to the HPC.

There is no minimum threshold required for PP 06-PP 11. PCMH PRIME standards require practices to report numerators and denominators for review, but we will not be looking for a specific threshold percentage.