FAQ Directory

Yes, this criterion may be met through tele-behavioral health services if the behavioral health care provider has at least partial access to the practice’s systems. To meet this criterion through tele-behavioral health, the off-site BH provider must provide BH treatment to patients. Remote coordination of behavioral health needs is not sufficient to meet this criterion.

No. Care managers must be able to serve any patient within a practice, not just patients from specific payers. The aim of PCMH PRIME Certification is to encourage coordinated, team-based care for all patients, regardless of payer status. To that end, criterion PP 01 can only be satisfied through use of care managers whose services are made available to patients based on need and not payer type.

The PCMH PRIME Standards and Guidelines include a list of qualifying behavioral health providers for these criteria under PP 03 guidance.  To satisfy criteria PP 03 and PP 04, practices must coordinate with or integrate with providers that provide behavioral health treatment to patients. Staff that only identify and coordinate behavioral health needs and do not treat patients are not sufficient for these factors, but may be used to meet criterion PP 01.

Yes. A practice may satisfy criterion PP 02 by having a prescribing clinician who is accessible through telehealth,  provided that the clinician is integrated into the practice’s workflow for MAT (e.g., can exchange patient information with the practice site, as appropriate).

The intent of the requirement is that the denial or appeal notice be written in language that can be easily understood by members. Because abbreviations/acronyms may include terms that are not easily understood, even when spelled out, they must be explained. NCQA is updating the explanation under each applicable factor of the referenced elements to read:

NCQA will post an update in December for the 2018 and 2019 HP and UM-CR-PN and 2018 MBHO publications to reflect this change.

HP 2019

NCQA does not prescribe a frequency; practices determine the time frame for conducting and updating patient health assessments according to a protocol that suits their patient population, aligns with evidence-based guidelines and allows for meaningful evaluation of data.

NCQA is not prescriptive regarding which depression screening tool is used as long as it’s a standardized tool. Some depression screening tool examples that would be appropriate for adolescents include but are not limited to PHQ2, PHQ9, PHQ-A, PSC, PSC-Y, RAAPS, or HEADSS. 

NCQA does not prescribe a frequency; practices determine the time frame for conducting and updating patient health assessments according to a protocol that suits their patient population, aligns with evidence-based guidelines and allows for meaningful evaluation of data.

The intent of PP 08 is for the practice to implement universal screening for depression based on guidelines, so all adult and adolescent patients must be included. The practice should have a process to routinely screen patients and the frequency at which the screening is conducted should be based on evidence-based guidelines. The documented process should also include what follow-up occurs for positive screens.

NCQA is not prescriptive regarding which clinical staff may serve as a care manager (clinician, nurse, social worker or other provider) and the practice may determine the training and skills needed to address and manage the behavioral health care needs of their patient population.
 

Use of flow sheets, demonstration of EHR prompts or other evidence of guideline implementation with which the provider is alerted when a specific service or action is needed at the point of care, based on evidence-based guidelines, would meet the intent of PP 12. In addition to the evidence, practices must also provide information on the condition addressed by the clinical decision support and the source of the evidence-based guideline on which the clinical decision support is based.

Flow charts, copies of guidelines or empty templates do not demonstrate implementation of clinical decision support. These items show the guideline, but do not demonstrate its use at the point of care.

Yes. A comprehensive health assessment should be conducted for all patients and described in a documented process so the practice has relevant and documented information about patients' physical health and social and behavioral influences. That information is then utilized to provide appropriate services, interventions and resources to the patient population.