FAQ Directory

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.   

This applies to the following Programs and Years:

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.  

This applies to the following Programs and Years:

If your practice has additional questions about PCMH PRIME, you can: 

• Speak to an NCQA representative by calling 617-996-0081.
• Submit questions via NCQA’s Program/Policy Clarification Support (PCS) system at https://my.ncqa.org. 
• E-mail your questions to HPC staff at HPC-Certification@state.ma.us.

This applies to the following Programs and Years:

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. 

This applies to the following Programs and Years:

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.

This applies to the following Programs and Years:

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. 

This applies to the following Programs and Years:

PCMH PRIME adds 13 behavioral health integration criteria to NCQA PCMH Recognition standards. A practice must be NCQA PCMH Recognized (at any level except PCMH 2011 Level 1)) and meet 7 of the 13 behavioral health integration criteria to qualify for PCMH PRIME.

Criteria reflect capabilities primary care providers need to develop in order to identify and manage behavioral health conditions in a timely manner. The criteria include integration of, or collaboration with, behavioral health providers; comprehensive diagnostic screenings; identifying high risk patients; referral tracking and follow-up; and provision of medication-assisted treatment for addiction. 

This applies to the following Programs and Years:

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. 

This applies to the following Programs and Years:

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.

This applies to the following Programs and Years:

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.

This applies to the following Programs and Years:

There are a variety of validated screening tools that practices may use to meet PP 07-PP 11.These include, but are not limited to, PHQ-9, AUDIT, GAD-7, CRAFFT, and SWYC. The PCMH PRIME Standards and Guidelines document gives additional examples of screening tools that may be used to fulfill each factor. Practices may select from among those examples, or use any other validated screening tools that work for them.

This applies to the following Programs and Years:

No; PCMH PRIME is a voluntary program. Eligible practices (see below) are encouraged to participate, but are not required to participate.

This applies to the following Programs and Years: