FAQ Directory

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.  

This applies to the following Programs and Years:

• 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.

This applies to the following Programs and Years:

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. 

This applies to the following Programs and Years:

The HPC is committed to engaging payers to support PCMH PRIME practices and their efforts toward behavioral health integration.  The HPC is involved in ongoing discussions with payers about PCMH PRIME, and we encourage practices to speak with their payer contacts about certification incentives or other payments that may be available

This applies to the following Programs and Years:

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.

This applies to the following Programs and Years:

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.

This applies to the following Programs and Years:

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).

This applies to the following Programs and Years:

No. For criterion PP 01, the care manager function must be filled by practice staff

This applies to the following Programs and Years:

The PCMH PRIME program standards do not define care manager qualifications; this requirement was intentionally left flexible so that practices could fulfill PP 01 with a care manager that best suits the practice’s patient population needs.

Generally, a care manager must facilitate appropriate behavioral healthcare services by applying specialized knowledge and judgment to support and address behavioral health needs. The practice must define the qualifications and/or training a care manager must have in order to manage patients’ behavioral health conditions. The practice must also demonstrate that at least one member of the staff with care management responsibilities has the necessary qualifications/training to support patients with behavioral health needs.

This applies to the following Programs and Years:

Yes. A care manager may be shared and rotate between affiliated practice sites, as long as the care manager is integrated into the practice’s care team(s) and workflows for providing team-based care. 

This applies to the following Programs and Years:

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:

No, the percentage should reflect the screenings that are completed at the primary care practice. Practices, including those that are a part of an integrated system, should still have a process in place to ensure that all patients who have recently given birth have the opportunity to be screened for postpartum depression. Practices are not required to achieve a minimum percentage threshold to meet this factor; therefore, practices may focus on completing postpartum depression screening for patients who have not been screened in another setting, e.g. an OB/GYN appointment.

This applies to the following Programs and Years: