FAQ Directory

Identifying children with Medicaid insurance would meet the intent of this criterion, as this identifies a population that could be at risk or require additional attention or care management. Other areas of diversity could include homelessness, immigrant status, living in a rural or urban environment, family employment status, family socioeconomic status, families with a single parent, etc. 

PCMH 2017

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. 

PCMH 2017

− Shared Decision-Making in Pediatrics: A National Perspective Pediatrics 2010;126;306: 
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3373306/ 

PCMH 2017

If the condition is acute care management, the plan may be simpler than for a patient with a complex, chronic condition. The plan of care would include current medications, tests, treatment, patient/family self-care and important information about the family. While not every referral would have the same level of detail, be prepared to show a referral example for a patient that does have a care plan with the expected details. 

PCMH 2017

 –https://www.aap.org/en-us/professional-resources/practice-support/Telephone-Care/Pages/Telephone-Care.aspx 

PCMH 2017

Practices can use two methods to collect language need information:

1. Collect data from all patients and their families to create a report showing language needs.

2. Obtain data from an external source (e.g., data about the local community or its patient population).

Patients who do not speak English and patients from racial/ethnic minority groups may be less inclined to provide this information. Care should be taken to request the information using methods that respect multi-cultural differences.

PCMH 2017

Practices need to identify behavioral health-related criteria pertinent to their specific patient population such as a behavioral health diagnosis, substance use, a positive screening result from a standardized behavioral health screen, or psychiatric hospitalizations. If the practice feels that patients with temper tantrums is an identifier for patients in need of care management, the practice can use that defining criteria.

PCMH 2017

No. Practices may not use the same immunization for two age groups, and must identify two different immunizations for this criterion.

PCMH 2017

PCMH 2017

Social determinants of health include things like poverty, food insecurity, poor housing quality or homelessness, unstable neighborhoods, and parental dysfunction (e.g., domestic violence, mental illness, etc.).

PCMH 2017

No, just having extra appointments based on the season would not meet the intent. The practice may have more same day appointments offered during these high-volume time periods but some same day appointments should be provided daily throughout the year.

PCMH 2017

A social-emotional screening tool would be the best route to assess this, and the recommendation is for that screening to be done on a regular basis.

PCMH 2017