FAQ Directory

Here are some of the most frequently asked questions about NCQA’s various programs. If you don’t see what you are looking for in one of the entries below, you can  ask a question through My NCQA.

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6.14.2018 AC 12 (Pediatric Specific) • AAP practice transformation resources—telephone care:

6.14.2018 CM 08 (Pediatric Specific) Does the asthma action plan count as a self-management tool for pediatric patients?

If the asthma action plan enables patients to track/monitor their progress and document health information at home using a form or some other method of documentation with helpful instructions for self-management, then it would be acceptable.

This applies to the following Programs and Years:
PCMH 2017

6.14.2018 CC 12 (Pediatric Specific) • AAP resource:

6.14.2018 KM 12A (Pediatric Specific) Other than well-child visits, provide some examples of preventative care services that qualify for outreach in a pediatric population

For younger children, practices may also identify patients and provide outreach for services for developmental screenings, autism screening, oral health risk assessment, Hematocrit or Hemoglobin screening, iron supplements for children ages 6 to 12 months at risk for anemia, or tuberculin testing for children at higher risk for tuberculosis  

For adolescent patients, other preventive care services could also include (but not limited to) patients in need of specific preventive care-related lab tests, alcohol and drug screening, cervical dysplasia screening for sexually active females, sexually transmitted infection prevention counseling for adolescents at higher risk, obesity screening and counseling, HIV screening for adolescents at higher risk or other required screenings (e.g., chlamydia, depression, dyslipidemia at specific ages).
 

AAP resources: 

 
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This applies to the following Programs and Years:
PCMH 2017

6.14.2018 KM 12B (Pediatric Specific) Do Tdap and DTaP count as two different immunizations?

No. Although the immunizations are different formulations, Tdap and DTaP are integrally related. For this reason, NCQA considers them the same immunization for different age groups and does not accept them as two different immunizations.

This applies to the following Programs and Years:
PCMH 2017

6.14.2018 KM 03 (Pediatric Specific) What type of standardized screening tool for depression would meet the requirement for a pediatric population?

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. 

This applies to the following Programs and Years:
PCMH 2017

6.14.2018 CM 01A (Pediatric Specific) Would temper tantrums as a behavioral health condition meet the intent of CM 01A?

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.

This applies to the following Programs and Years:
PCMH 2017

6.14.2018 TC 03 (Pediatric Specific) What are some examples of PCMH-oriented collaborative activities for pediatric practices?

Pediatric practices may want to look into quality improvement projects offered by state AAP chapters and national AAP. The AAP QI Webpage lists a variety of opportunities: https://www.aap.org/en-us/professional-resources/quality-improvement/Pages/ActivityList.aspx

This applies to the following Programs and Years:
PCMH 2017

6.14.2018 KM 02G (Pediatric Specific) What are some examples of social determinants of health for children?

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.).

This applies to the following Programs and Years:
PCMH 2017

6.14.2018 KM 02F (Pediatric Specific) How do clinicians assess the pediatric patient's ability to interact with other kids in a normal fashion? If the child is functioning normally in school would that suffice?

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.

This applies to the following Programs and Years:
PCMH 2017

6.14.2018 KM 12B (Pediatric Specific) Does a list of pediatric patients from two age groups (e.g., 2-year-olds and 6-year-olds) that are “behind” on immunizations meet the requirements of this criterion?

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

This applies to the following Programs and Years:
PCMH 2017

6.14.2018 KM 09 (Pediatric Specific) The examples provided in the guidance section for this criterion aren’t typical characteristics for pediatric practices (e.g. gender identify, sexual orientation, occupation, etc.). What other options can a pediatric population use for its third aspect of diversity?

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. 

This applies to the following Programs and Years:
PCMH 2017