No. NCQA does not prescribe a percentage, nor does it expect patients to be seen by their selected primary care clinician for a specific percentage of visits.
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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5.22.2018 AC 11 Urgent care visits or visits during extended hours may not be available with a patient’s primary care clinician. Does NCQA require a particular percentage of visits must be with a selected primary care clinician?
5.22.2018 AC 12 Our practice offers night and weekend clinical advice coverage to patients through a phone service staffed by RNs. Does this meet the requirement for access to clinical advice?
5.22.2018 AC 01 What are examples for how and where practices should collect data to address AC 01?
The intent of AC 01 is to assess the access needs and preferences of the practice’s patient population. To identify the best way to obtain this information, practices may need to review how they are currently collecting patient feedback on access needs. For example, a patient survey may ask patients if they are able to get an appointment when needed; however, that question doesn't tell you when patients want to access the practice. The practice may be offering access when the majority of patients don't or aren't able to utilize it.
Practices should collect and assess the feedback from patients to see if there's a need to adjust the access provided to patients. Some questions to consider include:
- What data are you already collecting on patient access (e.g. surveys, use of appointments)? Is it current and does it cover the whole patient population?
- How often do you need to assess the access needs of your patients?
- What variables may impact changes in the use of appointment types?
- If using patient satisfaction surveys, how many patients are actually responding? If the response rate is low, is there another mode of collecting feedback to get more input.
- Do the questions on your survey ask patients directly about their access needs or preferences?
This applies to the following Programs and Years:
PCMH 20175.22.2018 AC 02 May practices block nurse practitioners’ schedules for same-day appointments?
Yes. Practices may use nonphysician members of the clinical care team, such as nurse practitioners or physician assistants (PA) who have their own panel of patients, for same-day appointments. There is no requirement for all clinicians to have same-day appointment slots available every day.
This applies to the following Programs and Years:
PCMH 20175.22.2018 AC 02 Are practices required to provide a minimum number of same-day appointments?
5.22.2018 AC 02 Are practices required to reserve separate same-day appointment slots for routine and urgent visits?
5.22.2018 AC 06 What are “alternative clinical encounters”?
“Alternative clinical encounters” are scheduled clinical encounters between patient and clinician in lieu of a traditional, one-on-one, in-person office visit; for example:
- A scheduled telephone clinical visit.
- A scheduled clinical video chat visit.
This applies to the following Programs and Years:
PCMH 20175.22.2018 CM 01A Does tobacco use count as a behavioral health condition?
No. Tobacco use is an unhealthy behavior and is not considered a behavioral health condition. Practices need to identify behavioral health-related criteria pertinent to their specific patient population, which could include other (non-tobacco-related) substance use treatment, a behavioral health diagnosis, a positive screening result from a standardized behavioral health screener or psychiatric hospitalizations.
This applies to the following Programs and Years:
PCMH 20175.21.2018 TC 04 May patient/family/caregiver members of a practice’s advisory council participate in meetings by telephone?
5.21.2018 TC 01 Does the clinician lead and staff managing the medical home transformation need to be an MD?
The clinician lead of the medical home must be a clinician as defined in the PCMH Policies and Procedures, which includes clinicians with an unrestricted license as an MD, DO, APRN or PA; however, NCQA is not prescriptive regarding the staff member who can be designated as the PCMH manager. Both can serve multiple sites and both roles can be assumed by the same person.
This applies to the following Programs and Years:
PCMH 20175.21.2018 TC 09 Is a practice brochure sufficient evidence for this criterion?
This criterion requires both a documented process ensuring information is distributed to patients and demonstration of patient materials with the minimum information described in the guidance. However, if the practice's documented process is described in the patient brochure, that brochure could be sufficient evidence for TC 09.
This applies to the following Programs and Years:
PCMH 20175.21.2018 TC 06 Our clinical staff teams are on different schedules, so they often meet in separate teams to discuss patients. Does this meet the requirement?
The requirement is met if teams share questions or concerns about shared patients via regular, structured communication (such as the EHR). The intent of the criterion is for all members of the care team to be involved in communication about patient care, but care teams can meet separately for each clinician’s scheduled patients.
