NCQA Updates PCMH Standards and Guidelines

July 24, 2018 · Amy Tennant

On July 24, the National Committee for Quality Assurance (NCQA) updated the 2017 editions of the Patient-Centered Medical Home (PCMH) Standards and Guidelines and New York State (NYS) NYS PCMH Standards and Guidelines. Annual Reporting requirements for reporting year 2019 were also published.  See below for more on NCQA Updates PCMH Standards.

What are the Updates to PCMH Standards?

The PCMH Standards and Guidelines, 2017 Edition, Version 3 update clarified guidance, refined expectations and expanded the number of criteria that organizations with multiple sites can share. Moving forward, customers can expect summer updates to the PCMH program annually. With this update to the PCMH Standards and Guidelines, NCQA gives practices more flexibility to demonstrate how they meet the intent of the criteria. Notably, 16 additional criteria can be fully shared across an organization’s practice sites and practices can now share care management patient examples for CM 04-CM 08.

If you have previously downloaded the PCMH Standards for 2017, the version 3 update is already in your Download Center, for click here to retrieve it. If you have not downloaded the PCMH standards previously, click here to order a free copy.

The table below gives a detailed look at the changes:

Practices may share evidence for these criteria:

·    KM 02–KM 05

·    AC 05

·    CC 01

·    CC 02

·    CC 04

·    CC 10

·    CC 14–CC 16

·    CC 18

·    CC 19

·    QI 15

·    QI 16

·    BH 02


CM 04–CM 08Practices may share examples for CM 04–CM 08, although each site must still provide a Record Review Workbook.
QI 06Practices must provide site-specific evidence for QI 06.
TC 01, TC 04Clarified requirements for these criteria.
TC 03

Removed the reference to health information exchanges (HIE).

Updated guidance to clarify that participating in an ACO or clinically integrated network does not meet this criterion.

TC 09Clarified the criterion language to require practices to periodically remind patients of the roles and responsibilities of the medical home.
CM 05Clarified criterion language to require practices to give written care plans to patients electronically or as a printed document.
CC 09/BH 05Removed text: “The practice must provide a report, log or electronic tracking system as evidence of implementation.”
CC 14 Updated evidence from “Report” to “Evidence of implementation.”
CC 16Evidence updated from “Evidence of follow-up” to “Evidence of implementation.”
CC 18–CC19Removed the requirement for practices to provide at least three examples of data exchange (CC 18) and obtaining discharge summaries (CC 19).
QI 07Clarified the criteria’s language and guidance to further differentiate between QI 05 and QI 07.
QI 10Clarified the criterion language to state that practices that have met their appointment availability access goals may focus on improvement in another patient-access area.
QI 15–QI 16Modified criteria language to clarify that practices may report clinician-level data or practice-level data.
Policies and Procedures

Rearranged and updated portions of the Overview section for clarity.

Updated the Commit, Transform and Succeed sections to align with changes to the Q-PASS process.

Added a section describing the role of the prevalidated vendor and NCQA investigation.

Expanded the Reportable Events Policy to clarify when and how to inform NCQA of reportable events such as mergers, acquisitions, consolidations and investigations.

Publicationwide changesUpdated selected concept and competency descriptions to align with criteria included in the concepts and competencies.

Annual Reporting Requirements for Reporting Year 2019:

PCMH practices with an Annual Reporting Date between January 1, 2019 and December 31, 2019 will use the newly published requirements to demonstrate that they have continued to sustain the PCMH model of care. These annual reporting requirements ask practices to submit a sample of evidence from each of the six concept areas in the PCMH program as well as a special topic. As in 2018, the special topic for 2019 is behavioral health. The 2019 Annual Reporting requirements can be found here.

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