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 02 (Pediatric Specific) If a pediatric practice has extra appointments based on the season [in the summer for physicals (prior to school starting) and has extra appointments in the winter for sick appointments] does this meet the criterion?

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

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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PCMH 2017

6.14.2018 AC 06 (Pediatric Specific)` If a pediatrician sees more than one child from the same family during one visit, does this meet the requirement for an alternative clinical encounter?

No. Shared appointments would not meet the requirement. Alternative appointments need to be offered through telephone or other technology-supported mechanisms.

PCMH 2017

6.14.2018 CM 01D (Pediatric Specific) May practices use “limited or no family/caregiver support” as a social determinant of health?

Yes. For pediatric populations, practices may identify children and youth with special health care needs who are defined by the U.S. Department of Health and Human Services Maternal and Child Health Bureau as children “who have or are at risk for chronic physical, developmental, behavioral or emotional conditions and who require health and related services of a type or amount beyond that required generally.” 

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

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.

PCMH 2017

6.14.2018 KM 02E (Pediatric Specific) Would unhealthy behaviors associated with a parent’s behavior be acceptable for KM 02 E since they are responsible for preventing these behaviors?

Yes, unhealthy behaviors can be the result of parent behavior but ultimately, we're looking for the unhealthy behaviors demonstrated by the patient (child). Secondhand smoke may be a direct example of a parent’s behavior affecting the child’s health and poor oral hygiene may be a child’s unhealthy behavior, but could result from lack of parental oversight or health literacy.

PCMH 2017

6.14.2018 KM 12D (Pediatric Specific) Why would our practice recall pediatric patients, if not for preventive care, immunizations or acute/chronic care services? Give pediatric-specific examples.

KM 12 categories A-C refer to needed services and are intended for routine, proactive reminders.
 
 

Category D addresses patients who miss routine visits, annual exams or follow-up appointments and need to be reminded to visit the practice for services. 

PCMH 2017

5.29.2018 CC 04B How do practices document providing pertinent demographic and clinical information to a specialist if they use the same EHR?

Practices must provide a documented process for staff to follow to ensure that demographic and clinical data are available for the specialist, and either a report/log or an example showing that the process is followed (e.g., a screen shot of available information and how the information is made available to the specialist). If external referrals are made, the practice must specify the process for sharing information with those providers, as well. 

PCMH 2017

5.29.2018 CC 10 (PP 04) Our practice has agreements with and shares patient records with behavioral healthcare providers, but we do not share the same EHR or physical location. Do we meet the requirement for integrating behavioral healthcare in our practice?

No. Although there is no requirement for a behavioral healthcare provider to be physically in the practice’s office, the behavioral healthcare provider must have at least partial access to the practice’s systems. Although the arrangements mentioned meet the intent of CC 09 (maintaining agreements with behavioral healthcare providers), they do not meet the requirements for this criterion. 

If a practice site in an organization has integrated behavioral healthcare, the other sites in the organization may receive credit if there is also a process for their patients to access those behavioral healthcare services.  

PCMH 2017

5.29.2018 QI 11 May practices focus on improving the number of patient experience survey responses it receives back from patients?

No. A measure looking to increase the number of patients who complete the satisfaction survey would not meet the requirement. Practice should look at improving an area identified using the patient experience data collected in QI 04.

PCMH 2017

5.29.2018 QI 04A Are practices required to use the CAHPS PCMH survey to meet this requirement?

No. Practices may use any patient experience survey that includes questions related to three of the four categories specified in the standards (access; communication; coordination; whole-person care, self-management support and comprehensiveness).

PCMH 2017