FAQ Directory

The PCMH PRIME Certification program launched on January 1, 2016.

This applies to the following Programs and Years:

First, go to the HPC’s website to complete a short application indicating your practice’s intent to pursue PCMH PRIME.

Once your practice has submitted the HPC application and is ready for next steps with NCQA, you should apply through the new NCQA Q-PASS system. The PCMH PRIME application is separate from the PCMH application in Q-PASS. Practices may apply for PCMH PRIME Certification separately or concurrently with the PCMH Recognition process and Annual Reporting.

• For PCMH 2011 (except Level 1) and PCMH 2014 Level 1 or 2 Recognized practices:
  • Practices planning to undergo the PCMH 2017 Recognition process in the near future are encouraged to apply for PCMH 2017 Recognition and PCMH PRIME Certification concurrently. Applying to these programs concurrently may make your practice eligible for a discount on the PCMH Recognition survey tool; please contact Government Recognition Initiative and Projects (GRIP) Staff at pcmh-grip@ncqa.org for more information.
  • Recognized practices not planning to renew their PCMH Recognition in the near future may apply for PCMH PRIME Certification separately, at any time.

§  For PCMH 2014 Level 3 or PCMH 2017 Recognized practices:

• Practices that are maintaining PCMH Recognition through the Annual Reporting process may apply for PCMH PRIME Certification concurrently or separately from the Annual Reporting process, whichever is most convenient for the practice.

• For Practices without PCMH Recognition:
  •  Practices must attain PCMH Recognition in order to be eligible for PCMH PRIME Certification. Such practices are encouraged to apply for PCMH 2017 Recognition and PCMH PRIME Certification concurrently. Applying to these programs concurrently may make your practice eligible for a discount on the PCMH Recognition survey tool; please contact GRIP Staff, pcmh-grip@ncqa.org, for more information.

This applies to the following Programs and Years:

The program is open to practices in Massachusetts currently recognized as: 

• NCQA PCMH 2011, Level 2 or 3. 
• NCQA PCMH 2014, Level 1, 2 or 3. 
• NCQA PCMH 2017

A practice that is working toward NCQA Recognition may apply for the PCMH PRIME program and NCQA PCMH recognition concurrently. 

This applies to the following Programs and Years:

As practices obtain PCMH PRIME Certification, or make a commitment to doing so (thereby receiving “Pathway to PCMH PRIME” status), their names are posted on this website. 

This applies to the following Programs and Years:

• Accreditation Process and Timeline: Key steps, timing and resources for a successful accreditation.
• Standards and Guidelines: The complete standards and guidelines, including the intent and scope of review.
• Interactive Survey Tool: Contains the complete standards and guidelines; you can also determine your organization’s survey readiness—the tool calculates your potential survey score.

This applies to the following Programs and Years:

PCMH PRIME is a site-specific certification program.  Unless otherwise noted in the PCMH PRIME Standards and Guidelines, practices must submit site-specific evidence.  For some of the PCMH PRIME criteria, practices that are part of a multi-site organization can share the same evidence.  Please see the PCMH PRIME Standards and Guidelines for specific details regarding which evidence can be shared across practice sites.  

This applies to the following Programs and Years:

No, practices do not pay an additional fee for PCMH PRIME Certification.

Practices seeking NCQA PCMH 2017 Recognition and PCMH PRIME Certification concurrently are charged only the standard NCQA PCMH Recognition application fee. Applying to these programs concurrently may make your practice eligible for a discount on PCMH 2017 Recognition; please contact GRIP Staff, pcmh-grip@ncqa.org for more information. Practices seeking PCMH PRIME Certification only, to supplement a previously achieved PCMH Recognition, are not billed for the PCMH PRIME survey.

Note: If a practice fails to achieve PCMH PRIME in two attempts, the HPC reserves the right to require the practice to cover the cost of additional attempts.

This applies to the following Programs and Years:

Behavioral health conditions (mental illnesses and substance use disorders) suffer from both under-diagnosis and delayed diagnosis. This is a serious public health problem nationally and across the Commonwealth. Untreated behavioral health conditions contribute to morbidity and increase the total cost of care. The gap in care and treatment for behavioral health conditions requires action and a coordinated effort by providers and payers to ensure that patients get the care they need, before illness is severe and results in a crisis situation (e.g., avoidable ED visit or inpatient admission). Integrating behavioral health—including appropriate screening for behavioral health conditions (and treatment, when appropriate)—is critical in the primary care setting.   

This applies to the following Programs and Years:

There is no minimum threshold required for PP 06-PP 11. PCMH PRIME standards require practices to report numerators and denominators for review, but we will not be looking for a specific threshold percentage.

This applies to the following Programs and Years:

On September 30, 2017, the HPC released an updated set of PCMH PRIME standards with the aim of aligning with NCQA’s PCMH 2017 program. Beginning November 17, 2017, all practices seeking PCMH PRIME Certification will apply through a new NCQA survey platform (Q-PASS) and will be subject to these modified standards. The 2017 version of the PCMH PRIME standards can be found in the NCQA store and a summary of the differences between 2016 and 2017 PCMH PRIME standards can be found on the HPC website.

 
Additionally, practices that seek 2017 PCMH Recognition and PCMH PRIME concurrently will have an integrated review process with NCQA, which may include both submitting documentation to NCQA and going through their new “virtual review” process.  Practices that seek only PCMH PRIME Certification (after having already achieved PCMH Recognition) will upload all evidence to Q-PASS, with no virtual reviews. 

 
While NCQA PCMH 2017 Recognition requires an annual review process to maintain recognition, at this time, PCMH PRIME remains a 3-year certification.  

This applies to the following Programs and Years:

There are a variety of validated screening tools that practices may use to meet PP 07-PP 11.These include, but are not limited to, PHQ-9, AUDIT, GAD-7, CRAFFT, and SWYC. The PCMH PRIME Standards and Guidelines document gives additional examples of screening tools that may be used to fulfill each factor. Practices may select from among those examples, or use any other validated screening tools that work for them.

This applies to the following Programs and Years:

The PCMH PRIME review process varies depending on whether a practice applies to PCMH PRIME concurrently with a PCMH 2017 survey or applies to PCMH PRIME only (to supplement previously earned PCMH Recognition).

·        Practices applying to PCMH PRIME concurrently with a PCMH 2017 survey will submit PCMH PRIME evidence as part of the PCMH 2017 virtual review process. The PCMH 2017 review process may take up to 12 months but varies by individual practice timelines and capabilities. This process includes up to three virtual check-ins lasting up to two hours each.  Practices applying only to PCMH PRIME or to PCMH PRIME concurrently with Annual Reporting will upload all evidence to Q-PASS without participating in a virtual check-in. NCQA evaluates a practice’s documentation for PCMH PRIME within 60 days of receipt. 

Once the PCMH PRIME documentation review is complete, NCQA provides its assessment results to the HPC.  The HPC issues a final scoring decision to the practice within 15 business days of receiving results from NCQA.

This applies to the following Programs and Years: