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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The program is open to practices in Massachusetts currently recognized as:
A practice that is working toward NCQA Recognition may apply for the PCMH PRIME program and NCQA PCMH recognition concurrently.
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.
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.
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.
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.
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.
The HPC’s current policy is that PCMH PRIME Certification lasts for up to three years. This differs from NCQA’s PCMH 2017 Recognition program which has a one-year recognition period. A practice must maintain its NCQA PCMH Recognition throughout that period in order to maintain PCMH PRIME Certification. If NCQA Recognition lapses while the practice is PCMH PRIME Certified, the practice will need to re-attain NCQA Recognition within 6 months in order to keep their PCMH PRIME status.
A PCMH PRIME Certified practice could choose to renew its PCMH PRIME Certification before the three-year expiration date if the practice is renewing its NCQA PCMH Recognition and wants to simultaneously renew PCMH PRIME Certification in order to align the two recognition periods.
PCMH PRIME adds 13 behavioral health integration criteria to NCQA PCMH Recognition standards. A practice must be NCQA PCMH Recognized (at any level except PCMH 2011 Level 1)) and meet 7 of the 13 behavioral health integration criteria to qualify for PCMH PRIME.
Criteria reflect capabilities primary care providers need to develop in order to identify and manage behavioral health conditions in a timely manner. The criteria include integration of, or collaboration with, behavioral health providers; comprehensive diagnostic screenings; identifying high risk patients; referral tracking and follow-up; and provision of medication-assisted treatment for addiction.
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.
No. The PCMH PRIME Certification program is limited to practices in Massachusetts. Practices outside of Massachusetts offering integrated behavioral health services are encouraged to apply to NCQA’s Distinction in Behavioral Health Integration, which is available nationally.
Practices seeking PCMH PRIME Certification must submit documentation to NCQA for review or participate in an NCQA virtual review. NCQA reviewers evaluate the evidence to determine whether the practice has met the PCMH PRIME criteria. NCQA provides its assessment to the HPC. Based on this assessment, the HPC then scores the practice and determines whether it has met PCMH PRIME Certification requirements.
