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 KM 12B (Pediatric Specific) Do Tdap and DTaP count as two different immunizations?

No. Although the immunizations are different formulations, Tdap and DTaP are integrally related. For this reason, NCQA considers them the same immunization for different age groups and does not accept them as two different immunizations.

This applies to the following Programs and Years:
PCMH 2017

6.14.2018 KM 24 (Pediatric Specific) • AAP resource:

− Shared Decision-Making in Pediatrics: A National Perspective Pediatrics 2010;126;306: 
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3373306/ 

This applies to the following Programs and Years:
PCMH 2017

6.14.2018 QI 01 (Pediatric Specific) Can a practice use the CHIPRA Initial Core Set of Children’s Health Care Quality Measures?

Yes. Measures from the CHIPRA Initial Core Set meet the requirements.

This applies to the following Programs and Years:
PCMH 2017

6.14.2018 CM 08 (Pediatric Specific) Does the asthma action plan count as a self-management tool for pediatric patients?

If the asthma action plan enables patients to track/monitor their progress and document health information at home using a form or some other method of documentation with helpful instructions for self-management, then it would be acceptable.

This applies to the following Programs and Years:
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.

This applies to the following Programs and Years:
PCMH 2017

6.14.2018 CM 01A (Pediatric Specific) Can NCQA provide some examples of behavioral health conditions other than ADHD, depression and anxiety that are appropriate for pediatric practices?

Pediatric examples for behavioral health conditions would also include but are not limited to autism or ASD, downs syndrome, Asperger's, cerebral palsy, or developmental delay.

This applies to the following Programs and Years:
PCMH 2017

6.14.2018 KM 03 (Pediatric Specific) What type of standardized screening tool for depression would meet the requirement for a pediatric population?

NCQA is not prescriptive regarding which depression screening tool is used as long as it’s a standardized tool. Some depression screening tool examples that would be appropriate for adolescents include but are not limited to PHQ2, PHQ9, PHQ-A, PSC, PSC-Y, RAAPS, or HEADSS. 

This applies to the following Programs and Years:
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.” 

This applies to the following Programs and Years:
PCMH 2017

6.14.2018 CC 04B (Pediatric Specific) Does every referral to a specialist require sharing test results and a current care plan? Pediatric patients may be referred to a specialist for an acute condition that does not require a care plan.

If the condition is acute care management, the plan may be simpler than for a patient with a complex, chronic condition. The plan of care would include current medications, tests, treatment, patient/family self-care and important information about the family. While not every referral would have the same level of detail, be prepared to show a referral example for a patient that does have a care plan with the expected details. 

This applies to the following Programs and Years:
PCMH 2017

6.14.2018 CC 12 (Pediatric Specific) • AAP resource:

5.29.2018 QI 06 Does the CAHPS PCMH Survey meet both QI 04 and QI 06?

The CAHPS PCMH Survey meets the requirement for QI 06 but only partially meets QI 04. The CAHPS PCMH Survey only meets the quantitative data requirement (QI 04A) for this criterion.  
 

Note: No modifications to the survey questions or length may be made. 

This applies to the following Programs and Years:
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. 

This applies to the following Programs and Years:
PCMH 2017