No. Shared appointments would not meet the requirement. Alternative appointments need to be offered through telephone or other technology-supported mechanisms.
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 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?
6.14.2018 KM 02F (Pediatric Specific) How do clinicians assess the pediatric patient's ability to interact with other kids in a normal fashion? If the child is functioning normally in school would that suffice?
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?
6.14.2018 KM 02G (Pediatric Specific) What are some examples of social determinants of health for children?
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 20176.14.2018 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 20175.29.2018 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 20175.29.2018 CM 04 Does a clinical summary meet the requirement for a “plan of care”?
If the clinical summary also includes the details of the patient’s care plan (i.e., information outlined in the criterion guidance), then it would meet the requirement. A clinical summary alone that does not include the patient’s care plan information would not meet the requirement.
This applies to the following Programs and Years:
PCMH 20175.29.2018 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).
This applies to the following Programs and Years:
PCMH 20175.29.2018 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.
