FAQ Directory

The intent of AC 01 is to assess the access needs and preferences of the practice’s patient population. To identify the best way to obtain this information, practices may need to review how they are currently collecting patient feedback on access needs. For example, a patient survey may ask patients if they are able to get an appointment when needed; however, that question doesn't tell you when patients want to access the practice. The practice may be offering access when the majority of patients don't or aren't able to utilize it.
Practices should collect and assess the feedback from patients to see if there's a need to adjust the access provided to patients. Some questions to   consider include:

1. What data are you already collecting on patient access (e.g. surveys, use of appointments)? Is it current and does it cover the whole patient population?
2. How often do you need to assess the access needs of your patients?
3. What variables may impact changes in the use of appointment types?
4. If using patient satisfaction surveys, how many patients are actually responding? If the response rate is low, is there another mode of collecting feedback to get more input.
5. Do the questions on your survey ask patients directly about their access needs or preferences?

This applies to the following Programs and Years:

Yes. Practices may refer patients to associated urgent care sites or facilities (i.e., facilities with which the practice has a relationship or an agreement to work together) to meet AC 03, but must provide a documented process demonstrating how patients are referred to facilities for scheduled routine and urgent appointments. The facility must have access to patient medical records outside regular business hours.

This applies to the following Programs and Years:

Yes. NCQA accepts telepsychiatry visits as an alternative clinical encounter if the behavioral healthcare practitioner is at least partially integrated with the practice site (i.e., sharing at least partial access to the same systems and patient records).

This applies to the following Programs and Years:

“Alternative clinical encounters” are scheduled clinical encounters between patient and clinician in lieu of a traditional, one-on-one, in-person office visit; for example:

• A scheduled telephone clinical visit.
• A scheduled clinical video chat visit.

This applies to the following Programs and Years:

No. NCQA does not prescribe a percentage, nor does it expect patients to be seen by their selected primary care clinician for a specific percentage of visits.
 

This applies to the following Programs and Years:

Yes. Practices may use nonphysician members of the clinical care team, such as nurse practitioners or physician assistants (PA) who have their own panel of patients, for same-day appointments. There is no requirement for all clinicians to have same-day appointment slots available every day.

This applies to the following Programs and Years:

Practices are expected to show both availability (i.e., open appointment slots at the beginning of the day) and use of same-day appointments for a period of five consecutive days. Practices should also monitor the availability of same-day appointments against their documented process. Practices may use utilization of same-day appointment access as an indication of patient need.

This applies to the following Programs and Years:

NCQA is not prescriptive regarding which clinical staff it is (clinician, nurse, social worker or other provider) and the practice may determine the training and skills needed to address and manage the behavioral health care needs of their patient population.
 

This applies to the following Programs and Years:

This criterion requires both a documented process ensuring information is distributed to patients and demonstration of patient materials with the minimum information described in the guidance. However, if the practice's documented process is described in the patient brochure, that brochure could be sufficient evidence for TC 09.
 

This applies to the following Programs and Years:

TC 06 requires practices to engage in regular communication to discuss care for patients scheduled each day, but this requirement can be satisfied by demonstration of either scheduled team meetings or scheduled electronic team communication, depending on the practice’s process for communication. Please note this communication is focused on patient care needs and is not to discuss practice transformation activities or staffing schedules.
All members of the practice care team, including clinicians, must participate in the communication; however, it is not required that the clinician be present if the team meets in-person, as long as there is a process in place to communicate the information from the meeting to the clinician.
 

This applies to the following Programs and Years:

The requirement is met if teams share questions or concerns about shared patients via regular, structured communication (such as the EHR). The intent of the criterion is for all members of the care team to be involved in communication about patient care, but care teams can meet separately for each clinician’s scheduled patients.
 

This applies to the following Programs and Years:

The clinician lead of the medical home must be a clinician as defined in the PCMH Policies and Procedures, which includes clinicians with an unrestricted license as an MD, DO, APRN or PA; however, NCQA is not prescriptive regarding the staff member who can be designated as the PCMH manager. Both can serve multiple sites and both roles can be assumed by the same person.
 

This applies to the following Programs and Years: