FAQ Directory: Patient-Centered Medical Home (PCMH)

Filter Results
  • Save
  • Email
  • Print
expand all

4.01.2022 Is there a minimum threshold requirement when reporting a rate for Annual Reporting?

It depends. If the AR requirement aligns with a PCMH criteria that specifies a threshold, then that value would be the minimum threshold. However, if a threshold is not explicitly stated in the criteria, then a threshold of 80% or more is expected to ensure consistent application of the process. Please note that there may be some cases where it’s acceptable for the rate to fall below 80%. 
An explanation is required for practices that report a rate less than 80% for the following criteria: AR-AC 1, AR-AC 2, AR-CC 3 [Tracking Imaging Results], and AR-CC 3 [Tracking Lab Results]. 
Additionally, this threshold requirement of 80% would also apply if a practice chooses to submit a depression screening measure for AR-QI 1.

PCMH 2017

4.01.2022 Why do I need to provide more information for a low denominator or rate if there is no minimum requirement?

It is to ensure patient safety and routine implementation of medical home activities. Depending on the population served and/or the reporting period, a small denominator is unexpected and may indicate issues (e.g., with data, documentation, implementation). Providing additional information allows the practice to explain—beyond the numbers—when performance is outside the expected range.

PCMH 2017

4.01.2022 Is there a minimum denominator requirement when reporting a rate for Annual Reporting?

No. There is no minimum denominator requirement. A sample of 30 (or more, because this increases the reliability of the sample) is expected to ensure statistical soundness, but there may be cases where it may be appropriate for the denominator to be <30. NCQA requests practices enter an explanation in the Notes from the Organization section in QPASS in this case.

If a practice reports a denominator <30 without a note, the evaluator may contact the practice to confirm data accuracy and to understand the data. The evaluation will be returned to the practice so they can enter an explanation in the Notes from the Organization section for the cited criteria.

PCMH 2017

6.29.2021 July 2021 Summary of Updates What changes were made to the PCMH Standards and Guidelines in Version 7?

Topic Update Highlights
Policies and Procedures Added a section on Natural Disasters and Cybercrime.
Policies and Procedures Updated policy on eligibility to clarify that organizations that operate entirely remotely are eligible.
Appendix 2 – Glossary Added an entry on Behavioral Health Care Clinician.
TC 08/BH 01 Added a note to the guidance language to clarify the required qualifications of a Behavioral Health Care Manager.
KM 20/BH 13 Updated the list of CDS examples in the guidance language.
AC 04 Added language to the guidance to clarify that patient inquiries regarding prescription refills or appointment requests are not considered clinical advice.
CM 06 Updated guidance language to detail how Person-Driven Outcome goals can be used to meet the criteria.
QI 01/ QI 02 Measures data must be input from the new ‘Measures Reporting’ tile of the Organization Dashboard.
Appendix 5 Redesigned Appendix 5 to outline measures reporting including a table of standardized measures now supported.
Distinction in Behavioral Health Integration Clarified that already Recognized practices seeking Distinction have one virtual review.

PCMH 2017

6.25.2020 July 2020 PCMH Summary of Changes What changes were made to the PCMH Standards and Guidelines?

PCMH (Version 6) Summary of Changes
Topic Update Highlights
Standards and Guidelines / Appendix 7 The New York State PCMH program was integrated into the PCMH Standards and Guidelines and is no longer a separate publication. The ‘NYS’ icon was added to all 12 required criteria for NYS PCMH. The new Appendix 7,  NYS PCMH Recognition Program, outlines the specifics of the NYS program.
Standards and Guidelines Added the ‘Site-Specific’ and ‘Cross-Program Shared Credit Option’ symbols to all relevant criteria.
Standards and Guidelines/ Appendix 6 The new appendix outlines the updated Merger, Acquisition and Consolidation Policy for Recognition Programs policy.
TC 03 Updated language describing an appropriate external PCMH collaborative and clarified than participation in an HIE will not meet the requirement.
TC 08 Highlighted the behavioral healthcare manager may conduct their duties through telehealth.
TC 09 Specified that if appointments are conducted using telehealth, the practice should have a process for informing patients about the availability.
KM 04 Clarified that the practice must use a standardized screening tool and have a process for following up on results.
KM 05 Clarified that asking patients for the date of their last dental exam or providing a list of local dentists does not meet the intent of the criterion.
KM 09 Specified that age and gender are not acceptable as a third aspect of diversity.
KM 11A Specified that the identification of a disparity in care/service for a vulnerable group should be driven by the practice’s data and compared to the general practice population. Actions taken to reduce the disparity should be specific to that vulnerable group.
KM 13 Specified that excellence in a performance-based recognition programs must be at the site level.
AC 01 Specified that AC 01 focuses on assessing patient access needs and preferences specific to appointments. Also clarified that this differs from more general patient experience assessment of access in QI 04.
AC 02-AC 03 Highlighted that same-day appointments and after-hours appointments may be conducted through telehealth.
AC 03 Clarified that an ED cannot be used to provide appointments outside business hours.
AC 04 and AC 08 Clarified that the report includes calls or messages received both during and after office hours.
AC 05 Specified that clinical advice documentation is inclusive of telehealth appointments.
AC 06 Clarified that disease specific appointments, home visits and group visits do not meet the intent of the criterion.
AC 12 Stated that continuity of the medical record is inclusive of telehealth appointments.
CM 02 Specified that small sites and satellite sites may share a care management population with NCQA approval.
CM 03 Specified that comprehensive risk stratification must include at least 3 of the categories outlined in CM 01.
CM 04 – CM 08 Specified that care plans must be established for at least 75% of patients identified for care management.
CC 09 Clarified that the agreement may be with a contracted behavioral telehealth provider.
CC 10 Clarified that behavioral health integration may be done through behavioral telehealth.
CC 13

Clarified and updated the expectations for engagement regarding cost implications of treatments options. Practices should not only engage with patients regarding cost implications of treatment options, but also provide information about current coverage and make connections to financial resources as needed.
CC 16 Highlighted that follow-up visits may be conducted through telehealth.
CC 21 Clarified that electronically exchanging information should include data both sent and received.
QI 04B Clarified that the report provided should summarize collected feedback.
QI 05 Updated the vulnerable patient population definition.
QI 01 and QI 02 Clarified that measures include activities conducted during telehealth visits.
QI 03 Specified that major appointments may be conducted in person or via telehealth.
QI 04 Clarified that the access category may include questions regarding telehealth.
Policies and Procedures Added a description of telehealth in NCQA recognition programs.
Policies and Procedures Updated the reconsideration process.
Policies and Procedures The “Discretionary Audit” is now called the “Discretionary Review”.
 

PCMH 2017

4.07.2020 QI 11 May a practice use qualitative feedback to meet QI 11?

To meet criterion QI 11 a practice must first establish a baseline for a patient experience measure and then set goals and take actions to improve upon this measure. Qualitative measures can be used if the qualitative feedback can be measured and the baseline can be compared to any improvement. An example of this may be the practice trying to reduce the total number of negative feedback responses they receive through a suggestion box pertaining to wait times by 50%.

PCMH 2017

4.07.2020 TC 04 & QI 17 Can a large organization meet TC 04 and QI 17 through a shared Patient and Family Advisory Council (PFAC)?

Organizations may share a Patient and Family Advisory Council (PFAC) among sites as long as every site has representation on the council. Large organizations with many sites may consider creating multiple PFACs based on region or clinic type.

PCMH 2017

4.07.2020 CM 01 Could a chronic condition be considered under the high cost/high utilization category if it is expensive to treat?

The intent behind the high cost/high utilization category is that the practice is actively measuring the total cost of services or how much utilization occurs. A diagnosis of a condition may not be used as a proxy for high cost/high utilization. For instance, measuring the number of patients with uncontrolled asthma would not count under high cost/high utilization, but if those patients have multiple ER visits per year, this would be considered high utilization.

PCMH

4.07.2020 KM 13 Do benchmarked/ performance-based recognition programs at the organization or health system level meet KM 13?

No, organization or health system involvement in a benchmarked/ performance-based recognition program will not meet. For KM 13, the practice must participate in an external recognition program that assesses the practice or clinician-level performance, using a common set of specifications to benchmark results. The external recognition program should also publicly report results and have a process to validate measure integrity.

PCMH 2017

4.07.2020 AC 04 For AC 04, must a practice report on calls during and after business hours?

Yes, to meet AC 04 a practice’s report must include calls received both during and after business hours. If the practice has different standard response time expectations during and after business hours, they may format this as two separate reports.

PCMH 2017

4.07.2020 TC 03 Would being connected to an HIE or RHIO meet the intent of TC 03?

No, connection to an HIE or RHIO alone would not meet the intent of TC 03. A PCMH collaborative activity must be external to practice, involve multiple practices, be ongoing (not a short-term activity), cover multiple aspects of patient-centered care, and involve some level of collaboration between practices to learn and share best practices with their peers. Connection to an HIE or RHIO may help the practice meet elective criterion CC21A.

PCMH 2017

4.06.2020 AC 10 & 11 If there is one MD practicing at a site with mid level providers (PA, APRN) would this be considered a solo site for AC 10 and AC 11?

If a PA or an APRN shares a panel of patients with a physician then that team would be considered a solo site since all patients are assigned to the primary provider with a single panel.
If the PA or APRNs that have their own panel of patients and can be selected as a patient’s primary care clinician, the site would not be considered a solo site.

PCMH 2017