No. Shared appointments would not meet the requirement. Alternative appointments need to be offered through telephone or other technology-supported mechanisms.
FAQ Directory: Patient-Centered Medical Home (PCMH)
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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 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 AC 02 (Pediatric Specific) If a pediatric practice has extra appointments based on the season [in the summer for physicals (prior to school starting) and has extra appointments in the winter for sick appointments] does this meet the criterion?
No, just having extra appointments based on the season would not meet the intent. The practice may have more same day appointments offered during these high-volume time periods but some same day appointments should be provided daily throughout the year.
This applies to the following Programs and Years:
PCMH 20176.14.2018 KM 12B (Pediatric Specific) Does a list of pediatric patients from two age groups (e.g., 2-year-olds and 6-year-olds) that are “behind” on immunizations meet the requirements of this criterion?
6.14.2018 KM 02G (Pediatric Specific) What are some examples of social determinants of health for children?
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 20176.14.2018 CM 01A (Pediatric Specific) Would temper tantrums as a behavioral health condition meet the intent of CM 01A?
Practices need to identify behavioral health-related criteria pertinent to their specific patient population such as a behavioral health diagnosis, substance use, a positive screening result from a standardized behavioral health screen, or psychiatric hospitalizations. If the practice feels that patients with temper tantrums is an identifier for patients in need of care management, the practice can use that defining criteria.
This applies to the following Programs and Years:
PCMH 20176.14.2018 KM 12D (Pediatric Specific) Why would our practice recall pediatric patients, if not for preventive care, immunizations or acute/chronic care services? Give pediatric-specific examples.
KM 12 categories A-C refer to needed services and are intended for routine, proactive reminders.
Category D addresses patients who miss routine visits, annual exams or follow-up appointments and need to be reminded to visit the practice for services.
This applies to the following Programs and Years:
PCMH 20176.14.2018 KM 02E (Pediatric Specific) Would unhealthy behaviors associated with a parent’s behavior be acceptable for KM 02 E since they are responsible for preventing these behaviors?
Yes, unhealthy behaviors can be the result of parent behavior but ultimately, we're looking for the unhealthy behaviors demonstrated by the patient (child). Secondhand smoke may be a direct example of a parent’s behavior affecting the child’s health and poor oral hygiene may be a child’s unhealthy behavior, but could result from lack of parental oversight or health literacy.
This applies to the following Programs and Years:
PCMH 20176.14.2018 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 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.
