Here are some of the most frequently asked questions about the NYS PCMH Recognition program. If you don’t see what you are looking for below, you can always ask a question through My NCQA.
What is NYS PCMH Recognition?
The Patient-Centered Medical Home (PCMH) is a care delivery model where the primary care team, with the involvement of the patient (and family, when appropriate), is responsible for managing the full spectrum of health care needs, coordinating with clinicians in other settings when care cannot be provided in the primary care setting. Research shows that PCMHs improve quality, the patient experience and staff satisfaction, while reducing health care costs. Practices that earn recognition show that they have made a commitment to providing quality improvement within their practice and a patient-centered approach to care.
How does NYS PCMH Recognition help my organization?
The PCMH model emphasizes care coordination, population health, evidence-based guidelines and effective use of health information technology (HIT) to meet the patient’s needs. NYS PCMH Recognition helps practices put in place the structure, systems and processes to be effective in this model. The NYS PCMH model helps practices:
- Improve patient-centered access and the patient experience.
- Perform comprehensive health assessments to identify patient needs.
- Deliver better preventive care such as immunizations and cancer screenings.
- Prioritize comprehensive care management to keep chronic conditions under control.
- Coordinate with other clinicians involved in patient care and close referral loops to improve continuity and avoid gaps.
- Identify patients who require recommended interventions and patients who need medication monitoring.
What benefits are available to practices in New York state?
To support the efforts required in transforming New York practices to this new, exclusive model of patient care, NYSDOH provides the following resources:
- Recognition at no cost to practices. NYSDOH covers the first-year’s NYS PCMH Recognition fee or the first NYS PCMH Annual Reporting fee. The practice is responsible for paying their Annual Reporting fee each year after earning NYS PCMH Recognition.
- Transformation assistance. New York State has contracted with 15 organizations that specialize in NYS PCMH transformation and are being made available at no cost to participating practices. These entities provide step-by-step assistance in managing the transformation process and support the efforts of improving the patient experience. For more information, or to find a Transformation Assistance Contractor, visit ncqa.org/ta.
- Enhanced reimbursement opportunities. Practices that participate in NYS PCMH transformation may be eligible to receive supplemental payments through state programs such as the Medicaid PCMH Incentive Program. In addition, NYSDOH is engaged regionally with commercial payers to implement voluntary, multi-payer value-based payment (VBP) arrangements to support practices that have not had these opportunities through previous transformation efforts. Many of these models and eligibility to participate will depend on practices achieving NYS PCMH Recognition.
What are the requirements for NYS PCMH Recognition?
The NYS PCMH Recognition Program features six concepts that make up a medical home. Underlying these concepts are criteria (activities for which a practice must demonstrate adequate performance to obtain NYS PCMH Recognition) developed from evidence-based guidelines and best practices.
To earn recognition through NYS PCMH, the practice must meet all 40 core criteria and 12 NYS required criteria (with elective credit), earning a total of 25 credits in elective criteria across 5 of 6 concepts (16–19 credits are earned by the required NYS criteria, crossing all 6 concepts). Which of the remaining 6–9 credits of elective criteria to complete are up to the practice. The NYS PCMH Standards and Guidelines document details program requirements.
Where can I find the Standards and Guidelines?
The NYS PCMH Standards and Guidelines document contains program requirements and information your practice needs to demonstrate to NCQA that you meet the program’s criteria. The document is available for free via download in the NCQA Store.
What organizations are eligible for NYS PCMH Recognition?
NYS PCMH Recognition is open to all primary care practices in New York state, although only physician-led practices can receive the free transformation assistance.
What is the process for earning NYS PCMH Recognition?
A practice downloads the Standards and Guidelines document, which contains the requirements for the program, and works with a Transformation Assistance Contractor to begin applying the standards to the practice. The entire recognition process is managed through NCQA’s Quality Performance Assessment Support System (Q-PASS), a user-friendly, online platform that allows practices to upload documentation, track progress and manage practice sites and clinicians.
What is the price for NYS PCMH Recognition?
Recognition is at no cost to practices. NYSDOH covers the first-year NYS PCMH Recognition fee or the first NYS PCMH Annual Reporting fee. The practice is responsible for paying their Annual Reporting fee each year after earning NYS PCMH Recognition.
New York State has contracted with 15 organizations that specialize in NYS PCMH transformation and are being made available at no cost to participating practices. These entities provide step-by-step assistance in managing the transformation process and support the efforts of improving the patient experience. For more information, or to find a Transformation Assistance Contractor, visit ncqa.org/ta.
How long will it take to earn NYS PCMH Recognition?
Although it varies because practices work at their own pace, typically it takes 6–9 months for currently PCMH-Recognized practices and 9–12 months for practices that are not currently recognized.
How do I get started?
If your practice is not currently recognized and is interested in learning more about NCQA Recognition, contact NCQA. If your practice is currently recognized and want to talk to someone about its current status, renewing or adding recognitions, submit a question through My NCQA.
Are there any other documents or information that will help us get started?
Go to the Get Started section on the NCQA website for everything you need to move forward with the PCMH Recognition process.
What other organizations have earned PCMH Recognition?
More than 13,000 primary care practices (with more than 67,000 clinicians) have been recognized as medical homes by NCQA. Find a directory of recognized organizations at the NCQA Report Card.
WHAT IS NCQA’S VIRTUAL REVIEW CANCELLATION POLICY FOR NYS PCMH PRACTICES?
NCQA has a 48-hour cancellation notice requirement for scheduled check-ins for practices participating in the NYS PCMH program. Practices that need to cancel or reschedule a check-in must do so no later than 48 hours prior to the currently scheduled check-in date and time.
If a check-in is cancelled after the 48-hour timeframe, the check-in will not be reset and will be counted as one of the three allowed check-ins for the process. The practice will be responsible for paying for a 4th check-in, if needed, to complete their Recognition.
If a practice needs to cancel or reschedule a check-in, please contact your NCQA Representative via the “Ask a Question” feature in the practice’s Q-PASS account or send the request using my.ncqa.org. Please remember to cancel or reschedule the check-in no later than 48 hours prior to the currently scheduled check-in date and time.