PCMH PRIME Certification

PCMH PRIME Certification is for practices in Massachusetts that demonstrate the ability to address behavioral health in primary care. You can also search NCQA’s database of additional common questions or ask a question through My NCQA.

The Massachusetts Health Policy Commission (HPC), in collaboration with NCQA, developed the PCMH PRIME Certification Program. This program identifies criteria that are key to integrating behavioral health care into primary care. The program certifies practices that meet a majority of these criteria.

Why PCMH PRIME?

Behavioral health issues can often be identified in a primary care setting, and there is growing consensus that behavioral health should be integrated into primary care. Behavioral health conditions (mental illnesses, substance use disorders) can be exacerbated by under-/delayed diagnosis and treatment. This is a serious public health problem nationally and across Massachusetts.

PCMH PRIME promotes best practices for integrating behavioral health care into a patient-centered primary care setting.

The program provides benefits to practices and their patients by:

  • Supporting the use of evidence-based guidelines in treating patients.
  • Helping increase patient access to behavioral healthcare services.
  • Recognizing practices that address both physical and behavioral health in the practice setting.
  • Providing opportunities for practices to receive technical assistance from the HPC.
  • Identifying behavioral health issues before they become acute, resulting in better outcomes and improved patient experience.

Program Requirements

Practices meet PCMH PRIME criteria by demonstrating capabilities in a majority of the following areas:

  • Behavioral Health Integration: Integration of behavioral health through agreements, co-location or provider integration.
  • Comprehensive Health Assessment: Assessments that include screenings for behavioral health conditions, such as depression, post-partum depression, anxiety, developmental delays and substance use disorder.
  • Identifying High-Risk Patients: A system for identifying high-risk patients for targeted care management.
  • Referral Tracking and Follow-Up: Tracking and following up on referrals to specialists, including behavioral healthcare providers.
  • Evidence-Based Decision Support: Using evidence-based guidelines to make decisions about support for mental health and substance use disorders.
  • Addiction Treatment: Medication-assisted treatment for addiction.

Practice Eligibility

Eligible practices:

  • Are located in the Commonwealth of Massachusetts.
  • Have NCQA PCMH Recognition (any year/level, except PCMH 2011 Level 1).
  • Must complete and submit an application to the Massachusetts Health Policy Commission (HPC).
  • Must submit documentation to NCQA for evaluation on the PCMH PRIME behavioral health criteria. (Practices are not charged for PCMH PRIME review.)
  • Meet at least 7 of 13 criteria to achieve PCMH PRIME certification.

FAQs

Review the list of the most frequently asked questions about the NCQA PCMH PRIME Certification program. If you don’t see what you are looking for ask a question through My NCQA.

Educational Events

See what education events are scheduled for PCMH PRIME Certification.

Getting Started With PCMH PRIME Certification

See what you need to do to get started with PCMH PRIME Recognition.

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