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FAQ Directory: PCMH Prime

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8.22.2018 Where can we find more information about PCMH PRIME criteria and documentation requirements?

Eligibility

A list of the 13 PCMH PRIME criteria can be found on the HPC website here. The full PCMH PRIME requirements, including the criteria and all documentation requirements, is available for download at no cost from the NCQA Store.

PRIME 2017

8.17.2018 When did the PCMH PRIME Certification program begin?

General

The PCMH PRIME Certification program launched on January 1, 2016.

PRIME 2017

8.17.2018 For criteria PP 06-PP 11, is a there a threshold percentage practices need to meet to receive credit?

PP 06-PP 11

There is no minimum threshold required for PP 06-PP 11. PCMH PRIME standards require practices to report numerators and denominators for review, but we will not be looking for a specific threshold percentage.

PRIME 2017

8.17.2018 Our organization has NCQA PCMH Recognition for multiple sites. Should we submit site-specific information or program-wide information to HPC?

Q-Pass System

PCMH PRIME is a site-specific certification program.  Unless otherwise noted in the PCMH PRIME Standards and Guidelines, practices must submit site-specific evidence.  For some of the PCMH PRIME criteria, practices that are part of a multi-site organization can share the same evidence.  Please see the PCMH PRIME Standards and Guidelines for specific details regarding which evidence can be shared across practice sites.  

 

PRIME 2017

8.17.2018 Is there an additional fee to practices for applying for PCMH PRIME Certification?

Cost

No, practices do not pay an additional fee for PCMH PRIME Certification.

Practices seeking NCQA PCMH 2017 Recognition and PCMH PRIME Certification concurrently are charged only the standard NCQA PCMH Recognition application fee. Applying to these programs concurrently may make your practice eligible for a discount on PCMH 2017 Recognition; please contact GRIP Staff, pcmh-grip@ncqa.org for more information. Practices seeking PCMH PRIME Certification only, to supplement a previously achieved PCMH Recognition, are not billed for the PCMH PRIME survey.

Note: If a practice fails to achieve PCMH PRIME in two attempts, the HPC reserves the right to require the practice to cover the cost of additional attempts.

PRIME 2017

8.17.2018 How do the PCMH PRIME standards and application process align with NCQA’s PCMH 2017 program?

General

On September 30, 2017, the HPC released an updated set of PCMH PRIME standards with the aim of aligning with NCQA’s PCMH 2017 program. Beginning November 17, 2017, all practices seeking PCMH PRIME Certification will apply through a new NCQA survey platform (Q-PASS) and will be subject to these modified standards. The 2017 version of the PCMH PRIME standards can be found in the NCQA store and a summary of the differences between 2016 and 2017 PCMH PRIME standards can be found on the HPC website.

 
Additionally, practices that seek 2017 PCMH Recognition and PCMH PRIME concurrently will have an integrated review process with NCQA, which may include both submitting documentation to NCQA and going through their new “virtual review” process.  Practices that seek only PCMH PRIME Certification (after having already achieved PCMH Recognition) will upload all evidence to Q-PASS, with no virtual reviews. 

 
While NCQA PCMH 2017 Recognition requires an annual review process to maintain recognition, at this time, PCMH PRIME remains a 3-year certification.  

PRIME 2017

8.17.2018 How long does the PCMH PRIME review process take?

General

The PCMH PRIME review process varies depending on whether a practice applies to PCMH PRIME concurrently with a PCMH 2017 survey or applies to PCMH PRIME only (to supplement previously earned PCMH Recognition).

·        Practices applying to PCMH PRIME concurrently with a PCMH 2017 survey will submit PCMH PRIME evidence as part of the PCMH 2017 virtual review process. The PCMH 2017 review process may take up to 12 months but varies by individual practice timelines and capabilities. This process includes up to three virtual check-ins lasting up to two hours each.  Practices applying only to PCMH PRIME or to PCMH PRIME concurrently with Annual Reporting will upload all evidence to Q-PASS without participating in a virtual check-in. NCQA evaluates a practice’s documentation for PCMH PRIME within 60 days of receipt. 

 

Once the PCMH PRIME documentation review is complete, NCQA provides its assessment results to the HPC.  The HPC issues a final scoring decision to the practice within 15 business days of receiving results from NCQA.

PRIME 2017

8.17.2018 Our practice is interested in attaining PCMH PRIME Certification. How do we get started?

General

First, go to the HPC’s website to complete a short application indicating your practice’s intent to pursue PCMH PRIME.

Once your practice has submitted the HPC application and is ready for next steps with NCQA, you should apply through the new NCQA Q-PASS system. The PCMH PRIME application is separate from the PCMH application in Q-PASS. Practices may apply for PCMH PRIME Certification separately or concurrently with the PCMH Recognition process and Annual Reporting.

  • For PCMH 2011 (except Level 1) and PCMH 2014 Level 1 or 2 Recognized practices:
    • Practices planning to undergo the PCMH 2017 Recognition process in the near future are encouraged to apply for PCMH 2017 Recognition and PCMH PRIME Certification concurrently. Applying to these programs concurrently may make your practice eligible for a discount on the PCMH Recognition survey tool; please contact Government Recognition Initiative and Projects (GRIP) Staff at pcmh-grip@ncqa.org for more information.
    • Recognized practices not planning to renew their PCMH Recognition in the near future may apply for PCMH PRIME Certification separately, at any time.

§  For PCMH 2014 Level 3 or PCMH 2017 Recognized practices:

  • Practices that are maintaining PCMH Recognition through the Annual Reporting process may apply for PCMH PRIME Certification concurrently or separately from the Annual Reporting process, whichever is most convenient for the practice.
  • For Practices without PCMH Recognition:
    •  Practices must attain PCMH Recognition in order to be eligible for PCMH PRIME Certification. Such practices are encouraged to apply for PCMH 2017 Recognition and PCMH PRIME Certification concurrently. Applying to these programs concurrently may make your practice eligible for a discount on the PCMH Recognition survey tool; please contact GRIP Staff, pcmh-grip@ncqa.org, for more information.

PRIME 2017

8.17.2018 Is there a timeline for earning PCMH PRIME Certification?

General

Massachusetts practices may apply for PCMH PRIME Certification at any time; there is no application submission deadline. Practices may apply for PCMH PRIME Certification at the same time as they are renewing or sustaining their NCQA PCMH Recognition, or they may apply for PCMH PRIME as a separate program at any time. 

PRIME 2017

8.17.2018 Are there recommended screening tools that would satisfy PCMH PRIME criteria PP 07-PP 11?

PP 07-PP 11

There are a variety of validated screening tools that practices may use to meet PP 07-PP 11.These include, but are not limited to, PHQ-9, AUDIT, GAD-7, CRAFFT, and SWYC. The PCMH PRIME Standards and Guidelines document gives additional examples of screening tools that may be used to fulfill each factor. Practices may select from among those examples, or use any other validated screening tools that work for them.

PRIME 2017

8.17.2018 Who is eligible for PCMH PRIME?

Eligibility

The program is open to practices in Massachusetts currently recognized as: 

  • NCQA PCMH 2011, Level 2 or 3. 
  • NCQA PCMH 2014, Level 1, 2 or 3. 
  • NCQA PCMH 2017

A practice that is working toward NCQA Recognition may apply for the PCMH PRIME program and NCQA PCMH recognition concurrently. 

PRIME 2017

8.17.2018 Our practice is not located in Massachusetts, but we have behavioral health integrated at the practice site and would like to achieve certification. Can our practice pursue the PCMH PRIME program?

Eligibility

No. The PCMH PRIME Certification program is limited to practices in Massachusetts. Practices outside of Massachusetts offering integrated behavioral health services are encouraged to apply to NCQA’s Distinction in Behavioral Health Integration, which is available nationally.  
 

PRIME 2017