FAQ Directory: PCMH Prime

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8.22.2018 Would unhealthy behaviors associated with a parent’s behavior be acceptable for PP 06 since they are responsible for preventing these behaviors?

PP 06

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. 

8.22.2018 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.  
 

8.22.2018 What is the required frequency for a patient health assessment?

PP 06

NCQA does not prescribe a frequency; practices determine the time frame for conducting and updating patient health assessments according to a protocol that suits their patient population, aligns with evidence-based guidelines and allows for meaningful evaluation of data.

8.22.2018 What type of standardized screening tool for depression would meet the requirement for a pediatric population?

PP 08

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. 

8.22.2018 Our practice offers telepsychiatry. Does this meet the requirement for a care manager qualified to manage behavioral health?

PP 01

No. For criterion PP 01, the care manager function must be filled by practice staff

8.22.2018 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.  

8.22.2018 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. 

8.22.2018 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. 

8.22.2018 Is there a website or list of PCMH PRIME Certified practices?

Eligibility

As practices obtain PCMH PRIME Certification, or make a commitment to doing so (thereby receiving “Pathway to PCMH PRIME” status), their names are posted on this website. 

8.22.2018 How long is the PCMH PRIME Certification good/valid for?

General

The HPC’s current policy is that PCMH PRIME Certification lasts for up to three years. This differs from NCQA’s PCMH 2017 Recognition program which has a one-year recognition period. A practice must maintain its NCQA PCMH Recognition throughout that period in order to maintain PCMH PRIME Certification.  If NCQA Recognition lapses while the practice is PCMH PRIME Certified, the practice will need to re-attain NCQA Recognition within 6 months in order to keep their PCMH PRIME status.    

 

A PCMH PRIME Certified practice could choose to renew its PCMH PRIME Certification before the three-year expiration date if the practice is renewing its NCQA PCMH Recognition and wants to simultaneously renew PCMH PRIME Certification in order to align the two recognition periods.

8.22.2018 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.

8.22.2018 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.