Patient-Centered Specialty Practice (PCSP) Clinician Eligibility
Frequently Asked Questions
Q: Who is eligible for PCSP recognition?
A: All types of medical specialties or subspecialties are eligible, including specialists who see patients infrequently, those who see patients for a short episode of care and those who provide care for chronic diseases or extended illnesses.
- Eligible clinicians who typically receive referrals from PCPs and other non-primary care specialists, and can demonstrate a capability to meet the standards, are eligible, including non-primary care specialty doctors of medicine, doctors of osteopathy, nurse practitioners, physician assistants, certified nurse midwives and the following behavioral healthcare practitioners:
- Doctoral or master’s-level psychologists who are state certified or licensed
- Doctoral or master’s-level clinical social workers who are state certified or licensed
- Doctoral or master’s-level marriage and family counselors who are state certified, registered or licensed by the state to practice independently.
- Physician assistants, certified nurse midwives and nurse practitioners are eligible to be listed on NCQA’s Web site as providers if they have their own panel of patients.
Q: Why doesn’t PCSP include other health care professionals?
A: NCQA’s research suggested a focus on medical specialty practices and clinicians, not the broader health care community. This decision was supported by the PCSP Advisory Committee, NCQA’s Leadership and Board of Directors.
- Medical specialists were the original target of the program in alignment with both ACP’s and AHRQ’s whitepapers. ACP placed a strong emphasis on establishing PCP-specialist agreements and on identifying the types of relationships between primary care and specialists.
- Some advisory committee members suggested beginning with a narrow focus for this program and possibly, at a later time, expanding or developing another program for the broader healthcare community.
- Research suggests that payers are vitally interested in reducing the costs associated with over-use of services, unnecessary referrals to specialists, timely transitioning of patients back to the PCP and patient safety issues associated with medication management.
- There is a strong imperative to link mental health with primary care and to encourage coordination of care and communication between primary care and mental health providers
Q: Are Doctors of Chiropractic (DCs), Doctors of Optometry (ODs) or Doctors of Podiatric Medicine (DPM) eligible?
A: No. Chiropractors, Optometrists, Podiatrists are not eligible for the PCSP program.