PCMH PRIME Certification

For Massachusetts Practices That Demonstrate the Ability to Address Behavioral Health in Primary Care

Behavioral health issues can often first 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 and substance use disorders) can be exacerbated by under-/delayed diagnosis and treatment. This is a serious public health problem nationally and across Massachusetts. 

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

Benefits of PCMH PRIME Certification

PCMH PRIME promotes best practices for integrating behavioral health care into a patient-centered primary care setting. The program seeks to provide 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 deliver comprehensive care by addressing both physical and behavioral health in the practice setting.
  • Providing opportunities for practices to receive technical assistance from the HPC. 
  • Helping practices identify 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: Comprehensive health 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

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

Getting Started 

Interested in attaining PCMH PRIME Certification? Here’s how you get started:

First, go to the HPC’s website to complete a short applicationindicating your practice’s intent to pursue PCMH PRIME. Practices can also request HPC technical assistance with building capabilities specific to the PCMH PRIME program.

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 within the next six months 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.
    • Recognized practices not planning to renew their PCMH Recognition in the near future may apply for PCMH PRIME Certification separately, at any time.

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.

Practices that are not currently PCMH Recognized: 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.orgfor more information.

PCMH PRIME Alignment with NCQA’s PCMH 2017 Program

To align with NCQA PCMH 2017, the HPC and NCQA recently revised the PCMH PRIME standards and application process. Practices currently applying for PCMH PRIME Certification must follow the PCMH PRIME 2017 standards.

Please see the HPC Website for more information about recent changes to the PCMH PRIME program.

Questions?

Have more questions. Visit my.ncqa.org to ask a question and a representative will get back to you shortly.


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