So, again, welcome, everyone, and, thank you for joining us today. We are thrilled that you are here for our September office hours on the 2027 update on the PCMH standards, changes for the transforming, and, course, of we'll also be talking about the annual reporting as well. Before we get into the meat of the program, though, I wanna go through a disclaimer that HRSA has had us... Has asked us, excuse me, to include in all of our presentations, noting this is, being done under our contract number right there, our contract that NCQA has with HRSA. And, of course, the publication or the the presentation includes nonfederal resources in order to provide additional information, and those have not been approved, by HRSA or HHS because they are NCQA's work product. And, of course, since this is, this system refers to our PCMH standards, that's gonna be all of NCQA's work product. So, just wanted to point that out. Also, if you are, interested in interacting with us, please feel free to either send questions in through the q and a. At the bottom of the screen, that would be questions about standards themselves, about, any kind of, process issues, that sort of thing. And then also, if you have, feedback or questions about technical issues, please send those through the chat. If you have, questions that you want the other participants to see and perhaps respond to, please make sure you're chatting with everyone. If it's an audio issue or a visual issue, and you're going to chat just directly with me, please feel free to, put those through, to host and panelists only. Okay. And if you want to, address me verbally, I wanna bring up, some... Something too long to type, raise your hand, and I can elevate you up to a panelist, and we can hear from you directly. So just the, formal introductions. I'm Bill Tullock, director in our federal services center here at NCQA, is part of the quality measurement and resource group... Research group, excuse me, here at NCQA, which is basically, the part the part, of NCQA that handles our federal contracts. And also the state contracts as well in a different area. But I've been working on the HIERSA contract since 2016... 2010, excuse me, since... For sixteen years since we got it back in 2010. So happy to be with you all today. We're gonna talk a little bit about how to access the publications, in NCQA. Make sure that you have access to those. And then also, talk a bit about the updates for transforming 2027 and then our annual reporting requirements, which, of course, change each, year. So feel free up. So someone's saying they think I'm muted, but I'm not actually on mute here. Can other folks hear me? Okay. So, Aaron, I'm not sure what's happening with you. Okay. So it's not... It doesn't seem... Okay. I'm getting a lot of yes. We can hear you. So I'm not sure. Let me just type. Okay. Good. Thank you, Wanda. Alright. So, Aaron, I think, here. Let me... I'm gonna, chat directly. Sorry. Okay. Perfect. Okay. So Aaron's gonna resign in. Okay. Great. Alright. Always a bit of a panic moment when you think you've been talking for so long on mute. So glad I'm not. Alright. As I mentioned, we do change the annual reporting standards each year. And so we'll go over what those are. And those, of course, are based on a subset of the overall requirements. So just accessing publications, I wanna make sure everyone is aware of how to do this. So it's important to note that the transforming standards begin at about a $140. That was the last time I checked the price. And, however, health centers, including all look alikes, if you are supported by HRSA, you can access a complimentary copy. So what you wanna do is go to, and I'll show you exactly how to do this on... Online in just a second. You go to my.ncqa.org, which is NCQA's centralized customer service hub. You can either log in with your email address. If you've logged in for anything, if you've... I think if you've registered for this program, in fact, you've automatically set up an account with NCQA. We have a single site login system now. If you if you haven't ever done that before, though, you will have to create an account. And then you're gonna go to my questions and then request a complimentary copy, and I will show you how to do that. And then if you, have already downloaded the transforming standards, that is a living publication that is you only have access to it once, and you get every update that comes in with it. And I'll show you exactly what that looks like as well. And then if you are doing annual reporting standards, if that's what you're looking for, you can get those at no cost. Those are free to everyone, but you have to go to our publications and actually specifically ask for that. So what I'm gonna do is I'm actually gonna stop sharing on the slides for a moment, and I'm going to bring up the... Just to show you guys what this looks like. So here I'm gonna share again. So this is the my.ncqa.org, website. But first, I wanna show you the store, which is over here. This is our, centralized publication store. So if you were looking for our standards, you'd go here to health care providers and PCMH. And you can see that we have the, readiness, package. We've got, the standards and guidelines and then the annual reporting notice. The standards and guidelines are at a 140. Annual reporting are free. So if you were going to actually get the annual reporting, you would just start the order here. You would buy the publication like you would buy every... Any publication. There's no cost, though, so there's no payment information. You just give them your address, and they will and they will, send you a copy electronically. That's very important, to note. However, if you're looking for a complimentary copy of the standards... Of the transforming standards, then you can come here. I'm actually using a customer account, rather than my NCQA account. And this will show you all of your questions that have been opened or closed in the last little bit. Actually, this goes back quite a while to, it gives you a full history. Come up here to ask a question, and you're just gonna choose the correct options there, and then basically request a copy of the complimentary standards, the PCMH standards, and note that you are a HRSA supported health center and provide your grant ID, which is gonna start either with H80 or LAL. It's the same grant ID you use. It's an eight digit or nine... Eight character or nine character. I can't remember which now, but it'll be on the slides when we go back to them. A number that you'll be... You use to communicate with HRSA. We have a list of all the active, codes that HRSA, all the grant IDs, so we can actually look it up and provide you with a complimentary copy. If we don't see your grant ID, we'll we'll contact HRSA to see if if, if they have a more updated list or if we have to go back to you and and get a, maybe digits, you know, transcribed or something, transposed. Excuse me. But we will we will communicate with you and get that publication out to you because as part of our contract with HRSA, we do provide the standards free to all the the centers that they support. When you get your publications, it's gonna be over here in my downloads. And so this is not actually showing a download. So what I'm gonna do is I'm gonna log out. I'm gonna log back in. Oops. I'm gonna log in as my NCQA account. Oops. Oops. What happens when I try to type on a keyboard without my my reading glasses on? Okay. Here we go. The stored password is always fun. Right? Alright. So here, if you're gonna be looking for your publications, you're gonna come to my downloads, and you'll see I have every publication under the sun. That's why I try not to show folks this. But notice it tells you what's been updated and then the last time it was updated and the last time you download it. So if you have... Once you get a copy of the transforming standards, every every time we update those standards, you'll be able to come here and download a copy of the updates. And if you're not sure, if you have the most up to date version, this is gonna tell you right away. So that's a living document, the transforming standards. They will, continue. Every time we update, you'll get an... A a new copy of them. Now what's important to note there is the standards are actually assigned to someone, via, email address. So what often happens is your organization, obviously has some turnover, and... I'm just gonna bring my... There we go. May have some turnover, and the person who has access to the standards leaves, so you just request a new copy under a new email address. It happens all the time. We actually estimate when we are working with HRSA that we have to provide a copy every two to three years to every health center for that reason. So if you've got someone who still has access, you can download a copy at any point. You you can print those off as a PDF if you want. They're very long, so, enjoy doing that. However, if you, don't have access, please just get a new copy, and we'll assign that. And we we expect to be able to give, you know, as I said, what... A new copy every two to three years, with the health centers. And, actually, let me also just show you. I'm going to, stop the slideshow real quick. I wanna also show you what it looks like when the standards actually show up. So I'm gonna open up my file, here. So question, yes. Actually, the standards are updated. I just wanna make sure I find... Hold on. I'm gonna answer that question just a moment. So here's actually what happens. You get a a a folder like this right now. Transformer, you're actually getting the 11.1 version, which is for, the current calendar year and version 12, which is for the next calendar year. And if you open this up, you'll see you'll have all... Basically, this is the publication. If we we if we were to put together a book and send you a book, this would be all, the areas of the book, the the front matter, the actual standards and guidelines, and all these appendices. Plus you have these resources, so you can do a self assessment. You can look at the record review workbook. All of those are also available here. So the question is, are they sometimes updated later in the year? They are. So if you notice, if we go back up here to this download, version, 11.1 denotes that this was the the first update of version 11. So this was an update that they did probably in July of last year. So 11 came out and basically was, official in January. They updated in July. So when we update... That's why it's important to note your downloads will always keep track in my.ncqa.org. Go to my downloads. It will always keep track of your last download date, and then it will highlight whether the standards have been updated since that time. So you can always make sure you have the most recent copy. So, yes, those standards are updated. If you get a copy of the standards, you should get an email from NCQA alerting you to that update, but sometimes that goes into spam as we all know. And so just, if you're not sure, you can always check at my downloads, to make sure you have the most recent copy. But thanks. It's a great question. For the annual reporting standards, those come in at a very similar, but it's, just one PDF because all those resources and things are not applicable. So I'm gonna go back to the slides. Okay. So let's talk about the update for 2027 for, the PCMH standards, is now, version 12 of the of the standards. As many of you know, we did a lot of updates in 2026. We retired a number of standards. You will note the numbers of the standards that were retired are skipped now in the in the publication. For, technical reasons in QPass, we can't change the standard number or else we can't share credit if it's a shareable, standard across organizations, particularly when new sites come on. If we were to change the standards numbers to reflect, say, a retired standard and have all the not all the, numbers sort of sort of go back one, it would mess up that that ability. So when we retire the standards, we simply retire the, the number itself, but we skip it. So if standard seven was retired in the concept, it's gonna go six to eight, and it will tell you that seven was retired. That's just to keep the the numbering, in in order. But since we did do all those changes to 2026, we kept the 2027 changes minimal, and the real, important changes are all in Centimeters. And this allows for more flexibility in choosing your care management, patients and also how large a population we're expecting to see. So first, a big change was for pediatric practices, whereas normally, in c m o one, we require practices to pick three of the five categories. Pediatrics, because they have a a more limited patient population in terms of chronic illness, things like that, they have to they have to include at least two of the five categories rather than three. If you are a pediatric practice only, please note if you're, internal medicine for adults, geriatric, or family practice where you have adults in your in your practice, that wouldn't apply. This would be for pediatric practices only. We also have, for all practices, have said we expect either to see a minimum of 30 patients or one percent of the total population in the care management program, whichever is smaller. And this is really for those very small rural sites that have had a hard time meeting those 30 patient file, standards. 1% that would be about, if I'm doing the math correctly, 300 patients. And... Wait. No. 300. 1% would be three. So it'd be 3,000 patients at a site, would be 30 patients, would be 1%. I... Math was was was a long time ago for me, so, you'll have to forgive me on that one. So if you have more than three three thousand or more patients, then 30 patients is the minimum. But if there are fewer than 3,000 patients that you count as your population at a site, then we would expect that 1%, of the population to be in your care management program. Please note also that you define what your population is, so it is not every patient that has been assigned to a provider at your practice. We understand some of those assignments are based on people enrolling in health plans, particularly Medicaid, where they have no history with a provider and they have to just pick someone, and so they do, but they may never come into your practice. So you're absolutely, allowed to define your population as those you've seen once in the last year, twice in the last year, however you do it. But that would be the population that we're we're basing that 1% on. We also, made it very clear about what we are, expecting in care plans. So the active problem list, that's not new. They, expect a clinical outcome or prognosis, what you're aiming for, and either the patient treatment goals or a SMART goal, which is, you know, a standardized measurable... I'm trying remember the the full acronym, but you all know what SMART goals are. So we're looking for one of those two. So there's a little bit more flexibility there. Still looking for that medication list with management of of those medications and then the schedule for review and revision. So we just, wanted to make those explicit as well. But those are the only changes to the transforming standards for 2027. All the rest, are gonna be the same as they were in 2026. Any other updates would be in explanations, of the standards where we we give a little bit of insight into what we're looking for. We do update those, but those are not considered changes to the standard. They're just expanded, expectations or understandings. I think it's what's... That case, the question for, Josie, I would say everything that is active, at that point, not just what they were seen for for that day, but it it does include, it does mean that that inactive problems or old problems, or issues that are no longer, affecting the patient can be left off. But I would say it... We're looking for active, for the patient that that were active on the day even if they if even if they weren't seen for that day. Seen for... Sorry. Seen for that problem that day. Let me make sure I'm being very clear here. Okay. So for annual reporting, it's important to remember... Okay. Perfect. That was... Wanna make sure that that answered your question. Perfect. For annual reporting, remember that these are a subset of standards. They are based on the transforming standards, and we will tell you in each of these which transforming standards they're based on. Hold on. I have to keep the whistle wet during these, these presentations. But it's also important to know that you have to provide a couple of, questionnaires for each of your sites each year. First is just confirming you're still eligible for PCMH. That is you're still seeing predominantly, primary care outpatient, patients for your your provider panels. That's 75% of your care... Or 50%. Excuse me. I don't remember which one now, but the eligibility questionnaire is there. And also updating any practice information on demographics, insurance break... Breakdowns, things like that. If you added behavioral health, this is when you would wanna indicate that or added dental. Those kinds of things would be would be in the practice questionnaire. You also have to attest annually that you are still meeting the requirements of the PCMH program. Now, of course, providing the data for annual reporting is one way that you're demonstrating you're meeting those. But the attestation is basically saying, I can still meet all the core requirements. Remember, are now 39. We did retire one core requirement. So there are 39 core requirements, and that you can still get the required 25 elective credits, remembering that you must get one credit in five of the six concepts. So you're saying you can still do that, but remember that you are not saying we can still do this the same way as when we got recognized. It is fine to change EMRs, to expand services, to change your focus on certain, practices or programs that meet your patients' needs, that that meet your patients' needs so you may be meeting the requirements in a different way than you did two or three or five or ten years ago because we are getting to the point where we had our our first practices were, in fact, ten years ago. Whoops. I did not mean to do that. Sorry. I was getting a piece of dust off my screen. So the question, please confirm these are changes in effect. Yes. For 2027. So these are, the... Those of you who are reporting in 2027, these are are the standards you'll be reporting on starting 01/01/2027. It will be based on 2026 data. Remember that's, really important for quality improvement data because our standardized measures, we do expect the previous calendar year to be what's reported. And I will note that the changes that we're talking about for annual reporting, it's just a change in which standards we're looking at. So the standards themselves, the expectations haven't changed. So the way that we divide this up is not to go, through the annual the annual reporting standards from front to back. What I do instead is I do it by evidence type. So, we are looking for, for instance, for AR k m two, which is the equivalent of k m o nine. We are looking for an actual report on your demographic data. So they're showing that you can actually report based on there's a whole, list of information in k m o nine for diversity. We are looking for a a report for your transformation lead showing that you still have a PCMH transformation lead and a clinical transformation lead. They can be the same person. For your timely communication with patients, which is based on a c o four, the core requirement, or a c o eight, the elective one. Either of those, meaning either of those would be the same evidence we're looking for in a r a c two. In a r c c one is referral management. Again, we are looking for how you're doing that, and this is a... For c c o four c. Okay. I was not aware of the, of sort of the process for, so looking at Don's question, the the request about, having that many practice sites and sample size, and we are two plus weeks out from the question being responded to. I'm not sure what their process I can check with our operations folks who are answering those questions. They may have been somewhat inundated, with with questions about that. So, let me check on that, and we'll get back to you on on that question because I'm not sure exactly what the process is they're going through at the operation's end. Okay. We are also looking for a report or attestation, on patient visits with the clinician team. In that case, I believe the attestation is you only have one clinician is if you only have one. We are looking for evidence, which would typically be, the documented processes or evidence of implementation for the, structure and staff responsibilities, the equivalent to c c o two, that comprehensive health assessment, which is KMO two, the same day appointments, which is ACO two, always an important part of PCMH, and then the, identifying patients for care management. Now the changes that we did make in 2027 because we made things a little bit easier are gonna apply going forward in annual reporting. But, again, that means the pediatric practices will only have to have two out of the five, required, categories for CML. One, if they're using that And also, the size of the of the population, that 1% or 30, whichever smaller would apply going forward. So we... When we make things, less challenging, we do make those sort of immediate changes. If we were making things more challenging, then we would give you a date when those would be, applicable. Will the slides be shared? When we do the recording, when we upload those, we will upload the slides as well. Yep. They'll be in a PDF version. So the, again, for... Also for evidence, we're looking for the post hospital, ED visit follow-up, that process, and then appointment availability assessment, as well. That's part of QI o three. And then for care management, again, we are talking about, the actual, percentage of folks that are in your care management, program. So you're gonna attest that you're doing this, but we also want that report, and the evidence upload. And, again, those transformation changes for the size of the of the the population, those expectations, those go forward as well for annual reporting. And then, of course, the, clinical and resource stewardship measures, we are still collecting those through the QI, measure reporting tile, with the standardized measures where appropriate. And remember, no matter when you're reporting in 2027 or annual reporting, we always want calendar year 2026 data. Okay. So a question. And you know what? I made an error here. So I'm gonna go back to my, downloads because I wanna open up the standards to answer that question. So I'm gonna bring that off your screen. So I'm just gonna open this up. I wanna make sure exactly, what they're suggesting. So Second, I'm just going through the annual reporting standards. The the transforming standards have a link. So in the table of contents, you can go right to any standard. In the in your reporting, you've gotta scroll through the whole obligation. I don't like that setup. Okay. So what we're looking for in terms of the, q y o three, the appointment availability assessment. So we are looking for a documented process that includes, the major appointment types you're you're, tracking, and then, evidence that you are actually, tracking this this data. So that could be third next available, appointment, or it could be a report that actually looks at... The other suggestion we have is a report demonstrating the utilization of different appointment types. So, you know, we have this many, appointment, same day appointments available each day. This is the percentage that are used. We have this many, you know, urgent care appointments or this many short, appointments. It's longer ones for physical. However you're defining those. So so third next available is probably the most common, but it is not the only way to do that. So that's important to note. But making sure that you are meeting the needs and preferences of, your, your patients, and that also could be in person or... And or telehealth. So however you define your appointments, then you're gonna track at least how they're being used. So that's an important note, there. Okay. Alright. I'm gonna go back to the slideshow. And, actually, that is the the end of the annual reporting standards themselves. As I said, the the... You know, there's always a subset. We do change those each year, so we could be looking out, for the updates in July. So I'm looking at, so the question is about a r a c two. So, again, I'm gonna double check that I'm looking at the standard. I always wanna make sure I'm looking at the standard because I remember things, and then, I've been known to misremember them. So, actually, let's go back up. Alright. So so AR, AC two is about timely communication with patients. This is via... Either by telephone or telephone and two way electronic communications. So for instance, I'm a member, and I can chat directly with them, online real time in in in their website. So the question is... So, we're looking for ACA four, timely clinical advice by telephone. So in your question, John, you mentioned that there are a few calls that don't end with an appointment. So if it is a medical advice call that ends up the the the, the, response from the clinician is, well, we need to make you an appointment, and then they do, that's that's still a medical advice call. So I wanna make sure that's clear. It doesn't it doesn't mean that you only provide advice. The advice may be coming for an appointment, maybe tomorrow morning versus go to the ER right now. That's the kind of thing we're trying to to avoid with those. But, certainly, for ACO four, that's the number of clinical calls. That's a core requirement that received a response within expected time frame. So, again, you're saying that they may have very low numbers of of clinical calls. I would make sure that that's clear to the the evaluator, that most of our calls are, the med refills or appointment requests that are not I'm having this symptom. It's just, oh, I need to make this appointment because I know I have to make it. If you can provide data on your, sort of all the the the number of calls and the percentage in each of those categories, that's probably gonna be very helpful as well. That isn't required, but that might be a good way of showing, look. We've we've done the breakdown. We have a minuscule amount of calls that are, about medical advice. Now more of those may be coming in with electronic communications, which is a a c o eight, and that's why we've included this as well. So if they're coming in electronically, that's the other way to show that, as well, when you're responding. But make sure if they are a very low percentage of your of your overall calls, that that's clear to your evaluator as well. Are there, whoops. Sorry. So the weight assessment counts for nutrition and physical activity for children's adolescents. CMS one four five requires three rates. Can you explain what those rates are? I'm gonna have to go back to this rate. I'm actually going to... I'm copying your your question because it's in chat. I wanna make sure I get it. But I'm gonna have to probably bring that to our policy folks because I'm not sure about that measure. So I need to go back and look at that. Are there any plans in allowing for additional options for resource stewardship? I know we're always looking for more, but I don't know of any specific plans at the moment. So most of our patients are now using the patient portal for medical advice. We've noticed a big drop on phone calls, and what they do is is usually questions for med refills or asking for an appointment. And that's exactly why we included a c o eight in that, in the annual reporting requirement. Because if they're mostly coming through the patient portal, then you... Then basically respond with the number of electronic communications. You should still have a a standard for how quickly you're responding to those based on the clinical urgency, and make sure that you're meeting those requirements, in your own practice. But, yeah, that that seems to be a lot of things. And, honestly, I I would never call Kaiser at this point. I would always go through the portal, to ask that question. So clinical device can become a headache. It's easier to offer the device over the phone instead of opening a telephone encounter and document the information, which can become time consuming and burdensome for nursing staff. Makes a lot of sense. Absolutely. But, again, we... Part of what what you need to be tracking is to make sure you are responding to patients, quickly enough. There may also be, ways that you can survey patients who have called the practice to see if they are getting, responses in, a timely manner. If you are... If you're asking for specific time frames, that may also be a way to document that if you aren't requiring a, documentation of each of the of the advice calls. Other questions on the, in your reporting standards, the, transforming changes, how to access the standards, anything like that? Right. So thank you, Dawn. You've you've linked to the, the, standardized measurement website, which is a great resource for all of those measures. So on the comment for medical advice outreach via the patient portal, if the response results in a virtual express visit offered by the system, not necessarily the site or clinic itself. Could that satisfy the requirement? That's a very good question. And, again, I don't wanna answer yes or no because I'm not sure if our interpretation is that a person has to get involved in that as we're moving more to this AI. That... That's one of those... Well, this is what I call a really great question I don't know the answer to, so I'm gonna bring that back to policy as well. Okay. Alright. So, the link... Yeah. John did provide the link to the standardized measures, explanations, and I'll make sure that we include that in the slide deck when we update that and add it to the website as well. Alright. Other questions? We are a bit early, but I'm fine with, breaking a little early if you, are out of questions. Sorry if I'm not looking directly at the camera. I've got four screens going on here at the moment. It's always fun trying to to to run these, office hours. Alright. Well, we are still working since since we are... Is there a is there a sample care plan that is shareable? Certainly, may be ones that, are, available through your PCMH. NCQA, as a as a rule, does not sort of do sample policies or things like that because we don't want it to become, this is the NCQA requirement. We want you to be able to to work on those yourself. But you may have, through your your primary care associations or other, sort of networking opportunities. There may be, ones available. And if if anyone knows of some good sample care plans, please, let us know in the chat. Our practice is still being audited in 2026. You'd be a quiet year, not complaining. Just curious if the process was halted. I believe they made some changes that reduced, the number of audits simply because, it was found that that folks are passing the audits a little bit, too easily, so we didn't feel the need. So I believe they have cut down on the number of audits, so I'm not surprised. You've seen... I believe it... We used to go for, like, 5% every three years. And I think they cut it down, like, 1% or something. I don't remember the exact numbers, but, yes, it definitely has, been reduced. We had a sample care plan last year. I'll have to I'll have to double check that. Yep. A summary of changes from one year to next. I am not sure if we've published one of those. Let me check that as well. I'm gonna... I have to download this chat and and answer a lot of questions. For the closed loop referral, we are in recreditation now. So when I run the report for calendar year '25, the loop or close are better than if we'd run the report in March. Would that be an issue showing that our rate is now so high? If you if you have better, data showing you've improved, over time, I would provide both sets of data. It shouldn't be... You know, sort of overwhelm them with evidence. So this is what, we would produce, but if we actually... Oh, the differences are in the FAQs. Wonderful. Thank you, Josie. I would provide both. If your rates have gotten better, then the calendar year rates are are showing, then I would actually, provide both sets of data just to show you are working on it and you're getting better. Any last questions? Yes. If you've got some issues with the with the New York specific requirements, please please email those to us, and we'll, we'll get back to you directly. Yep. Interesting. Alright. Yep. We'll have to take a look at that as well. Thank you. Alright. Well, I wanna thank you all for attending. This has always been... Always a lively, presentation to do each year. Well, we had to, delay to this month, to make sure we had all the changes in, but we are thrilled. And as I mentioned, we are moving into a new task order with HRSA right now. So we are still working to schedule the office hours for the remainder of the year, but we'll get those schedules up and on our website as soon as possible. Alright. Everyone have a great afternoon. Happy fall to you as well. I don't believe HRSA has any funds to pay to attend our summit. No. Alright. Thank you all, and have a great day.