Okay. So we are now recording. And, again, welcome to all of you. Good afternoon, here on the East Coast. Still good morning for you on the west. I'm Bill Tullock, director in our federal services center here at NCQA, and happy to be with you for yet another office hours for, our PCMH program, specifically for the health center community sponsored by HRSA. These these, office hours are part of our technical assistance that we provide to health centers as part of our contract with HRSA, so we are thrilled to have you here. And what we're gonna be talking about today is the self assessment and some of the other resources that are available when you have, access to the electronic version of the PCMH standards that can help you both prepare for a transforming survey, prepare for, potential audits if you're in annual reporting. Also, you can help prepare for, annual reporting as well, when you try and answer those standards, as well as help train new staff if you're looking to do that, in the PCMH model. So resources that you can use, at your leisure, to actually help you be a better medical home. So that's what we're gonna be talking about today. And before we get, too far in, there is a disclaimer that we have now added to all our presentations. Just noting that this is our presentation. It is under a HRSA contract, through HHS, but any non federal resources are ours alone. So please just, note that. So we just did the welcome introductions. Happy to have you with us. We're gonna talk a little bit about how to get electronic copies of the PCMH standards and guidelines if you don't already have those. We're also going to talk a little bit about those resources in the standards and guidelines and go through a couple of them in in live demos. So there'll be a lot of screen switching and live demos during this. Of course, if you have questions, please send them through the q and a. You can also send in feedback through the chat. We do, download both, q and a and chat, as part of our reporting back to HRSA on these office hours. So, please feel free to ask questions about the the subject matter recovering or if you have questions about the standards themselves. Always, welcome to, ask those questions as well. So let's talk just go over again how to obtain the PCMH standards and guidelines. So as many of you know, for many years, the, the actual, publications so gonna call them books, but I guess we don't really publish, books any longer. Hold on. I'm just going to get rid of the, warning message that were being recorded. We don't really publish the the physical books any longer, although you're welcome to spend your own money to print them out if you'd like, but they are all electronic now, which also allows us to update over time. So, if you have attended one of our regional training programs in the past, you have gotten copies of the standards that are in PDF format, but it and it includes all the the front matter and the appendices and all that kind of thing. The electronic copies, though, allow you to have access to these, other resources that I'll be going over and also ensure that you have updated versions of the standards and guidelines. These publications used to be, completely free, but we now do charge for the, full book of standards and guidelines for PCMH. The annual reporting standards are still actually, free of of charge, and I'll show you sort of how that works as well. Excuse me. Sorry. But the, the transformation PCMH standards and guidelines, the full book, that now, I believe, it costs a hundred and fifty So as part of our contract with HRSA, we do provide those standards and guidelines free of charge to any health center. And we understand that because the, publications are assigned to a user ID, not to an organization, If that user happens to leave your organization, unless you still have access to their email address, you are not gonna be able to get the those electronic copies, on the regular download. So we estimate probably every two years. I may have stated that the price are realizing looking at my slide. But we estimate probably every two years, a sender is gonna have to come up with a new book. And we actually factor, a a new a new copy of the publication because of staff turnover, and we do factor that into the cost of the surveys for HRSA. So, feel free even if you've had copies in the past. If the staff member who had access to that copy has left, feel free to request a new one. So, again, this includes look alikes. If you have HRSA support, if you are, part of the health center community that gets that HRSA support, then you can get a free electronic copy of the standards and guidelines. Again, the, transforming standards are normally about two hundred, sorry, a hundred and thirty. I hope it's a hundred and fifteen, and we have changed our prices in the past. And then I'll show you actually how to do this in a live demo in just a a moment. But, basically, you go through the my dot n c q a dot org link if you want to get a complimentary copy of those standards and guidelines. And and requesting the the complimentary copy, the big thing you need to to have is your, grant ID number. That is for your whole health center. It will begin with either h eighty or LAL, for look alike, And that is the ID that you put on your notice of intent, and you use with HRSA to identify your organization. Basically, what happens is when you put in a request for complimentary copy, that goes to our customer support department. They will confirm we have a list of all of the active h eighty codes and LAL codes, for all of the health centers nationwide. They will confirm that the ID is, correct, and then they will provide the download to the individual. If for some reason we can't verify, particularly if it's a lookalike, maybe you're new, we will then confirm with HRSA to make sure that we have a we can get an updated copy of those of those IDs if necessary. But they're usually good about within one business day responding to us, and so we can usually verify that pretty quickly if we don't have the list. And then, it will be sent to you as a complimentary copy. Please pardon me for a little bit of of refreshment there. And then the standards actually appear automatically in in, what we call the my downloads area of your, my dot n c q a a dot org portal. And then, again, the annual reporting standards are free, and and those are gonna change annually. This the PCMH standards and guidelines are meant to be a living document for transforming. So the the the standards themselves, it's the same publication being updated over time. With the annual reporting, it's a new publication every year. So what that means also is that you have to download a new copy of the annual reporting each year, or you have to purchase a new copy for zero cost. I'll show you both of those now. So I'm gonna stop for a moment, stop sharing just real quickly, and I'm going to get out of our screen excuse me, the slideshow version there, and I'm going to show you what how to obtain both, sets of guidelines. So Alright. Let me share my screen again. Just wanna make sure I had the right website up. Here we go. So here, we have the actual NCQA store. So I wanna show you if you wanna just buy the publications yourself, this is how you would do it. And I'm I am looking at the screen over here, so I do apologize if I'm if my eye contact is no longer, on the the the camera. So if I wanna, find an actual publication, I can come over here to health care providers. That's where we'd find the PCMH. And you can see we have that listed right here. So I click on PCMH. And notice it is still a hundred and thirty dollars for the standards and guidelines, but the annual reporting, requirements are still zero. So if you want the annual reporting requirements, you can go on here anytime you want. You click order. It's gonna you're gonna have to log in. So if you don't have an account, you'll have to create one. But if you have an account for any purposes with NCQA, you'll be able to log in with your email address and password to the store as well. And then you guys come over here to order the, annual reporting requirements. I had to click order again, and it's going to basically, I add one to the cart. Notice the cost is zero because, there is no fee for these standards and guidelines, and then I just go to checkout to actually order the book itself. I'm actually gonna try not to finalize this because I already have a copy, but it will, show you all of this information, and then, you hit next. And I'm not gonna place this order because I already have these standards, but that's just how you get the annual reporting, standards. If you want the, transformation standards for free, so you don't wanna spend that hundred and thirty dollars, You can log in here on our this is, again, this is the my dot n c q a dot org, portal. This is our customer service portal. So you can see all kinds of things that you can do on this page. I'm gonna go to my questions. If you want a new publication, you actually just ask a question. You're gonna come in here, and you're gonna, put in go to orders. You can pretty much do any of these, topics, subject matter, anything like that. But you can see I've I've done this presentation before, so I'm gonna ask for company standards. And I'm basically gonna go in and say, I would like a complimentary copy of the PCMH transformation standards, and here is my grant ID. That's all you need to do. Submit your question, and it will go into customer support. They will then respond to your question as if they as as they would to any question. They will say, yes. We've we've provided you a complimentary copy. Please give twenty four hours for the download to appear. Once you have gotten that confirmation that, in fact, you have the complimentary copy of the standards, you're gonna come over here to my dot n c q a dot org again, log in, and go to my downloads. And that's gonna show you the standards. Now as you can see, I have access to a ridiculous number of publications. I have four pages of publication downloads on this page, because I've been working for NCQA since, the last century, literally, and I have a lot of publications. But you can see here, we've got the virtual primary care. We've got the PCMH standards and guidelines, that was last updated on January eighth and then downloaded on the my last download, this was August twenty fourth. But if you notice, if we scroll down, I have another version right here, completely different order number, where I downloaded them on the twenty first of January twenty twenty six. So what this is telling me is that for this version, somehow I ended up with two orders. Don't ask me how I did that. Probably doing too many demos is probably how that happened. But it's telling me that, oh, these were updated, and you haven't, downloaded them since before they were updated. So you would wanna download a new copy. But I've already done that because down here, I have the same publication, just I downloaded it, more recently. So I don't have to be worry too worried about that. Please note I also have access to the New York State publications. If you are from New York State, please make sure you you include that in your question. It's not really that that much of a different, publication, because we do designate the, elective criteria that New York State requires. So that's the difference between the programs. New York State, there's a number of additional requirements that we consider elective in our program that they want everyone in New York to choose as electives, and you have to choose those and pass those electives to get the financial benefits that New York state provides for PCMH. So you would wanna use the New York state version if you are from New York. But, again, the the New York state requirements are also designated, excuse me, in the regular PCMH, book. You can also see that I have the annual reporting standards here. Oh, that's for nineteen for twenty twenty three. Hold on. I'm gonna have to put my I try not to wear my reading glasses during these because they make my eyes very large, but I'm gonna have to here we go. This is the one I was looking for. These are the annual reporting requirements for twenty twenty six. They were, put out on, July first, and they haven't been updated since then. And so I downloaded them, just a couple weeks ago. It seemed like March twelfth was too, was was, too late to have downloaded them, but I realized now it's March twenty sixth. So in fact, two weeks ago, I downloaded them, and so I don't need to download them again. If I did need to download, like, these standards and guidelines, let me just download this one to show you how it works. I'm gonna have to accept the licensing agreement, and I can up open that in PDF if I want. You all know what these look like. And then up here, it's gonna tell me that I have, the download. It's already done now. I'm using, Chrome, by the way. And then it's gonna show me the actual, publication itself. So this is gonna show up in my downloads, file. You can see I have the reporting annual reporting requirements download from, excuse me, from a couple weeks ago, you can see that that publication is actually much shorter. Right? We have just the sort of the book itself and then the goals and action workbook for QI. Those are the only two things that we have included in this, publication. But in the full transformation, we see a lot more, documents here. We've got the standards and guidelines. We've got the, what we call the front matter. Actually, let me expand this so you can see. The front matter is basically explaining the program, explains our at our, expert panel and and counsel that we use to actually set the standards. It gives all the the, audit procedures and the merger acquisition consolidation. All of those wonderful exciting things that you need to have to know how to work within the program, that's all in the front matter. Then the standards and guidelines themselves, and then, all the appendices, which, you know, scoring, our glossary, the record review workbook. So if you're trying to do, care management file review, this is what you're gonna wanna use. If you want distinction in behavioral health, the standards are here. The standards, the standardized measures, list is here as well. So this you can just open this up if you wanna see. Of course, it opened up a different screen. Hold on. So there we go. So the standardized measures are all here where it actually shows all about how we choose these measures and which ones, we're selecting, and where to find the list here on the NCQA website. We also have the New York state, version, there as well, plus the MAC policy is here. So, actually, I thought the MAC policy is in the front matter. It's actually down here. And this is basically what you need to do if your organization has any major changes to its ownership or its structure. You have to alert NCQA, and we will make determinations based on that policy if your recognition continues, how how it continues, if it's a merger, those kinds of things. So I'm gonna, again, stop sharing very quickly and go back to the slides. Oops. So, again, that's the these are the instructions to request a complimentary copy of the standards. Just wanna again go over the resources. We'll show this, again in just a moment. But as part of that download, you saw there was another folder. That subfolder includes, along with the record review workbook itself. You've got the care management and improvement worksheet if you are, sorry, the quality measurement and improvement worksheet, a little free insulate there. And that's if you are actually trying to provide information about your QI program, in sort of written form. We are asking you to put the standardized measures into themselves the measurements themselves into the measures panel in QBAS, and that's you're actually gonna put your numerator, denominator for each measure. But when you're trying to show that you are doing, quality improvement cycles, this workbook can be very helpful for that. We still include the corporate credit transition to shared credit table. This is a a a vestige of our move to the new format for PCMH back in twenty seventeen. So it's been nine years since we did that. And organizations that were in the old version level three recognized did not have to go through transformation. They went directly into annual reporting. But what that means is that in in QPass, if you go through transformation and you have shared credit that goes across all of your sites, when you get that credit in QPass, that automatically moves to each new site as long as the standard hasn't changed if you add sites next year, the year after, etcetera. If you were in the old version of the program when you were level three, you never went through transforming, so there's no shared credit that's documented in QBASS because we change systems as well. And so this table allows you, this table here, the oops. I did not do that. Allows you to then translate, your what was then corporate credit back under the old system into shared credit, here so we can actually, make sure that those customers don't have any, sort of penalty from not having gone through transformation. There's the self assessment tool we'll go over and then the two suggested pathways, which give you an idea as to how to tackle the program in your three check ins if you're doing a transformation survey. There is no requirement that you follow these pathways. It's just a suggestion that came out of our policy department, to help you navigate the process a little easier. So let's go over those resources. And, again, I'm gonna switch over, so, bear with me. Okay. So let's look at these resources. I'm gonna share my screen again. Alright. So as I mentioned, we have all the appendices. Now the record review workbook is in here, as a PDF version. I don't understand why PDFs are opening in a different screen. So this has a PDF version of the record review workbook instructions that explains to you how to actually pull a file review if you are, actually looking at physical files for your care management requirements for your core and elective requirements and care management. However, if you open the resources, notice we have PDF documents, we have Word documents, and we have Excel spreadsheets or Excel workbooks. So worksheets. So each of these is a slightly different type of of file because they're interactive and they're usable. So let's just go through these real quickly. We have the record view workbook here. As I mentioned, we have a whole file management office hours we did last month that, we should be posting soon to the website, but that goes to the record review workbook and how to use it. But this is an interactive spreadsheet that allows you to actually, select patients and then fill out your responses for each of the care management standards. Don't want to save it. No. You have the quality measurement. Again, it's opening in a new screen, so bear with me while I oh, here we go. The quality measurement improvement worksheet, which allows you to document quality activities, in various areas. And you can see we have some examples as to how to fill this out. This is really used for those, measures where you are trying to show the reviewer that you are actively working to improve the measure. So that's showing your analyses, or at least summarizing your analyses and then also showing the actions taken when you remeasure it if you have. Those kinds of questions all go into this worksheet. You don't have to use this worksheet, though. You may have other reporting mechanism mechanisms that show the same QA life cycle for any of your measures. You can feel free to send in that in as evidence, but this is a nice way to summarize it if you are looking for that. I don't wanna save changes. No. The corporate credit, as I mentioned, this just shows you this is a PDF document that's gonna show you how to transition that corporate, shared credit, into the QPAS shared credit. So a question came in. Using the record review workbook, do you only answer the boxes that are noted on the AR application, or do you answer all the boxes all the way across? If you are doing only annual reporting and the annual reporting requirements are only asking for a subset, just do the subset. Do not feel the need to do the full file review. That's you need those data for other purposes. You can use the file review process to sort of, assess your own progress towards care management goals, things like that. So feel free to use it as completely as possible for that. But if you're looking at annual reporting and they're only asking for a subset, of the items, you only have to do a subset. Don't feel the need to do the full record review workbook. But great question. Thank you. So, again, the corporate shared credit table, which only applies if you have the old level three recognition from before twenty seventeen and you are adding new sites now. I can show you sort of what you can get credit for, in this. Alright. So question. How do you know which standards you should reference, particularly if you have multiple sites with different reporting periods or processes? So, okay, great question. Annual reporting is very straightforward. Annual reporting goes for a calendar year. So if you are reporting in twenty twenty six, you use the twenty twenty six annual reporting standards for any site reporting in twenty twenty six. If you're in annual reporting, all of your sites should be reporting on the same standards each calendar year, although you may have different reporting dates if you're a large organization. With transformation, you use the standards that were in place when you enrolled in the program. So if you had sites that were enrolled in twenty twenty five, you would use the standards for twenty twenty five, and you can still, ask for those complimentary copies too if you if you don't have them. Hopefully, if you enrolled in twenty twenty five, you had the standards before you enrolled, but you may have lost access to them. So feel free to request that publication. We should be able to still provide that to you. If you are, enrolling new new sites, though, in twenty twenty six, you would go through the twenty twenty six version of the standards, which did have some significant updates in terms of new standards and retired items. But we're gonna keep you to the standards that were in place when you enrolled. So in Q PASS, if you've got sites that are in twenty twenty five that were enrolled in transformation in twenty twenty five and then in twenty twenty six as well, then you will actually, when you go into the system and you go to do anything in the PCMH, standards, it will ask you which version of standards to look at. And you will then go to twenty twenty five for your twenty twenty five sites, twenty twenty six for the twenty twenty six sites. Again, it's based on enrollment date, and we don't require you if you're halfway through your your year of transformation and we update the standards, we're not gonna make you, answer the new standards. You're gonna answer the ones that were there when you enrolled. But, again, great question. Thank you. Okay. So that's the corporate credit table. And then let's go over the actual, resources that we wanted to highlight in this program. So the self assessment tool is a way that you can I'm gonna put my glasses back on for this one, that you can, in fact, go through and see how your organization is doing. This is also a great tool if you wanna, help, with new staff and training. You can have them sort of assess and see if they're coming up with the same conclusions you are. So you can see that we have, all six concept areas down below. And okay. I I wanted to double check this because I hadn't had a chance to. I've I'd forgotten to check it before. Notice what's happening here with t c o three. It's retired in twenty twenty six, so we are no longer having you look at, and I believe that was the, whether you had a certified EHR. It that was an elective. So we are now since we have retired that, we're not even going to have oh, no. I took that's a t c o five. Never mind. Can't remember what t c o three was now. This is why I always open the standards book. But anything that was retired, you can see it's grayed out. We're not gonna ask you about this any longer. But for everything else, you're going to come in here and say, okay. Do you have right now something like a staff structure and overview? Do you have a description of your staff roles and responsibilities? If you answer those both yes, then you are gonna be able to meet the criteria, and then you are gonna be able to say, okay. What kind of evidence are we gonna provide? This is not NCQA telling you what to provide, but you're gonna say, okay. We've got, a document. We've got a link to our website. Something like structure and staff responsibilities. Your website may very well display a organizational structure for your patients to to review. Simply link to that. That's absolutely a completely appropriate way to show evidence in the QBAS system. Then you can actually make some notes on here and then tell us if that's gonna be shared across all your sites or if it's not. Well, not tell us, but tell yourself. This helps you start to go through standard by standard and say, okay. Are we actually gonna meet this right now? If not, what do we have to work on? And those the notes on evidence could actually let you know that as well. You can, you know, type whatever you need to in that, in that box. It really helps you go through and say, okay. Are we really meeting these requirements? Notice also we tell you what's core, and we tell you what are elective and how many credits you're gonna get. Remember that you must meet all the core requirements. There are forty. And then you must get twenty five elective credits with at least at least one elective credit in five out of the six concept areas. So we want you to have both abroad, but you can also go deep into the electives into one area if you have one concept where you have a lot of electives. But this really allows you to determine, okay. Where are we going to how are we meeting the core, and which electives are we going to select? Our advice is always to aim for about thirty elective credits when you're going through, like, the self assessment to make sure that if you don't get all the credit you you expect, you have some backup, you're gonna be able to still meet that twenty five. Just something to think about. And, again, you could use this if you're preparing for a transform transformation survey. You could use it if you're trying to help staff understand the standards. Okay? If you're gonna respond to this for NCQA, what would, do we have these, do we have these, here? And then how would we display that? How would we show that to an outside, individual It'll help you really, drive home some of the importance of these areas to new staff. Again, you don't have to use this, but it does provide a great opportunity if you're looking for those. And you can actually you can see it will keep an up up a running update of how many credits you think you're getting. Please remember, you can't then submit this and say, look. We're we're all set. We're we're going to meet the requirements. We still have to review all the evidence. This is just for your own purposes to see, are we as, far enough along the pathway that we want to actually enroll, for instance? This might answer that question for you. Now there are two selected pathways. I'm gonna not save this. I'm sorry. There there's one self assessment tool, and then there are two, suggested pathways as well, one for adult practices and one for pediatric. This, again, is just a series of suggestions. So a question, is the self assessment tool a requirement for NCQA or HRSA to answer the questionnaire in QPAS about readiness? No. It is not. So in QPAS, there is a basic eligibility questionnaire that you will have to fill out each year that's gonna ask you, you know, are you providing at least fifty percent of your care as outpatient primary care? How many Medicare beneficiaries do you have? What percentage of Medicaid? Those kinds of questions. Those are both to make sure that you are still eligible for PCMH and that you have updated for our reviewers the the basic information about your practice. So you don't have to do the self assessment tool, and you don't have to submit it to anyone. In when you're, submitting your notice of intent with HRSA, they will also ask you questions like, have you gotten a copy of the standards? Have you attended training? Those kinds of basic things. But you can answer those directly in the electronic handbook. You don't need to do the self assessment tool. Again, great question. Thank you. So, again, for the selected pathway, this again just shows, again, the the, core requirements and then how many credits are available. There are forty three criteria with one credit, twenty one with two, and one with up to four. So, again, it will show you for each item where would we suggest you try to do a virtual review, in terms of when you would wanna include them. Things like the basic structure of your practice should be in place, so that would make sense. But many of you have a board of directors that's patient centered, that or patient majority that can act as as sort of this body to provide feedback on governance, etcetera. We would suggest that you provide that in virtual review too. But you may say, you know what? We we have our minutes down. Our board is great. We're gonna do that in virtual review one because it's a it's an easy pickup for some elective credits for us. So you can completely change and alter the way you do these. This is just a suggestion. We we're gonna suggest you get all the core done in virtual review one, maybe two. But, what's important is that you wanna make sure that you get those those core credits in. And notice that, this little icon of the computer screen means you can do, virtual review only. That is you can provide evidence during the virtual review rather than providing a document up front. Again, that that's completely allowed. And then the little what these arrows with this little, whoops, this little indication here with the the looks like they're supposed to be sheets of paper that are sort of flying this way. That's our little indication that this is a shared item that is you can have the same staff and structure, across all of your sites, or they may be individual. So you may be able to share this, the evidence across all your sites or not. Certainly, something like the PCMH transformation leads very commonly. They're the same across all of your sites. Let's look down here a little bit. Let's look at cam where you can see, to double check our and then the this little indication is going to tell us, that I see. That, this little arrow here is that there may be reports that you can share. And I did notice that we had gone to the, the little asterisk here next to our shared icon mean that there may be items that are only, maybe one component of the standard can be shared, but you're gonna have to provide evidence for each site on the other component. So just be aware of that as well. But here, if we look at Kilometers, for instance, we've got problem lists. You wanna make sure you have an up to date problem list for each patient. That's gonna be a site by site data, but it can be done as a report. You can show us, live if you want. And, again, we're gonna suggest that for virtual review one, then for depression screening, other behavioral health screenings, if that's something that's part of your, practice, all of those kinds of things. So as you can see, we we we try to provide that for you in terms of how to best go through and navigate. But, again, how you actually are gonna navigate is gonna depend on how much shared credit you have, how many sites you're trying to bring through, and how centralized, your organization is. So for instance, you may have items that are not shareable because we have to have to have we have to have, excuse me, data for each site, in your in your organization, but you may be able to centralize the reporting. So you can provide us with a workbook in Excel that has on each worksheet has a different site, that you are reporting on, and that allows us to say, okay. We can see that you have all twelve of your sites listed here. It's one piece of evidence. It's not shared evidence in that we don't have to we're not reviewing it for one site and then applying credit across all the rest. It is, however, a jointly shared document that you are providing that provides us data for each of the sites, and that's completely fine as well. So you may be able to consolidate some of this, more centrally, depending on your structure. I hope that makes sense. Okay. Stop sharing very quickly. Alright. So those were the items we were gonna go over this month. Fairly straightforward. I think very usable, very helpful if you are going through, annual reporting, or transformation. Although the annual reporting standards are numbered differently, we cross reference them with the transformation standards that are based on every year. So you can go back to that self assessment and use the transformation number, but still make sure you have the right documentation for annual reporting. So it's a little bit more complicated, but you can definitely navigate it. We're at two thirty five, and normally, these are scheduled for an hour. But I don't wanna keep you if, we don't have a lot of questions, so I'll sort of open it up for one final round of questions here. Again, we do these office hours each month, and the enrollment is on our website. If you just Google NCQA HRSA, you will find the, specific website that we have dedicated to our HRSA contract, where you can find the other office hours and sign up for those. Alright. Well, I thank you all for joining us today. Short and sweet, presentation on our resources. I hope you all have a great weekend, and, we will see you, at our future office hours. Have a great day.