If the practice offers to print the care plan and the patient declines, the practice may count the patient as a 'Yes'.
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10.12.2018 CM 05 If a practice offers to print a care plan for the patient but the patient declines, would this count as a 'Yes' or 'No' in the numerator.
10.12.2018 QI 04B Can my practice use comments received in a social media format (i.e., Yelp, Facebook, etc.) as qualitative feedback for QI 04B?
Yes, collection of qualitative data through reviews on Google, Yelp, Facebook, Health Grades, etc. may be used as data for QI 04B if the practice actively notifies patients of the availability of those sites to submit patient experience information. If the sites are not actively advertised and not all patients are aware and represented, it would not meet the intent of the criteria.
This applies to the following Programs and Years:
PCMH 201710.12.2018 CM 04 - CM 08 Is there a minimum threshold a practice must meet for these criteria?
The expectation is that these facets of the care plan should be happening routinely. NCQA has not set a specific threshold, however if the practice is reporting less than 75% the evaluator may question whether the practice has truly implemented the criteria as part of their care plan routine.
This applies to the following Programs and Years:
PCMH 201710.12.2018 Evidence Do documented processes need to be 90 days old to be submitted?
No, the redesigned PCMH process enables practices to enroll and transform into a PCMH over the course of a 12 month period. If the documented process has been implemented for a sufficient amount of time for the practice to demonstrate the needed evidence to meet criteria, the practice may submit it for review.
This applies to the following Programs and Years:
PCMH 201710.12.2018 CC 06 For CC 06, is the practice required to include specialists' names on their list of commonly used specialists or is a list of just the commonly used specialty types acceptable (E.g., a list that says cardiology, ortho, endocrinology, etc.)?
The list should include the specialist office names or specialist's names in addition to their specialty types. The intent of CC 06 is for the practice to monitor its referral patterns and identify areas where it might improve care coordination (e.g., identifying clinicians most commonly referred to and ensuring that communication expectations are established for the relationship with those providers, like for CC 08). This criterion requires that the practice demonstrate how it monitors referral patterns, which could be a report showing referral trends.
This applies to the following Programs and Years:
PCMH 201710.12.2018 KM 07 For KM 07, should the required report outline what percentage of patients have a social determinant of health noted in the chart, or should the report include what the social determinants are and what percentage of patients fall under each?
Elective criterion KM 07 goes beyond providing the percentage of patients with social determinants of health documented in the medical record; the report should include the breakdown by social determinant(s) so the practice understands which social determinants impact their patients to better implement appropriate care interventions. The intent of elective criterion is for the practice to show how it monitors social determinants of health at the population level for its patient population and also how it uses that data to address and assist in overcoming those social determinants of health. Reports may be generated from data collected in KM 02 G.
This applies to the following Programs and Years:
PCMH 201710.12.2018 AC 10 & 11 Does a single clinician practice need to provide a documented process and report for AC 10 and AC 11 as all patients would be on the same panel and always see their selected clinician by default?
10.12.2018 BH 06 How would a practice fulfill this criteria if they are already fully integrated?
A practice with integrated behavioral health may provide its documented process and evidence of implementation. For evidence of implementation, the practice might demonstrate the practice's internal process for entering patient treatment notes, referral guidance and medication management within its system and how the integrated BH provider updates the PCP about the patient's progress. The documented process may also include how the practice facilitates transition to BH, such as through warm handoffs.
This applies to the following Programs and Years:
PCMH 201710.12.2018 AR-PH-1 (2018 Version) AR-KM 01 (2019 Version) Is it necessary to provide evidence in addition to affirming that we send out proactive reminders for all the necessary categories and noting the frequency?
No additional evidence is needed beyond answering the questions. Since all practices completing Annual Reporting have already shown detailed evidence previously during the transformation phase, Annual Reporting has reduced the administrative burden of maintaining recognition by reducing the amount of evidence that must be submitted.
This applies to the following Programs and Years:
PCMH 20179.07.2018 KM 13 Would the annual UDS report, by which FQHC’s are required to submit data to HRSA, be acceptable to provide as a report?
For FQHCs that are part of a larger organization with multiple practices under the same umbrella, UDS reporting would not meet KM 13 because the data is at the organizational/corporate level. The data for KM 13 must be at the practice level because recognition is at the practice level. An exception to this is for standalone practices whose UDS data is specific to the practice site location.
This applies to the following Programs and Years:
PCMH 20177.18.2018 CC 10 (Pediatric Specific) AAP resource:
–Strategies for System Change in Children’s Mental Health: A Chapter Action Kit developed by the American Academy of Pediatrics (AAP) Task Force on Mental Health assists AAP chapters in addressing and improving children’s mental health in primary care in their state.
This applies to the following Programs and Years:
PCMH 20177.18.2018 AC 07 (Pediatric Specific) How do practices account for adolescent confidentiality issues; for example, if an adolescent asks that information not be shared with a parent?
Pediatric practices are not penalized for not sharing information with parents if the adolescent requests that information not be shared, but applicants must explain the exclusion of adolescent patients in the associated documentation. The system must include only legitimate requests for information based on state and federal confidentiality requirements
AAP resources:
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Confidentiality considerations in the care of young adolescents, AAP News 2008;29;15: http://aapnews.aappublications.org/cgi/reprint/29/7/15.pdf
