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FAQ Directory

Here are some of the most frequently asked questions about NCQA’s various programs. If you don’t see what you are looking for in one of the entries below, you can  ask a question through My NCQA.

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10.12.2018 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.

PCMH 2017

10.12.2018 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.

PCMH 2017

9.07.2018 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.

PCMH 2017

7.18.2018 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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PCMH 2017

7.18.2018 CM 04 (Pediatric Specific) Where can I find an example of a patient care plan for a pediatric patient- centered medical home?

Care coordination resources, including a sample patient care plan can be found at: 
https://www.aap.org/en-us/professional-resources/practice-transformation/managing-patients/Pages/Care-Coordination.aspx 

National Center for Medical Home Implementation Building Your Medical Home Guide: 
https://medicalhomes.aap.org/Pages/Managing-Your-Patient-Population.aspx
https://medicalhomes.aap.org/Documents/PediatricCarePlan.pdf 

NICHQ Care Plan Template: https://www.nichq.org/resource/nichqs-care-plan-template 
 

PCMH 2017

7.18.2018 CC 10 (Pediatric Specific) AAP resource:

7.09.2018 KM 08 (Pediatric Specific) Are there health literacy training programs tailored to pediatric practices?

No, but health literacy training programs are only a suggested approach for addressing communication needs and reducing barriers for patients and their families to access and understand health and safety information.

  • AAP resources: 
           – AAP Pedialink course on health literacy: https://shop.aap.org/health-literacy/  
  • Other resources:
HRSA: Culture, Language, and Health Literacy Tools & Resources: https://www.hrsa.gov/about/organization/bureaus/ohe/health-literacy/resources/index.html  

 

 

PCMH 2017

6.14.2018 KM 24 (Pediatric Specific) • AAP resource:

− Shared Decision-Making in Pediatrics: A National Perspective Pediatrics 2010;126;306: 
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3373306/ 

PCMH 2017

6.14.2018 QI 01 (Pediatric Specific) Can a practice use the CHIPRA Initial Core Set of Children’s Health Care Quality Measures?

Yes. Measures from the CHIPRA Initial Core Set meet the requirements.

PCMH 2017

6.14.2018 KM 12B (Pediatric Specific) Do Tdap and DTaP count as two different immunizations?

No. Although the immunizations are different formulations, Tdap and DTaP are integrally related. For this reason, NCQA considers them the same immunization for different age groups and does not accept them as two different immunizations.

PCMH 2017

6.14.2018 CM 01A (Pediatric Specific) Can NCQA provide some examples of behavioral health conditions other than ADHD, depression and anxiety that are appropriate for pediatric practices?

Pediatric examples for behavioral health conditions would also include but are not limited to autism or ASD, downs syndrome, Asperger's, cerebral palsy, or developmental delay.

PCMH 2017

6.14.2018 CM 08 (Pediatric Specific) Does the asthma action plan count as a self-management tool for pediatric patients?

If the asthma action plan enables patients to track/monitor their progress and document health information at home using a form or some other method of documentation with helpful instructions for self-management, then it would be acceptable.

PCMH 2017