FAQ Directory

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CM-LTSS 2017

Case Management Accreditation assesses an organization’s performance in the following key areas:

• Identification and assessment
• Care planning
• Care monitoring
• Care transitions
• Measurement and quality improvement

CM 2014

The first step to earning accreditation is a discussion with an NCQA program expert. Purchase and review the program resources, conduct a gap analysis and submit your online application.

Align your organization’s processes with the standards. NCQA conducts the survey and determines your accreditation status within 30 days of the final review.

See a step-by-step process.

CM-LTSS 2017

The PCMH PRIME Certification program launched on January 1, 2016.

First, go to the HPC’s website to complete a short application indicating your practice’s intent to pursue PCMH PRIME.

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 in the near future 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 Government Recognition Initiative and Projects (GRIP) Staff at 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.

§  For 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.

• For Practices without PCMH Recognition:
  •  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.org, for more information.

No, practices do not pay an additional fee for PCMH PRIME Certification.

Practices seeking NCQA PCMH 2017 Recognition and PCMH PRIME Certification concurrently are charged only the standard NCQA PCMH Recognition application fee. Applying to these programs concurrently may make your practice eligible for a discount on PCMH 2017 Recognition; please contact GRIP Staff, pcmh-grip@ncqa.org for more information. Practices seeking PCMH PRIME Certification only, to supplement a previously achieved PCMH Recognition, are not billed for the PCMH PRIME survey.

Note: If a practice fails to achieve PCMH PRIME in two attempts, the HPC reserves the right to require the practice to cover the cost of additional attempts.

Yes, if the pediatric practice conducts postpartum depression screening during an infant care visit, the practice may receive credit for this diagnostic. The practice does not necessarily have to create a new patient record, nor store the results of the screening in the infant’s record, so long as it can provide the required documentation to NCQA. 

Some practices seeking PCMH PRIME Certification may be designated by the HPC as on the “Pathway to PCMH PRIME.”  Practices qualify for Pathway to PCMH PRIME status if they are currently NCQA PCMH Recognized (at any level except PCMH 2011 Level 1) and commit to applying to NCQA for PCMH PRIME Certification within 18 months of submitting a PCMH PRIME application to the HPC.

As practices obtain PCMH PRIME Certification, or make a commitment to doing so (thereby receiving “Pathway to PCMH PRIME” status), their names are posted on this website. 

• Accreditation Process and Timeline: Key steps, timing and resources for a successful accreditation.
• Standards and Guidelines: The complete standards and guidelines, including the intent and scope of review.
• Interactive Survey Tool: Contains the complete standards and guidelines; you can also determine your organization’s survey readiness—the tool calculates your potential survey score.

HP 2020

The HPC’s current policy is that PCMH PRIME Certification lasts for up to three years. This differs from NCQA’s PCMH 2017 Recognition program which has a one-year recognition period. A practice must maintain its NCQA PCMH Recognition throughout that period in order to maintain PCMH PRIME Certification.  If NCQA Recognition lapses while the practice is PCMH PRIME Certified, the practice will need to re-attain NCQA Recognition within 6 months in order to keep their PCMH PRIME status.    

A PCMH PRIME Certified practice could choose to renew its PCMH PRIME Certification before the three-year expiration date if the practice is renewing its NCQA PCMH Recognition and wants to simultaneously renew PCMH PRIME Certification in order to align the two recognition periods.

The PCMH PRIME review process varies depending on whether a practice applies to PCMH PRIME concurrently with a PCMH 2017 survey or applies to PCMH PRIME only (to supplement previously earned PCMH Recognition).

·        Practices applying to PCMH PRIME concurrently with a PCMH 2017 survey will submit PCMH PRIME evidence as part of the PCMH 2017 virtual review process. The PCMH 2017 review process may take up to 12 months but varies by individual practice timelines and capabilities. This process includes up to three virtual check-ins lasting up to two hours each.  Practices applying only to PCMH PRIME or to PCMH PRIME concurrently with Annual Reporting will upload all evidence to Q-PASS without participating in a virtual check-in. NCQA evaluates a practice’s documentation for PCMH PRIME within 60 days of receipt. 

Once the PCMH PRIME documentation review is complete, NCQA provides its assessment results to the HPC.  The HPC issues a final scoring decision to the practice within 15 business days of receiving results from NCQA.