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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6.14.2018 KM 12D (Pediatric Specific) Why would our practice recall pediatric patients, if not for preventive care, immunizations or acute/chronic care services? Give pediatric-specific examples.

KM 12 categories A-C refer to needed services and are intended for routine, proactive reminders.
  

Category D addresses patients who miss routine visits, annual exams or follow-up appointments and need to be reminded to visit the practice for services. 

PCMH 2017

6.14.2018 CM 01A (Pediatric Specific) Would temper tantrums as a behavioral health condition meet the intent of CM 01A?

Practices need to identify behavioral health-related criteria pertinent to their specific patient population such as a behavioral health diagnosis, substance use, a positive screening result from a standardized behavioral health screen, or psychiatric hospitalizations. If the practice feels that patients with temper tantrums is an identifier for patients in need of care management, the practice can use that defining criteria.

PCMH 2017

6.14.2018 AC 12 (Pediatric Specific) • AAP practice transformation resources—telephone care:

6.14.2018 KM 02G (Pediatric Specific) What are some examples of social determinants of health for children?

Social determinants of health include things like poverty, food insecurity, poor housing quality or homelessness, unstable neighborhoods, and parental dysfunction (e.g., domestic violence, mental illness, etc.).

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

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 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 AC 06 (Pediatric Specific)` If a pediatrician sees more than one child from the same family during one visit, does this meet the requirement for an alternative clinical encounter?

No. Shared appointments would not meet the requirement. Alternative appointments need to be offered through telephone or other technology-supported mechanisms.

PCMH 2017

6.14.2018 KM 10 (Pediatric Specific) How can we best collect language needs information from all patients in our large population?

Practices can use two methods to collect language need information:

1. Collect data from all patients and their families to create a report showing language needs.

2. Obtain data from an external source (e.g., data about the local community or its patient population).

Patients who do not speak English and patients from racial/ethnic minority groups may be less inclined to provide this information. Care should be taken to request the information using methods that respect multi-cultural differences.

  • Pediatric-specific resources: 

 

PCMH 2017

6.14.2018 CM 01D (Pediatric Specific) May practices use “limited or no family/caregiver support” as a social determinant of health?

Yes. For pediatric populations, practices may identify children and youth with special health care needs who are defined by the U.S. Department of Health and Human Services Maternal and Child Health Bureau as children “who have or are at risk for chronic physical, developmental, behavioral or emotional conditions and who require health and related services of a type or amount beyond that required generally.” 

PCMH 2017

6.14.2018 KM 09 (Pediatric Specific) The examples provided in the guidance section for this criterion aren’t typical characteristics for pediatric practices (e.g. gender identify, sexual orientation, occupation, etc.). What other options can a pediatric population use for its third aspect of diversity?

Identifying children with Medicaid insurance would meet the intent of this criterion, as this identifies a population that could be at risk or require additional attention or care management. Other areas of diversity could include homelessness, immigrant status, living in a rural or urban environment, family employment status, family socioeconomic status, families with a single parent, etc. 

PCMH 2017

6.14.2018 KM 12C (Pediatric Specific) Give examples of pediatric acute care services.

A reminder to schedule a follow-up visit related to an infection (e.g., otitis media, pharyngitis, urinary tract infection) or an injury (e.g., fracture, burn or cut requiring stitches) applies as an acute care service. 

PCMH 2017