Yes. AR-KM 01 confirms that practices meet PCSP Transform KM 09, in which more than 80% compliance is required for medication lists. A rate less than or equal to 80% does not meet criteria.
PCSP 2019
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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6.13.2022 AR KM 01 For AR-KM 01: Medication Management (aligns with PCSP Transform KM 9), is a reported rate <80% automatically marked as “Not Met”? (PCSP AR 2022)
6.13.2022 Why do I need to provide more information for a low denominator or rate if there is no minimum requirement?
It is to ensure patient safety and routine implementation of medical home activities. Depending on the population served and/or the reporting period, a small denominator is unexpected and may indicate issues (e.g., with data, documentation, implementation). Providing additional information allows the practice to explain—beyond the numbers—when performance is outside the expected range.
PCSP 2019
6.13.2022 Is there a minimum denominator requirement when reporting a rate for Annual Reporting?
No. There is no minimum denominator requirement. A sample of 30 (or more, because this increases the reliability of the sample) is expected to ensure statistical soundness, but there may be cases where it may be appropriate for the denominator to be <30. NCQA requests practices enter an explanation in the Notes from the Organization section in QPASS in this case.
If a practice reports a denominator <30 without a note, the evaluator may contact the practice to confirm data accuracy and to understand the data. The evaluation will be returned to the practice so they can enter an explanation in the Notes from the Organization section for the cited criteria.
PCSP 2019
6.13.2022 For AR-KM 1: Medication Lists (aligns with PCMH KM 15), is a reported rate <80% automatically marked as “Not Met”? For AR-KM 1: Medication Lists (aligns with PCMH KM 15), is a reported rate <80% automatically marked as “Not Met”? (PCMH AR 2022)
5.24.2022 Updated: Boilerplate Language in Delegation Agreements for System Controls May organizations’ delegation agreements contain boilerplate language for system controls delegates?
Yes, if the language specifies that the delegate must meet NCQA requirements (UM 12, Elements A and C, factor 6; UM 13, Element C, factor 5; CR 1, Element C, factor 4; CR 8, Element C, factor 5), template language may be used in the delegation agreement. Language specific to each delegate is not required.
Note: The underlined text is a correction. The previous FAQ referred to the wrong element.
UM-CR-PN 2022
5.16.2022 Reducing the Sample for CIS for MY 2022 Reporting May organizations reduce the minimum required sample size for the Childhood Immunization Status measure when reporting MY 2022?
5.16.2022 MY 2022 Technical Update – COL-E Measure In the updated version of the COL-E measure that was re-released in the MY 2022 Technical Update, the “Total” data element listed in the age column is not highlighted in Table COL-E-A-3: Data Elements for Colorectal Cancer Screening. Should this cell be highlighted?
5.15.2022 Clarify scope for UM 12, Elements A and C What are the differences in scope for system controls at the factor level in UM 12, Elements A and C?
For UM 12, Elements A and C:
- Factors 1–5 apply to receipt and notification dates, covered in UM 5 and UM 8–UM 9.
- Factor 6 applies to all UM system data for managing denials and appeals (not only the dates specified in factors 1–5), covered in UM 4–UM 7 and UM 8–UM 9.
- Factor 7 requires a monitoring process that covers compliance with all policies and procedures described in factors 1–6.
UM-CR-PN 2022
5.15.2022 Clarify scope for CR 1, Element C What are the differences in scope for system controls at the factor level in CR 1, Element C?
For CR 1, Element C:
- Factor 1 applies to verification source information from credentialing and recredentialing cycles, covered in CR 3, Elements A–C.
- Factor 2 applies to modified credentialing verification information from initial credentialing and recredentialing cycles, covered in CR 3, elements A–C.
- Factors 3–4 apply to all information associated with credentialing/recredentialing of practitioners, covered in CR 2–CR 5.
- Factor 5 requires a monitoring process that covers compliance with all policies and procedures described in factors 1–4.
UM-CR-PN 2022
5.15.2022 MBHO: Delegation Oversight System Controls Monitoring - Audits Are both the organization and delegate required to conduct system controls audits for factor 5 in UM 12, Element C and CR 8, Element C?
Both the organization and delegate must monitor the delegate’s system security controls as part of the delegation oversight requirements and may choose audit as the monitoring method. If auditing is the chosen method, the delegate provides an audit report of modifications that did not comply with its policies and procedures or with the delegation agreement.
The organization is not required to conduct an audit if it determines that the delegate adequately monitored and reported noncompliant modifications, but must provide documentation (a report, meeting minutes or other evidence) that it reviewed and agreed with the delegate’s findings. If the organization determines that the delegate did not adequately monitor noncompliant modifications, it must conduct its own audit of the delegate’s system controls.
The organization must submit its documentation and the delegate’s documentation as part of the survey.
MBHO 2022
5.15.2022 MBHO: Clarify scope for new UM System Controls Oversight requirement (UM 11, Elements B and D) How are the new oversight requirements, UM 11 Elements B and D, different from the monitoring requirements in factor 7 in UM 11, Element A and C?
UM 11, Elements A and C, factor 7 require organizations to have a process for monitoring that policies and procedures are followed for all other factors (factors 1–6) in this element at least annually. Policies and procedures must describe the monitoring process for factor 7.
For UM 11, Elements B and D, the organization submits evidence that it identified, analyzed and acted only on modifications to receipt and notification dates (UM 5) that did not meet the organization’s policies and procedures.
MBHO 2022