No, a single clinician practice may simply attest to having a single clinician. This can be done using the text box option of Q-PASS to receive credit for these criteria.
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 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 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 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 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 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 201710.12.2018 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 BH 15 & 16 What is the difference between BH 15 & BH 16 in the Behavioral Health Distinction program?
In BH 15 (Core), the practice monitors either a mental health condition OR a substance use disorder. BH 16 is elective because it raises the bar by evaluating whether practices monitor both a mental health condition AND a substance use disorder.
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 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 20179.15.2018 Life-planning activities for Complex Case Management (CCM) Policies and Assessment Are organizations required to address life-planning activities at the first contact and start of the CCM initial assessment?
No. After consideration, NCQA removed the requirement for case managers to address life-planning activities at the start of the initial assessment (first contact). This FAQ replaces the previous FAQ issued on October 15, 2017 (which has been deleted) regarding first contact, and the workbook has been adjusted to accommodate the change.
This applies to the following Programs and Years:
HP 2018, 2019|CM 2017|CM-LTSS 2017|MBHO 20189.15.2018 Data collection for prevention programs for behavioral healthcare for QI 6, Element A, factor 5 For QI 6, Element A, factor 5, are organizations required to have implemented a preventive behavioral healthcare program in order to meet the factor?
No. Element A does not require organizations to implement a preventive behavioral healthcare program. The intent of factor 5 is that organizations collect data to determine if there are behavioral health issues that could be prevented if a program were to be implemented. Organizations collect data to meet Element A. Identifying the opportunity for such a program and implementing it is applicable to Element B.