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 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/ 

This applies to the following Programs and Years:
PCMH 2017

6.14.2018 CC 04B (Pediatric Specific) Does every referral to a specialist require sharing test results and a current care plan? Pediatric patients may be referred to a specialist for an acute condition that does not require a care plan.

If the condition is acute care management, the plan may be simpler than for a patient with a complex, chronic condition. The plan of care would include current medications, tests, treatment, patient/family self-care and important information about the family. While not every referral would have the same level of detail, be prepared to show a referral example for a patient that does have a care plan with the expected details. 

This applies to the following Programs and Years:
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: 

This applies to the following Programs and Years:
PCMH 2017

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. 

This applies to the following Programs and Years:
PCMH 2017

6.14.2018 TC 03 (Pediatric Specific) What are some examples of PCMH-oriented collaborative activities for pediatric practices?

Pediatric practices may want to look into quality improvement projects offered by state AAP chapters and national AAP. The AAP QI Webpage lists a variety of opportunities: https://www.aap.org/en-us/professional-resources/quality-improvement/Pages/ActivityList.aspx

This applies to the following Programs and Years:
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.

This applies to the following Programs and Years:
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.

This applies to the following Programs and Years:
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.

This applies to the following Programs and Years:
PCMH 2017

5.29.2018 QI 04B May practices use the “comments” section in the patient experience survey to meet this requirement?

No. Comment sections or “free text” questions on a patient experience survey do not meet the requirement as a method of collecting qualitative feedback from patients and their families.

This applies to the following Programs and Years:
PCMH 2017

5.29.2018 CC 04B How do practices document providing pertinent demographic and clinical information to a specialist if they use the same EHR?

Practices must provide a documented process for staff to follow to ensure that demographic and clinical data are available for the specialist, and either a report/log or an example showing that the process is followed (e.g., a screen shot of available information and how the information is made available to the specialist). If external referrals are made, the practice must specify the process for sharing information with those providers, as well. 

This applies to the following Programs and Years:
PCMH 2017

5.29.2018 CM 04 Does a clinical summary meet the requirement for a “plan of care”?

If the clinical summary also includes the details of the patient’s care plan (i.e., information outlined in the criterion guidance), then it would meet the requirement. A clinical summary alone that does not include the patient’s care plan information would not meet the requirement.

This applies to the following Programs and Years:
PCMH 2017

5.29.2018 CM 05 May practices make the individualized care plan available via patient portal, or are they required to provide the document in writing?

Although the care plan can be made available via the patient portal, it is essential that all patients have access to the document. If patients are not registered for the portal, they will not have access. In those cases, practices should use an alternative method to provide the written care plan to patients to ensure that all patients have access after an appointment. Please note practices must document that the care plan is provided to the patient in the patient’s medical record.
 

This applies to the following Programs and Years:
PCMH 2017