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.
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.
For younger children, practices may also identify patients and provide outreach for services for developmental screenings, autism screening, oral health risk assessment, Hematocrit or Hemoglobin screening, iron supplements for children ages 6 to 12 months at risk for anemia, or tuberculin testing for children at higher risk for tuberculosis
For adolescent patients, other preventive care services could also include (but not limited to) patients in need of specific preventive care-related lab tests, alcohol and drug screening, cervical dysplasia screening for sexually active females, sexually transmitted infection prevention counseling for adolescents at higher risk, obesity screening and counseling, HIV screening for adolescents at higher risk or other required screenings (e.g., chlamydia, depression, dyslipidemia at specific ages).
AAP resources:
Recommendations for Preventive Pediatric Health Care (PDF): https://brightfutures.aap.org/materials-and-tools/PerfPrevServ/Pages/default.aspx
Interactive Periodicity Schedule (AAP Pediatric Care Online- Web resource): https://pediatriccare.solutions.aap.org/periodicity-schedule.aspx
Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition (Web site and links to associated text/materials): http://brightfutures.aap.org/index.html
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.
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.
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:
Medical Home Data Portal state pages:
http://www.childhealthdata.org/browse/medicalhome
KIDS COUNT Data Center:
http://datacenter.kidscount.org/data/acrossstates/Rankings.aspx?ind=103
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
NCQA is not prescriptive regarding which depression screening tool is used as long as it’s a standardized tool. Some depression screening tool examples that would be appropriate for adolescents include but are not limited to PHQ2, PHQ9, PHQ-A, PSC, PSC-Y, RAAPS, or HEADSS.
