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.
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 12C (Pediatric Specific) Give examples of pediatric acute care services.
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 20176.14.2018 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.”
This applies to the following Programs and Years:
PCMH 20176.14.2018 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.
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Pediatric-specific resources:
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Medical Home Data Portal state pages:
http://www.childhealthdata.org/browse/medicalhome
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KIDS COUNT Data Center:
http://datacenter.kidscount.org/data/acrossstates/Rankings.aspx?ind=103
This applies to the following Programs and Years:
PCMH 20176.14.2018 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 20176.14.2018 KM 24 (Pediatric Specific) • AAP resource:
6.14.2018 QI 01 (Pediatric Specific) Can a practice use the CHIPRA Initial Core Set of Children’s Health Care Quality Measures?
6.14.2018 AC 02 (Pediatric Specific) If a pediatric practice has extra appointments based on the season [in the summer for physicals (prior to school starting) and has extra appointments in the winter for sick appointments] does this meet the criterion?
No, just having extra appointments based on the season would not meet the intent. The practice may have more same day appointments offered during these high-volume time periods but some same day appointments should be provided daily throughout the year.
This applies to the following Programs and Years:
PCMH 20176.14.2018 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?
5.29.2018 QI 06 Does the CAHPS PCMH Survey meet both QI 04 and QI 06?
The CAHPS PCMH Survey meets the requirement for QI 06 but only partially meets QI 04. The CAHPS PCMH Survey only meets the quantitative data requirement (QI 04A) for this criterion.
Note: No modifications to the survey questions or length may be made.
This applies to the following Programs and Years:
PCMH 20175.29.2018 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 20175.29.2018 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.
