Distinction in Behavioral Health Integration

What Is Behavioral Health Distinction?

NCQA Distinction in Behavioral Health Integration is available to NCQA-Recognized PCMHs. Standards are based on input from clinicians and thought leaders and on industry best practices.

Primary care practices can download the standards, perform a gap analysis and implement changes to align with the standard requirements. Practices submit evidence to NCQA to validate alignment with the standards to earn distinction.

The Value of Behavioral Health Distinction

Behavioral health conditions (mental illnesses, substance use disorders) are often under-diagnosed or diagnosed late, delaying treatment. This leads to poorer health outcomes and higher costs of care.

These conditions can often be identified and treated in a primary care setting, which can result in seamless care. This improves treatment of behavioral health conditions, and other chronic medical conditions, resulting in better health outcomes overall.

Benefits of Distinction

• Stand out. Demonstrate to patients, payers and partners that your practice has the right resources, evidence-based protocols, standardized tools and quality measures in the primary care setting to support the needs of patients.
• Improve outcomes. Distinction results in an enhanced level of care and improved access, clinical outcomes and patient experience.
• Deliver whole-person care. Distinction helps practices provide comprehensive care that acknowledges patients’ behavioral health needs beyond the core requirements of NCQA PCMH Recognition.

Practice Eligibility

• Practices in the process of earning NCQA PCMH recognition.
• Practices that have earned NCQA PCMH Recognition and are seeking NCQA Distinction during Annual Reporting.

Program Requirements

The Distinction in Behavioral Health Integration module includes 18 criteria across 4 competencies related to behavioral health integration:

• Behavioral Health Workforce. The practice incorporates behavioral health providers at the site, utilizes behavioral health providers outside the practice and trains the care team to address patients’ mental health and substance use concerns.
• Information Sharing. The practice shares patient information within and outside of the practice to support an integrated/coordinated patient treatment plan.
• Evidence-Based Care. The practice uses evidence-based protocols to identify and address patients’ behavioral health needs.
• Measuring and Monitoring. The practice utilizes quality measures to monitor the care of patients with behavioral health needs.

Seven criteria in the module are also criteria in PCMH Recognition. Practices seeking this Distinction must meet all core criteria and two elective credits.

Pricing

Effective January 11, 2024.

Distinction in Behavioral Health Integration can be added as part of the initial PCMH Recognition transformation process, during the Annual Reporting process or it can be added after achieving PCMH Recognition. There is a $555 flat fee per site to add Distinction in Behavioral Health Integration.

Note: Practices seeking Distinction in Behavioral Health Integration at the same time they are going through the PCMH Transformation process will use their three allotted PCMH Virtual Reviews to demonstrate their Distinction evidence. Practices that have already achieved NCQA PCMH Recognition and are adding the Distinction in Behavioral Health Integration will have one scheduled Virtual Review to demonstrate evidence.

Example: The example below will provide you some context as to how pricing is applied for initial PCMH Recognition. For this example, an organization has 1 practice site with 16 clinicians.

Annual Reporting for Distinction in Behavioral Health Integration

As part of maintaining your Distinction in Behavioral Health Integration, each year your practice will undergo an Annual Reporting process utilizing a streamlined set of requirements.

Pricing effective January 11, 2024.

Effective January 11, 2024, the Annual Reporting fee for Distinction in Behavioral Health Integration is $175.

Example: The example below will provide you some context as to how pricing is applied for Annual Reporting. For this example, an organization has 1 practice site with 16 clinicians.

Getting Started

To learn more about Distinction in Behavioral Health Integration, download the PCMH standards and guidelines. Refer to Appendix 4: Distinction in Behavioral Health Integration for the standards. You can also access the Behavioral Health Distinction module in Q-PASS.

If you have any questions, submit them through My NCQA.