Getting OnBoard Part 3
After: Keep It
The Recognition Process
All materials © 2014, National Committee for Quality Assurance
Start-to-Finish (S2F) Pathway
Your Roadmap to Recognition
2
3
3 PHASES
• BEFORE: LEARN IT – Am I eligible? Can I make
the commitment? Why would I want to do this?
• DURING: EARN IT – I am committed what do I
need to do submit? What is required?
• AFTER: KEEP IT – I made it!
How do I keep my recognition?
What do I do if my practice changes?
How do I promote my achievement?
4
What Happens After Recognition?
Moving on to “Keep It” Phase
5
Recognized Practices
Marketing Materials and Seals
NCQA
sends press
releases on
request
Tools to
promote
Recognition
6
After | Keep It
Reconsiderations, Add-ons,
& CAHPS Distinction
7
Reconsiderations
• Available to any practice that does not agree with
NCQA’s decision
• Initiated by letter to NCQA within 30 days of
decision
• Practice provides rationale only – no additional
documentation
• Different NCQA reviewers and peer reviewers than
original review team
• Fee - $500
• Decision is final
• Does not prevent from continuing on to do an Addon
8
Add-On Surveys
When will a practice utilize an add-on survey?
• Practices with a Not Passing score or practices with
Level 1 or 2 Recognition who want to increase their
Level
• Practices able to provide additional documentation
and scoring
• Level 1 or 2 practices can submit an add-on survey
anytime within the current 3 year Recognition period
• Practice with a Not Passing score and number of Must
Pass elements passed can submit an add-on within 12
months of decision
• Application fee is discounted (50%)
9
Process
Add-On Surveys (cont.)
1. Request an Add-On survey via the online application
account
2. NCQA merges data from previous Survey Tool into new
PCMH Survey Tool and makes available to practice
(new license#)
3. Practice may change response in any element with
score of <100%; no need to reattach already submitted
documents (saved scores - data from previous survey)
4. Practice submits a new application with the new license
#
5. Practice uploads new documents and submits survey
and payment
New status after 30-60 day review based on:
• Total of saved scores and new assessment
10
Distinction in Patient Experience
Reporting
Purpose: Acknowledge NCQA Recognized medical
homes that put in the extra effort to collect and
report patient experience information in a
standardized way
Eligibility: Practice sites with PCMH Recognition are
eligible for Distinction. Practices planning to
submit for PCMH Recognition may submit data;
Distinction will confer with Recognition.
Term of Distinction: 1 year, renewable
11
Screenshot of Online Application
Demonstrating CAPHS-PCMH
12
Steps to Distinction
Practice
1. Selects an NCQA Certified Vendor based on business
terms Certified Vendors
2. Recognized practices access the CAHPS-PCMH
application through their Online Application Account
3. Not yet Recognized order a free Online Account preloaded with a CAHPS-PCMH application
Order Free Online Application Here
4. In the Online Application, practice e-signs the CAHPSPCMH agreement and assigned their selected Certified
Vendor
13
Steps to Distinction
5. Vendor:
a) consults with practice on methodology and
scheduling
NCQA CAHPS-PCMH Methodology
b) administers survey
c) collects data
d) submits data and fee to NCQA
at designated time
6. NCQA notifies practice of data submission and
Distinction
14
CAHPS-PCMH in PCMH
• Practices using CAHPS-PCMH, or other
patient experience survey tools covering
the same domains, receive credit
• Only practices using full CAHPS-PCMH surveys receive
credit for PCMH 6C, factor 2 in the PCMH 2014
standards
– Distinction is not required and using a certified
vendor is not required to get credit for factor 2
• Practices can use CAHPS-PCMH survey results for
quality improvement activities that are scored in PCMH
15
Maintain – Renewal Time
• NCQA e-mails reminder to practice primary contact 6
months before expiration
• Expired practices:
– Lose eligibility for streamlined renewal option
– No longer included in data feed to P4P sponsors
– No longer displayed on NCQA’s directory
– Practice MUST submit before expiration to avoid a
lapse in Recognition
16
Data Submission Requirements
PCMH 2014 Standard/Element
Requirements for Renewing
Practices
3D: Use Data for Population Management (MUST-PASS)
1. At least two different preventive care services
2. At least two different immunizations
3. At least three different chronic or acute care services
4. Patients not recently seen by the practice
5. Medication monitoring or alert
Annual data for at least TWO
factors for each of last two years
6A: Measure Clinical Quality Performance
1. At least two immunization measures
2. At least two other preventive care measures
3. At least three chronic or acute care clinical measures
4. Performance data stratified for vulnerable populations (to assess disparities
in care)
Attestation
6B: Measure Resource Use and Care Coordination
1. At least two measures related to care coordination. (NEW)
2. At least two utilization measures affecting health care costs.
Factor 1 - One measurement (no
more than 12 months old)
Factor 2 – Annual data for each
of last two years
6C: Measure Patient/Family Experience
Attestation
1. The practice conducts a survey (using any instrument) to evaluate
patient/family experiences on at least three of the following categories:
Access, Communication, Coordination, Whole-person care/self-management
support
2. The practice uses the PCMH version of the CAHPS Clinician & Group Survey
Tool
3. The practice obtains feedback on experiences of vulnerable patient
groups
4. The practice obtains feedback from patients/families through qualitative
means
17
Select Renewal Elements
This is the PCMH 2014
ISS Corporate Survey
Tool Organizational
Background
18
Streamlined Renewals
A streamlined process for renewals
Level II or III practice sites
Purchase and complete a new survey for each site

Submit current documentation for select Elements
only; attest to the others

Pay current survey pricing

New 3-year Recognition period

Multi-Site organizations need to be re-approved

19
Streamlined Renewal
Elements that DO Require Documentation for
Renewal
Level 2 and 3 sites must submit documentation for
the following Elements for Renewal to PCMH 2014:
1A*
2D*
3C
3D*
4A
4C
5B*
6B
6D*
6E
Corporate
Element
*Must
Pass
4B*
20
Streamlined Renewal Requirements (cont.)
• For elements other than those identified in the table, the
practice may receive credit for specific factors if it:
1) answers “YES” in the Survey Tool
AND
2) attests to its eligibility and meeting the requirements for
identified factors with the following statement:
“Our practice achieved Level 2 or Level 3 Recognition as a
patient-centered medical home and attests that the responses
to the factors of this element reflect the current operation of the
organization/practice sites. Documentation to support these
responses can be provided upon request.”
• If selected for audit, the practice must be able to provide
documentation for the elements for which it did not
submit documentation.
21
Elements that Do Not Require
Documentation for Renewal
Choose elements for
attestation here
22
NCQA Policy Re: Practice Changes
PCMH Policies and Procedures require the practice to notify NCQA of
changes in: location, mergers or consolidations.
Scenario
Ownership change only*
Location change only*
A material change in clinicians assigned
to site*
Two or more Recognized practice sites
merge or a Recognized practice
merges with an unrecognized site*
Recognized practice splits into two or
more locations
NCQA’s Usual Response
No change in Recognition
No change in Recognition
No change in Recognition
Merged site takes Recognition
level of the final location
Case-by-case assessment.
* NCQA reserves the right to request a) a written attestation that the change resulted in
no material changes in operational procedures or electronic systems, b) additional
documentation for selected PCMH elements, c) a new survey submission.
Recognitions may be revoked for reasonable cause at NCQA’s discretion.
23
Adding/Deleting Clinicians
Practices:
• Add or delete eligible clinicians at
any time during the Recognition period
• Delete clinicians who no longer
maintain a panel of PCP patients
• Submit clinician changes by the 20th of a month to be
effective the following month
• Send Workbook for Adding/Deleting Clinicians to a
Recognition (from ncqa.org website) to
pcmh@ncqa.org or pcsp@ncqa.org
NCQA:
• Sends lists to Pay-for-Performance sponsors each month
• Has no role in administration of payment programs
24
NCQA Contact Information
Contact NCQA Customer Support at 1-888-275-7585
M-F, 8:30 a.m. - 5:00 p.m. ET to:
 Acquire standards documents, application account, survey tools
 Questions about your user ID, password, access
Visit NCQA Web Site at www.ncqa.org to:
 Follow the Start-to-Finish Pathway
 View Frequently Asked Questions
 View Recognition Programs Training Schedule
• For questions about interpretation of standards or
elements to submit a question to PCS (Policy/Program
Clarification Support)
25