All materials © 2014, National Committee for Quality Assurance

The Recognition Process

Getting OnBoard Part 3After: Keep It

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Start-to-Finish (S2F) PathwayYour Roadmap to Recognition

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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?

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What Happens After Recognition?Moving on to “Keep It” Phase

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Recognized PracticesMarketing Materials and Seals

NCQA sends press releases on request

Tools to promote Recognition

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After | Keep It

Reconsiderations, Add-ons, & CAHPS Distinction

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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 Add-on

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Add-On SurveysWhen 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%)

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Add-On Surveys (cont.)Process

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

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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

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Screenshot of Online ApplicationDemonstrating CAPHS-PCMH

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Practice1.Selects an NCQA Certified Vendor based on

business terms Certified Vendors2.Recognized practices access the CAHPS-PCMH

application through their Online Application Account

3.Not yet Recognized order a free Online Account pre-loaded with a CAHPS-PCMH application Order Free Online Application Here

4.In the Online Application, practice e-signs the CAHPS-PCMH agreement and assigned their selected Certified Vendor

Steps to Distinction

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5. Vendor: a) consults with practice on methodology

and scheduling NCQA CAHPS-PCMH Methodology

b) administers surveyc) collects datad) submits data and fee to NCQA at designated time

6. NCQA notifies practice of data submission and Distinction

Steps to Distinction

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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

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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

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Data Submission RequirementsPCMH 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 Performance1. At least two immunization measures2. 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 Coordination1. 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 Experience1. 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 support2. The practice uses the PCMH version of the CAHPS Clinician & Group Survey Tool3. The practice obtains feedback on experiences of vulnerable patient groups4. The practice obtains feedback from patients/families through qualitative means

Attestation

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Select Renewal Elements

This is the PCMH 2014 ISS Corporate Survey Tool Organizational

Background

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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

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Streamlined RenewalElements 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 4B*

4C 5B* 6B 6D* 6E

*Must Pass

Corporate Element

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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.

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Elements that Do Not Require Documentation for Renewal

Choose elements for attestation here

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NCQA Policy Re: Practice ChangesPCMH Policies and Procedures require the practice to notify NCQA of changes in: location, mergers or consolidations.

* 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.

Scenario NCQA’s Usual ResponseOwnership change only* No change in RecognitionLocation change only* No change in RecognitionA material change in clinicians assigned to site*

No change in Recognition

Two or more Recognized practice sites merge or a Recognized practice merges with an unrecognized site*

Merged site takes Recognition level of the final location

Recognized practice splits into two or more locations

Case-by-case assessment.

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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

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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)