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 ItReconsiderations, 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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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 InformationContact 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)