All materials © 2014, National Committee for Quality Assurance The Recognition Process Getting OnBoard Part 3 After: Keep It

2 Start-to-Finish (S2F) Pathway Your Roadmap to Recognition

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4 3 PHASES BEFORE: LEARN IT BEFORE: LEARN IT – Am I eligible? Can I make the commitment? Why would I want to do this? DURING: EARN IT DURING: EARN IT – I am committed what do I need to do submit? What is required? AFTER: KEEP IT 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?

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

6 Recognized Practices Marketing Materials and Seals NCQA sends press releases on request Tools to promote Recognition

7 After | Keep It Reconsiderations, Add-ons, & CAHPS Distinction

8 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

9 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%)

10 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 day review based on: Total of saved scores and new assessment

11 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

12 Screenshot of Online Application Demonstrating CAPHS-PCMH

13 Practice 1.Selects an NCQA Certified Vendor based on business terms Certified VendorsCertified Vendors 2.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 HereOrder 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

14 5. Vendor: a) consults with practice on methodology and scheduling NCQA CAHPS-PCMH MethodologyNCQA 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 Steps to Distinction

15 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

16 Maintain – Renewal Time NCQA s 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

17 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 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 Attestation

18 Select Renewal Elements This is the PCMH 2014 ISS Corporate Survey Tool Organizational Background

19 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

20 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*4A4B* 4C 5B* 6B6D*6E *Must Pass Corporate Element

21 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.

22 Elements that Do Not Require Documentation for Renewal Choose elements for attestation here

23 NCQA Policy Re: Practice Changes PCMH 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. ScenarioNCQA’s Usual Response Ownership change only*No change in Recognition Location change only*No change in Recognition A 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.

24 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 20 th of a month to be effective the following month Send Workbook for Adding/Deleting Clinicians to a Recognition (from ncqa.org website) to or NCQA: Sends lists to Pay-for-Performance sponsors each month Has no role in administration of payment programs

25 NCQA Contact Information Contact NCQA Customer Support at 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 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) submit a question to PCS