National Committee for Quality Assurance

This page includes information about the National Committee for Quality Assurance (NCQA) and their innovative Patient-Centered Medical Home (PCMH) recognition program for improving primary care. Find eligibility, standards, requirements, application process, and training information here.


NCQA Patient-Centered Medical Home (PCMH) Recognition Process

Please follow these instructions carefully as you begin this process.

Before you start:

  • All PCMH materials can be obtained from http://www.ncqa.org/programs/recognition/practices/patient-centered-medical-home-pcmh or call 1.888.275.7585, M-F, 8:30 a.m. - 5:00 p.m. ET.
  • We recommend that you order the PCMH 2011 Standards and Guidelines (free) and receive training (work through step 4c below) before you order any other materials.
  • Practices may use the Standards and Guidelines to self-assess prior to submitting to NCQA. However, the survey tool must be submitted online (instructions follow).
  • After you order the online application and survey tool, NCQA will send you a response e-mail for each order. Please keep these e-mails available as they contain important access information that you will need going forward. **Multi-sites do not order Survey Tools until Multi-site Eligibility Approval.**
  • For help with usernames, passwords, missing e-mails, and technical difficulties, please contact NCQA at 1.888.275.7585.

1. Information technology (IT) requirements to complete the PCMH Recognition process:

Please follow these instructions carefully as you begin this process.

PCMH is for practices with primary care clinicians, where at least 75% of the Primary Care Physicians’ (PCPs’) patients come for:

  • You will need a computer with:
    • Access to the Internet
    • Microsoft Word
    • Microsoft Excel
    • Adobe Acrobat Reader (available for free online)
  • Practices may use the Standards and Guidelines to self-assess prior to submitting to NCQA. However, the survey tool must be submitted online (instructions follow).
  • Please note that the survey system should be accessed and the survey completed using Internet Explorer. Other internet programs may not be compatible (i.e. Firefox, Safari).

2. Your organization’s key staff members

  • The organization’s party responsible for the PCMH submission should assess the resources required prior to making work assignments.
  • A primary Contact needs to be designated in the Online Application Tool to receive communications. The organization may grant access to other staff member to the Online Application and ISS survey tool.
  • Your practice should designate one or more staff members to complete all necessary application information and the ISS survey tool.

3. Support from a sponsor, state, or organization

  • If you have a sponsor, determine if you or the sponsor will be paying the PCMH submission fees.
  • If your sponsor is officially engaged with NCQA, you may be eligible for a 20% discounts on single site PCMH submissions.
  • Confirm your sponsor’s timeline. NCQA requires up to 60 days for decisions once you have submitted your ISS survey tool. Allow yourself plenty of time; the PCMH submission process is complex
  • Determine your sponsor’s contact information, and what help they may offer to you.
  • You will need to retrieve your Sponsor Discount Code from your sponsor to input in your Online Application.
  • NCQA does not provide information on incentive programs or financial rewards offered by sponsors.

4. PCMH Training

  • NCQA provides four types of free PCMH training: PCMH On-Boarding, Online Application and How to Submit as a Multi-site Practice, PCMH Standards and Guidelines, and the ISS Survey Tool.
  • We strongly encourage you to attend ALL trainings. Each training session is about 1-2 hours long. You can attend more than once. The training schedule and instructions are located at http://www.ncqa.org/education-events/seminars-and-webinars/live-seminars-webinars.
  • Training will help you understand the PCMH process, how to navigate the Online Application, what the standards requirements are, and how to complete your survey tool and submit.
  • At this point, order your Online Application (free) and ISS survey tool (except for organizations applying for the Multi-site process). Watch for those response e-mails from NCQA and safeguard them.

5. The Online Application

  • Refer to the e-mails received from publications@ncqa.org when you ordered your Online Application.
  • Launch your Online Application. Start a "New Single Site Application" or a "New Multi-site Application."
  • If fees are being paid for by a Sponsor, you can ignore the fee instructions. Information on Sponsor must be entered for each application to use the discounted application fee schedule. The fee schedule is posted on the Web site and available in the resources of the Online Application.
  • **For Multi-site applicants, answer the Multi-site Eligibility Request in the Online Application. NCQA will schedule a Multi-site Eligibility Conference Call with a Recognition Manager. You will be e-mailed materials that you need to prepare for the call. You will need to enter your sites following the naming convention into your Recognition Account prior to the call. On the call the manager will review the multi-site process, determine eligibility, and approve entered sites. You will need to print the list of approved sites to order your survey tools.**
  • Add your clinicians and your application(s) to your practice site(s). **For Multi-site applicants, you do not need to enter any clinicians at your Corporate site.**
  • Enter your ISS survey tool license number into the application. By entering your license number you will link your ISS tool and your online application. The license number can be found in the e-mail you received or on the first welcome screen after logging into the ISS survey tool.
  • You must sign the Business Associate Agreement (BAA) and PCMH Agreement. We encourage you to do so electronically through the Online Application. If you need to make custom changes to the two agreements download the Manual Signature versions on each of the agreements’ starting page. Red line any changes you would like made to the agreement and submit to NCQA at the address below. Please note you will not be able to submit your application until any customized agreements are accepted, signed, and uploaded by NCQA. NCQA Attn: PCMH Program 1100 13th Street NW Suite 1000 Washington, DC 20005
  • Application(s) must be received prior to submitting the ISS survey tool(s). You will receive an e-mail from NCQA confirming the receipt of your application(s) and an additional e-mail to inform you that your ISS survey tool is ready for you to complete and upload documents to.

6. Initializing your PCMH ISS survey tool and self assessment

  • Refer to the e-mails you received from publications@ncqa.org when you ordered your ISS survey tool(s).
  • Follow the instructions in the e-mail to access your ISS survey tool(s).
  • Self assess. Use the Standards and Guidelines to determine your baseline. Pay special attention to the Must Pass Elements.
  • Understand the scoring. Refer to the Standards and Guidelines to determine the Level of Recognition you will earn once you have implemented any capabilities not currently in practice from your baseline self-assessment

7. Preparing your PCMH ISS survey for submission

  • Your PCMH program fee is due when you submit your ISS tool(s). Use the fee schedule in effect at the date of submission. Fees are available on NCQA’s website and in the resources of the online application. Send your fee to: NCQA Attn: PCMH Program 1100 13th Street NW Suite 1000 Washington, DC 20005
  • To log in, refer to the NCQA e-mail containing the link to your ISS survey tool. Once you are logged in, the Help and Instructions are located at the top right corner of the screen.
  • Complete Organization Background section in ISS survey tool(s). **Multi-site applicants need to complete the Corporate Survey tab. Designate which Elements you will be answering in your Corporate Survey Tool**
  • Respond to Elements and attach documentation to the ISS library.
  • Upload your saved documents to the document library. Verify the location of your files.

Perform completeness check available in the "Submit Survey Tool" menu. Verify that your documents have been uploaded.

  • Self assess again. Note your total points and the Must Pass Elements.
  • If you are satisfied with your self assessment, submit your ISS survey.
  • **Multi-site applicants must submit their Corporate Survey Tool 30 days prior to site-specific tools. NCQA will review and score Corporate Survey Tool. NCQA will then merge your corporate tool with site-specific tools to display a complete score for each site tool. Practice will need to complete remaining elements that were not answered on the corporate tool. Submit site-specific tools.**
  • You will receive an error message if:
    • You did not have your application processed
    • You did not upload any documents
    • After you have submitted your survey tool(s), you will receive e-mail confirmation from NCQA
  • You will receive an e-mail within 60 days informing you of NCQA’s decision. **Multi-site applicants will receive a Recognition decision for each practice site within 60 days of submission of each site tool (after merging of the corporate survey scoring).**

Source: www.ncqa.com

What is NCQA?

NCQA is a private, not-for-profit organization dedicated to improving health care quality. Since its founding in 1990, NCQA has been a central figure in driving improvement throughout the health care system, helping to elevate the issue of health care quality to the top of the national agenda.

1. What is the National Committee for Quality Assurance (NCQA)?

NCQA is a private, not-for-profit organization dedicated to improving health care quality. Since its founding in 1990, NCQA has been a central figure in driving improvement throughout the health care system, helping to elevate the issue of health care quality to the top of the national agenda.

The NCQA seal is a widely recognized symbol of quality. Organizations incorporating the seal into advertising and marketing materials must first pass a rigorous, comprehensive review and must annually report on their performance. For consumers and employers, the seal is a reliable indicator that an organization is well-managed and delivers high quality care and service. For more information, please visit www.ncqa.org.

2. What is the NCQA Patient-Centered Medical Home (PCMH) Program?

NCQA’s PCMH 2011 is an innovative program for improving primary care. In a set of standards that describe clear and specific criteria, the program gives practices information about organizing care around patients, working in teams, and coordinating and tracking care over time. The NCQA PCMH standards strengthen and add to the issues addressed by NCQA’s original program.

A PCMH is a health care setting that facilitates partnerships between individual patients and their personal physicians, and, when appropriate, the patient’s family. Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally- and linguistically-appropriate manner.

3. What is a PCMH?

A PCMH is a model of care that strengthens the clinician-patient relationship by replacing episodic care with coordinated care and a long-term healing relationship. Each patient has a relationship with a primary care clinician who leads a team that takes collective responsibility for patient care, providing for the patient’s health care needs and arranging for appropriate care with other qualified clinicians. The medical home is intended to result in more personalized, coordinated, effective and efficient care.

A medical home achieves these goals through a high level of accessibility, by providing excellent communication among patients, clinicians and staff and by taking full advantage of the latest information technology to prescribe, communicate, track test results, obtain clinical support information and monitor performance.

4. Is my practice eligible for PCMH Recognition?

The PCMH 2011 program is for practices that provide first contact, continuous, comprehensive, whole person care for patients across the practice. PCMH has at its foundation the Joint Principles developed by the primary care medical societies (American College of Physicians, American Academy of Family Physicians, American Academy of Pediatrics, American Osteopathic Association), which are:

  • Whole-person care
  • Personal clinician provides first contact, continuous, comprehensive care
  • Care is coordinated or integrated across the health care system
  • Team-based care

Whole person care includes provisions of comprehensive care and self-management support, and emphasizes the spectrum of care needs, such as routine and urgent care, mental health, advice, assistance, and support for making changes in health habits and making health care decisions. Preventive care is also a key component of the expectation for clinician focus. Primary care physicians represent most of the recognized practices including family practitioners, general practitioners, internists and pediatricians.

If a practice can demonstrate that it provides whole person care and meets the other elements of the joint principles for most of its patients (at least 75%), it can be eligible for PCMH recognition by NCQA even if it is not a traditional primary care practice.

5. What are the levels of NCQA PCMH recognition and what do they mean?

There are three levels of NCQA PCMH recognition. The scoring consists of six standards and six must-pass elements that equal a total of 100 points. The scoring for each of the levels of recognition is below. Practices with a numeric score of 0 to 34 points and/or achieve less than six "Must Pass" Elements are not recognized.

Level of Qualifying Points Must Pass Elements at 50% Performance Level
Level 3 85-100 6 of 6
Level 2 60-84 6 of 6
Level 1 35-59 6 of 6
Not Recognized 0-34 < 6

6. What are the six standards for PCMH?

  • Enhanced Access and Continuity: Accommodate patients’ needs with access and advice during and after hours, give patients and their families information about their medical home and provide patients with team-based care.
  • Identify and Manage Patient Population: Collect and use data for population management.
  • Plan and Manage Care: Use evidence-based guidelines for preventive, acute and chronic care management, including medication management.
  • Provide Self-Care Support and Community Resources: Assist patients and their families in self-care management with information, tools and resources
  • Track and Coordinate Care: Track and coordinate tests, referrals and transitions of care.
  • Measure and Improve Performance: Use performance and patient experience data for continuous quality improvement.

7. What is an element?

An element is the scored component of a standard that provides details about performance expectations. NCQA evaluates each element in a standard to determine how well the practice meets the element’s requirements. Of the 27 elements in PCMH 2011, six are must-pass elements.

8. What is a must-pass element?

Six must-pass elements are considered essential to the PCMH, and are required for practices at all recognition levels. Practices must achieve a score of 50% or higher on must-pass elements to achieve recognition at any level.

  • Standard 1A: Access During Office Hours
  • Standard 2D: Using Data for Population Management
  • Standard 3C: Care Management
  • Standard 4A: Self-Care Process
  • Standard 5B: Referral Tracking and Follow-up
  • Standard 6C: Implement Continuous Quality Improvement Process

9. What is a factor?

A factor is a scored item in an element. For example, an element may require the practice to demonstrate that its policies and procedures include four specific items; each item is a factor. When an element includes multiple numbered factors, the scoring indicates the number of factors that the practice must meet to achieve each scoring level.

10. What is a critical factor?

A critical factor is a factor that is required for practices to receive more than minimal or, for some factors, any points. Critical factors are identified in the scoring section of the element.

11. Is it possible to earn NCQA Recognition without an Electronic Health Record (EHR)?

Yes. Although a practice can earn Level 1 or Level 2 PCMH recognition without an EHR, Level 2 recognition is easier to achieve with a basic EHR.

In order to earn the necessary points for Level 3 recognition and to generate the documentation demonstrating that the requirements for that level are met, a practice must use an EHR. Additionally, in order to meet all of the must-pass elements for any level of recognition, a practice must use a practice management system or registry.

12. What is a multi-site organization?

Multi-site practices:

  • Have three or more clinical sites
  • Share the same EMR
  • Share the same policies and procedures for staff
  • Have the ability to be bound under a single contract

13. What resources are available?

You may download a free copy of the PCMH 2011 Standards and Guidelines at http://www.ncqa.org/tabid/629/Default.aspx#pcmh. PCMH 2011 uses two NCQA platforms and two software products:

  • The Online Application Account contains the business and demographic information, and is free of charge. The software is the Online Application.
  • The Interactive Survey System (ISS) is where practices enter responses to the Standards and Guidelines, and is $80 per tool. The software is the ISS Survey Tool.

14. What training is available?

NCQA conducts free trainings via webinar each month. You can download the training schedule at http://www.ncqa.org/education-training/pcmh-pcsp. Topics include Getting on Board, PCMH 2011 Standards (two-part program), Using the ISS System for PCMH 2011, the Online Application and How to Submit as a Multi-Site. There is also recorded training on the NCQA website. Classroom training is available for a fee at locations across the country.

NCQA hosts in person PCMH training events. These one-and-a-half day seminars give attendees a thorough overview of NCQA’s PCMH 2011 standards and guidelines, and the documentation necessary to apply for recognition. Seminars also give physicians, nurses and other quality leaders a chance to network and learn from their peers. Many of these live seminars are approved for continuing education credits. For practices that can’t attend a live seminar but have a group of colleagues interested in PCMH training, training at your location is also available. Customized trainings may also be approved for continuing education credits at your request.

Source: www.ncqa.com

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