The Recognition Process

1. Getting OnBoard Part 3 After: Keep It The Recognition Process

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

4. 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?

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

6. Recognized PracticesMarketing 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 • Request an Add-On survey via the online application account • NCQA merges data from previous Survey Tool into new PCMH Survey Tool and makes available to practice (new license#) • Practice may change response in any element with score of <100%; no need to reattach already submitted documents (saved scores- data from previous survey) • Practice submits a new application with the new license # • 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

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. Steps to Distinction Practice Selects an NCQA Certified Vendor based on business terms Certified Vendors Recognized practices access the CAHPS-PCMH application through their Online Application Account Not yet Recognized order a free Online Account pre-loaded with a CAHPS-PCMH applicationOrder Free Online Application Here In the Online Application, practice e-signs the CAHPS-PCMH agreement and assigned their selected Certified Vendor

14. Steps to Distinction • 5. Vendor: • consults with practice on methodology and schedulingNCQA CAHPS-PCMH Methodology • administers survey • collects data • submits data and fee to NCQA • at designated time • 6. NCQA notifies practice of data submission and 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 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

17. Data Submission Requirements

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

20. Streamlined RenewalElements that DO Require Documentation for Renewal Level 2 and 3 sites mustsubmit documentationfor the following Elements for Renewal to PCMH 2014:

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 NotRequire 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.

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 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

25. 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 elementsto submit a question to PCS(Policy/Program Clarification Support)