As you likely know, NCQA releases updates and clarifications to PCMH and PCSP standards and guidelines every July.
Still, we think it’s best to remind, to keep you up-to-date and informed, whenever we can.
The charts below give a quick reference to the most notable updates this year. Below the charts, we share some key information on when the changes take effect and remind you about a few important dates that should be on your calendar.
PCMH 2019 Updates July 2019
|Topic||PCMH Update/Clarification Highlights|
|PCMH Title||Removed the year (2017) from “PCMH 2017” on all documents and kept the version number.|
|AC 01||Specified that access needs and preferences cannot be assessed through unguided qualitative methods and/or nonactionable questions.|
|AC 06||Clarified that alternative appointments may not be restricted to a subset of patients. Removed “care manager” as a provider in the guidance.|
|KM 04||Clarified that the documented process must include next steps for patients who present with a positive screening.|
|KM 29||Added new competency G and elective criterion, “Opioid Treatment Agreement.”|
|CC 14||Clarified that patients must be proactively identified. Waiting for notification of discharge does not meet the intent.|
|QI 04A||Specified that access must focus on access to clinical care.|
|QI 04B||Added clarification around use of a PFAC for qualitative feedback.|
|CC 06||Clarified that providing specialty alone is insufficient.|
|QI 15, QI 16||Specified that at least one clinical quality, one resource stewardship and one patient experience must be reported.|
|QI WS||Clarified that a percentage must be included with the numerator/ denominator.|
|General Updates||Updated language and format in TC 02, KM 02, QI 18 and QI 19.|
|Policies & Procedures||Added section for practices using manual reports in place of automated reports. Updated the PCMH Audit and NCQA Investigation process: Clinicians on the Review Oversight Committee will only make the final revocation decision for a practice that failed its initial audit.|
|Appendix 6||Removed Distinction in Patient Experience Reporting (retired).|
PCSP 2019 Updates July 2019
|Topic||PCSP Update Highlights|
|KM 09||Clarified that practices should ensure that medications are up to date at every encounter and are being reconciled where needed for care coordination or at least annually.|
|KM 04,KM05, AC 03||Removed the partial credit shared between PCMH and PCSP to allow for a clearer view for customers in the Q-PASS system. (Criteria will be re-added as shared at the next PCSP update.)|
|QI 15, QI 16||Specified that at least one clinical quality, one resource stewardship, one patient experience must be reported.|
|Policies & Procedures||
Added a section for practices using manual reports in place of automated reports.
Updated the PCMH Audit and NCQA Investigation process: Clinicians on the Review Oversight Committee will only make the final revocation decision for a practice that failed its initial audit.
Effective Dates for Updates
When NCQA updates criteria in the PCSP or PCMH Standards and Guidelines that makes any significant change to intent, practices have 30 days to prepare and implement the change.
Many updates are clarifications and do not change the intent of criteria, and therefore do not have an effective date. Practices are expected to provide the appropriate evidence and meet the intent. NCQA provides clarifications to criteria if there is a common theme of misinterpretation or if incorrect evidence is regularly submitted.
Calendar Reminders for PCSP
Patient-Centered Specialty Practices, here’s a couple of important dates for your calendar.
12/13/2019: Last Day to Submit PCSP 2016 Single-Site Application
12/31/2019: Last Day to Submit PCSP 2016 Single-Site ISS Survey Tool