Cost Management Requirement NCQA Requirement Deeming Recommendation PCMH-Kids Common Contract Language The practice has implemented one of the following approaches to behavioral health integration by the end of Year 1 To promote better access to and 2011 NCQA PCMH 1, 2011 PCMH NCQA requirements Hannah notes: we did not coordination of behavioral health Element E requires a PCMH lack specificity around better require a documented services, the practice has developed to coordinate patient care coordinating behavioral health written agreement. A practice preferred referral arrangements with across multiple settings, services. may choose to include all community behavioral health including behavioral health. required information in a providers such that appointments are 2014 PCMH NCQA requirements compact required for NCQA. available consistent with the urgency 2014 NCQA PCMH 5, address only exchange of of the medical and behavioral health Element B, Factor 3: the information, not timely access to of the practice’s patients and practice maintains services. 2014 NCQA PCMH 5, there is an operational protocol agreements with behavioral Factor 4 is not a critical factor. adopted by the PCP and the preferred health provider. specialists for the exchange of Agreements typically NCQA: Do not allow deeming. information. The terms of the indicate the type of preferred arrangement are information that will be TCPI: Do not allow deeming. documented in a written agreement. provided when referring a Requirements regarding behavioral patient to a specialist and health integration are insufficiently expectations regarding specific. timeliness and content of response from the specialist. 2014 NCQA PCMH 5, Element B, Factor 4: Integrates behavioral healthcare providers within the practice site. To promote better access to and No NCQA requirement. NCQA: N/A Hannah notes: we did not coordination of behavioral health require and explicitly stated services, the practice has arranged for TCPI: same as above. that this would not be a behavioral health provider(s) to be financially feasible to co-located (or virtually located) at the in the current contract. practice for at least one per week and assists patients in scheduling appointments with the on-site provider(s).
Cost Management Requirement NCQA Requirement Deeming Recommendation PCMH-Kids Common Contract Language The practice has implemented one of the following approaches to behavioral health integration by the end of Year 1 To promote better access to and coordination of behavioral health services, the practice has developed preferred referral arrangements with community behavioral health providers such that appointments are available consistent with the urgency of the medical and behavioral health of the practice’s patients and there is an operational protocol adopted by the PCP and the preferred specialists for the exchange of information. The terms of the preferred arrangement are documented in a written agreement. 2011 NCQA PCMH 1, Element E requires a PCMH to coordinate patient care across multiple settings, including behavioral health. 2014 NCQA PCMH 5, Element B, Factor 3: the practice maintains agreements with behavioral health provider. Agreements typically indicate the type of information that will be provided when referring a patient to a specialist and expectations regarding timeliness and content of response from the specialist. 2014 NCQA PCMH 5, Element B, Factor 4: Integrates behavioral healthcare providers within the practice site. 2011 PCMH NCQA requirements lack specificity around better coordinating behavioral health services. 2014 PCMH NCQA requirements address only exchange of information, not timely access to services. 2014 NCQA PCMH 5, Factor 4 is not a critical factor. NCQA: Do not allow deeming. TCPI: Do not allow deeming. Requirements regarding behavioral health integration are insufficiently specific. Hannah notes: we did not require a documented written agreement. A practice may choose to include all required information in a compact required for NCQA. To promote better access to and coordination of behavioral health services, the practice has arranged for a behavioral health provider(s) to be co-located (or virtually located) at the practice for at least one per week and assists patients in scheduling appointments with the on-site provider(s). No NCQA requirement. NCQA: N/A TCPI: same as above. Hannah notes: we did not require and explicitly stated that this would not be financially feasible to in the current contract.