Report OR No Elective CM08 - Includes a self-management plan in [Record Review Workbook and No individual care plans Patient examples] No Documented process AND Yes CM09 - Care plan is integrated and accessible Elective across settings of care Evidence of implementation Yes Core vs. Criterion for Care Coordination (CC) Evidence Type Elective Eligible CC01 - The practice systematically manages Documented process AND Yes lab and imaging according to NCQA Core guidelines Evidence of implementation No CC02 - Follows up with the inpatient facility Documented process AND Yes about newborn hearing and blood-spot Elective screening Evidence of implementation No CC03- Uses clinical protocols to determine Elective Evidence of implementation Yes when imaging and lab are necessary Documented process Yes CC04 - The practice systematically manages Core referrals according to NCQA guidelines Evidence of implementation No CC05 - Uses clinical protocols to determine Elective Evidence of implementation Yes when a referral to a specialist is necessary CC06 - Identifies the specialists/specialty Elective Evidence of implementation No frequently used by the practice Data source AND Yes CC07 - Considers performance information on Elective specialists when making referrals Examples Yes CC08 - Works with frequently referred Documented process OR Yes specialists to set expectations for information Elective sharing and patient care Agreement Yes Agreement OR Yes CC09 - with behavioral healthcare providers to set expectations for information Elective [Documented process and Yes sharing and patient care Evidence of implementation] Yes CC10 - Integrates behavioral healthcare Documented process AND Yes providers into the care delivery system of the Elective practice site Evidence of implementation No Documented process AND Yes CC11 - Monitors the timeliness and quality of Elective the referral response Report No CC12 - Documents co-management Elective Evidence of implementation No arrangements in the patient's medical record Documented process AND Yes CC13 - Engages with patients regarding cost Elective implications of treatment options Evidence of implementation No
CM08 - Includes a self-management plan in individual care plans Elective Report OR No [Record Review Workbook and No Patient examples] No CM09 - Care plan is integrated and accessible across settings of care Elective Documented process AND Yes Evidence of implementation Yes Criterion for Care Coordination (CC) Core vs. Elective Evidence Type Eligible CC01 - The practice systematically manages lab and imaging according to NCQA guidelines Core Documented process AND Yes Evidence of implementation No CC02 - Follows up with the inpatient facility about newborn hearing and blood-spot screening Elective Documented process AND Yes Evidence of implementation No CC03- Uses clinical protocols to determine when imaging and lab are necessary Elective Evidence of implementation Yes CC04 - The practice systematically manages referrals according to NCQA guidelines Core Documented process Yes Evidence of implementation No CC05 - Uses clinical protocols to determine when a referral to a specialist is necessary Elective Evidence of implementation Yes CC06 - Identifies the specialists/specialty frequently used by the practice Elective Evidence of implementation No CC07 - Considers performance information on specialists when making referrals Elective Data source AND Yes Examples Yes CC08 - Works with frequently referred specialists to set expectations for information sharing and patient care Elective Documented process OR Yes Agreement Yes CC09 - with behavioral healthcare providers to set expectations for information sharing and patient care Elective Agreement OR Yes [Documented process and Yes Evidence of implementation] Yes CC10 - Integrates behavioral healthcare providers into the care delivery system of the practice site Elective Documented process AND Yes Evidence of implementation No CC11 - Monitors the timeliness and quality of the referral response Elective Documented process AND Yes Report No CC12 - Documents co-management arrangements in the patient's medical record Elective Evidence of implementation No CC13 - Engages with patients regarding cost implications of treatment options Elective Documented process AND Yes Evidence of implementation No
2017%20PCMH%20SBHC%20Criterion%20List%20(1).docx