Redesign Overview and Pricing

As many of you are already aware, NCQA redesigned the PCMH recognition program in 2017, including pricing, structure and application process. Below are a few highlights about the redesigned NCQA PCMH program and pricing.

Updates about PCMH Content

NCQA held an informational webinar for health centers which provided more details about the structure and content in the redesigned PCMH program. Included below are a few highlights.

  1. NCQA will be retiring the language of “Standards, Elements, and Factors” which outlined the program up until this point. The program requirements will now be called “Concepts, Competency, and Criteria.” See the images to the right for an overview of the six Concepts that will be reflected in the redesigned PCMH program.
  2. In order to achieve PCMH recognition, practices will need to meet 40 CORE criteria plus an additional 25 ELECTIVE credits. Elective criteria are assigned 1, 2, or 3 credits. Practices may choose any criteria among the elective, as long as at least 1 elective criteria is chosen from 5 of 6 of the concepts (see images at right).

Program and Pricing Changes

Changes in NCQA PCMH Recognition Program

  • No Levels. NCQA is getting rid of the Level 1, 2, 3 recognition. Centers will simply be NCQA PCMH recognized based on attainment of a core set of criteria and their selections from a menu of additional criteria.
  • Connection to NCQA representative. Practices will be assigned an NCQA representative who works with them throughout the recognition process and is a consistent point of contact.
  • Virtual, Instant Review. Centers will have a series of 3-4 virtual reviews (web meetings/conference calls) with the NCQA reviewer to show or demonstrate how they meet certain PCMH requirements. The reviewer will give instant feedback and the practice will have an opportunity to present revised documentation/demonstration during the next web meeting.
  • Annual Renewal. Recognition will now be awarded and renewed on an annual basis, rather than every three years.

 

Pricing

Currently (as of 2020) HRSA has an agreement with NCQA to cover the cost of recognition application. That includes the cost of the Survey Tool, Recognition and Renewal. For CHCs to take advantage of this agreement, they must submit an NOI to HRSA prior to purchasing the survey tool. Click here to submit your NOI to HRSA. This means that the pricing information is not necessarily directly relevant to CHCs at this point in time. However, the HRSA and NCQA agreement in the future is contingent on the status of federal funding, so we include it here for your information in case things change in the future.

Please be advised, HRSA will not cover the cost of extra virtual reviews for new recognition or accelerated renewal if a center requires these for recognition.