Health Care Homes / NCQA 2014 Standards Crosswalk4764.00000030Subp. 1MN Health Care HomeRule LanguageIntentCertification and recertificationprocedures Eligibility for certification.Verification RequirementsData Sources /DocumentationSubmit at application: Theapplicant submits documentationto meets the requirements ofhealth care home proceduresMDH allows for significant flexibility inhow clinics demonstrate the HCHstandards. Our goal is not to addadditional significant burden inrequiring detailed verificationelements.A. Organizational structure, 0030 1,A, B Primary care mission or aimstatement of services, 0030 1B0030Subp.1AAn eligible provider, supportedby a care team and systemsaccording to the requirementsin part 4764.0040, may applyfor certification as a healthcare home.Definitions:Subp. 16. Eligible provider.“Eligible provider” means apersonal clinician, local tradearea clinician, or clinic thatprovides primary careservices.The clinic providescare delivery using ateam of staff (clinician,care coordinator andother staff as definedby the patient’s needsand clinic’s resources)to engage withparticipants inproviding “wholeperson” care delivery.Applicant demonstrates that cliniciansare supported by a team care deliverysystem. There is evidence of teamculture in which both team membersand patients and families observe andunderstand how the team functions.1. There is documentation of the clinic’sorganizational structure that showsthe clinic’s health care home teamstructure, such as an organizationalchart that shows how the health carehome team and participants areinvolved in the HCH.2. There is description of servicesprovided by the clinic and supportedby the organization.At site visit: Team interviewand participant interviewA. Organizational structure, 0030 1, A,B. Primary care mission or aimstatement of services, 0030 1BNCQA StandardNotations: HCH / NCQALevels of recognition: There are 3 levels ofrecognition; each reflects the degree to which apractice meets the required elements.100 points, 27 elements, 6 must-passelements.Recognition levels reflects the degree to which apractice meets the requirements of the elementsLevel 1 35-59 points & all 6 must-pass elementsLevel 2 60-84 points & all 6 must-pass elementsLevel 3 85-100 points & all 6 must-passelements6 of 6 elements are required for each level. Scorefor each “must-pass” element must be 50%.Special Acknowledgement for practices reportingresults from CAHPS-PCMH. Practices earndistinction for collecting data through a certifiedEligibility: NCQA PCMH Recognition Program is apractice based evaluation for clinicians who providecare in primary care specialties.Recognition status lasts for 3 years.PCMH 2014 – Elements of Program More integration of behavioralhealthcare Additional emphasis on team-basedcare Focus care management for highneed populations Encourage involvement of patientsand families in QI activities. Alignment of QI activities with theTriple Aim; improved quality, costand experience of care Alignment with health informationtechnology MU Stage 2.Clinicians who qualify for PCMH: Clinicians who hold a current, unrestrictedlicense as MD, DO APRN, or PA. Only clinicians that a patient can select as a“personal clinician” are eligible to be listed Physicians, APRNs and PAs who practice inspecialty of Internal Med, Family Medicine orPediatrics, with intent of serving as personalclinician for their patients Physician-led practices applying with identifiedAPRN;s or PA’s!19/24/2015

Health Care Homes / NCQA 2014 Standards Crosswalk!29/24/2015

Health Care Homes / NCQA 2014 Standards Crosswalk4764.00000030Subp.1BMN Health Care HomeRule LanguageIntentVerification RequirementsData Sources /DocumentationNCQA StandardNotations: HCH / NCQAA clinic will be certified only ifall of the clinic’s personalclinicians and local trade areaclinicians meet therequirements for participationin the health care home.Subp. 28. Personalclinician. “Personal clinician”means a physician licensedunder Minnesota Statutes,chapter 147, a physicianassistant licensed andpracticing under MinnesotaStatutes, chapter 147A, oran advanced practice nurselicensed and registered topractice under Minnesotastatutes, chapter 148.Subp. 31. Primary care.“Primary care” means overalland ongoing medicalresponsibility for a patient’scomprehensive care forpreventive care and a fullrange of acute and chronicconditions, including end-oflife care when appropriate.Subp. 29. Preventivecare. “Preventive care”means disease preventionand healthThe intent is to meetthe requirements ofthe health care homeslegislation “thatencourages theprovision of primarycare services,” and theJoint Principles forPPC- PCMH. Eachpatient has an ongoingpersonal relationshipwith a personalclinician trained toprovide first point ofcontact, continuousand comprehensivecare, includingpreventive, acute andchronic care.HCH provides verification thatclinician applicants provide the fullrange of primary care services, suchas1. Documentation showing boardcertification and / or licensure inprimary care specialties forphysicians, nurse practitioners andphysician assistants.2. A document showing evidence oforganizational commitment to primarycare services such as a mission oraim statement that demonstratescommitment to HCH model, carecoordination and other components ofthe HCH criteria. Primary caremission or aim statement ofservices, 0030 1BFor Specialists Only:3. In addition, non-primary careapplicant specialists must provideevidence in the form of a chart auditthat they are providingcomprehensive primary care servicesincluding first point of contact acutecare, preventive and chronic carethemselves and not referring outprimary care services.4. In addition non-primary careapplicant specialists must provideevidence by measurement that theycommunicate to their patientpopulation that they provide primarycare and pts understand role.NCQA Definition of Practice: One or moreclinicians (including all eligible primary careclinicians) who practice together and providepatient care at a single geographical location.Practice together means that all the cliniciansin a practice: Follow the same procedures andprotocols. Have access to and share medical recordsfor all patients treated at the practice site. Electronic and paper based systems andprocedures support clinical andadministrative functions e.g. scheduling,treating patients, ordering services,prescribing, maintaining medical recordsand follow-up.NCQA Definition of Multi-Site group: 3 or more primary care practice sites usingthe same systems and processes,including an electronic medical recordsystem. Must submit a Multi-Site Approval requestform to cover all sites, For a minimum of 3 months practice sitesmust have shared and used in the sameway a practice management system,registry or EMR to document patient carefor administration and billingAt HCH application the applicant isasked if the practice team follows thesame protocols, has a consistentleadership structure and hasimplemented the HCH in a consistentmanner. The applicant is also asked tocomplete a survey to identify if theyhave an EMR and what structuralelements are in place in their EMR orwill be implemented.Primary care providers are certified,see the definitions in subp. 28, 29, 31,and an eligible provider provides thefull scope of primary care as defined insubp. 16.*See standards for clinicians who do notquality and special circumstances.!39/24/2015

Health Care Homes / NCQA 2014 Standards Crosswalk!49/24/2015

Health Care Homes / NCQA 2014 Standards Crosswalk4764.00000030 Subp.2.A., B., C. –Subp. 4.MN Health Care HomeRule Languagemaintenance. It includesscreening, earlyidentification, counseling,treatment, and educationto prevent healthproblems.Subp. 26. Participant."Participant" means thepatient and, whereapplicable, the patient'sfamily, who has elected toreceive care through a healthcare home.Subp. 27. Patient andfamily- centered care.“Patient and family-centeredcare” means planning,delivering, and evaluatinghealth care through patientdriven, shared decisionmaking that is based onparticipation, cooperation,trust, and respect ofparticipant perspectives andchoices. It also incorporatesthe participant’s knowledge,values, beliefs and culturalbackground into careplanningand delivery.PatientAn applicationforcertification or recertificationis complete when thecommissioner has receivedall information in subpart 2;the on-site review, if any, hasbeen completed; and thecommissioner has receivedany additionaldocumentation requestedIntentVerificationRequirements DataSources / DocumentationNCQA StandardPractice Readiness Evaluation:Practices can conduct a readiness andself-evaluation on the PCMH standardsand elements before submitting theSurvey Tool to NCQA. The survey toolestimates the score for each standardand element and provides an overallpreliminary score. NCQA does not reviewreadiness assessment documentationprior to survey submission.The applicationprocess providesnecessaryinformation to verifythe applicant meetsthe standards andcriteria and there issufficient informationto evaluate theprogress of HCHs forRequired: Applicant submitsthrough MDH Web portal:1.Letter of intent2.Application and HCHCertification Assessmentform.Supporting documents that aresubmitted at application orreviewed at site visit.3.Participates in site visit.Six PCMH Standards and one overall score.Each standard has several specificelements.1 . Patient Centered Access -3 elements2. Team Based Care-4 elements3. Population Health Management-5elements4. Care Management and Support-5elements5. Care Coordination and CareNotations: HCH / NCQACertification Assessment Tool: HCHprovides a certification assessment toolon-line and a second version withexamples for training purposes. Thistool is not submitted ahead of time. Thetool is designed to help clinics selfassess and determine their readiness forcertification.The HCH certification process is aquality improvement process. Thereare five HCH standards implementedover two yrs. HCH Five Standards:1. Access & Communication2. Registry & Tracking3. Care Coordination4. Care Plan5. Performance Reporting & QualityImprovement!59/24/2015

Health Care Homes / NCQA 2014 Standards Crosswalk4764.0000MN Health Care HomeRule LanguageIntent4764.0040Subp. 1.CertificationAccess and communication standard; certificationrequirements. The applicant for certification musthave a system in place to support effectivecommunication among the members of the healthcare home team, the participant, and otherproviders. The applicant must do the following:0040, Subp.1, A 1,2A. offer the applicant'shealth care home servicesto all of the applicant'spatients who:(1) have or are at risk ofdeveloping complex orchronic conditions;(2) areinterested inparticipation.Subp. 32. Primary careservices patient population."Primary care services patientpopulation" means all of thepatients who are receivingprimary care services fromthe health care home,regardless of whether apatient has chosen toparticipate in the health carehome.The health care homepopulation is the clinicpopulation. The HCHis responsible formanagement of theclinic’s population. Theapplicant establishes aprocess tosystematically screenpatients to identifypatients who wouldbenefit from carecoordination servicesbased on the patient’smedical and nonmedical complexity.The HCH screeningprocess provides thefoundation for patientparticipation andactivation and definesthe patient’s riskVerification RequirementsData Sources /Documentation4.MDH review and notification5.Standards are met or not met.Variances are implemented asneeded as defined in chapter0050 in the HCH rule.Submit at application:Documentation that describes theapplicant’s procedures /workflows to meet the Access andCommunication standard.A. Systematic screening /communication processSubp 0040 1, AB. Triage and schedulingprotocol, Subp 0040 1, B3A. Establish a systematic screening/ communication process forHCHs that includes the followingpoints:1. The screening mechanism that isdefined by the clinic which mayinclude the registry, populationbased screening mechanism, panelmanagement or a combination ofmethods. (There will be arecommended risk-assessment toolthat defines the risk levels for billingand care coordination services.)2. The HCH has a process todiscuss with patients the role ofthe HCH, including the followinginformation: the purpose and theservices of the HCH, the name ofthe patient’s responsible primaryclinician, the responsibilities ofteam members including theNCQA StandardComplete the NCQA Application: 5 steps1. Order application tool2. Access online application system3. Sign Business Associate Agreement4. Submit on-line application5. Submit the application feeNCQA6.Standard Structure: Element, Factor,Scoring, Explanation and Examples. Each element has up to 5 possible scores:100%, 75%, 50%, 25%, 0% Required documentation listed in examples:Policy & Procedures in place for a least 3months, Data no more than 12 months old.Notations: HCH / NCQAInitial HCH Certification Process:1. Submit LOI2. Submit Application3. Complete Assessment inportal4. Site VisitPCMH 2: Team Based Care Thepractice provides continuity of careusing culturally and linguisticallyappropriate team based approaches.Element B: Medical homeresponsibility:The practice has a process for informingpts / families about the role of the medicalhome and give pts/families materials thatcontain the following information:1. The practice is responsible forcoordinating patient care across multiplesettings;2. Instructions on obtaining care andclinical advice during office hours andwhen the office is closed;3. The practice functions most effectivelyas medical home if pts provide acomplete medical hx and info aboutcare received outside practice.!69/24/2015

Health Care Homes / NCQA 2014 Standards Crosswalk4764.0000MN Health Care HomeRule LanguageIntentlevel for services andbilling