Adding NCQA’s Behavioral Health Distinction To Your PCMH Recognition

If you are already an NCQA Recognized Patient Centered Medical Home, and may be considering adding behavioral health services to your practice, there is an add-on program that may help get you recognized for that good work.

Why add behavioral health to your practice? There is evidence that suggests providing behavioral health services within a primary care setting contributes to improved health outcomes in patients. Participating in the “warm hand-off” between primary care physician and behavioral health clinician increases the likelihood that patients will be able to follow through with needed care, and can potentially reduce any stigma associated by patients seeking behavioral health treatment from other providers less known to them.

NCQA ‘distinction’ in behavioral health can be considered a gold star for practices that have successfully integrated behavioral health services. The program functions as an add-on component to the Patient Centered Medical Home (PCMH) Recognition program. Currently, there are no financial incentives from payers for this distinction, separate to what they may offer for achieving the PCMH designation; however, recognition for providing behavioral health in your practice can help promote those services while integrating them into your medical home model. Therefore, the NCQA fee of $500 to submit for the distinction may well be worth the investment.

Primary care is exactly where behavioral health services should be.

Who can qualify?

Primary care practices that have in-house behavioral health services offered by a licensed behavioral health specialist can qualify for the distinction. The behavioral health specialist can be your employee, a specialist who rents space from your office, or even a tele-health service.

When is the best time to seek the distinction?

A practice can seek the distinction at any time! However, it’s recommended to do it during the initial work of becoming a Patient Centered Medical Home [PCMH] or during renewal because it’s easy to work on the behavioral health distinction simultaneously… Furthermore, examples used to achieve your main PCMH recognition can be utilized for the BH distinction as well.

If you’re already doing annual reporting, align the behavioral health project with your annual reporting dates so that, once achieved, you will have only one date for meeting annual reporting and behavioral health distinction requirements.

How can practices meet the requirements?

You must use evidence-based guidelines and demonstrate that you can treat a patient over time and adjust their care plan while considering their goals. Practices that do one-time prescriptions and referrals to external behavioral health providers, and without a process for follow-up care, likely won’t meet the criteria.

WHAT YOU NEED TO KNOW

• To qualify: the practice must have in-house behavioral health specialist (ie, psychologist, psychiatrist, licensed clinical social worker, licensed mental health counselor) to achieve the distinction.
• The cost: there is a $500 flat fee per practice, regardless of the number of practice locations or providers.
• The process: once you have worked through the program requirements, you have an opportunity for the NCQA team to review the work before final submission. This helps to ensure that you meet all of the criteria before you submit, and can pass the requirements to achieve the distinction the first time you submit.

Need more information about the distinction? Contact Amanda Ciadella at [email protected]