OAR 409-055-0040
Recognition Criteria
(2) Must-Pass and 5 point measures focus on foundational PCPCH elements that should be achievable by most practices in Oregon with significant effort, but without significant financial outlay.
(3) 10 and 15 point measures reflect intermediate and advanced functions.
(4) Except for the 11 Must-Pass measures, each measure is assigned a point value. A practice must meet the following point allocation criteria to be recognized as a PCPCH:
(a) Tier 1: 30 – 60 points and all 11 Must-Pass Measures;
(b) Tier 2: 65 – 125 points and all 11 Must-Pass Measures;
(c) Tier 3: 130 – 250 points and all 11 Must-Pass Measures;
(d) Tier 4: 255 – 430 points and all 11 Must-Pass Measures.
(5) The Authority may designate a practice as a Tier 5 STAR Patient-Centered Primary Care Home for implementing multiple advanced PCPCH criteria as described in OAR 409-055-0045 (5 STAR Designation).
(6) The Authority shall calculate a practice’s point score through the recognition process described in OAR 409-055-0030 (Practice Application and Recognition Process).
(7) Table 1, incorporated by reference, contains the detailed list of Measures and corresponding point assignments.
(8) Table 2, incorporated by reference, contains a detailed list of the PCPCH Quality Measures.
(9) Measure specifications, thresholds for demonstrating improvement, and benchmarks for quantitative data elements are available on the Program website.
(10) National Committee for Quality Assurance (NCQA) recognition shall be acknowledged in the Authority’s PCPCH recognition process; however, a practice is not required to use its NCQA recognition to meet the Oregon PCPCH standards. A practice that does not wish to use its NCQA recognition to meet the Oregon PCPCH standards must indicate so during the PCPCH application process and submit a complete PCPCH application.
(11) A practice seeking Oregon PCPCH Tier 1, 2, 3 or 4 recognition based on its NCQA recognition must:
(a) Submit a PCPCH application and evidence of its NCQA recognition along with its application;
(b) Comply with Table 3, incorporated by reference, for NCQA PCMH practices using 2014 or 2017 NCQA criteria.
(12) A practice seeking Oregon PCPCH Tier 5 (5 STAR designation) is required to submit a complete PCPCH application and comply with OAR 409-055-0045 (5 STAR Designation).
Source:
Rule 409-055-0040 — Recognition Criteria, https://secure.sos.state.or.us/oard/view.action?ruleNumber=409-055-0040.