Patient-Centered Medical Home Certification in Ambulatory Care

Refer to: OQ

1. PURPOSE.    The purpose of this Circular is to establish the Indian Health Service (IHS) policy on Patient-Centered Medical Home (PCMH) certification/designation for all IHS ambulatory care facilities. Health stations may be excluded; however, it is recommended that health stations work toward implementation of PCMH principles to improve quality of care.
2. BACKGROUND.    The PCMH is a model of primary care delivery in which patients receive well-coordinated services and enhanced access to a care team. Providers practicing in PCMH models measure their performance, engage patients in their own care, and conduct quality improvement activities to address patients’ needs. Many medical home evaluations have shown improvements in quality and the patient’s experience of care.
   
   The IHS leadership determined that implementation of the PCMH model of care will promote high quality patient-centered care, enhance patient experience, and improve the work environment within the IHS system. Implementation of recognized PCMH models of care will best position the IHS in alignment with the Centers for Medicare & Medicaid Services (CMS) in movement toward value-based payment and care delivery models. PCMH is a model of primary care that may be referred to as Primary Care Medical Home (PCMH) by The Joint Commission (TJC), and Patient-Centered Medical Home (PCMH) by the Accreditation Association for Ambulatory Health Care, or other state-recognized Health Care Home standards.
3. POLICY.    All IHS health centers, critical access hospitals, and hospital-based ambulatory care health centers, excluding health stations, will attain PCMH certification/designation from a recognized accreditation organization by December 31, 2024. Once PCMH certification/designation is attained, it is the policy of the IHS for PCMH certification/designation to be maintained. Any new IHS health center, critical access hospital, or hospital-based ambulatory care health center will apply and attain PCMH certification/designation with their first accreditation survey, which generally occurs within the first two years of operation.
4. RESPONSIBILITIES.   
   1. Chief Medical Officer, IHS.    The IHS Chief Medical Officer has the authority and responsibility to ensure that the policy requirements of this Circular are duly supported, enforced, and completed.
   2. Director, Office of Quality.    The Director of the Office of Quality is responsible for monitoring the PCMH certification/designation status of each IHS facility including current status, applicable accreditation organization, and relevant dates such as date of last designation and anticipated renewal date.
   3. Governing Body of each facility.    Each facility’s Governing Body is responsible for the execution of this Circular. For each eligible facility, the requirements to obtain and maintain PCMH certification/designation are completed, monitored, reported to Area and IHS leadership including the Office of Quality, and duly documented.
5. PROCEDURES.   
   1. CERTIFICATION.    Certified PCMH practices are those that have received certification from any of the following nationally recognized accreditation organizations or state-based Health Care Home certification/designation programs:
      1. Medical Home designations recognized by the CMS Quality Payment Program Merit-based Incentive Payment System or Advanced Alternative Payment Models.
      2. Medical home designations recognized by at least one state-based program in which the IHS facility provides service.
      3. Medical Home models that are recognized as:
         1. PCMH recognition by the National Committee for Quality Assurance;
         2. Patient-Centered Medical Home certification by the Accreditation Association for Ambulatory Health Care; or
         3. Primary Care Medical Home Certification by The Joint Commission.
   2. REMEDIATION OF CERTIFICATION FAILURE.    If a service unit fails to achieve PCMH certification/designation (initial or recertification) by the deadline set by this Circular or after a formal accreditation organization survey (certification failure); the Governing Body must alert the Director, Office of Quality, the HQ Chief Medical Officer, and the Deputy Director of Field Operations, IHS within seven days of receipt of the notification of failure to certify by an accreditation organization, or seven days prior to the deadline set by this Circular, whichever is applicable.
      1. Corrective Action Plan (CAP). A CAP will be established to address those necessary steps needed to rectify any findings. The Governing Body must approve the initial CAP within 45 days of certification failure and submit to the Director, Office of Quality, and the Chief Medical Officer, IHS. Updates on progress will be provided to the Governing Body, Director of the Office of Quality, and Chief Medical Officer, IHS, with updates due at minimum every 28 days until the CAP is completed and certification status is reestablished.
      2. Root Cause Analysis (RCA). Certification failure represents a potential high-risk event. The facility will complete an RCA to investigate what system-level issues may exist that contributed to a certification failure. Please refer to any applicable local and Indian Health Manual policies for procedures on how to complete an RCA. It is the responsibility of the facility to submit the RCA to its Governing Body and the Governing Body to the Director of the Office of Quality and HQ Chief Medical Officer, IHS.
      3. Oversight. Until a service unit corrects the certification failure by re/establishing PCMH certification, this will be noted and tracked and reported on the quarterly Quality Assurance Reports by the Office of Quality to IHS senior leadership.
6. SUPERSEDURE.    This Circular supersedes SGM No. 17-01, “Patient-Centered Medical Home Designation in Ambulatory Care,” dated May 1, 2017.
7. EFFECTIVE DATE.    This Circular becomes effective on the date signed.

Distribution: IHS-wide
Date: 02/08/2024