Or. Admin. R. 409-055-0040 - Recognition Criteria

(1) The PCPCH recognition criteria are divided into "Must-Pass" measures and other measures that place the practice on a scale of maturity or 'tier' that reflect basic to more advanced PCPCH functions.

(2) Must-Pass and 5-point measures focus on foundational PCPCH elements.

(3) 10- and 15-point measures reflect intermediate and advanced functions.

(4) Except for the 13 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 3: 100-245 points and all 13 Must-Pass Measures;

(b) Tier 4: 250-390 points and all 13 Must-Pass Measures;

(c) Tier 5: 395-530 points and all 13 Must-Pass Measures.

(5) The Authority may award a Patient-Centered Primary Care Home the Health Equity Designation for implementing health equity measures as described OAR 409-055-0045.

(6) The Authority shall calculate a practice's point score through the recognition process described in OAR 409-055-0030.

(7) Table 1, incorporated by reference, contains the detailed list of Measures and corresponding point assignments.

(8) 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.

(9) A practice seeking Oregon PCPCH Tier 5 recognition based on its NCQA recognition must submit an abbreviated PCPCH application attesting to selected Oregon PCPCH standards and evidence of its NCQA recognition along with its application.

(10) A practice seeking Oregon PCPCH Health Equity Designation based on its NCQA recognition must submit a complete PCPCH application and comply with OAR 409-055-0045.

Notes

Or. Admin. R. 409-055-0040

OHP 6-2011(Temp), f. 9-29-11, cert. ef. 10-1-11 thru 3-15-12; OHP 2-2012, f. 2-29-12, cert. ef. 3-1-12; OHP 9-2013, f. 10-1-13, cert. ef. 1-1-14; OHP 2-2015, f. 1-16-15, cert. ef. 2/1/2015; OHP 10-2015(Temp), f. 12-29-15, cert. ef. 1-1-16 thru 6-24-16; OHP 9-2016, f. & cert. ef. 5/13/2016; OHP 16-2016, f. & cert. ef. 12/22/2016; OHP 3-2020, amend filed 08/10/2020, effective 8/10/2020; OHP 3-2023, amend filed 11/30/2023, effective 11/30/2023

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Statutory/Other Authority: ORS 413.042, ORS 413.259 & 414.655

Statutes/Other Implemented: ORS 413.259, 413.260 & 414.655