The practice has a documented process for giving patients/families/caregivers information about the role and responsibilities of the medical home:

Specific services patients can expect from the practice.
Whom to contact for specific concerns, questions and information.
The roles of the care team.
The practice is encouraged to provide information in multiple formats to accommodate patient preference and language needs.

Required Documentation:

For all factors that require a documented process, the documented process includes a date of implementation or revision and has been in place for at least three months prior to submitting the PCMH 2014 Survey Tool.

For the factors below, NCQA reviews a documented process for giving patients information and materials about the role of a medical home, and patient materials, such as:

Patient brochure.
Letter to the patient/family/caregiver.
Web materials.
A written agreement between the patient/family/caregiver and the practice, specifying the role of the medical home, the practice and the patient/family/caregiver (i.e., a patient compact).
A sample record transfer request form.

2.B.1 The practice is responsible for coordinating patient care across multiple settings.

Description	Example/Screenshot/Documentation	Source	Date Added

2.B.2 Instructions for obtaining care and clinical advice during office hours and when the office is closed.

Description	Example/Screenshot/Documentation	Source	Date Added

2.B.3 The practice functions most effectively as a medical home if patients provide a complete medical history and information about care obtained outside the practice.

Description	Example/Screenshot/Documentation	Source	Date Added

2.B.4 The care team provides access to evidence-based care, patient/family education and self-management support.

Description	Example/Screenshot/Documentation	Source	Date Added

2.B.5 The scope of services available within the practice including how behavioral health needs are addressed.

Description	Example/Screenshot/Documentation	Source	Date Added

2.B.6 The practice provides equal access to all of their patients regardless of source of payment.

Description	Example/Screenshot/Documentation	Source	Date Added

2.B.7 The practice gives uninsured patients information about obtaining coverage.

Description	Example/Screenshot/Documentation	Source	Date Added

2.B.8 Instructions on transferring records to the practice, including a point of contact at the practice.

Description	Example/Screenshot/Documentation	Source	Date Added

2014 - PCMH2B

Contents

2.B.1 The practice is responsible for coordinating patient care across multiple settings.

2.B.2 Instructions for obtaining care and clinical advice during office hours and when the office is closed.

2.B.3 The practice functions most effectively as a medical home if patients provide a complete medical history and information about care obtained outside the practice.

2.B.4 The care team provides access to evidence-based care, patient/family education and self-management support.

2.B.5 The scope of services available within the practice including how behavioral health needs are addressed.

2.B.6 The practice provides equal access to all of their patients regardless of source of payment.

2.B.7 The practice gives uninsured patients information about obtaining coverage.

2.B.8 Instructions on transferring records to the practice, including a point of contact at the practice.

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2014 - PCMH2B

2.B.1 The practice is responsible for coordinating patient care across multiple settings.

2.B.2 Instructions for obtaining care and clinical advice during office hours and when the office is closed.

2.B.3 The practice functions most effectively as a medical home if patients provide a complete medical history and information about care obtained outside the practice.

2.B.4 The care team provides access to evidence-based care, patient/family education and self-management support.

2.B.5 The scope of services available within the practice including how behavioral health needs are addressed.

2.B.6 The practice provides equal access to all of their patients regardless of source of payment.

2.B.7 The practice gives uninsured patients information about obtaining coverage.

2.B.8 Instructions on transferring records to the practice, including a point of contact at the practice.

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