Participation Agreement

PARTICIPATION AGREEMENT

Massachusetts Health Policy Commission and Primary Care Practice Sites Participating in PCMH PRIME Technical Assistance Program

This Participation Agreement is entered into between the Massachusetts Health Policy Commission (HPC) and ______(the Practice).

The Massachusetts Health Policy Commission (HPC), in collaboration with the National Committee for Quality Assurance (NCQA), has developed the Patient Centered Medical Home (PCMH) PRIME Certification program to recognize patient-centered medical home providers who build and demonstrate capabilities in behavioral health integration. To help primary care practices develop behavioral health capabilities and achieve PCMH PRIME certification, the HPC is offering a behavioral health integration technical assistance (TA) program, which will be administered by HPC’s contractor. This Participation Agreement describes the TA program and sets forth the terms and conditions pursuant to which the Practice may receive TA.

The TA Program and the Role of the HPC

The HPC’s TAprogram seeks to support a participating primary care practice in developing behavioral health integration capabilities and meeting PCMH PRIME criteria. The HPC has engaged a contractor to design and implement TA directly with the Practice, while retaining ultimate oversight and decision making for the TA program.

The HPC will determine the TA curriculum and delivery modes in collaboration with its contractor. The TA program may include learning collaboratives, regional knowledge sharing opportunities, webinars, individual practice coaching, and a TA website. The HPC will determine the format, intensity, and timeline of TA and may modify the TA program as needed.

Based on the results of a practice self-assessment to be administered by HPC’s contractor, the HPC will determine the type of TA each participating primary care practice may receive. Some components of the TA program will be available to all practices that enter into a TA Participation Agreement with the HPC. Other components may be offered to certain practices only, based on available resources and the results of the practice self-assessment.

The TA program will be provided to groups of practices over a period of approximately six months per group. The HPC does not guarantee that using HPC-provided TA will lead to a practice achieving PCMH PRIME certification.

The TA program will be provided to the practice by the HPC at no cost to the practice. The HPC may terminate TA to a practice if the practice violates the terms of participation described below.

Terms of Participation in the TA Program

By accepting participation in the PCMH PRIME TA program, the Practiceagrees to the

following:

• If the Practice is not yet PCMH PRIME Certified, the Practice commitsto working toward

meeting PCMH PRIME criteria and submitting a complete application to the National Committee for Quality Assurance for PCMH PRIME certification within 18 months of the Practice’s six-month TA program start date.

• If the Practice is PCMH PRIME Certified, the Practice commits to working toward developing additional behavioral health integration capabilities, including such capabilities as may be required to meet any PCMH PRIME criteria that the Practice did not meet through its initial certification.

• The Practice will make best efforts to fully participate in PCMH PRIME TA activities by:
• Engaging a multidisciplinary team in TA activities;
• Completing the practice self-assessment;

• Sharing information with other participating practices, including attendingand actively participating in in-person TA convenings such as learning collaboratives and regional knowledge sharing opportunities, and as otherwise may be requested by the HPC;
• Utilizing recommended webinars or other web-based resources;
• Participating in practice coaching activities, if offered. This may include sharing information with adesignated practice coach about the Practice’s current capabilities and operations, working with the HPC’s contractor to develop an individualized practice work plan, attending coaching meetings, and conducting agreed-upon follow-up activities;
• Participating in reporting or TA evaluation activities as may be requested by the HPC or its contractor, such as completing feedback surveys and providing status updates on practice activities and progress on TA goals.

• The Practice authorizes the HPC to use the Practice’s name and/or logo for HPC communications and/or marketing regarding the TA program.

• The Practice agrees to provide the HPC with information about practice redesign efforts undertaken to achieve PCMH PRIME certification. In addition, the Practice acknowledges and agrees that the HPC, through its contractor, may review the results of the Practice’s self-assessment and any other documents pertaining to the Practice’s participation in the TA program. Please note that pursuant to M.G.L. c. 6D, § 2A, the HPC will keep confidential all nonpublic clinical, financial, strategic or operational documents or information provided or reported to the HPC in connection with the PCMH PRIME certification program and will only disclose any such documents or information consistent with the terms of M.G.L. c. 6D, § 2A.

IN WITNESS THEREOF, the parties below have caused this Participation Agreement to be executed and effective as of the last date written below.

Practice site nameHealth Policy Commission

By: ______By: ______

Signatory nameDavid Seltz

Signatory titleExecutive Director

Date: ______Date: ______