PCMH and OSV Specialist Referral Requirements Comparison.

Specialist Referral PCMH 2024 Standards(CC Competency B) HRSA Health Center Compliance Manual Alignment Strategies to Achieve Compliance
Formalized Agreements PCMH 2024 emphasizes having referral protocols and encourages formal agreements with specialists but does not mandate written contracts for all referrals. HRSA requires documented formal agreements (MOUs/MOAs) with specialty service providers, especially for required services not directly provided by the health center. Partially Aligned – PCMH encourages formal agreements, while HRSA mandates them. 1. Develop MOUs/MOAs with key specialty providers and review them annually.

2. Conduct periodic meetings with specialists to maintain agreement alignment.
Tracking and Follow-Up Requires a structured process for tracking referrals, following up on referral results, and documenting the entire process to close the referral loop. HRSA mandates a systematic tracking mechanism to monitor the status of all referrals, including evidence that the referral loop is closed effectively. Aligned – Both require a structured system to track and ensure follow-up. 1. Implement an EHR-based referral tracking system to manage referrals.

2. Assign staff members to follow up with patients and specialists to ensure results are received and documented.
Patient Engagement Requires practices to involve patients in referral decisions and provide relevant information, ensuring that referrals are patient-centered and address individual needs. Requires documentation that patients are informed of referral options, with consideration for individual preferences and health literacy levels, ensuring shared decision-making. Aligned – Both focus on patient engagement and shared decision-making in referrals. 1. Educate patients about referral options during visits using visual aids or handouts.

2. Incorporate shared decision-making tools in consultations to align referrals with patient preferences.
Referral Coordination PCMH 2024 requires effective care coordination between primary care providers and specialists, with a focus on establishing workflows for efficient information exchange. HRSA mandates policies and procedures that detail how coordination with external providers occurs, ensuring appropriate follow-up and communication throughout the referral process. Aligned – Both require effective coordination and communication between providers. 1. Use secure messaging within the EHR to facilitate direct communication between primary care and specialists.

2. Develop workflows to ensure timely information exchange and assign dedicated care coordinators for complex cases.
Documentation Requirements Referral activities must be documented in the EHR, including referral initiation, patient consent, and feedback from specialists integrated into the patient care record. Requires all referral-related documentation to be included in the health center’s EHR, with proof of tracking, outcomes, and any follow-up actions taken as part of continuous care. Aligned – Both require detailed documentation in the EHR for tracking referral activities. 1. Establish standardized templates within the EHR for documenting all referral activities.

2. Regularly audit referral records to verify completeness and adherence to documentation policies.
Patient Information Transfer Requires practices to share necessary clinical information with specialists in a secure, timely manner, as per patient consent and privacy guidelines. HRSA requires detailed protocols for securely transmitting patient health information, including verifying receipt of information and compliance with HIPAA standards. Aligned – Both emphasize secure, timely information sharing with specialists. 1. Use encrypted EHR messaging for all information transfers.

2. Verify receipt and acknowledgment from specialists to ensure information is delivered securely and completely.
Culturally Competent Referral Services PCMH 2024 requires the provision of culturally and linguistically appropriate services, including when making referrals, to ensure equity in access to specialty care. HRSA requires health centers to demonstrate that referral services are culturally and linguistically appropriate, aligned with the diverse needs of the patient population. Aligned – Both require culturally and linguistically appropriate referral practices. 1. Ensure interpreter services are available during referral discussions.

2. Partner with culturally relevant organizations to make appropriate specialty care referrals.
Follow-Up on Referral Results Requires that referral results are reviewed by the primary care provider, with the outcome integrated into the care plan, ensuring a comprehensive approach to ongoing patient management. HRSA compliance mandates evidence that specialists’ reports are reviewed and incorporated into patient care, with appropriate actions taken based on referral outcomes. Aligned – Both require that referral results be reviewed and integrated into the care plan. 1. Develop a checklist for reviewing and incorporating referral results into the patient care plan.

2. Assign dedicated clinical staff to follow up on pending referral results with specialists.
Timeliness of Referral PCMH 2024 requires practices to have a policy ensuring timely initiation of referrals and follow-up actions, focusing on minimizing delays in specialty care. HRSA requires adherence to specific timelines for making referrals, including policies for monitoring the timeliness of referrals and taking corrective actions when delays are identified. Aligned – Both require timely referral initiation and follow-up, with mechanisms to avoid delays. 1. Establish a timeline and protocol for initiating referrals and follow-ups, with alerts in the EHR for overdue referrals.

2. Implement regular review meetings to identify and address delayed referrals.