FAQ Directory

Yes. Using UM 13: Delegation of UM as an example, the following describes factors that would be considered NA:
UM 13, Element A: Delegation Agreement

• Factor 3 (semiannual reporting): This factor is NA for mail service organization delegates that only perform annual distribution (e.g., UM 11, Element B (annual updates for pharmaceutical restrictions/preferences).
  • Note: Factor 4 (performance monitoring): Annual distribution must be specified as part of the organization’s process for monitoring delegate performance, if applicable.
  • Factor 3 is not scored NA for distribution that occurs more frequently than annually (e.g., denial and appeal notices).
• Factor 5 (process for providing member experience and clinical performance data to delegates when requested): This factor is NA for mail service organization delegates.

UM 13, Element C: Review of the UM Program

• Factor 1 (annual review of delegate’s UM program): This factor is NA for mail service organization delegates.
• Factor 4 (semiannual evaluation of reports): This factor is NA for mail service organization delegates that only perform annual distribution.
  • Factor 4 is not scored NA for distribution that occurs more frequently than annually (e.g., denial and appeal notices).

Note: Factor 2 (annual audits): This factor is not scored NA, but the organization may submit the delegate’s timeliness report of mail distribution in lieu of an audit. This must be specified in the delegation agreement.
 

This applies to the following Programs and Years:

The Statin Therapy for Patients With Cardiovascular Disease (SPC) and Statin Therapy for Patients With Diabetes (SPD) measures include an exclusion for members with myalgia, myositis, myopathy or rhabdomyolysis during the measurement year. However, an allergy or history of an intolerance to a statin medication is not considered an exclusion for the measure.  
The general guidance NCQA received from our experts, as well as guidance from the American College of Cardiology , is that patients with atherosclerotic cardiovascular disease should be rechallenged on lower statin doses and alternative statins before being put on non-statin therapies (e.g., PCSK-9 inhibitors) due to statin intolerance. The decision-making process might vary from case to case. Although we incorporated exclusions for muscle-related statin side effects, we acknowledge that the measure may not address all instances of true statin intolerance. We will consider all feedback on this issue, while also ensuring that changes to the measure are valid, scientifically sound and true to the measure's intent (to measure the quality of cardiovascular care provided at the population level).

This applies to the following Programs and Years:

No. Members who die during the measurement year must be removed from all applicable measures. For episode-based measures, a member who died during the measurement year must be removed for all events (even if they meet numerator criteria for an event).

This applies to the following Programs and Years:

Yes. Because the board would have primary-source verified education and training before awarding certification, NCQA allows organizations to use expired board certifications to meet the requirements. Education and training information does not change even if board certification expires.

This applies to the following Programs and Years:

In step 1 identify all children in the specified age range who were dispensed an ADHD medication during the 12-month Intake Period. This clarification will be in the MY 2023 Technical Update.

This applies to the following Programs and Years:

As an ECDS-reported measure, the SNS-E screening numerator counts only screenings that use instruments in the measure specification as identified by the associated LOINC code(s). Allowed screening instruments and LOINC codes for each social need domain are listed in “Definitions” in the measure specification.

NCQA recognizes that organizations might need to adapt or modify instruments to meet the needs of their membership. To clarify:

• The SNS-E measure specification does not prohibit cultural adaptations or linguistic translations from being counted toward the measure’s screening numerators.
• Only screenings documented using the LOINC codes specified in the SNS-E measure count toward the measure’s screening numerators.
• The Regenstrief Institute, which maintains the LOINC database, has indicated that LOINC codes do not distinguish between adapted and translated instruments.
• Tool developers have varying policies with regard to cultural adaptation and translations; some state that users may adapt screening instruments, others state that organizations must obtain permission first.

NCQA urges organizations to refer to the tool developer for information about adaptations or translations that are available or allowed.

This applies to the following Programs and Years:

No. Replace “NUCC Provider Taxonomy Value Set” with “Dental Provider Value Set.” This correction will be in the MY 2023 Technical Update.

This applies to the following Programs and Years:

Yes. The Residential Program Detoxification Value Set and codes will be included in the Update release of the Value Set Directory on March 31, 2023. The OID for the value set is 2.16.840.1.113883.3.464.1004.2408, and it includes two HCPCS codes:

• H0010     Alcohol and/or drug services; sub-acute detoxification (residential addiction program inpatient) (H0010)
• H0011   Alcohol and/or drug services; acute detoxification (residential addiction program inpatient) (H0011)

This applies to the following Programs and Years:

We recommend that organizations not use PCS responses that are over 3 years old. If a question relates directly to a measure specification or a general guideline that was revised from a previous measurement year, you should resubmit the question.

This applies to the following Programs and Years:

You can experience Quality Compass’ functionality by watching the demo videos available on the Quality Compass webpage (https://www.ncqa.org/programs/data-and-information-technology/data-purchase-and-licensing/quality-compass/). The demo videos walks viewers through some of the key features of Quality Compass as well as how to navigate the tool.

You can also request a walk-through live demo from the Information Products team. Please submit your request through your my.NCQA.org account or contact NCQA’s Customer Support team.
 

This applies to the following Programs and Years:

Customers interested in accessing prior year data can choose to add up to three years of trended results to their Quality Compass purchase. For example, if you purchase Quality Compass 2022 (MY 2021), you can choose to add the trended data feature to access MY 2020 MY 2019 results.

It is important to note that not all data can be trended due to significant changes in the measure specifications. Quality Compass indicates when measures should be trended with caution or if there has been a break in trending and results should not be trended year-to-year. These trending determinations can be found on the Help tab within the Quality Compass tool or in the Volume 2 HEDIS technical specifications.

Access to the latest data year must be purchased annually.
 

This applies to the following Programs and Years:

The Medicare product line does not include CAHPS survey results. We recommend contacting Centers for Medicare and Medicaid Services (CMS) if you are interested in obtaining Medicare CAHPS data.

This applies to the following Programs and Years: