No. Documentation of an “unknown” eye exam result does not meet criteria for hybrid reporting for the eye exam indicator of the CDC measure or the EED measure.
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11.15.2021 Comprehensive Diabetes Care If medical record documentation indicates that an eye exam result is “unknown,” does this qualify as a result when reporting the eye exam indicator of the CDC measure or the EED measure?
11.15.2021 NCQA DAV Data May organizations use NCQA-validated data resulting from Data Aggregator Validation (DAV) as standard supplemental data when reporting HEDIS measures?
Yes. NCQA DAV data may be used as standard supplemental data if the auditor receives a completed current year’s Roadmap Section 5 from the reporting entity using the data. The Roadmap must explain how data from the validated DAV entity is transferred to the reporting entity and what the entity does to the data. The Roadmap is completed by the health plan; no documentation is required from the DAV entity except for the final list of validated ingestion sites and clusters, along with the date they were approved. If the reporting entity processes the validated CCD in any way after receipt, the auditor must validate the file back to the original validated CCD to ensure that no data were changed.
If an NCQA-validated DAV entity includes data from an unvalidated data cluster, the auditor must validate that data, following the nonstandard supplemental data guidelines, before the data can be used for HEDIS reporting. The auditor may not perform PSV on any validated data files.
The NCQA DAV data definition will be included in General Guideline 31 for MY 2022.
This applies to the following Programs and Years:
HEDIS MY 202111.15.2021 UM 3, Element A, Notification to Members May notifications sent to members be used as materials to satisfy UM 3, Element A, factors 4 and 5?
11.15.2021 Removal of APM Example In the 2022 NCQA standards for QI 4, Element A, factor 6, the HEDIS measure Metabolic Monitoring for Children and Adolescents on Antipsychotics was removed as an example for the requirement. Why? Can it still be used to fulfill the requirement?
The APM measure may be used if it is relevant to the population. Because it applies to children and adolescents, it was removed from the factor 6 examples to align with the exception (factor 6 is NA if the organization’s membership does not include adult members).
This applies to the following Programs and Years:
HP 202211.15.2021 General Guideline 18: Deceased Members How should we apply the “deceased members” exclusion in General Guideline 18: Deceased Members for episode-based measures?
The guideline for deceased members (General Guideline 18) is a member-level exclusion. For episode-based measures, if one event does not meet numerator criteria, and the organization chooses to use this optional exclusion, remove all member events/episodes from the measure.
This applies to the following Programs and Years:
HEDIS MY 202110.15.2021 Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents The WCC measure includes a summary of change (SOC) to indicate that the value is stratified. Should this be removed from the SOC?
Yes. Remove the SOC that reads, “Revised the Reporting Instructions for the ‘NumeratorByAdminElig’ data element in Table WCC-1/2 to read ‘For each Metric and Stratification.’” Organizations reported “NumeratorByAdminElig” by age stratification in the past, so this is not a change to the measure for MY 2020 & MY 2021 reporting.
This applies to the following Programs and Years:
HEDIS MY 202110.15.2021 General Guideline 32: Obtaining Information for the Systematic Sample Should the number of numerator events by administrative data in the eligible population (before exclusions), the number of required exclusions and the current year’s administrative rate (before exclusions) data elements change with a data refresh after the sample has been drawn?
No. The number of numerator events by administrative data in eligible population, the number of required exclusions and the current year’s administrative rate data elements must remain frozen at the time of sampling and do not change with data refresh.
This applies to the following Programs and Years:
HEDIS MY 202110.15.2021 General Guideline 32: Obtaining Information for the Systematic Sample Should the number of numerator events by administrative data in the eligible population (before exclusions), the number of required exclusions and the current year’s administrative rate (before exclusions) data elements change with a data refresh after the sample has been drawn?
No. The number of numerator events by administrative data in eligible population, the number of required exclusions and the current year’s administrative rate data elements must remain frozen at the time of sampling and do not change with data refresh.
This applies to the following Programs and Years:
HEDIS MY 202210.15.2021 Transitions of Care The TRC measure includes a summary of change (SOC) to indicate that it the value is stratified. Should this be removed from the SOC?
Yes. Remove the SOC text that reads, “Revised the Reporting Instructions for the ‘NumeratorByAdminElig’ data element in Table TRC-3: Data Elements for Transitions of Care to ‘For each Metric and Stratification.’” Organizations reported “NumeratorByAdminElig” by age stratification in the past, so this is not a change to the measure for MY 2020 & MY 2021 reporting.
This applies to the following Programs and Years:
HEDIS MY 202110.15.2021 Transitions of Care The TRC measure includes a summary of change (SOC) to indicate that it the value is stratified. Should this be removed from the SOC?
Yes. Remove the SOC text that reads, “Revised the Reporting Instructions for the ‘NumeratorByAdminElig’ data element in Table TRC-3: Data Elements for Transitions of Care to ‘For each Metric and Stratification.’” Organizations reported “NumeratorByAdminElig” by age stratification in the past, so this is not a change to the measure for MY 2020 & MY 2021 reporting.
This applies to the following Programs and Years:
HEDIS MY 202210.15.2021 Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents The WCC measure includes a summary of change (SOC) to indicate that the value is stratified. Should this be removed from the SOC?
Yes. Remove the SOC that reads, “Revised the Reporting Instructions for the ‘NumeratorByAdminElig’ data element in Table WCC-1/2 to read ‘For each Metric and Stratification.’” Organizations reported “NumeratorByAdminElig” by age stratification in the past, so this is not a change to the measure for MY 2020 & MY 2021 reporting.