Yes. Replace the reference to “date/time” in the first bullet in the Note section with “date.”
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11.15.2017
Transitions of Care The HEDIS 2018 Volume 2 Technical Update memo indicates the following change in the Transitions of Care specifications: In the first sentence of the third paragraph, replace “date/time” with “date.”
Should this change also apply to the first bullet in the “Note” section of the technical specifications that reads, “The following notations or examples of documentation do not count as numerator compliant:
*Documentation of notification that does not include a time frame or date/time stamp.”
11.15.2017 Delegation of NET Directories How is NET 7, Element E, factor 1 scored when an organization delegates only the directory functions in NET 6?
11.15.2017 Updated: Timeliness of postservice appeal decisions for Medicare and Medicaid Does the recent change for Medicare and Medicaid postservice appeals from 60 calendar days to 30 calendar days align with Chapter 13 of the Medicare Managed Care Manual?
No. Medicare product lines continue to follow the 60-calendar-day time frame for postservice appeals.
Note: The requirement is correct for Medicare product lines; Medicaid product lines continue to follow the 30-calendar-day time frame for postservice appeals.
This applies to the following Programs and Years:
HP 2018|UM-CR-PN 201811.15.2017 Guidelines for Calculations and Sampling The footnote on page 45 of HEDIS 2018 Volume 2 indicates that the lowest Prior Year rate from “Prenatal and Postpartum Care” and “Frequency of Prenatal Care” should be used to reduce the sample size for PPC. Given that FPC was retired with the HEDIS 2018 Volume 2 Technical Update, should the PPC MRSS use the lower rate of the Postpartum and Prenatal care indicators?
Yes. With the retirement of the FPC measure, organizations may reduce the sample size for the PPC measure using the lowest rate of the 2 indicators from the current year’s administrative rate or the prior year’s audited, product line-specific rate.
This applies to the following Programs and Years:
HEDIS 201811.09.2017 Additional Resources Are there any outside resources that may help me in the PCMH transformation process?
| Content Area | Criteria | Resource Link | Description |
| TC | 02 | http://www.ihi.org/resources/Pages/Changes/OptimizetheCareTeam.aspx | Resource on how to optimize staff responsibilities |
| 02 | https://www.integration.samhsa.gov/operations-administration/OATI_Tool3_ART.pdf | Toolkit on how to optimize administrative staff responsibilities to benefit clinical practice | |
| 02 | http://www.improvingprimarycare.org/team/pcp | Resource on how to optimize staff responsibilities | |
| 04 | https://www.stepsforward.org/modules/pfac | Module teaching how to create a patient advisory council | |
| 07 | http://www.nachc.org/research-and-data/prapare/toolkit/ | Toolkit to better understand social determinants of health | |
| 08 | https://integrationacademy.ahrq.gov/sites/default/files/AHRQ_AcademyGuidebook.pdf | Information on behavioral healthcare integration in primary practice | |
| KM | 02 G | https://healthleadsusa.org/resources/the-health-leads-screening-toolkit/ | Social needs screening toolkit |
| 12 | https://www.cdc.gov/media/releases/2012/p0614_preventive_health.html | Discussion on benefits of preventative care | |
| 14 | https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/match/match.pdf | Guide to medication reconciliation at transitions | |
| 16 | http://www.teachbacktraining.org/ | Information on teach back training | |
| 17 | http://www.improvingprimarycare.org/work/medication-management | Guide to medication management | |
| 24 | https://www.ahrq.gov/professionals/education/curriculum-tools/shareddecisionmaking/index.html | Toolkit for shared decision making | |
| 24 | http://msdmc.org/3-assess/ | Toolkit for shared decision making | |
| 24 | https://shareddecisions.mayoclinic.org/ | Informative website about shared decision making | |
| 13 | http://www.jabfm.org/content/28/2/170.full.pdf | "Patient Empanelment: The Importance of Understanding Who Is at Home in a Medical Home" | |
| AC | 13 | http://www.annfammed.org/content/10/5/396.full | "Estimating a Reasonable Patient Panel Size for Primary Care Physicians With Team-Based Task Delegation" |
| http://www.commonwealthfund.org/~/media/files/publications/issue-brief/2014/aug/1764_hong_caring_for_high_need_high_cost_patients_ccm_ib.pdf | Article discussing benefits and strategies to care management | ||
| CM | 03 | https://nf.aafp.org/Shop/practice-transformation/risk-stratified-care-mgmt-rubric | Risk stratification rubric available to members of the AAFP |
| 03 | http://www.calquality.org/storage/documents/cqc_complexcaremanagement_toolkit_final.pdf | Risk stratification rubric from California Quality Collaborative | |
| 03 | http://www.millimanriskadjustment.com/ | MARA – The Milliman Advanced Risk Adjuster is a model of risk stratification in which risk scores are normalized to a given population. | |
| 04 | http://www.aafp.org/fpm/2015/0100/fpm20150100p7-rt1.pdf | Care Plan template from AAFP, not exclusive to members | |
| 06 | http://www.dartmouthatlas.org/downloads/reports/preference_sensitive.pdf | Resource on how to incorporate patient preference into care management | |
| 08 | http://www.ihi.org/resources/pages/tools/selfmanagementtoolkitforclinicians.aspx | Toolkit to aid clinicians in promoting self-management | |
| 08 | https://www.ahrq.gov/professionals/prevention-chronic-care/improve/self-mgmt/index.html | Resources on self management | |
| 08 | http://champsonline.org/tools-products/clinical-resources/patient-education-tools/patient-self-management-tools | Condition specific self management tools | |
| 08 | https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/ | Article discussing proper communication between primary and specialist clinicians | |
| CC | 14 | http://nihcr.org/analysis/improving-care-delivery/prevention-improving-health/ed-coordination/ | Information on improving communication between emergency and primary physicians |
| 16 | https://share.kaiserpermanente.org/article/kaiser-permanente-study-finds-tailored-post-hospital-visits-lower-risk-readmission-medicare-advantage-patients/ | Article discussing advantages of post hospital primary care visits | |
| QI | https://www.ahrq.gov/sites/default/files/publications/files/pcmhqi2.pdf | Resource for building quality improvement in primary care | |
| 03 | http://www.ihi.org/resources/Pages/Measures/ThirdNextAvailableAppointment.aspx | Information on how to utlize third next available appointment measurement | |
| 08 | https://www.ahrq.gov/professionals/prevention-chronic-care/improve/system/pfhandbook/mod4.html | Benefits of PDSA cycle |
This applies to the following Programs and Years:
PCMH 201710.15.2017 ECDS For IP-ECDS coverage, does NCQA look for the number of members in the initial population?
IP-ECDS coverage count includes all members in the initial population who are being managed by at least one provider with the capacity to send, receive and use electronic data for quality improvement purposes.The Initial Population includes all members (covered and not covered by ECDS) who are identified as eligible for the measure reported by the data source category used to determine eligibility.
This applies to the following Programs and Years:
HEDIS 201810.15.2017 ECDS May electronic data feeds from groups that include screenings be used if depression screening results are included?
Electronic data feeds are appropriate for ECDS reporting if they include the standard data required by the measure specifications (e.g., PHQ-9 total score, LOINC code for alcohol screening performed).
All data sources used for ECDS reporting must be reviewed and approved by NCQA-Certified auditors to ensure they meet domain requirements.
This applies to the following Programs and Years:
HEDIS 201810.15.2017 ECDS Clarify “data must be accessible by the health care team at point of care.”
To qualify for HEDIS ECDS reporting, practitioners/practitioner groups that are accountable for clinical services provided to members must be able to access all ECDS data used by a health plan for quality measure reporting.Qualifying modes of access may be as simple as a provider’s phone request for member information, or as sophisticated as an integrated decision support system.
This applies to the following Programs and Years:
HEDIS 201810.15.2017 ECDS Must a specific provider type be able to access ECDS sources?
10.15.2017 ECDS If case management data are used only by behavioral health-care providers (not by primary care providers), may these data be an ECDS data source?
Case management data may be used for measures using the ECDS reporting method if the information collected by case managers is available on request to all providers treating the same member in another setting.
Data are not required to be accessed to qualify for ECDS reporting, but must be available on request to providers providing care to the member.
This applies to the following Programs and Years:
HEDIS 201810.15.2017 ECDS May we use depression screening performed by case managers who are employees of a health plan and are not part of an external provider group directly serving the member?
Yes. Data collected by care/case managers employed by a health plan are appropriate, and are reported in the Case Management category in the measure report.
Care/case managers are considered part of the member’s care team because they help members manage a condition and/or their use of health care services.
