No. Do not include long-acting inhaled beta-2 agonists when calculating the Asthma Medication Ratio measure.
FAQ Directory
Here are some of the most frequently asked questions about NCQA’s various programs. If you don’t see what you are looking for in one of the entries below, you can ask a question through My NCQA.
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3.16.2012 Asthma Medication Ratio (AMR) Based on the MY 2010 P4P Crosswalk to HEDIS 2011 NDC List document, P4P Table AMR-C crosswalks to the HEDIS table ASM-C for the NDC list, but long-acting inhaled beta-2 agonists are no longer included in Table AMR-C. Should they be used in the Asthma Medication Ratio measure for P4P?
3.16.2012 Diabetes Care (CDC) In the November 2011 release of the MY 2011 P4P specifications, Table CDC-A: Prescriptions to Identify Members With Diabetes does not match exactly with Table CDC-A in the 2012 HEDIS volume. Is this an error?
There is an error in the manual. In Table CDC-A: Prescriptions to Identify Members With Diabetes, in the row Miscellaneous antidiabetic agents, the drug Liraglutide should be included in the table.
This error will be corrected in the September 2012 release of the MY 2012 manual.
This applies to the following Programs and Years:
3.16.2012 Diabetes Care Blood Pressure Control (<140/90 mm Hg) In the November 2011 release of the MY 2011 P4P specifications, Blood Pressure Control (<140/90 mm Hg) for Diabetes replaced exclusions with the note, The blood pressure reading must be in conjunction with an outpatient visit code or a nonacute inpatient visit code from Table CDC-C. This new note requires physician organizations to map blood pressure pulled from a registry to claim data to identify the specific visit codes. This change is extremely burdensome! Why was it necessary?
P4P made this change to align with HEDIS, but did not consider the unintended impact it will have on POs, which must pull the information from EHRs. Because of the burden to POs, P4P will revert to the prior language for this measure, outlined below.
When identifying the most recent BP reading noted during the measurement year, do not include BP readings that meet the following criteria.
BPs taken during an acute inpatient stay (Table CDC-O)
BPs taken during an ED visit (Table CDC-P)
BPs taken during an outpatient visit where a diagnostic test or surgical procedure was performed (e.g., sigmoidoscopy, removal of a mole) or BPs obtained the same day as a major diagnostic or surgical procedure (e.g., stress test, administration of IV contrast for a radiology procedure, endoscopy) (Table CDC-Q)
BP readings taken by the member.
This applies to the following Programs and Years:
3.16.2012 Chlamydia Screening in Women (CHL) In the November 2011 release of the MY 2011 P4P specifications, Table CHL-A: Prescriptions to Identify Contraceptives does not match exactly with Table CHL-A in the 2012 HEDIS volume. Is this an error?
There is an error in the manual. In Table CHL-A: Prescriptions to Identify Contraceptives,
in the row Contraceptives, the drugs Estradiol-medroxyprogesterone, Levonorgestrel, Medroxyprogesterone, and Norethindrone should be included in the table,
the drug Levonorgestrel-medroxyprogesterone should not be in the table.
These errors will be corrected in the September 2012 release of the MY 2012 manual.
This applies to the following Programs and Years:
3.16.2012 Avoidance of Antibiotic Treatment for Adults With Acute Bronchitis (AAB) In the November 2011 release of the MY 2011 P4P specifications, Table AAB-E: Antibiotic Medications does not match exactly with Table AAB-D in the 2012 HEDIS volume. Is this an error?
There is an error in the manual. In Table AAB-E: Antibiotic Medications,
the first two rows, 5-aminosalicylates and Amebicides should not be in the table,
in the row Aminoglycosides the drug Neomycin should not be in the table,
in the row First generation cephalosporins, the drug Cephradine should not be in the table,
in the row Miscellaneous antibiotics the drug Vancomycin should be included in the table,
the row sulfamethoxazole-trimethoprim DS should not be in the table,
in the row natural penicillins the drug Penicillin G benzathine should be included in the table,
in the row Third generation cephalosporins, the drugs Cefditoren and Cefpodoxime should be included in the table,
in the row Third generation cephalosporins, the drug Cefoperazone should not be in the table.
These errors will be corrected in the September 2012 release of the MY 2012 manual.
This applies to the following Programs and Years:
3.16.2012 Proportion of Days Covered by Medications (PDC) In the November 2011 release of the MY2011 P4P specifications, the wording under Definitions and Eligible Population is confusing. The definition of the Index Prescription Date (IPD) states that the index date should occur at least 91 days before the end of the measurement period, but under Continuous Enrollment, the manual states that the IPD must occur at least 91 days prior to the end of the measurement year. Should we be looking back from the end of the measurement period or the end of the measurement year?
The Index Prescription Date (IPD) should occur at least 91 days before the end of the measurement period, as stated in the definition of IPD. The Continuous Enrollment section should refer to the measurement period, for both self-reporting POs and for health plans.
This error will be corrected in the September 2012 release of the MY 2012 manual.
This applies to the following Programs and Years:
3.16.2012 Breast Cancer Screening (BCS) On the Clinical Measure file layout the BCS measure is listed as Breast Cancer Screening: Ages 52-69 but the measure description indicates that it is for ages 50 _ 69. Is there an error in the Clinical Measure file layout?
3.16.2012 Encounter Rate Threshold for Clinical Measures Table ENR-F Option A states to use the CMS ASC Approved HCPCS Codes and Payment Rates file and to only use the spreadsheet titled, "Addendum AA_ASC Covered Surgical Procedures (ASC_AddAA.csv) for October 2011". This exact file name is not found in the zip file on the CMS website. Please confirm the file and tab that should be used.
The file name has been updated on the CMS website. To reflect this change, the note under Table ENR-F should read as follow: * These codes can be found on the CMS Web site (http://www.cms.hhs.gov/ASCPayment/11_Addenda_Updates.asp#TopOfPage/). Click October 2011 ASC Approved HCPCS codes and Payment Rates. Use only the spreadsheet titled, Oct11_ASC_Add_AA-BB-DD1_ExtAct.xlsx, and the tab titled Oct11_ASC_AddAA-ExtAct. Only use 5-digit all-numeric CPT codes (Level 1 HCPCS) in the spreadsheet; do not include any codes with an alpha value. This update will be reflected in the September 2012 release of the MY 2012 manual.
This applies to the following Programs and Years:
3.16.2012 Appropriate Treatment for Children with Upper Respiratory Infection (URI) In the November 2011 release of the MY 2011 P4P specifications, Table URI-D: Antibiotic Medications does not match exactly with Table CWP-C in the 2012 HEDIS volume. Is this an error?
There is an error in the manual. In Table URI-D: Antibiotic Medications, in the row First generation cephalosporins, the drug Cephradine should not be in the table, in the row Macrolides the drug Erythromycin estolate should not be in the table, in the row Third generation cephalosporins, the drug Cefditoren should be included in the table. These errors will be corrected in the September 2012 release of the MY 2012 manual.
This applies to the following Programs and Years:
3.16.2012 Continuous Enrollment and Allowable Gaps Over Multiple Years In the MY2011 P4P Manual, are the dates correct in the example for Continuous Enrollment and Allowable Gaps Over Multiple Years? They do not seem to match up to the description of gaps in enrollment.
There is an error in the manual. The first date in the example should be November 30, 2010. The full example should read as follows:
For example, in the MY 2011 Breast Cancer Screening measure (which requires 2 years of continuous enrollment), a member who disenrolls on November 30, 2010 (the year prior to the measurement year), and re-enrolls on February 1, 2011 (the measurement year), is considered continuously enrolled as long as there were no other gaps in enrollment during either year. The member has one gap of 31 days (December 1_31) in 2010 and one gap of 31 days (January 1_31) in 2011.
This error will be corrected in the September 2012 release of the MY 2012 manual.
This applies to the following Programs and Years:
3.15.2012 Analysis of complaint and appeal data May organizations analyze complaint data by the five specified complaint categories and analyze appeal data by the type of procedures appealed?
No. While the organization may have different complaints and appeal category for business purposes, it must analyze and report both complaint and appeal data by the five specified categories for NCQA purposes. Even if the organization has no complaints or appeals in one or more reporting categories, it must still demonstrate its analysis and report the number of complaints and appeals for all five categories.
This applies to the following Programs and Years:
3.15.2012 Assessment against access standards If the organization-level assessment shows that established goals and thresholds were not met for access to appointments, must there be an additional assessment at the practitioner level?
Yes. If performance issues are identified through organization-wide analysis, the organization must perform an analysis at the practitioner level to identify the cause. Practitioner-level assessment may include the total population or a statistically valid sample.
