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9.15.2022 PCS Questions Do answers from the Policy Clarification Support system have an expiration date?
9.15.2022 Quality Compass How can I obtain plan performance data and/or benchmark results for HEDIS and CAHPS measures?
You can obtain access to performance data and benchmarks via the NCQA Quality Compass tool. Quality Compass is an interactive database containing individual plan performance results for HEDIS® and CAHPS® measures, as well as benchmark data at the national, regional (Census, HHS) and state levels. To learn more about Quality Compass and licensing access to HEDIS performance results, visit our Quality Compass homepage.
This applies to the following Programs and Years:
HEDIS MY 20229.15.2022 Publicly Reported Plans in Quality Compass How do I know what plans publicly reported data to NCQA? How do I know what measures will be reported in Quality Compass?
To obtain a list of health plan submissions and/or measures publicly reported in Quality Compass for a specific reporting year, contact the Information Products team by submitting your question on my.ncqa.org.
Quality Compass contains HEDIS and CAHPS measures that were eligible for publicly reporting during the measurement year. First year HEDIS measure results are not publicly reported in the tool.
This applies to the following Programs and Years:
HEDIS MY 20228.19.2022 Long-Term Services and Supports Shared Care Plan With Primary Care Practitioner (LTSS-SCP) For MY2022 reporting, should members without a care plan (or with a partial care plan) be excluded from the LTSS-SCP measure?
8.15.2022 Quality Compass: Data Exporter What is the Data Exporter feature on Quality Compass?
All versions of Quality Compass allow users to build customized reports within the tool. Versions of Quality Compass that include the Data Exporter feature allows users to download and export those custom reports into Microsoft Excel.
The Data Exporter feature also grants access to the “All Measures Download” file. This file contains plan-level performance data for all publicly reported health plan submissions and all HEDIS and CAHPS measure results in a single downloadable file. Versions purchased without Data Exporter will not have the ability to export plan level data but will still have access to Excel versions of the benchmarks.
This applies to the following Programs and Years:
HEDIS MY 20228.15.2022 Individual Plan Data - Quality Compass What are the “individual plan data” available on Quality Compass?
Individual plan data are the HEDIS and CAHPS performance rates submitted by health plans that chose to publicly report their results to NCQA. Users have access to all publicly reported plans in a specific product line (commercial, Medicaid, Medicare) and can easily select a subset of plans based on coverage in different regions/states.
This applies to the following Programs and Years:
HEDIS MY 20227.05.2022 KM 09 For which patients does a PCMH need to collect sexual orientation and gender identity data?
Starting in 2023 for Transforming practices and in 2024 for currently recognized practices, direct collection of data on sexual orientation and gender identity of patients is required for KM 09. This requirement applies to all patients aged 18+, though practices are encouraged to also ask adolescent patients if they have a system for doing so.
This applies to the following Programs and Years:
PCMH 20176.30.2022 PCSP July 2022 Summary of Updates What updates were made to the PCSP Standards and Guidelines for Version 5?
| Topic | Update Highlights |
| Policies and Procedures | Section restructured |
| Policies and Procedures | Addition of language regarding Corrective Action Plans |
| KM 06 | Addition of Sexual Orientation and Gender Identity as required topics of data collection. Added requirement that data be direct collection. |
| KM 06 | Added requirement that data be direct collection. |
| PM 19 | New elective criterion regarding person-driven outcomes. |
| Appendix 2 – Glossary | Added “Age as a Vulnerability” |
This applies to the following Programs and Years:
PCSP 20196.30.2022 July 2022 Summary of Updates What changes were made to the PCMH Standards and Guidelines for Version 8?
| Topic | Update Highlights |
| Policies and Procedures | Section restructured |
| Policies and Procedures | Addition of language regarding Corrective Action Plans |
| KM 09 | Addition of Sexual Orientation and Gender Identity as required topics of data collection. Added requirement that data be direct collection |
| KM 10 | Added requirement that data be direct collection |
| CM 10 | New elective criterion regarding person-driven outcomes |
| Appendix 2 – Glossary | Added “Age as a Vulnerability” |
This applies to the following Programs and Years:
PCMH 20176.15.2022 CVO: Boilerplate Language in Delegation Agreements for System Controls May organizations’ delegation agreements contain boilerplate language for system controls delegates?
Yes, if the language specifies that the delegate must meet NCQA requirements (CVO 3, Element B, factor 4; CVO 15, Element C, factor 5), template language may be used in the delegation agreement. Language specific to each delegate is not required.
This applies to the following Programs and Years:
CVO 20226.15.2022 CVO: CR Advanced System Controls—Policies and Procedures Are organizations that provide evidence of “advanced system controls” eligible to receive Met for CVO 3, Element B?
No. If the organization provides evidence of advanced system controls capabilities, it must submit policies and procedures for CVO 3, Element B. Policies and procedures must address all factors regarding advanced system control capabilities.
This applies to the following Programs and Years:
CVO 20226.15.2022 CVO: Annual Monitoring of CR System Controls Monitoring for Delegates Have the allowed methods to audit delegate files in CVO 15, Element C, factor 5 changed?
No. Delegate files may be audited using one of the following methods as described in the factor explanation and noted below:
- 5 percent or 50 files, whichever is less, to ensure that information is verified appropriately.
- At a minimum, the sample includes at least 10 credentialing files and 10 recredentialing files. If fewer than 10 practitioners were credentialed or recredentialed since the last annual audit, the organization audits the universe of files rather than a sample.
- The NCQA “8/30 methodology” available at https://www.ncqa.org/programs/health-plans/policy-accreditation-and-certification/
Either methodology is allowed, for consistency with other Delegation Oversight requirements for annual file audits.