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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9.15.2021 General Guideline 33: Race and Ethnicity Stratification May supplemental data be used for race and ethnicity stratifications?

Yes. Supplemental data may be used to identify race and ethnicity when stratifying the eligible population. 

This applies to the following Programs and Years:
HEDIS MY 2022

7.15.2021 Colorectal Cancer Screening (COL) On May 18, 2021 the U.S. Preventive Services Task Force (USPSTF) updated the colorectal cancer screening recommendations to screen for colorectal cancer in adults aged 45 to 49 years. Will NCQA update the COL measure to coincide with the USPSTF recommendations that lower the screening age to 45? If yes, what HEDIS year can we expect this change to be reflected in the measure specs?

NCQA is aware of updates to the US Preventive Services Task Force (USPSTF) guidelines for colorectal cancer screening. Given these updates, NCQA will evaluate potential changes to the HEDIS Colorectal Cancer Screening (COL) measure through input from our clinical and technical measurement advisory panels, the Committee on Performance Measurement and public comment. Any potential changes to the measure resulting from this evaluation would be included in the HEDIS MY 2022 Technical Update at the earliest.

This applies to the following Programs and Years:
HEDIS MY 2021

7.15.2021 Use of Mail Service Organizations for Distribution Requirements Is it considered delegation if an organization uses a mail service organization to meet distribution requirements?

NCQA considers it to be delegation if the organization uses another organization, including a mail service organization, to perform any function not listed in the “Vendor” section of Appendix 3. 
NCQA considers it to be a vendor relationship if the organization uses another organization (e.g., a mail service organization) to perform functions evaluated by the elements or element components listed in the "Vendor" section of Appendix 3.

This applies to the following Programs and Years:
MBHO 2021|UM-CR-PN 2021

7.15.2021 Use of Mail Service Organizations for Distribution Requirements Is it considered delegation if an organization uses a mail service organization to meet distribution requirements?

NCQA considers it to be delegation if the organization uses another organization, including a mail service organization, to perform any function not listed in the “Vendor” section of Appendix 2. 
NCQA considers it to be a vendor relationship if the organization uses another organization (e.g., a mail service organization) to perform functions evaluated by the elements or element components listed in the "Vendor" section of Appendix 2.

This applies to the following Programs and Years:
HP 2021

7.15.2021 Virtual-Only Practitioners If an organization wants to add virtual-only practitioners to its network for services such as behavioral health, does that affect NET 5 and CR 1?

Yes. If an organization adds virtual-only practitioners to its network, the provider directory must indicate that such practitioners are virtual only (i.e., in lieu of a physical office location) to meet NET 5, Element A. Virtual-only practitioners must also be fully credentialed, per requirements in CR 1, Element A.

This applies to the following Programs and Years:
HP 2021

6.29.2021 July 2021 Summary of Updates What changes were made to the PCSP Standards and Guidelines in Version 4?

Topic Update Highlights
Policies and Procedures Added a section on Natural Disasters and Cybercrime.
Policies and Procedures Updated policy on eligibility to clarify that organizations that operate entirely remotely are eligible.
KM 17 Updated the list of CDS examples in the guidance language.
AC 02 Added language to the guidance to clarify that patient inquiries regarding prescription refills or appointment requests are not considered clinical advice.
PM 11 Updated guidance language to detail how Person-Driven Outcome goals can be used to meet the criteria.
QI 01 A, B and C Measures data must be input from the new ‘Measures Reporting’ tile of the Organization Dashboard.

This applies to the following Programs and Years:
PCSP 2019

6.29.2021 July 2021 Summary of Updates What changes were made to the PCMH Standards and Guidelines in Version 7?

Topic Update Highlights
Policies and Procedures Added a section on Natural Disasters and Cybercrime.
Policies and Procedures Updated policy on eligibility to clarify that organizations that operate entirely remotely are eligible.
Appendix 2 – Glossary Added an entry on Behavioral Health Care Clinician.
TC 08/BH 01 Added a note to the guidance language to clarify the required qualifications of a Behavioral Health Care Manager.
KM 20/BH 13 Updated the list of CDS examples in the guidance language.
AC 04 Added language to the guidance to clarify that patient inquiries regarding prescription refills or appointment requests are not considered clinical advice.
CM 06 Updated guidance language to detail how Person-Driven Outcome goals can be used to meet the criteria.
QI 01/ QI 02 Measures data must be input from the new ‘Measures Reporting’ tile of the Organization Dashboard.
Appendix 5 Redesigned Appendix 5 to outline measures reporting including a table of standardized measures now supported.
Distinction in Behavioral Health Integration Clarified that already Recognized practices seeking Distinction have one virtual review.

This applies to the following Programs and Years:
PCMH 2017

6.15.2021 General Guideline 31 Is data from a certified eCQM vendor considered standard supplemental data?

No. NCQA released a policy change in July 2020 stating that certified QRDA I files are not considered standard supplemental data for HEDIS® reporting in 2022 for HEDIS MY 2021. Because of the dual HEDIS publication, HEDIS MY 2021 Volume 2 did not account for this policy change, but it will be reflected in HEDIS MY 2022 Volume 2. However, this FAQ is a reminder the policy changed in July 2020 and therefore must be followed. Organizations should work with their auditor to have this data validated as nonstandard supplemental data.

 

This applies to the following Programs and Years:
HEDIS MY 2021

4.15.2021 Antidepressant Medication Management (AMM) For Effective Continuation Phase Treatment, how many days are counted in the 232-day interval if a prescription of a 90-days supply is dispensed on the 151st day?

Count 82 days in the 232-day interval for a prescription of a 90-days supply dispensed on the 151st day.

**This FAQ applies only to HEDIS Volume 2 MY 2021.

This applies to the following Programs and Years:
HEDIS MY 2021

4.15.2021 Persistence of Beta-Blocker Treatment After a Heart Attack (PBH) How many days are counted in the 180-day interval if a prescription of 90 days supply is dispensed on the 100th day?

Count 81 days in the 180-day interval for a prescription of a 90-days supply dispensed on the 100th day.

**This FAQ applies only to HEDIS Volume 2 MY 2021.
 

This applies to the following Programs and Years:
HEDIS MY 2021

4.15.2021 Provisional Status Triggers In what circumstances will an organization receive Provisional status?

An organization will receive Provisional status if it:  
 

  1. Scores below 80% and above 55% of the maximum possible points in any Standards Category, or  

  1. Does not achieve an element score of “Met” in three or more must-pass elements.

This applies to the following Programs and Years:
HP 2021, 2020

4.15.2021 Provisional Status Triggers In what circumstances will an organization receive Provisional status?

An organization will receive Provisional status if it:  
 

  1. Has an overall standards score between 60 and 69.99, or  

  1. Does not achieve an element score of 80% in three or more must-pass elements.

This applies to the following Programs and Years:
MBHO 2020, 2021