Yes, if the interaction meets criteria based on the measure specifications. The caregiver is not required to be designated as the patient’s legal guardian for the interaction to count toward the 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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11.15.2018 Transitions of Care When reporting the Patient Engagement After Inpatient Discharge indicator, if the member is unable to communicate with the provider, does an interaction between the member’s caregiver and the provider meet criteria?
11.15.2018 Transitions of Care When reporting Notification of Inpatient Admission and Receipt of Discharge Information indicators using an integrated EMR system, is a “received date” required in the EMR if the information was in the shared EMR on the day of admission/discharge or on the following day?
No. With a shared EMR, evidence that the information was filed/accessible by the PCP or ongoing care provider on the day of admission/discharge or the following day meets criteria for Notification of Inpatient Admission and Receipt of Discharge Information indicators. The organization is not required to find additional notation of a “received date” if it is evident that the information was in the shared EMR on the day of admission/discharge or the following day.
This applies to the following Programs and Years:
HEDIS 201911.15.2018 SES Guidelines To calculate a member’s SES stratification, the instructions say to evaluate whether the member’s LIS values (item 35) are the same or different in the last 3 months of continuous enrollment (CE). How do you determine if a value is the same or different?
A value is different if it is either < or = 0 OR > 0. For the last 3 months of the CE period:
- Count the member as receiving an LIS payment if 2 of the last 3 months are >0, even if the values are different.
Example:
October LIS = 35
November LIS = 40
December LIS = -35
October LIS = 35
November LIS = 40
December LIS = -35
- Count the member as NOT receiving an LIS payment if 2 of the last 3 months are < or = 0, even if the values are different.
Example:
October LIS = 0
November LIS = -35
December LIS = 35
October LIS = 0
November LIS = -35
December LIS = 35
This applies to the following Programs and Years:
HEDIS 201910.15.2018 Standardized Healthcare-Associated Infection Ration The HEDIS® 2019 Volume 2 Technical Specifications Update announced the suspension of the Standardized Healthcare-Associated Infection Ration (HAI) measure for all product lines. This change causes a discrepancy between the CMS Reporting Memo and HEDIS 2019 Volume 2 Technical Specifications. Will CMS clarify what must be reported for HEDIS 2019 for Medicare?
Yes. CMS released a clarification, through Health Plan Management System (HPMS) on October 12, 2018, that HAI has been suspended and is not required for HEDIS 2019 reporting. If you have additional questions about CMS requirements, contact HEDISquestions@cms.hhs.gov.
This applies to the following Programs and Years:
HEDIS 201910.15.2018 Follow-Up After ED visit for People With Multiple High-Risk Chronic Conditions In Step 2 (Exclusions), ED visits followed by admission to an inpatient care setting on the date of the visit or within 7 days after the visit are excluded. Should ED visits that result in an inpatient stay (when the ED date of service occurs any time during the admission [admission date through discharge date]) also be excluded?
10.15.2018 Rules for Allowable Adjustments The General Guidelines in the Rules for Allowable Adjustments states, “use the separate HEDIS Adjustments VSD to calculate measure rates stemming from adjusted measure specification.” Does this mean that ONLY the HEDIS Adjustments VSD must be used?
No. The Allowable Adjustments VSD does not contain the standard HEDIS value sets; standard HEDIS value sets are in the HEDIS 2019 Volume 2 VSD. The Allowable Adjustments VSD includes only SNOMED and LOINC codes that are not in the Volume 2 VSD. Organizations collecting data using the rules for allowable adjustments can elect (but are not required) to use the value sets in the Allowable Adjustments VSD.
This applies to the following Programs and Years:
HEDIS 201910.15.2018 Required Exclusions Are members who are excluded because of hospice, advanced illness, frailty, Institutional SNP (I-SNP) or living long-term in an institution (LTI) included in the “Number of required exclusions” data element?
10.15.2018 Use of Imaging Studies for Low Back Pain Should the “Numerator events by supplemental data” row be removed from the Data Elements Table in the Use of Imaging Studies for Low Back Pain (LBP) measure?
10.15.2018 Avoidance of Antibiotic Treatment in Adults With Acute Bronchitis Should the “Numerator events by supplemental data” row be removed from the Data Elements Table in the Avoidance of Antibiotic Treatment in Adults With Acute Bronchitis (AAB) measure?
10.15.2018 Proportion of Days Covered Should the upper and lower Confidence Interval data elements be removed from the reporting tables in the Proportion of Days Covered (PDC) measure?
Yes. NCQA removed confidence intervals from all measures and data collection (IDSS) in HEDIS 2019; this applies to all related products using IDSS, including the QRS PDC measure.
Organizations that want to calculate or use confidence intervals must use the other data element fields and calculate confidence intervals for internal analysis.
This applies to the following Programs and Years:
Exchange 201910.15.2018 Immunizations for Adolescents Are issuers required to report Combo 1 for the Quality Ratings System in the Immunizations for Adolescents (IMA) measure?
No. HEDIS for QRS requires collection of only Combination 2 and related antigens. Change the reference in the Description from “two combination rates” to “one combination rate.” In the Data Elements Table, change “Each of the 5 rates” to “Each of the 4 rates.”
This applies to the following Programs and Years:
Exchange 201910.15.2018 80% must-pass threshold for UM elements Because NCQA raised the UM must-pass threshold from 50% to 80%, will NCQA create an 80% scoring option for requirements without such a scoring option?
No. To keep scoring simple, NCQA set a threshold of 80% or higher for all UM must-pass elements, rather than setting a specific threshold for each element based on its scoring options. If an element does not have an 80% option, the “or higher” applies. Keep in mind that an organization may miss the requirements for a few files and still score 100% on the element. For additional information on file review scoring, refer to the scoring table in each element or to the file review worksheet in the Interactive Review Tool (IRT).
