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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5.21.2018 TC 04 May patient/family/caregiver members of a practice’s advisory council participate in meetings by telephone?

Yes. This method of participation must be included in the practice’s documented process for involving patients/families/caregivers on QI teams or practice advisory councils.
 

PCMH 2017

5.21.2018 TC 08 What credentials are required for the care manager?

NCQA is not prescriptive regarding which clinical staff it is (clinician, nurse, social worker or other provider) and the practice may determine the training and skills needed to address and manage the behavioral health care needs of their patient population.
 

PCMH 2017

5.21.2018 TC 09 Is a practice brochure sufficient evidence for this criterion?

This criterion requires both a documented process ensuring information is distributed to patients and demonstration of patient materials with the minimum information described in the guidance. However, if the practice's documented process is described in the patient brochure, that brochure could be sufficient evidence for TC 09.
 

PCMH 2017

5.21.2018 TC 09 How can practices demonstrate that they provide access to evidence-based care?

Information about care can be provided to patients through materials such as brochures, flyers or information posted on the practice’s website. When describing the services provided by the practice, attention should be drawn to defining evidence-based guidelines for preventive and clinical care.
 

PCMH 2017

5.21.2018 TC 01 Does the clinician lead and staff managing the medical home transformation need to be an MD?

The clinician lead of the medical home must be a clinician as defined in the PCMH Policies and Procedures, which includes clinicians with an unrestricted license as an MD, DO, APRN or PA; however, NCQA is not prescriptive regarding the staff member who can be designated as the PCMH manager. Both can serve multiple sites and both roles can be assumed by the same person.
 

PCMH 2017

5.21.2018 TC 06 Our clinical staff teams are on different schedules, so they often meet in separate teams to discuss patients. Does this meet the requirement?

The requirement is met if teams share questions or concerns about shared patients via regular, structured communication (such as the EHR). The intent of the criterion is for all members of the care team to be involved in communication about patient care, but care teams can meet separately for each clinician’s scheduled patients.
 

PCMH 2017

5.21.2018 TC 06 Are practices required to have daily, structured meetings with the entire care team? Is the clinician required to attend?

TC 06 requires practices to engage in regular communication to discuss care for patients scheduled each day, but this requirement can be satisfied by demonstration of either scheduled team meetings or scheduled electronic team communication, depending on the practice’s process for communication. Please note this communication is focused on patient care needs and is not to discuss practice transformation activities or staffing schedules.
All members of the practice care team, including clinicians, must participate in the communication; however, it is not required that the clinician be present if the team meets in-person, as long as there is a process in place to communicate the information from the meeting to the clinician.
 

PCMH 2017

5.15.2018 ECDS Do you utilize FHIR to specify ECDS measures?

No. HEDIS ECDS measures use Quality Data Model (QDM) 5.3 as the reference model, although NCQA is researching the use of FHIR as a possible option.  

HEDIS 2018

5.15.2018 ECDS What data standards does NCQA use to specify ECDS measures?

HEDIS ECDS measures use the Quality Data Model (QDM) and Clinical Quality Language (CQL) HL7 standards for quality measurement.

HEDIS 2018

5.15.2018 ECDS How do ECDS measures differ from the eMeasures in Meaningful Use (eCQMs)?

HEDIS ECDS measures are similar to eCQMs in structure, but although eCQMs are reported at the provider level, using data from an EHR, ECDS measures are reported at the health-plan level, using data from multiple sources to form a complete picture of the patient’s experience across the care continuum.

HEDIS 2018

5.15.2018 MED standards and the new Medicaid module The previous MED standards are now 15 standards. Can you explain what happened?

In March, NCQA released an expanded Medicaid Module, a voluntary set of 15 standards for organizations with a Medicaid product line. This new module both incorporated the original MED standards (MED 1-MED 6) and added 10 new standards to align with provisions in the federal Medicaid Managed Care Final Rule released by CMS in April 2016.

The new MED module applies to only 2018 HPA; therefore, HPA survey tools for 2017 and earlier are unaffected and do not include the new Medicaid module.

HP 2018

5.02.2018 Plan All-Cause Readmissions For the Count of Expected 30-Day Readmissions, we are using the calculation in Step 6 in HEDIS Volume 2 (pg. 384), but IDSS is calculating differently. Is this calculation correct?

The calculation for the Count of Expected 30-Day Readmissions is incorrect in Volume 2. IDSS currently calculates this field by using the formula "Count of Expected 30-Day Readmissions" = "Expected Readmission Rate" * "Count of Index Stays".

Please provide data for the Expected Readmission Rate and the Count of Index Stays and IDSS will use these values to generate the correct calculation. 
 

HEDIS 2018