FAQ Directory

Yes. Value Based P4P General Guideline 19: Members in Hospice should apply to all clinical measures, including ENRST, PDC and HRM. We will add a note to all clinical measure specifications for the next release of the manual.  

This applies to the following Programs and Years:

Based on the potential burden of reporting PO-specific membership and because VBP4P is not currently scoring the PO-level aggregated performance rate, POs may include all patients for the provider. If the provider has the ability to only include the PO’s members, that is also accepted.

This applies to the following Programs and Years:

The Value Based P4P program intends to measure all commercial HMO/POS members, but we understand that not all POs can limit their numerators and denominators to specific product lines. For this reason, and because VBP4P is not currently scoring the PO-level aggregated performance, POs may include all payer types. If the PO has the ability to limit the patient population to just commercial HMO/POS, that is also accepted.

This applies to the following Programs and Years:

No. NCQA suspended collection of the RRU measures for HEDIS 2017 and health plans should not report RRU measures for HEDIS 2017. In 2017 NCQA will decide whether to permanently retire these measures. NCQA will hold a public comment process to aid in the decision. 

This applies to the following Programs and Years:

No. NCQA has decided to retire the Aspirin Use and Discussion (ASP) measure due to misalignment with updated recommendations from the United States Preventive Services Task Force (USPSTF). The updated USPSTF aspirin recommendations include a calculation of 10-year cardiovascular risk and an estimate of 10-year life expectancy. This information would be required to identify the denominator of the ASP measure and because it cannot be captured in the Consumer Assessment of Healthcare Providers & Systems (CAHPS) Health Plan Survey or claims data, we are unable to adapt the measure to be consistent with the USPSTF findings.

The aspirin questions remain in the HEDIS 2017 CAHPS questionnaire but member responses to the questions will not be submitted to NCQA by the certified survey vendor. The questions will be removed from the HEDIS 2018 CAHPS questionnaire.

This applies to the following Programs and Years:

No. The RDI measure will be removed from the Quality Rating System. For Marketplace plans, CMS will issue guidance, including, but not limited to, FAQs, updates to the 2017 Technical Guidance and the 2017 Call Letter.

This applies to the following Programs and Years:

Yes. Organizations may map NDC codes so that the same set of codes for high-intensity and moderate-intensity statins are used for both the SPC-B and SPD-A measures. An NDC code that is not on the HEDIS list may be used if its generic name, strength/dose and route match an NDC code on the HEDIS list. Organizations should document the method used to map codes: Mapping is subject to review during a HEDIS Compliance Audit. Requirements for mapping are described in General Guideline 50 in HEDIS 2017 Volume 2.

This applies to the following Programs and Years:

The criterion referenced must be identifiable by name and must be specific to an organization or source (e.g., ABC PBM’s Criteria for Treatment of Hypothyroidism with Synthroid or CriteriaCompany Inc.’s Guidelines for Wound Treatment). If it is clear that the criterion is attributable to the organization, it is acceptable to state “our Criteria for XXX” (e.g., our Criteria for Treating High Cholesterol with Lipitor).

Note: This also applies to Element E and Element H in HPA and Element E in UM-CR.

This applies to the following Programs and Years:

You are correct, cell D-10 in the "Overview" tab should say "PDC-D" as this refers to the Insulin Exclusions (Table PDC-D) and NOT the Renin Angiotensin System (RAS) Antagonists Exclusions (Table PDC-E). We will fix this for the next release of the file and work with the measure developer to add an additional row that includes the exclusion table (PDC-E).

The data for the Renin Angiotensin System (RAS) Antagonists Exclusions (Table PDC-E) can currently be found in the RASA tab, in rows 4661-4672. This drug is also flagged in column L: "Denominator_Exclusion_Flag".

This applies to the following Programs and Years:

The timeframe for this denominator exclusion should be any time during the treatment period and should read as follows:
 “Patients dispensed at least one prescription for an ARB/Neprilysin Inhibitor Combination Medication (Table PDC-E) any time during the treatment period.”

We will make this update for the next version of the VBP4P Manual.

This applies to the following Programs and Years:

For reporting HAI for HEDIS 2017, NCQA defines a contracted acute care hospital as any acute care hospital to which the organization paid a claim for a member’s inpatient stay during the measurement period. This is a first-year measure; based on the results, NCQA may review this definition for changes in 2018.The FAQ posted in October regarding this topic was retracted given the release of the FAQ above.

This applies to the following Programs and Years:

Yes. Add the following language to step 3 of the numerator: Note: For hospital stays where there was an acute-to-acute direct transfer (identified in step 2), use both the original stay and the direct transfer stay to identify exclusions in this step.

This applies to the following Programs and Years: