Yes. CAHPS 5.0H survey results may not be used for QI 6C: Annual Assessment of Behavioral Healthcare and Services, QI 7I: Experience with Case Management and QI 8I: Experience with Disease Management, where experience data must be limited to participants in the programs.
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.
Filter Results
1.16.2015 Use of CAHPS for Experience Survey requirements Are there assessment of members' experience or satisfaction requirements where CAHPS cannot be used?
1.15.2015 Credentialing standards and unlicensed or uncertified practitioners for CR 1, Element A May organizations contract with and include unlicensed or uncertified practitioners, who are not within the scope of NCQA credentialing standards, in their networks?
1.15.2015 Delegation oversight requirements if the previous delegation agreement was a draft If an organization’s draft delegation agreement was reviewed at the time of its Interim Survey, is the organization required to meet delegation oversight requirements if the delegation agreement is mutually agreed upon shortly before the organization submits its completed Survey Tool for its next survey?
If the delegate performed the activities prior to the agreement, the organization is expected to meet oversight requirements for the delegated activities during its next survey and associated elements are scored accordingly. Oversight relief and automatic credit rules apply if the delegate is NCQA Accredited or NCQA Certified.
1.15.2015 Applying First Survey requirements to organizations coming through WHP Certification for the first time If an organization is certified in HAs or Self-Management Tools under the HIP Standards and Guidelines and is coming through for certification under the WHP standards and guidelines, is it held to Renewal Survey requirements for WHP 3 and WHP 13 (new requirements for certified organizations)?
1.15.2015 Permitting practitioner’s review of UM denials with administrative licenses May practitioners with a current administrative license review denials of care based on medical necessity?
12.22.2014 QRS and Commercial HEDIS Submission Should off-Marketplace enrollees in a QHP, be included in an organization’s NCQA HEDIS commercial submission?
For 2015, QHP enrollees as defined by CMS should not be included in an organization’s NCQA HEDIS commercial submission; they should only be included in the organization’s QRS submission. However, if an organization has already completed programming, NCQA understands that off-Marketplace enrollees in a QHP may have been excluded from the QRS submission. In these instances, these enrollees should be included in the organization’s NCQA HEDIS commercial submission.
With regard to requirements for reporting enrollee survey results and HEDIS measure results, NCQA plans to accept results that follow CMS reporting requirements. NCQA will review CMS beta-test results in fall 2015 before making final decisions on Accreditation reporting requirements for 2016.
For 2015, NCQA HEDIS commercial submissions (which may include off-Marketplace enrollees) will be used to score commercial health plan accreditation (HPA). HEDIS submissions are not required for Marketplace HPA scoring in 2015.
Exchange 2015
12.15.2014 CAHPS Health Plan Survey 5.0H, Child & Adult Version Has the CAHPS survey sample frame validation process changed?
Yes. Starting in reporting year 2015, NCQA requires that all Licensed Organizations apply a password lock to the validated and approved sample frame file used for conducting the commercial and Medicaid Child and Adult CAHPS and the Qualified Health Plan (QHP) Enrollee surveys. Survey vendors may not pull a sample from an unlocked file.
HEDIS 2015
12.11.2014 P4P Overview Page 7 of the P4P manual, states that quality preliminary reports are released on June 3, 2015 and the final date to submit an appeal is June 24, 2015. This does not match the dates on the quality timeline on pages 8-9.
The table on page 8 indicates that the PO Quality Preliminary Reports are posted on May 25, 2015. The first column of the table states that the Quality Results Questions and Appeals period have a June 16-24th timeframe, but the timeline in the second column says May 25- June 15th.
Please clarify the dates for the Quality Results Questions and Appeals period.
Thank you for pointing this out. The correct dates are as follows:
Page 7
- Quality preliminary reports are released on May 25, 2015, and the final date to submit an appeal is June 15, 2015. IHA works with health plans and vendors to research and respond to PO questions about results provided in the PO Quality Preliminary Reports.
Page 8-9
Quality Results Questions and Appeals Period: IHA works with POs and Health Plans to address any data issues or questions related to quality results. Plans and POs may submit an appeal during this time.
| May 25–June 15, 2015 |
The P4P staff will update this timeline and post to the IHA website alongside the December 1, 2014 release of the MY 2014 Value Based P4P Manual.
IHA 2014
12.11.2014 Cervical Cancer Overscreening (CCO) The specifications indicate that three rates are reported (two rates for steps 1 and 2 and a total rate). The measure description describes each rate but it is unclear what the denominator for each rate should be. Are the denominators the same for the three rates?
The eligible population for the measure is all women 24–64 years of age as of December 1 of the measurement year, except those that meet the required exclusion. The denominator for each individual reported rate is also the total eligible population.
The denominator for the step 1 rate is all women 24–64; the numerator for step 1 is all women who had two or more Pap tests in the MY or the two years prior.
The denominator for step 2 is all women 24–64. The numerator is those who had two or more co-tests in the MY or the four years prior.
The description of the three rates should read as follows:
- Women age 21-64 with more than one cervical cytology performed every three years (denominator is the total eligible population).
- Women age 30-64 with more than one cervical cytology/HPV co-test performed every 5 years (denominator is the total eligible population).
- Total rate (the sum of the two numerators divided by the eligible population).
IHA 2014
12.11.2014 General Guidelines: Supplemental Data The Supplemental Data section of the P4P General Guidelines no longer includes information about supplemental data portability between health plans and POs, but there is still a note referring to this policy under general guideline #49. Are plans allowed to use audited PO supplemental data?
You are correct, the sections about supplemental data portability were removed from the December release of the MY 2014 P4P Manual, but they should be reinstated.
The section under the “Supplemental Data Timeline” on page 26 of the MY 2014 P4P Manual should read:
P4P Health plans that use audited PO supplemental data should receive the audited data files and audit results from the PO by the April deadline listed in the P4P Data Collection and Reporting timeline. The health plan should receive all supporting documents for each supplemental data source (e.g., Roadmap section, file layouts, training materials, [PSV samples], etc.,) at the time the Roadmap is submitted to the auditor. The PO is responsible for sending the health plan all necessary documentation to support the use of supplemental data.
The note under “Identifying and Validating Supplemental Data” on page 27 of the MY 2014 P4P Manual should read:
Note: Only health plans that participate in the P4P program can use audited PO supplemental data for their P4P and HEDIS data submissions. The PO must provide the health plan with a completed Roadmap section for each supplemental data source, all applicable attachments, the auditor’s review findings and PSV results. The P4P health plans are not required to also collect the proof-of-service documents for these audited and approved PO data. (see P4P Audit Review Guidelines, released in November 2014).
And the following Activity or Milestone and deadline should be added to the “P4P Data Collection and Reporting Timeline” on page 8 of the MY 2014 P4P Manual.
| Supplemental Data to Health Plans: P4P Health plans receive the audited supplemental data files and audit results from the PO. | April 15, 2015 |
Please also note, that although this policy is applicable to MY 2014, NCQA is currently reviewing many policies for P4P and HEDIS reporting; we expect to reassess these guidelines and others for MY 2015.
IHA 2014
12.11.2014 Meaningful Use of Health IT The MUHIT Overview section of the MY 2014 P4P Manual released on December 1 states that POs report two clinical quality e-measures, Controlling High Blood Pressure and Screening for Clinical Depression and Follow-Up Plan in the Clinical Measure File Layout. Are health plans expected to report the two e-measures? May POs that do not self-report clinical measures submit the measures? Are the measures subject to P4P audit review and measure certification?
The e-measures are part of the MUHIT Domain, but the numerators and denominators will be collected as part of the Physician Organization Clinical Measure File Layout.
Health plans are not expected to report the measures, which will not be included in the Health Plan Clinical Measure File.
Any PO may report the measures, even if it does not self-report P4P clinical measures.
The measures are not subject to NCQA audit or measure certification.
IHA 2014
12.11.2014 Meaningful Use of Health IT In the MUHIT Overview section, no changes are listed under the Measure Updates released in December for P4P MY 2014. Is this intentional?
No. The changes for December 2014 was omitted from the final version of the MY 2014 P4P Manual. The Measure Updates for December 2014 should include:
- In the “Computing the Results” section, clarified that IHA will solicit NPI lists from either POs or health plans.
- In the “Who We Measure” and “Computing the Results” sections, specified that primary care physicians (MDs and DOs), including internists, family practitioners, GPs and pediatricians, will be the basis of the denominator for assigning credit.
In the “Who We Measure” and “Computing the Results” sections, specified that primary care physicians (MDs and DOs), including internists, family practitioners, GPs and pediatricians, will be the basis of the denominator for assigning credit.
IHA 2014