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.
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
Thank you for pointing this out. The correct dates are as follows:
Page 7
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
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:
IHA 2014
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
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
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 “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
Yes. Starting in MY 2014, self-reporting POs are no longer expected to complete a survey to receive credit for Meaningful of Use of Health IT. Participation in Meaningful Use will be assessed by P4P staff using publicly available files from CMS Medicare and Medi-Cal Meaningful Use Incentive Programs. P4P staff will solicit provider NPI lists from all POs in order to assign credit.
IHA 2014
A version of the child survey that includes the CCC questions is part of HEDIS. If an organization uses the “With CCC” version of the questionnaire, the CCC items are considered part of the CAHPS 5.0H questionnaire and are not included in the count of 12 supplemental questions.
HEDIS 2015
Organizations are not required to identify or confirm the diagnosis of diabetes through medical record review; only the hypertension diagnosis must be confirmed. Only administrative data should be used to assign the diabetes flag. The intent of the flag is to determine the appropriate BP threshold to use for the member during numerator assessment because the threshold for members with diabetes is different from the threshold for members without diabetes.
The only exception is if the member is flagged as a diabetic but medical record evidence contains information that classifies the member as a valid data error. To meet criteria as a valid data error, the medical record must contain no evidence of diabetes and include a notation that refutes the diagnosis, as described in Substituting Medical Records in the Guidelines for Calculations and Sampling. In this case, the diabetes flag may be changed to “not diabetic”, but the member may not be removed from the sample.
HEDIS 2015
For certain elements with frequency or analysis requirements, (i.e., MEM 1 Element G; MEM 2 Element C; MEM 4 Element C; MEM 5 Element C; MEM 5 Element D; MEM 7 Element C, factors 3 and 5) the documentation requirement will be limited to a documented process for the Medicare, Medicaid and Marketplace product lines.
