FAQ Directory

Report only Combination 3. Combination 7 was listed in the manual in error and should not be reported. Per the MY 2014 Measure Set, only Combination 3 will be reported for this measure. The correction will be reflected in the PO and Health Plan Clinical Measure File. Note: Combination 3 and Combination 7 are reported for CIS, 12-Month Continuous Enrollment.

IHA 2014

No. The exclusion in the P4P CCS measure is required. The P4P CCS specification should list this change under Modifications From HEDIS.

IHA 2014

The MUHIT domain comprises three rates, the first is the percent of providers who have attested to the national or state Meaningful Use EHR Incentive programs, and the second two are e-measures. To receive credit, POs must report:

• A .csv file with a list of the PO’s providers’ national provider identifiers (NPIs). Instructions on file requirements were sent on January 7, 2015, and were discussed on the January 14–15 Webinars.
• The two e-measures, Controlling High Blood Pressure and Screening for Clinical Depression and Follow-Up Plan.
  • For self-reporting POs, these measures are reported via the PO Clinical File Layout (http://iha.org/manuals_operations_2014.html). There is a separate file layout provided for non-self-reporting PO submission.
  • For each measure, two metrics are collected:
    • The percentage of providers who can report the e-measure.
    • The aggregated numerator and denominator, for providers who can report the e-measure.

To calculate, pull the numerators and denominators from the EHR systems of all providers who can report the measures; specifications are programmed in the certified EHR systems of providers who can report. Refer to pp 150–152 of the MY 2014 P4P Manual, released December 1, 2014.

You should use the same definition of PCP as outlined in the NPI data file specification instructions. Providers in your denominator should include employed and contracted PCPs (MD or DO) in the following specialties: Family/General Practice, Internal Medicine and Pediatrician/Adolescent Medicine. As with the NPI file submission, POs have the option of excluding providers who were with the PO for less than six months of the measurement year. 

IHA 2014

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.  

Yes. NCQA allows practitioners with a current administrative license to review denials of care based on medical necessity if the state issues administrative licenses that permit review of UM medical necessity cases.

UM-CR 2013

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.

No. These organizations are held to Initial Survey requirements for the WHP 3 and WHP 13 standards.

WHP 2014

The organization may contract with and include practitioners in its network who are outside the scope of NCQA credentialing standards, at its discretion. 

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

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.

Exchange 2015

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

 
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

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.
 

 
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