FAQ Directory

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

This applies to the following Programs and Years:

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.
 

This applies to the following Programs and Years:

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.

This applies to the following Programs and Years:

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.

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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.
 

This applies to the following Programs and Years:

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.

This applies to the following Programs and Years:

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.

This applies to the following Programs and Years:

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.

This applies to the following Programs and Years:

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. 

This applies to the following Programs and Years:

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).

This applies to the following Programs and Years:

Yes. The explanation and requirements should be included in UM 5,  Element C.

This applies to the following Programs and Years:

Yes. Organizations may map Q2051 to J3489 (which is included in the Osteoporosis Medications Value Set and is for the same medication and dose) for HEDIS 2015 reporting. Auditors review mapped codes as part of the HEDIS Compliance Audit.

This applies to the following Programs and Years:

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.

This applies to the following Programs and Years: