The table for identifying asthma medication dispensing events was inadvertently left out of the December 2, 2013, version of the MY 2013 manual. Table AMR-B is identical to Table ASM-C in HEDIS 2014 Volume 2.
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12.20.2013 Asthma Medication Ratio (AMR) Step 1 in the Event/Diagnosis section of the Eligible Population criteria refers to Table ASM-C for identifying asthma medication dispensing events. There is no Table ASM-C in the specification.
12.20.2013 Controlling Blood Pressure for People with Hypertension (CBPH) The CBPH measure is not listed in the P4P Value Set Directory. Where can we find the Value Sets for this measure?
The CBPH Value Sets can be found by filtering for Value Set Name in the P4P Value Sets to Codes tab of the P4P VSD file. The Value Sets for CBPH already exist as part of the CDC measure. The next release of the Value Set Directory will list the CBPH measure separately.
This applies to the following Programs and Years:
IHA P4P12.16.2013 Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life Is a BMI growth chart sufficient for the physical requirement of the developmental history component?
No. Growth charts (height, weight, BMI or BMI percentile) do not meet criteria for physical developmental history for the W34 measure. The intent of the developmental history component (physical and mental) is to determine if the child was assessed for specific age-appropriate physical and mental developmental milestones, which are behaviors or physical skills seen in children as they grow and develop. For the W34 measure, examples of mental developmental milestones include ability to speak understandably, identify colors and define words appropriately. For the W34 measure, examples of physical developmental milestones include the ability to hop, throw a ball, draw and make a block tower. Documentation of "developing appropriately" or "normal development" meets criteria for both physical and mental development. Documentation of "growing appropriately" (without notation about "development") does not meet criteria for physical or mental developmental history.
Additional examples can be found in the Appendices of the Bright Futures Pocket Guide Guidelines for Health Supervision of Infants, Children, and Adolescents (http://brightfutures.aap.org/pdfs/bf3%20pocket%20guide_final.pdf).
This applies to the following Programs and Years:
HEDIS 201412.16.2013 General Guidelines Are HbA1c and LDL-C tests where the member collects a blood sample at home and sends it to a lab for results calculation allowed for HEDIS reporting?
12.16.2013 General Guidelines If an organization finds an undated lab result in a progress note, can the progress note date be used as the lab result date?
No. An undated lab result may not be used for HEDIS reporting. To be eligible for use, the date the test was performed (e.g., the date the sample was drawn) or the result date (e.g., the date the lab calculated the result) must be documented.
This applies to the following Programs and Years:
HEDIS 201412.16.2013 Cervical Cancer Screening In step 2 of the Administrative Specification, organizations identify women 30-64 years of age as of December 31 of the measurement year who had cervical cytology and a human papillomavirus (HPV) test, with service dates four or less days apart during the measurement year. When counting service dates, is the date of the cervical cytology considered day one or day zero of the four-day count?
The date of the cervical cytology is considered day zero. For example, if the service date for cervical cytology was December 1 of the measurement year, the HPV test must include a service date on or between December 1 and December 5 of the measurement year.
This applies to the following Programs and Years:
HEDIS 201411.15.2013 Effective dates of specificity requirements in Delegation Agreements For Element A in all standard categories in delegation (QI 12, UM 15, CR 9, RR 7, MEM 9), will existing delegation agreements be grandfathered if they do not meet the specificity required in the 2014 Written Delegation Agreement elements?
No. All existing delegation documents must be modified to reflect the specificity requirements before January 1, 2015. All new delegation documents that were effective on or after October 1, 2013, must meet the specificity requirement for standard year 2014.
This applies to the following Programs and Years:
11.15.2013 General Guidelines If a member is included in a measure's denominator due to an incorrect code, may a corrected claim be submitted to remove the member from the measure?
It is not NCQA's policy to dictate an organization's claims submission process. Claims may be corrected or updated as necessary before the HEDIS reporting process begins. However, once the HEDIS reporting process has begun (i.e., the measures' eligible populations are identified and samples are drawn for hybrid reporting), the requirements specified in Volume 2 General Guidelines and Technical Specifications must be followed.
For administrative-only measures, members who meet the eligible population criteria for the measure should remain in the measure. If an organization refreshes data for administrative-only measures, the most accurate and current information must be used for reporting. Additionally, the organization must apply the refresh to all applicable measures.
For hybrid measures, members who are in the denominator due to inaccurate claims data may meet criteria for a valid data error. Valid data errors are identified only for hybrid measures during medical record review and may not be identified using supplemental data. In order to categorize a member as a valid data error (and replace the member with another member from the sample), the chart must show no evidence of the diagnosis and must include evidence to explain or substantiate the data error. As described in General Guideline 40, organizations that elect to refresh data for the sample may not use the refreshed data to change the hybrid sample after it has been selected. The auditor reviews all valid data error exclusions during Medical Record Review Validation.
This applies to the following Programs and Years:
HEDIS 201411.15.2013 Value Set Directory The Summary of Changes spreadsheet in the HEDIS 2014 Volume 2 Value Set Directory lists LOINC code 72732-0 as added to the Sexual Activity Value Set, but that code is not in the Volume 2 Value Sets to Codes spreadsheet.
11.15.2013 Initiation and Engagement of Alcohol and Other Drug DependenceTreatment The list of code combinations to identify Initiation and Engagement visits do not include codes to identify inpatient admissions. Do inpatient admissions count as initiation and engagement of AOD treatment?
As stated in the paragraphs prior to the list of code combinations, an inpatient admission with a diagnosis of AOD meets criteria for both initiation and engagement. Because NCQA does not specify codes to identify inpatient admissions, inpatient admissions were not included in the list of code combinations. The lists of code combinations include only visits for which value sets exist (outpatient, intensive outpatient and partial hospitalization). Organizations should use their own methods for identifying inpatient admissions when identifying initiation and engagement visits.
This applies to the following Programs and Years:
HEDIS 201411.15.2013 General Guidelines Have the dates been extended for primary source verification (PSV) and final approval of supplemental data for HEDIS 2014?
Yes. Data collection and entry of all nonstandard and member-reported supplemental data must stop on March 3. PSV and final approval must be completed by March 14, for member-reported supplemental data, and by March 28, for nonstandard supplemental data. PSV may not occur before March 3 unless all supplemental data processes, collection and entry have stopped. Supplemental data approval and PSV may not occur, under any circumstances, before January 1 and receipt of the Roadmap.
This applies to the following Programs and Years:
HEDIS 201411.15.2013 Routine dental and vision care under medical benefit For UM and CR, are routine dental and vision care considered part of the medical benefit for the Exchange product line?
No. Although routine dental and vision care are included as essential benefits as part of the Affordable Care Act, NCQA was approved for its current requirements as an accrediting organization for Exchanges. Because routine dental and vision care are not included in the benefit requirements or utilization management, we will not survey them for 2013 and 2014 health plan accreditation.