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FAQ Directory: HEDIS for the Quality Rating System

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10.15.2018 Immunizations for Adolescents Are issuers required to report Combo 1 for the Quality Ratings System in the Immunizations for Adolescents (IMA) measure?

No. HEDIS for QRS requires collection of only Combination 2 and related antigens. Change the reference in the Description from “two combination rates” to “one combination rate.” In the Data Elements Table, change “Each of the 5 rates” to “Each of the 4 rates.”

MARKETPLACE 2019

10.15.2018 Avoidance of Antibiotic Treatment in Adults With Acute Bronchitis Should the “Numerator events by supplemental data” row be removed from the Data Elements Table in the Avoidance of Antibiotic Treatment in Adults With Acute Bronchitis (AAB) measure?

Yes. Remove the “Numerator events by supplemental data” row in the Data Elements Table.

MARKETPLACE 2019

10.15.2018 Appropriate Treatment for Children With Upper Respiratory Infection Should the “Numerator events by supplemental data” row be removed from the Data Elements Table in the Appropriate Treatment for Children With Upper Respiratory Infection (URI) measure?

Yes. Remove the “Numerator events by supplemental data” row in the Data Elements Table.

MARKETPLACE 2019

10.15.2018 Use of Imaging Studies for Low Back Pain Should the “Numerator events by supplemental data” row be removed from the Data Elements Table in the Use of Imaging Studies for Low Back Pain (LBP) measure?

Yes. Remove the “Numerator events by supplemental data” row in the Data Elements Table.

MARKETPLACE 2019

10.15.2018 Proportion of Days Covered Should the upper and lower Confidence Interval data elements be removed from the reporting tables in the Proportion of Days Covered (PDC) measure?

Yes. NCQA removed confidence intervals from all measures and data collection (IDSS) in HEDIS 2019; this applies to all related products using IDSS, including the QRS PDC measure.
Organizations that want to calculate or use confidence intervals must use the other data element fields and calculate confidence intervals for internal analysis.

MARKETPLACE 2019

1.15.2017 Relative Resource Use for People with Diabetes Should Marketplace plans report the Relative Resource Use for People with Diabetes (RDI) measure for 2017?

No. The RDI measure will be removed from the Quality Rating System. For Marketplace plans, CMS will issue guidance, including, but not limited to, FAQs, updates to the 2017 Technical Guidance and the 2017 Call Letter.

MARKETPLACE 2017

11.15.2016 Immunizations for Adolescents (IMA) For the Immunizations for Adolescents (IMA) measure, are issuers required to report Combination 1 for the Quality Ratings System?

No. HEDIS for QRS requires collection of only Combination 2 and related antigens. IMA will not be scored this year.

MARKETPLACE 2017

4.15.2016 Marketplace Benchmarking Data We are looking for external benchmarks for Marketplace results. When will they be available?

NCQA collects clinical data for the Quality Rating System (QRS) under contract for CMS, but does not collect or report Marketplace data for any other purpose.

Published CMS guidance (https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo/Downloads/QRS-and-QHP-Enrollee-Experience-Survey-Technical-Guidance-for-2016-V20.pdf) states (page 19, Section 8, Quality Rating Information Preview Process), “The proof sheets will include benchmark information for measure results and an associated definition/rationale for any invalid/non-numeric results (e.g., NR).”

You can e-mail the Exchange Operations Support Center Help Desk at CMS_FEPS@cms.hhs.gov or phone 855-267-1515 if you have questions about benchmarks for Marketplace QRS data. Reference “Marketplace Quality Initiatives (MQI)-QRS” in the subject line.

MARKETPLACE 2016

12.18.2015 HEDIS for the Quality Rating System Can organizations use the HEDIS for the Quality Rating System publication to report product lines other than Marketplace?

No. The Marketplace product line is specifically for use with QRS reporting. There are differences between the HEDIS for the Quality Rating System and Volume 2 measure specifications. General Guideline 1 of the HEDIS for the Quality Rating System publication specifically states that QRS measure data must be collected separately for the Marketplace population. Future versions of the HEDIS for the Quality Rating System publication will only list the Marketplace product line. For those reporting on other product lines, the HEDIS Volume 2 publication must be used. 

MARKETPLACE 2016

12.15.2015 Well-Child Visits in the First 15 Months of Life (W15) The Data Elements table for the W15 measure includes a field for required exclusions. Is this a mistake?

Yes. The W15 measure does not have exclusions and this data element was included in error. It will be deleted in future publications.

MARKETPLACE 2016

9.30.2015 QRS and Off-Market Commercial HEDIS Submission Should Off-Marketplace plans include their membership in QRS and in Marketplace accreditation?

No. Off-Marketplace plans should include its membership in its commercial HEDIS submission and in its commercial product line when submitting for health plan accreditation.

MARKETPLACE 2016

3.19.2015 Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life Is QRS Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life (W34) collected using the hybrid method or the administrative method?

Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life should be reported using only the administrative methodology as specified in the 2015 QRS Technical Specifications (http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo/Downloads/2015-QRS-Measure-Technical-Specifications.pdf). Hybrid specifications are not available for this measure in the QRS.  The W34 measure is listed as a measure in the sample size table of the QRS Sampling Guidelines and was a misprint which will be corrected in the 2016 QRS Measure Technical Specification.
 
For organizations who have started medical record review for W34, please note, the IDSS will only accept the administrative elements of the measure for QRS.

MARKETPLACE 2015