Yes. Remove the bullets that include I-SNP and LTI exclusions for Medicare members from the specifications. They are not intended for the Exchange population.
MARKETPLACE 2020
FAQ Directory: HEDIS for the Quality Rating System
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1.15.2020
Controlling High Blood Pressure The CBP measure lists the following exclusions in the eligible population:
• Medicare members 66 years of age and older as of December 31 of the measurement year who meet either of the following:
– Enrolled in an Institutional SNP (I-SNP) any time during the measurement year.
– Living long-term in an institution any time during the measurement year as identified by the LTI flag in the Monthly Membership Detail Data File. Use the run date of the file to determine if a member had an LTI flag during the measurement year.
Should these exclusions be removed from the CBP measure specifications?
11.15.2019 Well-Child Visits in the First 15 Months of Life Should the “Number of required exclusions” row be removed from the Data Elements Table in the Well-Child Visits in the First 15 Months of Life (W15) measure?
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?
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?
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?
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
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?
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?
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?
4.15.2016 Exchange Benchmarking Data We are looking for external benchmarks for Exchange 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 Exchange data for any other purpose.
Published CMS guidance (https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo/Downloads/2019-QRS-and-QHP-Enrollee-Survey-Technical-Guidance_FINAL_20181016_508.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 Exchange QRS data. Reference “Exhange 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?
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