FAQ Directory: HEDIS

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1.15.2017 Statin Therapy for Patients With Cardiovascular Disease There appear to be additional NDC codes for high- and moderate-intensity statins included in the NDC list for SPD-A that are not in SPC-B. May these additional codes be mapped to the HEDIS 2017 NDC list for table SPC-B?

Yes. Organizations may map NDC codes so that the same set of codes for high-intensity and moderate-intensity statins are used for both the SPC-B and SPD-A measures. An NDC code that is not on the HEDIS list may be used if its generic name, strength/dose and route match an NDC code on the HEDIS list. Organizations should document the method used to map codes: Mapping is subject to review during a HEDIS Compliance Audit. Requirements for mapping are described in General Guideline 50 in HEDIS 2017 Volume 2.

HEDIS 2017

1.15.2017 Reporting RRU Measures for HEDIS 2017 Should health plans report the RRU measures for HEDIS 2017?

No. NCQA suspended collection of the RRU measures for HEDIS 2017 and health plans should not report RRU measures for HEDIS 2017. In 2017 NCQA will decide whether to permanently retire these measures. NCQA will hold a public comment process to aid in the decision. 

HEDIS 2017

12.22.2016 Standardized Healthcare-Associated Infection Ratio How does NCQA determine that an acute care hospital is contracted with a health plan?

For reporting HAI for HEDIS 2017, NCQA defines a contracted acute care hospital as any acute care hospital to which the organization paid a claim for a member’s inpatient stay during the measurement period. This is a first-year measure; based on the results, NCQA may review this definition for changes in 2018.The FAQ posted in October regarding this topic was retracted given the release of the FAQ above.

HEDIS 2017

12.15.2016 PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults and Depression Remission or Response for Adolescents and Adults If an organization chooses to report the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults (DMS) and Depression Remission or Response for Adolescents and Adults (DRR) measures, must the data be audited?

No. The DMS and DRR measures are not required to be audited for HEDIS 2017.

HEDIS 2017

12.15.2016 Comprehensive Diabetes Care Organizations are instructed to exclude BPs taken on the same day as a diagnostic test or procedure that requires a change in diet or medication regimen on or one day before the day of the test or procedure (with the exception of fasting blood tests). May organizations exclude BPs on the same day as a procedure that typically requires a change in diet/medication or must the medical record documentation specifically state there was a change in diet/medication?

If it is standard practice to change diet or medications prior to a procedure, then exclude BPs on the same day as that procedure. For example, a colonoscopy requires a change in diet combined with bowel prep prior to the procedure. Therefore, BPs on the day of a colonoscopy are excluded even if the medical record documentation does not contain specific notation about a change in the member’s diet. Should organizations require support in identifying procedures where a diet or medication change is standard practice, they must consult with their internal clinical staff or their HEDIS auditor.

HEDIS 2017

12.15.2016 Controlling High Blood Pressure Organizations are instructed to exclude BPs taken on the same day as a diagnostic test or procedure that requires a change in diet or medication regimen on or one day before the day of the test or procedure (with the exception of fasting blood tests). May organizations exclude BPs on the same day as a procedure that typically requires a change in diet/medication or must the medical record documentation specifically state there was a change in diet/medication?

If it is standard practice to change diet or medications prior to a procedure, then exclude BPs on the same day as that procedure. For example, a colonoscopy requires a change in diet combined with bowel prep prior to the procedure. Therefore, BPs on the day of a colonoscopy are excluded even if the medical record documentation does not contain specific notation about a change in the member’s diet. Should organizations require support in identifying procedures where a diet or medication change is standard practice, they must consult with their internal clinical staff or their HEDIS auditor.

HEDIS 2017

12.15.2016 Plan All-Cause Readmission Does the Note at the end of step 4 (page 347) regarding required exclusions of the denominator of the administrative specification also apply to step 3 of the numerator (page 352)?

Yes. Add the following language to step 3 of the numerator: Note: For hospital stays where there was an acute-to-acute direct transfer (identified in step 2), use both the original stay and the direct transfer stay to identify exclusions in this step.

HEDIS 2017

11.15.2016 Prior Year’s Validated Historic Hybrid Medical Record Results How should prior year’s validated historic hybrid medical record results be flagged for HEDIS 2017, given their removal from the supplemental data list?

Prior year’s validated historic hybrid medical record result files were removed from Section 5 (Supplemental Data) of the HEDIS Roadmap and are now listed as a data source used for reporting in Section 7 (Data Integration). Because of this change, these data should be loaded as administrative data, rather than as supplemental data, as in the past and should be considered administrative hits. This applies only to the previous year’s validated hybrid data, not to all medical record data or medical record data previously approved as supplemental data.

HEDIS 2017

11.15.2016 Initiation and Engagement of Alcohol and Other Drug Dependence Treatment When determining the IESD for an ED visit that results in an inpatient stay, the IESD is the date of the inpatient discharge. Is an AOD diagnosis required for the inpatient stay and for the ED visit?

No. An AOD diagnosis is required for the ED visit, but not for the inpatient stay.

HEDIS 2017

11.15.2016 Immunizations for Adolescents The Advisory Committee on Immunization Practices (ACIP) approved a 2-dose schedule for the 9-valent HPV vaccine in October 2016. Will NCQA update the Immunizations for Adolescents (IMA) measure to accommodate the new HPV vaccination schedule?

NCQA has been monitoring ACIP’s review of the HPV vaccination schedule. Once the recommendation is published in CDC’s Morbidity and Mortality Weekly Report, the appropriate NCQA staff and panels will evaluate potential changes to the measure.
HEDIS 2017 evaluates performance for calendar year 2016; measure specifications for HEDIS 2017 are final. Proposed changes, if any, will be posted for Public Comment in February 2017 and, pending final approval by the NCQA Committee on Performance Measurement, will be included in HEDIS 2018.

HEDIS 2017

11.15.2016 Standardized Healthcare-Associated Infection Ratio CMS updates the Hospital Compare information throughout the year. How can organizations ensure that they are using the same Hospital ID (Provider ID) list from the CMS Hospital Compare website when reporting the HAI measure?

NCQA will release a locked Hospital ID (Provider ID) file, along with the HAI Standard Injection Ratio (SIR) table (Table HSIR) on January 2, 2017. This will allow both the Hospital ID and the appropriate SIR to be used when reporting the measure.

HEDIS 2017

11.15.2016 Follow-Up After Emergency Department Visit for Alcohol and Other Drug Dependence Table FUA-1/2/3, on page 179 of the HEDIS 2017, Volume 2 Technical Specifications, indicates that the Eligible Population is collected at the measure level. Should it also be collected for each of the two rates for each age stratification and for the total?

Yes. Replace the “ü” in the “Eligible Population” row with “Each of the 2 rates for each age stratification and total.” This is how the Eligible Population will be collected in IDSS.

HEDIS 2017