FAQ Directory: HEDIS

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10.15.2016 Comprehensive Diabetes Care In the Technical Update memo, the list of bullets when identifying BP readings to not include were revised in the Controlling High Blood Pressure (CBP) measure. Should organizations make the same change to the Comprehensive Diabetes Care (CDC) measure?

Yes. Organizations may make this change to the CDC measure. On page 143, in step 1 of the Medical Record, organizations may delete the second and third bullets and add the following bullet:

  • 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.

NCQA allows organizations to make this change because it does not impact software programming for the measure.  If an organization makes this change, it must do so consistently across all members.

HEDIS 2017

10.15.2016 October Release of the HEDIS 2017 Value Set Directory Where can I find the October 3 version of the HEDIS 2017 Volume 2 Value Set Directory?

The updated Value Set Directory (VSD) is available to customers who purchased HEDIS 2017 Volume 2. Go to the NCQA Download Center to obtain the file: https://downloads.ncqa.org/customer/Login.aspx.
Note: The updated VSD is not labeled “10-3” in the Download Center. Click “Download” and the file name will include the date 10.03.16.

HEDIS 2017

10.15.2016 Follow-Up After Care for Children Prescribed ADHD Medication In the Technical Update memo, the reference to “February 28” in the Intake Period definition was replaced with “February 29” because 2016 is a leap year. Should organizations make the same change to the “Ages” criteria in the Eligible Population of Rate 1 and Rate 2?

No.  Use February 28 of the measurement year when identifying the Age of the member for Rate 1 and Rate 2.  NCQA does not make changes that impact software programming after the release of the Technical Update memo.

HEDIS 2017

10.15.2016 Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults and Depression Remission or Response for Adolescents and Adults Which encounters should be used to identify the Initial Population and for calculating step 1 of the Denominator for Rate 2 of the Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults (DMS) and Depression Remission or Response for Adolescents and Adults (DRR) measures?

As stated in the measure guidance section for the DMS and DRR measures, include encounters where a diagnosis of major depression or dysthymia was addressed. The intent is to use encounters that are associated with managing depression to identify members in the Initial Population and to identify encounters to be included in the denominator calculation for Rate 2. In the HEDIS 2017 October Update, the Depression Encounter Value Set was renamed Interactive Outpatient Encounter Value Set, to clarify that it identifies outpatient encounters that can take place in a variety of settings. These encounters must be associated with a diagnosis of major depression or dysthymia in order to meet the intent of the measures.

HEDIS 2017

9.15.2016 Direct Transfers In a “direct transfer,” the discharge date from one inpatient setting and the admission date to a second inpatient setting are one calendar day apart or less. May the admission date from the second inpatient setting take place on the day before the discharge date from the first setting?

No. To be considered a direct transfer, the admission date for the second stay must be on the same date of service or one day after the discharge date from the first stay.

HEDIS 2017

9.15.2016 ED/Observation Visits Resulting in an Inpatient Stay Many measures instruct organizations to not include ED visits or observation visits that result in an inpatient stay. The ED visit or observation visit results in an inpatient stay when the ED/observation date of service and the admission date for the inpatient stay are one calendar day apart or less. May the inpatient admission take place on the day before the ED or the observation visit date?

No. The inpatient stay must be on the same date of service or one day after the ED or observation visit date.

HEDIS 2017

9.15.2016 Mapping Facilities to Provider Types May an organization map a facility to a provider type for reporting HEDIS measures (e.g., map a Federally Qualified Health Center [FQHC] to the type Primary Care Practitioner (PCP))?

No. Facilities may not be mapped to a provider type unless an organization can demonstrate that all providers rendering services at the facility meet the NCQA provider definition defined in Appendix 3. Organizations should work with their HEDIS Compliance Auditor, who can review and approve mapping.

HEDIS 2017

7.15.2016 Standardized Healthcare-Associated Infection Ratio Will NCQA post an example HAI Standardized Infection Ratio (SIR) table to be used when reporting the Hospital Acquired Infection (HAI) measure?

3.15.2016 Expected Counts in IDSS for IHU, EDU and HPC How should the Expected counts be reported in IDSS for Inpatient Hospital Utilization, Emergency Department Utilization and Hospitalization for Potentially Preventable Complications? Do they need to be rounded?

The Expected counts, discharges or visits depending on the measure, must be rounded to four decimal places using the .5 rule when reporting the final values in the IDSS.

HEDIS 2016

2.24.2016 Digital Mammography for Breast Cancer Screening Is digital mammography included in the HEDIS® Breast Cancer Screening Measure?

The HEDIS® 2016 Breast Cancer Screening (BCS) measure aligns with the 2009 US Preventive Services Task Force (USPSTF) guidelines. The guideline concluded the evidence was insufficient to assess the additional benefits and harms of digital mammography instead of film mammography for breast cancer screening. NCQA understands mammography practice, coding and technology have evolved over time to include digital mammography, and the current HEDIS measure includes CPT codes that represent either traditional mammography or digital mammography and cannot be delineated through administrative reporting. However, three HCPCS G codes, specific to digital mammography, were inadvertently included in the Mammography Value Set. Because the HEDIS 2016 specifications are frozen, NCQA will allow plans to follow the current measure specification and associated value sets as written.

The measure will be evaluated for HEDIS 2017 and the value-sets will be updated accordingly based on newly released USPSTF Guideline recommendations.

HEDIS 2016

1.15.2016 Care for Older Adults Are CMS Medicare-Medicaid Plans (MMPs) required to report the SNP-only measure, Care for Older Adults (COA), for HEDIS 2016?

Yes. According to the CMS HEDIS 2016 reporting requirements memo, MMPs are required to report all measures in Table 3. This includes COA, even though it is referenced as being SNP-only.

HEDIS 2016

1.15.2016 Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults Is the Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults (DMS) measure audited or part of the Measure Certification program for HEDIS 2016?

No. The DMS measure is not part of the NCQA Audit or the Measure Certification program for HEDIS 2016.

HEDIS 2016