FAQ Directory: HEDIS

Documentation does not need to specifically state the BP was taken with a digital device or that it was not taken with a manual blood pressure cuff and stethoscope.

**This FAQ applies to HEDIS Volume 2 MY 2020 & MY 2021.

HEDIS MY 2021

Yes. Although the required palliative care exclusion is intended to be identified using administrative data, medical record and supplemental data may also be used. If a member is identified as being in palliative care during hybrid medical record review, the member must be removed from the sample and replaced with a member from the oversample. Count the member in the “Number of medical records excluded because of valid data errors” data element.

If organizations use supplemental data to remove members in palliative care from administrative-only measures or hybrid measures, they must follow the supplemental data guidelines (General Guideline 31). Count these members in the “Number of required exclusions” data element.

**This FAQ applies to HEDIS Volume 2 MY 2020 & MY 2021.

HEDIS MY 2021

Yes. Due to changes in reporting requirements because of COVID-19, organizations that do not report HEDIS 2020 results this year may use their audited HEDIS 2019 (MY 2018) reportable hybrid rates when considering sample size reduction rules for HEDIS MY 2020 reporting. In addition, if an organization is required to report their MY2019 administrative rate for HEDIS 2020, they will still be able to use their audited HEDIS 2019 (MY 2018) reportable hybrid rates when considering sample size reduction.

HEDIS 2020

Yes. The final reported hybrid rates for HEDIS 2020 (MY2019), regardless of rotation decision, can be used when applying sample size reduction rules for HEDIS MY2020 reporting.

HEDIS 2020

Although HEDIS/CAHPS results collected in 2020 reflect Measurement Year (MY) 2019, COVID-19 is impacting key aspects of HEDIS hybrid data collection and consumer experience nationally in 2020. The NCQA ratings methodology includes HEDIS/CAHPS measures and Accreditation status. While HEDIS/CAHPS reporting remains a required component of commercial and Medicaid Accreditation, we will not calculate an overall Health Plan Rating for MY 2019, because key aspects of data collection—especially consumer experience/CAHPS survey data—are understood to be compromised by the 2020 pandemic.
In addition to Accreditation, there are two components of Health Plan Ratings to consider when determining comparability for performance assessment: HEDIS and CAHPS results.

1. HEDIS:
   1. Measures specified to use administrative data only: We expect HEDIS administrative measures to be less impacted; however, we are monitoring them closely. 
   2. Measures specified to use administrative data with a medical record review component (Hybrid Method): We expect some HEDIS hybrid measures to be compromised, given the challenge of accessing charts for abstraction.
2. CAHPS: We have concerns about the validity of CAHPS results because the survey is being fielded this year from February–May, during the height of the pandemic as it continues to spread unevenly across the country, with wide regional variation.

Considerations: Preliminary impact modeling using MY 2018 data has shown that approximately half of all plans’ overall ratings would be affected if Hybrid measures and/or CAHPS survey results were excluded from Health Plan Ratings. Given the uncertainty and likely variability of COVID-19’s impact on hybrid data collection efforts and consumer experience, NCQA will not calculate ratings for comparison of plans in 2020 for MY 2019. Ratings based on a reduced set of measures would not be comparable to previous Health Plan Ratings.

In addition, since NCQA will align with CMS guidance (https://www.federalregister.gov/documents/2020/04/06/2020-06990/medicare-and-medicaid-programs-policy-and-regulatory-revisions-in-response-to-the-covid-19-public), we will not require Medicare Advantage plans to submit data for Accreditation. In order to maintain alignment across all product lines, we want to recognize commercial and Medicaid plans for collecting and reporting data; however, we understand that some plans’ ability to submit HEDIS/CAHPS data might be compromised. We will work with these plans individually.

HEDIS 2020

CAHPS: CAHPS survey results will not be included in Quality Compass. We have concerns about the validity of CAHPS results because the survey is being fielded this year from February–May during the height of the pandemic as it continues to spread unevenly across the country, with wide regional variation.   

HEDIS: We will continually assess the feasibility of using the data reported to us for other purposes, including Quality Compass, provided data meet our usual standards for validity, accuracy and completeness. No public reporting will be done on any measures failing to meet such criteria. 
 

HEDIS 2020

NCQA’s Health Plan Accreditation program consists of three components that together uniquely evaluate a plan’s infrastructure, consistency, quality and compliance. In addition to structure and process standards, NCQA also requires plans to have a robust framework for gathering, reporting, analyzing and acting on member experience (CAHPS) data and health outcomes (HEDIS) measures.

Although compliance with our standards is reviewed every three years, HEDIS/CAHPS reporting is assessed annually. This assessment is two-fold: We evaluate reporting compliance and capabilities and we calculate performance outcomes for benchmarking with other plans. While we will not calculate a performance outcome by way of our Health Plan Ratings in 2020, we will still assess whether plans are maintaining their reporting and quality infrastructure.
 

HEDIS 2020

NCQA requires hybrid measures with multiple indicators to be reported using the same measurement year of data. Because of this requirement, if you report all CDC indicators hybrid last year (except for eye exam, which you reported administratively):

• Rotate all CDC indicators and report the hybrid data for all CDC indicators you reported hybrid, and
• Report eye exams using the MY 2018 administrative data.  

This is the only exception for using prior years’ administrative data.
 

HEDIS 2020

No. Organizations may apply this exception (i.e., rotation of the audited HEDIS 2019 hybrid rate) to any or all hybrid measures as they deem necessary.

HEDIS 2020

No, because of limitations in IDSS organizations must report all indicators of a hybrid measure using the same year of data. For example, if the audited HEDIS 2019 hybrid data are being reported for CDC, then all indicators in CDC must be reported using audited HEDIS 2019 hybrid data. You may not just report audited HEDIS 2019 data for one indicator. This also applies to measures like WCC, COA, CDC and TRC.
 

HEDIS 2020

Auditors are not expected to validate a retrieval rate. There is no required retrieval rate that organizations have to meet in order to decide to stop their hybrid project this year.

HEDIS 2020

Organizations must report all IDSS data elements for any hybrid measure they report using their audited HEDIS 2019 hybrid rate.

HEDIS 2020