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FAQ Directory: HEDIS

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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 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

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 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

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 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 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 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

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

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?