FAQ Directory: HEDIS

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10.15.2017 Transitions of Care Please clarify the September 15 FAQ stating that SNPs and MMPs are not required to report the TRC measure because it does not appear in Table 3 of the CMS reporting requirements memo. Are SNP and MMPs plans required to report TRC in their contract-level submission?

Yes. Contracts that offer SNP and MMP plan benefit packages are required to report TRC in their contract-level submission, as described in Table 2 of the CMS HEDIS 2018 Reporting Requirements memo.

HEDIS 2018

10.15.2017 ECDS Are all data used to determine member compliance with the denominator, numerator or exclusion required to come from an ECDS, or may data from multiple sources be used?

10.15.2017 ECDS For IP-ECDS coverage, does NCQA look for the number of members in the initial population?

IP-ECDS coverage count includes all members in the initial population who are being managed by at least one provider with the capacity to send, receive and use electronic data for quality improvement purposes.The Initial Population includes all members (covered and not covered by ECDS) who are identified as eligible for the measure reported by the data source category used to determine eligibility.

HEDIS 2018

10.15.2017 ECDS May we use claims for ECDS reporting?

Administrative claims are considered an ECDS data source if the payment system is automated and data are accessible by the practitioner/practitioner group that is accountable for clinical services provided to plan members (e.g., if claims are used to identify an inpatient stay, the primary care provider must be able to access the details of the stay). Report all measure results identified by claims in the “Administrative claims” source system of record (SSoR) category.

HEDIS 2018

10.15.2017 ECDS Are we required to collect and report the source vendor for the data e.g., by vendor)and source system of record (e.g., EHR, HIE, case management, claims) when reporting ECDS categories?

Details about the data vendor or source EHR system are not required for ECDS reporting, but should be documented in the HEDIS Roadmap when identifying data sources for an NCQA-Certified auditor. Use of data from NCQA eCQM-Certified vendors will ensure that measure data extracted from these systems are considered standard.
ECDS data should be categorized by one of the four source record categories stated in ECDS General Guideline 2: Data Collection Methods (EHR, HIE/clinical registry, case management registry, administrative claims).

HEDIS 2018

10.15.2017 ECDS Does the denominator only include plan members covered by ECDS who are in the initial population?

Yes. The denominator should be all members covered by ECDS who do not meet exclusion criteria.

HEDIS 2018

10.15.2017 ECDS Will ECDS measures be used for Health Plan Accreditation or ratings?

ECDS measures are currently not approved for public reporting by NCQA, and are not eligible for use in HPA or health plan ratings. All measures must be approved for public reporting by the Committee on Performance Measurement (CPM) before they can be considered for inclusion in an NCQA program.

HEDIS 2018

10.15.2017 Breast Cancer Screening, Colorectal Cancer Screening, Controlling High Blood Pressure, and Osteoporosis Management in Women Who Had a Fracture The Medicare Monthly Membership File includes a run date and a payment date. Which date should be used to determine that a member had an LTI flag during the measurement year?

Use the run date to determine that a member had an LTI flag during the measurement year.

HEDIS 2018

10.15.2017 ECDS How are ECDS different from supplemental data?

The ECDS reporting method uses much of the same data classified as supplemental for other HEDIS measures, but ECDS measures adhere to different reporting rules from those in other HEDIS domains. Unlike supplemental data used for HEDIS, data for ECDS reporting are classified by source and are used to report all measure elements (e.g., denominator, exclusions, numerator).

HEDIS 2018

9.15.2017 Transitions of Care Are Special Needs Plans (SNPs) and Medicare-Medicaid Plans (MMPs) required to report the Transitions of Care (TRC) measure?

No. In the 2018 CMS Reporting Requirements Memo, the TRC measure is not listed in Table 3, “HEDIS 2018 Measures for Reporting by SNPs and MMP PBPs.”

HEDIS 2018

8.15.2017 Breast Cancer Screening, Colorectal Cancer Screening, Controlling High Blood Pressure, and Osteoporosis Management in Women Who Had a Fracture A required exclusion was added to the Medicare product line for members 65 years of age and older living long-term in institutional settings for the Breast Cancer Screening, Colorectal Cancer Screening, Controlling High Blood Pressure and Osteoporosis Management in Women Who Had a Fracture measures. In addition to using the Medicare monthly membership file, may organizations use other data sources when identifying members living long-term in an institution?

No. Organizations may not use other data sources (e.g., supplemental or medical record data) when excluding members living long-term in an institution. The LTI flag in the Medicare Part C monthly membership file is the only source that may be used to identify this exclusion. NCQA was informed by CMS that all Medicare plans receive this file monthly and have access to this flag. NCQA plans to clarify this in the HEDIS 2018, Volume 2 Technical Update Memo, scheduled for release on October 2, 2017.

HEDIS 2018

8.15.2017 Use of Opioids From Multiple Providers The Use of Opioids From Multiple Providers (UOP) measure instructs organizations to use the National Provider Identifier (NPI) when identifying prescribers and pharmacies. How should organizations report pharmacy claims for opioids when the prescribing provider and/or pharmacy NPI is missing?

If the prescriber and/or pharmacy NPI is missing, count each dispensing event with a missing NPI as a different prescriber and/or different pharmacy when reporting the measure. NCQA plans to clarify this in the HEDIS 2018, Volume 2 Technical Update Memo, scheduled for release on October 2, 2017.

HEDIS 2018