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Health Plan Accreditation 2020: HEDIS® and CAHPS® Reporting Requirements

HEDIS and CAHPS reporting will still be required for Health Plan Accreditation, but the timeline has changed for newly accredited plans to help put a greater emphasis on quality measurement. .

Nothing changes for plans that are already Accredited and reporting HEDIS/CAHPS. They will continue submitting HEDIS/CAHPS annually. Organizations that have earned First or Interim Accreditation will be required to submit HEDIS/CAHPS during the first reporting period after their first full year of Accreditation. Refer to the table below.

Survey TypePrevious Reporting RequirementsHealth Plan 2020 Reporting Requirements
Interim AccreditationPlans with Interim Accreditation were not required to report HEDIS/CAHPS.All plans must report HEDIS/ CAHPS for the HEDIS reporting date after their first full year of Accreditation. Plans with fewer than 15,000 members are not required to report.
First AccreditationAll plans must report HEDIS/ CAHPS for the HEDIS reporting date after their first full year of Accreditation. Plans with fewer than 15,000 members are not required to report.All plans must report HEDIS/ CAHPS for the HEDIS reporting date after their first full year of Accreditation. Plans with fewer than 15,000 members are not required to report.

Like today, HEDIS/CAHPS data will be used to produce a rating for health plans. Ratings will be released in September of each year, starting with September 2020 (using the June 2020 HEDIS data). Organizations will earn their first star rating in September of their second year of HEDIS reporting, unless they request to have their star rating released during the first year.

Accreditation Issued On Or BetweenFirst HEDIS Reporting DateFirst Star Rating Released
July 1, 2020-June 30, 2021June 2022September 2023
July 1 2021-June 30, 2022June 2023September 2024
July 1, 2022-June 30, 2023June 2024September 2025
July 1, 2023-June 30, 2024June 2025September 2026
July 1, 2024-June 30, 2025June 2026September 2027

Note: Plans may choose to report HEDIS earlier and may request to earn a star rating earlier than their first release date by choosing to publicly report HEDIS results.

Frequently Asked Questions

Does HEDIS/CAHPS reporting change for Accredited organizations?  

No. Accredited organizations should keep reporting HEDIS/CAHPS annually.

Why is the first star rating released in the second year of reporting HEDIS?

The first year of HEDIS reporting is meant to give plans time to implement their performance measurement and improvement programs and get used to reporting HEDIS. Waiting until the second year to be scored gives organizations the opportunity to implement performance improvement programs and become accustomed to reporting HEDIS. However, organizations may request to publicly report HEDIS data in the first year.

Our organization wants to earn a star rating during the first year it submits HEDIS.

To have NCQA score your results prior to your required star rating year, complete the attestation when submitting HEDIS data to NCQA and indicate that your organization wants to publicly report results. NCQA will score results and release a star rating.

Where can we find more information on Health Plan Ratings?

Find information on Health Plan Ratings here.

 

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