Good morning and... Or afternoon, depending on where you're joining us from. My name is Tom Curtis. I'm with the NCQA state affairs team. Thank you, and welcome to preparing for MAC QRS reporting, a streamlined approach for health plans. We're gonna give it another minute or so to let everybody join before we actually jump into the presentation. Alright. The participants coming in has started to slow down a little bit, so let's go ahead and get started. Again, if you've just joined, I am Tom Curtis. I am director of state affairs for NCQA. And we are going to, myself and a few of my colleagues are gonna spend the next thirty to forty minutes talking to you about our Medicaid and CHIP quality rating system or MACQRS reporting solution for health plans. I do see folks raising their hand. Is there are we getting anything in the chat? Okay. What we, would like is to ask you to use the q and a function that is part of this webinar. And, once you put in a question, we will either type an answer in response, or we will, select to answer the question live, and we'll go ahead and just answer it live. But, please, start putting in your questions as soon as they're coming to you because we can then get to them, during the presentation or during the q and a portion of the webinar. And just for everybody's reference right now, there will be a copy of the slides to... That will go out. So that... The question... Or the answer to that question is yes. So let's go to the next slide, and, I'm gonna introduce you to our presenters. There's me, Tom, on the on the left. Then you'll hear a little bit from our vice president of measure and data operations, Wendy Talbot, and you will then hear from our director of data collection, Garcine Duckett. Next slide. So our agenda is going to be housekeeping and speaker introductions. I'm going to go into a bit of the MAC QRS policy and requirements. Then we will talk through how this streamlined measured data collection and reporting option can be used by health plans. Next slide. So before we get going, we have a few polling questions that we want to ask you. So please be ready to respond to the poll. The first question is, is your organization familiar with the federal MACQRS reporting requirements? Yes. Very familiar. Somewhat familiar, or no. Not familiar. Alright. Thank you, everybody, for participating in this poll. I'm gonna go ahead and close it so that we can move on to the next question. So it looks like, about half of you are somewhat familiar, and a quarter of you are very familiar, and a quarter of you are not very familiar, with the requirements. So a good mixture of audience there. Let's go to the next polling question. Question number two is, has your organization started preparing for MAC QRS reporting? Yes, no, or you're not sure? Alright. I'm gonna go ahead and end this poll as well and show you all. It looks like about half of you are actively preparing, and and only 10% are are... Haven't haven't yet started, and then there's a fair amount of you that aren't quite sure. And one more polling question for the audience is, has your state communicated its anticipated MACQRS reporting approach yet? Yes. They're working to, you are working to align with their their preparations. Yes. But the approach is still sort of being worked out. No. Your state has not communicated anything, or you are not sure. Alright. Thank you all so much for actively participating in in this. It looks a lot more mixed than the other, polling questions. So about a quarter of you are... They... You've received communication, but nothing's been finalized yet. And another quarter of you is you haven't received anything. And the rest are, yes, about 12%. Yes. We are working to align our preparations accordingly, and the rest are unsure. Oh, whoops. I wasn't sharing those results when I said all of that. I apologize. There's those results. And, I wanna thank you all for engaging in that. We can go on to the next slide. So I'm gonna give a couple slides here just to talk through what the Medicaid and CHIP quality rating system is and a little bit about what the rule entails. So the MAC QRS is a Medicaid QRS, requirement of states that was established in the 2024 rule that was published 05/10/2024. It requires states to report on a mandatory measure set for all of their Medicaid managed care health plans. This includes MCOs, but also prepaid ambulatory health plans or PAHPs or prepaid inpatient health plans, PIHPs. All are subject to this MAC QRS requirement. What we found is that of the 19 mandatory measures in the rule, 16 of them are HEDIS or CAHPS measures, and that states have to launch this public website that's displaying each measure rate for each health plan by 12/31/2028. The intention of the rule is to increase transparency and encourage beneficiary choice in health plans based on how they're, how they are rated, in quality measures. The caveat I'll I'll add here is that states are allowed to request a one year, extension to the deadline, and so some states may be, considering or may already be, discussing with CMS an extension to 12/31/2029 instead of 2028. Next slide. So for measure year 2026, which is the measure year that would be applicable for publication in, by the end of December twenty twenty eight, They have released subregulatory guidance, and it is known as the initial technical resource manual. The link is there in the slide. And and as I said, you all will get these slides, after the presentation. A few key contents in this resource manual are the measure year 2026 measure set, guidance, measure year 2026 stratification, and guidance on calculating multiple performance rates. And I'll go over these in more detail in a second, but the gist is most of the measures are already being reported to NCQA by your organization, CAPS or HEDIS. There is no stratification requirement for measure year 2026. The subregulatory guidance is silent on anything beyond 2026, but it is making stratification optional to states for 2026. It's not making it mandatory. And the multiple performance rate reporting, is covered by current HEDIS reporting. The other, distinction I want to point out to you all in this manual is that there are some key definitions, for you to to understand. First of all, this quality rating system or QRS is different than what generally folks tend to think of when a QRS is mentioned. So, usually, a star rating type system or in some methodology that aggregates performance of multiple measures up to a single rating is thought of in the context of QRS. In this case, for the Medicaid and CHIP QRS, they are not aggregating to a a higher star rating of any kind. So what they're asking states to publish on a website is each health plan's performance rate on each mandatory measure compared to one another on a single dashboard, for lack of a better word. So it's basically a comparison across health plans for each mandatory measure shown on a public website. That is, at this point, what the, QRS is being defined as in the rule and in the subregulatory guidance. Next slide. So as I said, one of the things in the resource manual is the measure set, and you can see that here on on this slide. 11 of these measures are HEDIS, Five of them are CAHPS measures, and there are three non HEDIS measures. That includes preventive care and screening, screening for depression and follow-up stewarded by CMS, oral evaluation dental services stewarded by the Dental Quality Alliance or DQA, and contraceptive care postpartum women stewarded by the Office of Population Affairs in the federal DHHS. NCQA has received approval from each of these measure stewards to collect data on these three non HEDIS measures. So that is what we're allowing, or offering health plans to do in the context of MAC QRS. So in other words, the measures, that are needed for MAC QRS would be reported to NCQA, and all would be subject to audit and validation. And that would allow health plans and states to meet the requirements of the rule simply by going about the same same quality measure collect... Calculation, collection, and reporting as you already do today. One caveat in the rule that I'll I'll point out here is that states are allowed to evaluate the applicability of each measure on this measure set relative to plan type or a benefit package. So in other words, if a prepaid ambulatory health plan, a dental plan, for example, did not cover breast cancer screenings or cervical cancer screenings or colorectal cancer screening services, then the state would not hold those plans accountable for the measure results of that plan's population. Instead, it is likely the only measure for that... For a dental PHP would would most likely be the oral evaluation dental services measure. Similarly, if there are certain CAHPS measures that really do not capture the accuracy of a beneficiary experience because a health plan doesn't cover certain benefits, then... And that also could be subject to, removal from the list, so to speak, for certain health plans by the state. Next slide. Okay. I've... I think I have one more slide here, and this is about calculating multiple performance rates, and it can... You know, probably be relatively quick here, because, as I stated, there are no stratification requirements for measure year 2026, which means there are no stratification requirements probably beyond 2028 because that's the first year that they would be published, or before 2028 rather. I'm... I apologize. And this table here is from the subregulatory guidance, and it's intended to show you what CMS is considering subrates for each measure, which is no different from the current HEDIS data collection reporting requirements already. So the the subrates here match the subrates that, plans report to NCQA already. So that would already be addressed. This portion of the subregulatory guidance and requirements would already be addressed through our current HEDIS process. Next slide. Alright. This is Wendy's turn. Wendy, should we jump into it or go... Get into some of these questions? I have not been able to follow. I think there's a two. Maybe take look at the first two questions. The first one, actually, I can ask you. Does the QRS apply to prepaid mental health plans? Yes. I'm assuming that's a PIHP prepaid inpatient health plan. Yes. It would apply. Health plans. Yep. Correct. Yep. And then there's another one that... Did I hear correctly that MY twenty twenty six results feed 12/31/2028 state reporting? So regardless of states sharing their own requirements, it sounds like plans must report MAT QRS measures in measurement year 2026 if they want to be included in mandatory state 12/3128 reporting. That's correct. CMS is stating that the first year of data that would need to be published by 12/31/2028 is measure year 2026. There is a stipulation in the rule that if states... First of all, that they can ask for that one year extension, but also if they are unable to report certain measures or unable to get complete data for for measures that they can include that in an annual report, regarding data that were missed or reporting burden and the impact on their rates. So there is a sort of, call it, like, a continuous quality improvement, data and reporting process to this rule as well. Alright. I think there's some that have come in that'll be answered when I do my section. So maybe we'll move on and Okay. Circle back. Okay? And I might type some answers while you're doing that too. Yep. Sounds good. Alright. Thanks, Tom. So I'm gonna talk a little bit about, really kinda why NCQA decided to kinda enter into this space, and it's really as about the screen says here, kind of streamlining the measure data collection and reporting process. So we can go to the next slide and really talking through howfirst of all, many of you on this call either participate in some way, shape, or form, probably in some HEDIS reporting to NCQA. Maybe you submit your Medicaid HEDIS results to NCQA for accreditation or to meet state reporting requirements. You may also do this for other CMS requirements or other lines of business. So NCQA is really looking to support these MET QRS efforts as a way to reduce duplicative work, redundant work. We keep hearing that we need to find ways to reduce burden in the marketplace, and so really kind of looking to see where was an opportunity for NCQA to leverage supporting these efforts, knowing that a lot of it would be redundant with some of the work that you're doing. So because the MAT QRS is a state reporting requirement, it will be mandatory. We did see this as an opportunity to really align kind of where those measures overlap to support that, to help reduce that redundancy or that need to stand up something secondarily if possible. The measures overlap quite nicely, as Tom pointed out in the slide. 11 of them are HEDIS, there's CAHPS, and then those three non HEDIS measures, but do follow very similarly to performance measure structures. So we really wanted to offer a way to minimize or potentially minimize duplicative reporting or unnecessary burden for having to maybe stand up a reporting template or something of that nature that would have to be done in addition to work that you're already doing to report to NCQA with the same data under the same audit, and really kind of just offering a way to contribute to quality ratings reporting in an accurate way with those same data. So, Garcine's going to get into the details when I pass this over to her, but on the next slide, I did want to talk about, and that's where some of the questions that I see kind of popping up in the Q and A, is where some of this really does streamline kind of more in line. If we want to advance to the next slide, as we've mentioned and probably will mention a couple more times, the measuresthe majority of the measures are already maintained by NCQA. They are HEDIS measures, and so really what we did is we reached out to the measure stewards to say, Hey, we understand these are all included in the MAT QRS measure set. We would like to develop a process by which the non HEDIS measures can also be reported at the same time through the same data collection system. So using the IDSS, setting up a similar process by which you would have a data element table, to really allow that kind of one time process by which you're going through reporting data collection and making that a little more streamlined where possible. The HEDIS compliance audit really does meet a lot of the requirements for not just HEDIS measures, but any performance measure, and because there is a requirement in the MAT QRS that these measure rates are validated, the HEDIS audit will meet that validation requirement. We envision this very much kind of adding on to maybe the current HEDIS audit that you undergo already. Many of you are gearing up to get that started here pretty soon, but these three non HEDIS measures, the set that's already part of the measure set that are HEDIS as well as your CAHPS, really should nicely just be able to roll into the HEDIS audit that you're preparing for additional measures, those three measures using the same data, same types of systems. So really, we're going to encourage you to work with your auditor to kind of see how this can be accommodated, but really the goal is that we see an opportunity to not have to make organizations kind of deviate from maybe the standard annual audit and reporting processes that you do already, and really just kind of offering a glide path by which this can be accommodated in that same stream. So before I pass this over to Garcine to get into more of the specific details around our reporting systems or how you might do this, there are a couple of questions that I will go ahead and answer live. One of them is, Will vendors be incorporating these non HEDIS measures into their standard reporting set, or will those be considered custom measures that will cost plans more to report? I do not know the process by which vendors charge or do any of that additional work. We are not certifying these measures, at least for this first year. There has not been any indication that we're going to include those into our certified measure set, but we have been kind of transparent with the vendors as they are aware that we will be collecting these data. We are kind of testing them in our IDSS system. The vendors have been participating in that so they are aware of them, but you will have to contact your vendor directly to find out what that will look like to include them. There's a question for non NCQA measures. What is required for auditing prior to submission? They are not currently subject to certified HIE's compliance audits or they are not NCQA measures. So, as I mentioned, the MAT QRS does require that the measure rates are validated and the HEDIS audit does meet that requirement for validation. So as I mentioned, they can be audited as part of the HEDIS audit if that's how the situation is arranged between the plan and their audit firm. So we would encourage those conversations to kind of happen now if this is something that you're looking to do in measurement year '26. And then it says, Do you mean we will not need a separate audit for MAT QRS? That is the intention. If you have your data together, your intentions are to report the MAT QRS set. There's maybe probably overlap with your state set. The accreditation set aligns very nicely. These three measures can be added on or could be added on to the HEDIS audit, and you should be able to do that completely throughout the audit season. Again, best to talk to your auditors about that to see how to incorporate that and indicate that that's something that you're interested in doing. There is a question. There are more than a few states that do not follow the HIEDA submission timeline. What is NCQA's plan for such states and MAT QRS reporting timelines? So unfortunately, at this time, our IDSS submission systems are only open according to the HIEDAS timeline, so we do have a June 15 stop, so the process right now that we are offering really aligns more with those who are going to report that traditional HIEDA cycle with those results coming in on June 15. We will, I think as Tom mentioned, this is an evolving program, potential stratifications down the road, so something that we'll keep in mind and work closely with CMS, as the program evolves. So another question around the vendor technologies. The vendors are not being certified on these measures. They do have the specifications. Similar to other non HEDIS measures that I know many vendors do create for or support for plans, These would undergo probably a logic review or a source code review type process as part of the audit, but we can offer more guidance on that post the call. One question on these measures would be submitted through IDSS. Yes, if you are reporting the MAQRS measure set, you're reporting HEDIS to NCQA, we are going to accommodate the reporting of the three non HEDIS measures through IDSS as well. Then I might be, Garcin, I'm gonna pass it to you and gonna digest the next couple of questions in the queue. So thank you. Alright. Thank you, Wendy, for answering all of those questions. So I am Garcin Duckett. I am the director for data collection. I'm gonna spend a little bit of time on our last part of the presentation talking about the next steps, for those who are interested in reporting MAC QRS to NCQA. Next slide. So what's provided for reporting? So many of you are familiar with our NCQA reporting tools, HOQ and IDSS. But those that are not familiar, HoQ is our health care organization questionnaire, and this is where the data collection process starts. So organizations begin requesting their submissions in the HoQ for what they would like to report for the year. So MacQA's component will be available in the HoQ when it's released for all of the Medicaid submissions, so you will have access to add that component to your submission. And then the IDSS system, it's the interactive data submission system, and this is where the HEDIS and the non HEDIS measure data will be imported for each submission. So for this year, we added a component style type of submission where, one submission can be used to fulfill the MAC QRS requirements. So we have our 11, HEDIS measures that Tom spoke about. And then the non HEDIS measures, which are those three, measures, where you're able to import into one submission file. This will help to reduce the number of submissions that are needed to meet the MAC QRS requirement. Then next, we have, resources. So along with the MAC QRS technical, resource manual, that Tom mentioned earlier, we've created our own documentation to help align reporting with requirements. So our IDSS files will also be available on our website. That will include our MAC QRS specific non HEDIS files along with information on how to report these measures in IDSS. So for our data reporting end use, so IDSS does have exports, and these exports will include the Mac QRS non HEDIS data. So they will be available for download, in many different formats. Also, the submission that you're trying to use for MAC QRS. So if you have a Medicaid submission, and you would like to report MAC QRS, that submission can be used for multiple programs. Like, if you are NCQA credited for Medicaid, you can also use that submission, to meet the requirements for MAC QRS and then also for your accreditation, just as long as you have the same population and all of the measures that you need are reported in that submission. And then for our communication and assistance, so we do have, account, assigned account managers that will help support Mac URS. We also have communications that we begin sending out in the October time frame with information that you may need to know before the season gets started. So all of that will be set up before, the data collection time frame begins in December. Alright. Next slide. Alright. So we put together some of the most common plan scenarios, that... For those plans that may want to report MAC QRS to us. So if you're already reporting Medicaid, HEDIS, and CAHPS, this is our our most common scenario. This is where you would add your MAC QRS component to your existing submission. This is with no separate submission required. And then our next scenario is for our new health plans. So if you are a new health plan and you've never reported HIE to stay up to us before, we ask that you reach out to the my NCQA portal, and let us know that you're interested in reporting MAC QRS. Because that's where we will set you up in our system so that you can receive our data collection communications. And then, like, any information that's important to know before the season begins. But for new health plans, a new submission would be requested in the HOQ where you would select HIEDAS, CAPS, and the MAC QRS component. Then for plans that are reporting for a chip, so your state may require you to report your chip members separately. So in this case, another submission would be needed, to create... To have those CHIP members only be reported in that submission. So you would have two submissions in this case. You may have a submission with, Medicaid and CHIP, and then you would have one stand alone submission with just those CHIP members. So these are just our most common scenarios. It's not a complete list. So if you do have a scenario that we didn't capture here, just please feel free to reach out to our team, and we can walk through your scenario with you. Right? Next slide. So on our next slide, we are... These are the next things that we want you to do. So if you are interested in reporting, we do want you to confirm with your state which, MAC QRS measures apply to your programs. And then we want you to take a look at the CMS technical resource manual, and compare that to our NCQA resource page. Our resource page has FAQs. It has, some questions. It has updates on our IDSS files. It has a lot of information there that you can compare back to, and then our HIE does volume two specification. And then also confirm your MAC QRS coverage with your auditor and your vendor, as Wendy spoke about, earlier, just so that they can prepare for this year's reporting. If you do decide to go through NCQA to, report your MAC QRS measures, we ask that when the HOQ was released, which that will happen in December, that you select the MAC QRS component, in the HOQ. Alright. So, next slide. Alright. So if you are interested in reporting to NCQA for m y twenty six, these are the key dates and deadlines that, are needed for reporting. So we... I think there was a question that asked about the timing. So from January to 12/31/2026, this is the data behind the MAC QRS ratings. So if you would like to report for this, you would need to report this data in 2027. So between October and November, if you haven't already secured your vendor firms and your audit firms, asked questions, this is the time to start getting prepared for it. Then in December, that's when we release the HoQ, and this is where health plans will start to request their submissions and start working with the data collection team. So you have from December until February... The first week of February to, request those submissions. And then from March to June 15, this is when the IDSS is released to health plans. So that's when you can start uploading, your HEDIS and your non HEDIS measures to IDSS. So m y twenty six data must be reported by 06/15/2027. Now these are just some key dates and, milestones, but we do have, a more detailed timeline on our data collection. I'm sorry, data submission NCQA resource page that will give you, all the dates, by month. Okay. So I think I'm at the end of my presentation, and I know there's some questions in here in the QA section. So I'm gonna try to see if there's any that we want to I'm happy to read some out to you, Garcia, and I've been kinda flagging them. Okay. Okay. There's a question. Idss requires the measures to have a GUID and that it is validated. So for the non HEDIS measures, is this validation point going to be turned off? Yes. So we have worked on turning off the validation for these measures since they're not certified. So IDSS will not throw a validation for the three non measures. Okay. Thank you. So we received, so we're looking to get some clarification. Will the MAC QRS submission containing the three non HEDIS measures have the same sub ID as the corresponding Medicaid submission, or will it have a separate submission ID? So it it can do both. So if you already report and you have a submission ID and the population is the same, you can use that same submission ID and just add the MAC QRS component to it. Now if you haven't never reported or if you have a separate population that you want to report from at QRS, that's when you'll get a new submission ID. Thank you. Is the IDSS upload format for the non HEDIS measure upload XML only, or will other options be available like Excel? So as of right now, it's only XML. We only provided the XML format because that's the format that IDSS, receives. So, we do have all of that. The measure templates and all of that will be on our website this week. So you can take a look at that to see if any of those, file formats meet your needs. There's a question. When will the MAT QRS documentation technical specifications be available for download? There was a link in the slide. I think one of our slides showed that link, but they are out there. They are available now. I think there's a map probably on the CMS webpage. When the slides get sent out after this webinar, there's also a link on one of the slides there that you can get those, so that's there. There's a question on, Will states have access to the IDSS exports available for MAP QRS? If not, how will states obtain these results in order to populate their state QRS? I can start with this one and then others chime in. We do not give IDSS access to anybody. That is really all driven by the owner of the data. So as typically the primary HEDIS contact assigns access to their IDSS, to their auditor, to their vendor, whoever they need access to it. So the short answer to this is no, states will not have access to the IDSS for direct download. So a couple of ways in which they can get those results is either directly through the plan would send either the XML export or the Excel file data workbook. There are other options by which NCQA can contract with the state to provide a state extract for any plan in that state that is reporting, and that would be between NCQA and the state, but ultimately we will not be giving states access to IDSS. Tom, I think there's a couple of... Garcine, I don't know real quick. Can you share what MAT QRS will look like in the HoQ? And I don't know necessarily that you have a visual, but maybe talk through a little bit, more on that one. Yeah. Sure. So we're working on it right now, so I don't have a visual. But what it will look like is you're familiar with it, you know that when you request a Medicaid submission, you'll see a a list of questions. You'll see, the Medicaid HMO, then you'll see a submission type, but then you'll see the question of, are you submitting measures to IDSS? So that's normally representing the HIEDA side. That, yes, I wanna import a a file into IDSS, and I wanna give I d s... I wanna give HIEDAS measures. So what we're doing is we're gonna add an additional question that says, only for Medicaid submissions, are you, reporting for MAC QRS or the three non HEDIS measures? I'm sorry. The three non HEDIS measures in MAC QRS. And if you say yes to that, that is what will add the component to your submission. So that's what it will look like. We will have some mock ups, soon enough, but we just started working on the HOQ. Tom, I think there's a couple I'm gonna toss to you. There's one that talks a little bit about, choosing to report through NCQA or not, and whether this is a requirement, what is the alternative. So I'm gonna toss that one to you. Yes. Thank you. I think I flagged that one. Yeah. We are actively working with a number of states to let them know about this option. And the reason we're doing that is because it's a much more cost efficient way for states to meet this reporting requirement. And second, if states don't choose this approach, then they will have to require, like, an external quality review organization or some other organization to do this work for all mandatory measures through the health plans. So the idea was that health plans would benefit from just leveraging the existing HIE does reporting process and HIE does audit process to meet all of the requirements for this reporting requirement rather than having to meet the HIE's requirements because they're required to by their state and then go through a separate process for all mandatory measures to meet the MAC QRS reporting requirements. So that's sort of what we're we're talking with states about, and it is not it is not required to use NCQA for this. The the rule doesn't say you have to go through NCQA. And... But when we looked at the rule, we thought it could be a pretty efficient and effective way for plans and states to meet the requirements and not spend a lot more money or stand up brand new reporting infrastructure and processes and just sort of seamlessly use the existing reporting process and strategy to meet this requirement. So that's kind of why we're saying if, you know, if you choose to go this route, because, we can't require ourselves in federal statute, but we can try to provide something to the market to make it, less burdensome. Tom, there's one. Are all state Medicaid agencies prepared to meet these requirements? Many states have not put out any requirements for reporting MAT QRS. Has NCQA worked with each state to support this? So I wonder if you wanted to talk a little bit about. We haven't reached every state. We've been talking with states all of this year, and we've reached probably half of them. And the the most advancement I've seen or heard from states is they are working on the first few steps of the protocol, which is basically identify applicable measures by health health plan type and then start looking at data sources. So they haven't gotten all the way through the protocol process down to the reporting as far as we can tell. But we have met with a number of states and even their health plans to describe this, and those plans are... Or those states rather are are either have already chosen to go... To use our option or are strongly considering going going our route. So if any of you wanted to... Us to talk with your state or come to a health plan state meeting, if if you think this would be a less burdensome approach to meeting the rule, we would be happy to do that. I also saw there were a couple... Oops. I don't mean to be writing on the slide. There were a couple questions here about the protocol 10 and not requiring validation, which, thank you, whoever the anonymous person. It does look like the the protocol was just updated again this month, which I was not aware of. Last it had been updated was in July, and that was requiring validation. And the CMS MACQRS website still states that validation is required. So we'll follow-up with CMS about that. I would also offer that, it's probably in everybody's best interest that these be validated because they are being, published publicly about, each of your health plans. And should they not be validated, that could that could, that'll look how it will look, but we've sort of been down that road before as a as a nationwide health care system. So validation is really in in everybody's best interest, I believe. And some states were considering leveraging MACQRS and the rates in the future for some of their other, policy levers such as incentives or even procurement scoring. So there was... So there is absolutely interest in using these measure rates for significant policy decisions, which, you know, suggests that validation is is very important. There's a question around if we select submitting, a QRS through the HoQ and IDSS and then change a decision prior to submission, is there any issue with the HIE to submission? So in this event... And, Garcin, you probably can answer a little more clearly, but there is the ability to back it out, or remove the submission prior to June 15. Right? Yeah. Yeah. So if you decide that you don't wanna report MAC QRS, we can remove the component. So if you wanna still report HIE to... You can do that. But if you decide you don't want to do MAC QRS, we can, remove it. We do ask that as soon as you know, you let us know so that we can remove it and so that things in IDSS can show correctly. There is another question that I flagged. Where is it? Okay. The other question is, does the HoQ acts if the same population that is reported under Medicaid CHIP will be included in MAC QRS as well? So we don't have a specific question for this. We are trying to do a little bit more alignment across the board. So we are adding a validation that is asking this question. So before you can go all the way through and say you're finished with requesting your submission, you'll get a question that says, are you sure this is the same population that you want to report? So, we do have something like that, but not Medicaid, CHIP, MAC QRS specific. There's a question. If the non HEDIS measures are not being validated, PMV will still need to be conducted separately. I'm not seeing that this will save steps for states and potentially create confusion if these non HEDIS measures are included in the IDSS. So, to be clear, I think, you know, just to reiterate, this is an offering that NCQA is putting out there as optional. As Tom stated, we can't make our process required for this. We just know that many of you are reporting to NCQA already these HEDIS measures, and therefore potentially adding the additional three could be a benefit, could be a burden reduction. If you are not doing the MAT QRS-three measures, you don't have to add that component, so there's nothingthere areyes, it's still quite possible that organizations will have to undergo a PMV through their ECRO and a HEDIS audit to come to NCQA. We're just offering this up as an option, so it is possible that it may not be solving problems right away. In addition, I think as a follow on to this one, it was a question around, are we going to expand this to all core set measures or just the QRS ones? This is our first endeavor into supporting measures that are not ours in our data collection system. So we will see, there is a potential that this could kind of be the catapult to being able to expand IDSS for other use cases as well to allow for any performance measures to come in through this same process to offer that kind of a one stop reporting platform, but no timeline or commitment to that as of yet. And sorry if we answered this and and missed it. We've we've got 55 questions, so we're we're speedily trying to respond to everybody. But I've seen a couple times, how states get the rates. Did we mention Quality Compass, guys? Oh, no. Okay. So Quality Compass is one way that we are looking at providing these measure rates to states. Kathy, Davis asking the question. So what... Again, we were trying not to add a bunch more burden and cost to meet this requirement. So we're really looking at how do we leverage what we have existing that's already collecting rates from health plans and providing rates to states, for essentially the same thing we're talking about here, which is a quality evaluation and comparison. So we are looking at, you know, leveraging Quality Compass, to provide those rates to states so there is no, like, additional, cost. That one. Will MAC QRS reporting be a required element or standard for NCQA accreditation? There is no requirement for accreditation or standard tied to this, so that answer is no. Some of these, so there's a question around, an organization who has two audit firms and how to decide how best to incorporate this into that audit. We probably can't speak specifically to kind of how you would go about that, probably because each of your scenarios are going be a little bit different. But in the event that you are juggling that, we are happy to discuss that, or it also potentially could be more of a direction from your state. As I would imagine, if there's a state audit that is funding that audit and then you are paying for other audits, likely connect with the state to see how best they would want this incorporated, as part of their audit or as part of the audit that you're doing on your own. But that one likely would be more of a state by state or plan level type of, answer, not necessarily a blanket one for all of you. There was one about alignment of MAC QRS and HPR. And so just to, give you all a sense, initially, when MAC QRS came out, we... That's that's immediately where our thoughts went is if we could, you know, create some alignment there so, you know, we don't have to create the wheel again. And that's when we discovered that the current MAC QRS is not yet intended to be an aggregated rating. And so that sort of disrupts alignment a little bit, but we did that year add some measures to HPR that were on the mandatory measure set. So we are monitoring actively and going in the direction of how can we keep MACQRS and HPR aligned to the extent possible. So that is sort of the part of the vision. And there was... Okay. Question. I'm gonna go to this one. It appears that the population for the QRS project should match our accreditation population. Should QRS be holistic of all of our Medicaid, or should it be broken down by subpopulations in our state? You want me to start that one out, Wendy? Start? My guess is it's going to be... I think this one plays into how your CHIP is set up if you're talking Medicaid and CHIP. So... Yeah. Yeah. So some states administer their CHIP or children health insurance program populations separate from their Medicaid or Medicaid managed care populations. And in these cases, these states already require their CHIP plans to submit separate from the population... The CHIP population separate from the managed care population. So what we found is for the most part, these Medicaid MCOs are already required or or familiar with submitting separate populations to NCQA. It... One policy issue states are are stuck with now is their quality withholds. And how do they how do they require reporting for the quality withhold in a way that maintains the integrity of that incentive structure while also creating reporting requirements that align with the requirements of MACQRS reporting, which aren't exactly aligned with how states have, have looked at their incentive programs. So it could be, states will choose to have separate submissions specific to their quality withhold and separate submission specific to MAC QRS, at least initially. And then there would be alignment, hopefully, in the next few years to where accreditation, MACURS, and incentives are all the same, submission. Some states actually already require, their health plans to include Medicare or Medicaid fee for service data into their health plan submissions, and those submissions are included in our benchmarking and move forward. So in some cases, that integration is already part of our quality evaluation system. So, states do it differently, and in some cases, it's already required, and part of the benchmark. In some cases, it is required to be separated out. So it it will be sort of up to the state how they choose to to to pursue this. It's, we maybe have time for one more, and then I think we do have another couple slides to wrap this up. There is a question on will inclusion of non HEDIS measures in the HoQ IDSS files count for PMV? Will PMV for these measures, if included, be completed as part of the HEDIS audit? If not, inclusion in the IDSS could be misconstrued as audited by individuals not familiar with the limitations. So to come through the IDSS, any measure that's coming in, whether it's a HEDIS measure or one of the non HEDIS measures, will require, an audit designation. So they will have undergone the audit. The HEDIS audit does meet the protocol for a PMV audit, if that's how the state is meeting those requirements. So I think it's really just, you know, making sure that as you're endeavoring down this path, if it's something you're choosing to consider, making sure that that's all kind of aligned with your organization, with your state, with your auditor, just to make sure that that's being set up correctly should you choose to do that. The rest of these questions that we're not going to have time to get to, we will follow-up along with the slides when they are provided post webinar. We'll do kind of some high level summary of some of the Q and As and get those answered. There are several questions around what the cost looks like, and that information usually is provided as part of like the data collection kickoff and kind of how those are being priced. So we're not going get into that on the call here today, but we will follow-up with that information. So with that, I think we have a couple more slides and we'll wrap it up. So up next, we will be diving a little bit deeper or actually have more of a chance, not really diving deeper on the topic, but really more of a chance for organizations to ask us questions at the Health Innovation Summit. Tom, myself, and our colleague Reza will be at a Meet the Experts session on Tuesday, October 6 from 01:30 to two where organizations can come and ask their questions live to us at that point, and we will do our best to answer those or provide some follow-up afterwards, but look forward to seeing you there if you're able to make it. And with that, on the next slide is just kind of a final, our conference, actually, I guess not. We will wrap it up with a thank you. I was just going to say the Health Innovation Summit starts next week. So those of you that are attending, we will be happy to see you there. Otherwise, have a great rest of your day. And if you have any questions, please do follow-up through my. NCQA and any of us will be happy to support you through this effort or clarify any questions you might have. So thanks again. Thank you.