Good afternoon again, and and welcome. Thank you for joining us today. My name is Alan Immelman. I'm here, as a deputy director of state affairs in NCQA's public policy department. And we're glad that you could join us today to have a state webinar around how accreditation can better help support states and reduce the burden that states are increasingly facing in this day and age. Next slide, please. So a couple quick, housekeeping items before we get started in the presentation. We do have a q and a function. So if you have any questions that you want to enter into the q and a function, please do that instead of the chat. We also have a raise hand function. So if you wanna ask a question verbally, use the raise hand function in Zoom, and our team members will unmute you, and you can ask your question. And lastly, we will have a recording of the event and provide the slides and supporting materials that'll be sent out after the webinar to all attendees. So with that, you go to the next slide. What are we speaking a little bit about today? So today, we're going to run through a couple of agenda topics that we've talked about with states before, but we increasingly want to make sure that states understand the different actual ideas that NCQA has, that we can help support states in reducing the burden as you all face increasing program complexity, staffing pressure. And so today, we'll discuss a little bit about how accreditation, the Medicaid module, NCQA's Medicaid managed care toolkit, and the new MAC QRS requirements and NCQA's nonduplication offerings can really help support state oversight activities, as you continue to face, increased workloads. So that's what's on the docket. Next slide for me, please. Before we even get started into jumping into the agenda, we wanted to first get a temperature check from the audience. We wanted to first see, of the folks that are joining us today, how familiar are you with the concept, the idea of nonduplication? So we have a, we're unfamiliar with nonduplication. B, we're familiar with it, but we don't really know how to put it into practice. Or c, you're very familiar as a state person and that you used up duplication. So give folks just a minute. Think about your answer. Put those in, and then we'll show the results in just a second. Alright. So about thirty eight percent said that they are unfamiliar with it, which is good to know. And about forty six are familiar with it, but don't really, understand how to effectively utilize it or put it into practice. And then seventeen percent, very familiar, and they used non duplication. Okay. So that is helpful context. We now know where folks are. And with that, we could jump right in. So if you could go to the next slide, Marilana. Thank you. Alright. I wanted to provide this at the top of the presentation to really help ground the audience here, in where the idea of nonduplication comes from. So it's grounded in federal Medicaid regulation. I put the citation here on the slide. It's forty two CFR four thirty eight three sixty. And, essentially, what this language is saying is that states can use information from national accreditation reviews, so from, like, NCQA, for all mandatory external quality review activities, including compliance review activities. And the regulation here on the screen, it really helps provide a lot of flexibility for states, and it provides that flexibility without really changing accountability. Right? Because states ultimately get to decide which activities are appropriate for non duplication and use of accreditation and how are they gonna really operationalize that decision. So while this authority has existed for many years, there are many states that are kind of reexamining this with the the workload increase, and are are looking to see if there are kind of reporting requirements that they can start to leverage the NCQA or credit credit review for, as those reporting requirements to the federal government continue to increase. Next slide for me, please. So now that we have that kind of grounding of where nonduplication is outlined in federal reg, we wanted to take a minute to put it all together for you all. So how does it work? How do you actually exercise nonduplication? Well, first and foremost, we're talking about states that are in managed care. Right? So you contract with your MCOs. You're required as a state to have a qualified external quality review done, and there's an EQRO or ECRO that is assigned those kind of responsibilities often. Right? And often, the ECROs do an annual compliance review. And many Medicaid plans are also annually reviewed or every three years reviewed through accreditation through NCQA programs, and they go through the HEDIS audit process every year as well with NCQA. So nonduplication really allows states to now think about leveraging the work that's already being done by NCQA. And rather than having the plan submit the same documentation multiple times to NCQA or to the ECRO for their annual compliance reviews, they can take advantage of nonduplication, reduce that burden on their plans, and state agencies and ECROs alike can preserve kind of program integrity and focus on resources in other areas, deficiencies, state specific priorities rather than repeating existing reviews that accreditation already covers. So the end goal here, as we kind of go through all those bullets, the end goal is to really kind of work smarter and, not work harder and do smarter oversight, not necessarily do less oversight. Right? So if you could go to the next slide for me, we have yet another polling question. Oh, thank you. Yet another polling question about kind of barriers. We wanna understand what is your state's biggest barrier when adopting nonduplication. Is it, again, a, kind of not understanding the roles of the state and what NCQA plays and the ICRW plays, the different roles and responsibilities? Is it, b, potential misalignment between the standards of NCQA and state regulations? Or c, not understanding how to implement done duplication? So I'll give folks just a minute to think about their answer. And then, again, we'll show the results here in a minute. Alright. Should be popping up. Great. Thank you, Maralina. So it looks like about thirty five percent is kind of that not understanding the roles and responsibilities component. Forty eight percent of respondents said the concern about potential misalignment between the credit standards and, state regulations, and then seventeen percent of not understanding how to really go about implementing it. Well, hopefully, we've given you, at least when we provide these slides to you all afterwards, you have that reference of how we really envision it all working. But we're gonna keep going. If you could go to the next slide. We wanted to kind of delve into some of the different, offerings that we have to states when thinking about how to exercise nonduplication in the most effective manner. Right? So the one tool kind of in your toolbox when looking at a credit review is what we call the Medicaid module or the med module. So the med module was really a set of optional standards that it's associated with health plan accreditation, so it's linked together. And it was really designed to help support Medicaid managed care oversight and activities. It directly aligns with what's in the Medicaid managed care final rule, and states can require their plans to undergo this optional set of standards, which is the med module. So you can expand the areas of NCQA's evaluation that kind of goes beyond the traditional health plan accreditation standard review. And it was really intentionally created to help support the nonduplication idea and the opportunity for states to really help ease that administrative burden. And we again, we reviewed these results, and they may remain valid for three years. So, again, it's kind of attached with health plan accreditation, and that really creates kind of long term oversight, you know, of, information for the states to use. So so that's what the med module is kind of in a nutshell. If you could go to the next slide, please. I wanted to then give you a sense of kind of what is in the med module. So these are, a a set of kind of different covered areas. So it covers care coordination, quality improvement, utilization management, information and communication services, and directories. So many of these areas are already covered in core health plan accreditation, but we build on these areas to, increase the alignment with the federal Medicaid requirements in the med module. So we build on them even more. And you can go to the next slide, please. Alright. So what's important when thinking about whether this med module makes sense for you all at the state level to consider adding on to any existing requirements that you have for health plan accreditation, we wanted to give you a sense of, you know, how do we score it, and how do you get the results, and all of that. So the med module, it really, again, provides states with that standardized regulatory kind of review type process. Right? The results are all reported separately from the core health plan accredit status, and states ultimately remain, you know, the authority for how the results are used. So you all get to decide. We at NCQA, what we do is we generate a regulatory report after the plans go through health plan accreditation, and in this case, the med module. So we get a report at the end, and that is what really helps, a lot of the states that do utilize non duplication. That report really helps states, conduct their oversight activities because that allows states to then see, that NCQA has gone in and reviewed the plans, that there's kind of consistent findings across plans, where the kind of standardized structure can help simplify oversight, where the ECRO can then be utilized to look at certain deficiencies in certain areas that maybe the plants aren't doing well in. And so this is our way of providing all of the results for that earlier point I tried to make about, the states being the one that are still in the driving seat for then. Okay. Let's go look at this particular area. Next slide for me, please. Alright. So now that we talked a little bit about the med module, we have this polling question of which of the following statements best characterizes your familiarity with the med module? So a, we require MCEOs to go through that optional additional set of standards. B, we're familiar with it, but, we need some support maybe from NCQA in considering, you know, using it. Or c, we're not familiar with it, but we are interested in learning more. So I'll give folks just a minute to think about your answer, and then we'll show the results. Alright. Thank you, Marilena. So, looks like ten percent for we require, twenty four percent, need some additional support, some familiarity. And then the overwhelming majority, are not familiar with it but are interested in learning more. So that's why that's really great feedback, and thank you all for providing that. That's why we've tried to, in years past, continue to talk about it. We feel like it's a a set of additional standards that not many states, do know know about, and, we're really excited to bring this, in front of you all. So that's great. That's great feedback. Thank you. Next slide for me, please. Okay. So state Medicaid uses of a credit nonduplication. So I wanted to just, spend a minute here kind of illustrating the several ways that states can and do leverage NCQA programs. Right? So try to put it again, all all of this together. So the Accredit standards, they can be applied to support external quality review compliance activities. Right? The med module that I just talked about, it expands that available nonduplication opportunities. Right? And then towards the bottom of the slide, I think what's also important to recognize are the NCQA HIE's audits that are part of the HIE's, process. So the HIE's audits are frequently leveraged, by states for performance measure validation activities. Right? That's p the PMV on the slide. So, states can use that submission process to meet the requirements of performance measure validation and utilize NCQA's existing HIE to submission process for for PMV. So that reminder. And then, one of the new things for this year's kind of presentation about nonduplication and all of these opportunities that we're really excited about is MAC QRS. And that's kind of the the new additional set of opportunities to kind of, NCQA is offering to help build upon existing reporting and audit infrastructure that we already have to help support states to do MAC QRS, as required by the federal government. So these tool all these tools kind of put together, they can help states really create a coordinated oversight strategy rather than necessarily, like, implementing multiple independent review processes. NCQA kind of helps provide kind of a one stop shop in a lot of ways. And I forgot to mention towards the top of the presentation that my colleague, Tom Curtis, he's gonna be talking about the the new MAC QRS offering that we're providing to states, in just a a couple slides, so he'll be coming up, shortly. So if you go to the next slide, please. Okay. So the audit. I wanted to spend a minute kind of delving into that a little bit deeper. The HEDIS audit really evaluates data systems, right, and measure production and reporting processes. And it helps to support states as that independent validation process of, providing you all that, that confidence in in the performance results that are collected by NCQA. So states can often leverage this work as part of performance measure validation activities, and NCQA maintains the audit standards and the auditor oversight to ensure that there's kind of consistency across organizations. And plans are already invested in these activities. Right? They've been doing HEDIS reporting for many years, and often, this now creates an opportunity for a state to maximize the kind of value of these existing processes and these invest existing investments into these processes that plans already make making. Right? And, this approach really can help, again, reduce that kind of redundancy of review cycles while really providing states that confidence in in the reporting of outcomes. Next slide for me, please. Alright. So how, how states use accreditation. So for those states that are already kind of taking advantage of the non duplication and and these different NCQA credit programs and HIE does audit, etcetera, we wanted to spend a minute about, you know, what do they do? How do they put it all together? Well, one of the major components of putting it all together is using what I like to kind of refer to as the map. The map is, NCQA's Medicaid managed care toolkit. And the why I refer to it as the map, even though it's an Excel document, is because that is NCQA's analysis of the all the accredit requirements in health plan accreditation, the med module, health outcomes accreditation, LTSS distinction, all those things. It's the map of where our Accredit requirements meet the CFRs and the federal Medicaid rules that are eligible for nonduplication. So it tells you in this document where that analysis and equivalency is. Right? So as I mentioned before, we provide states the Accredited reports, the results of the different surveys that the plans go through. And that allows plans to identify, are these certain areas that then NCQA has mapped out in the toolkit to say that these are actually federal Medicaid requirements? And our plans are potentially, they've done poorly in certain areas that NCQA has analyzed and mapped to the federal Medicaid requirements. And so those are really the ones we really wanna pay attention to, or, we want them to go through some kind of correction corrective action process with NCQA, or we want them to be looked at by the ECRO. So it gives you all that information, and the map or the toolkit kind of puts all that information together for states. And then last, I just wanted to include so if you do the med module, know that it that is scored at a hundred percent compliance. So it's a rigorous review of those additional standards, for either meeting the requirements or not. So with that, could you go to the next slide now that hopefully folks understand kind of how to put it all together? I did wanna take a minute still to talk about so what is this map? What is this toolkit? I talked about how it's our analysis of the federal Medicaid requirements compared to NCQA accredit programs, and it is a structured crosswalk, as we call it, between the regulations in the federal Medicare federal Medicaid managed care rules and their credit standards. And so states can use this toolkit. It's a free resource. It's on our website, and they can look at this technical resource when really evaluating nonduplication opportunities. Where do you want to use it? And the toolkit incorporates all those programs I mentioned before, health plan, LTSS, the med module, and we update it annually. So that way, it's always up to date for whatever is changing on the federal Medicaid level to help support states in operationalizing, non duplication. And so this is really what I like to think, and that's why I call it the map because that oftentimes is that starting point for, where you want to start thinking about using nonduplication. If you go to the next slide. So if you were to open it up and and go onto our website, download it today, again, it's free, how do you interpret it? Because it is a large document, and there's many columns, and it's in Excel, but it's not as complex it might look on the surface. Right? We organize the toolkit around those federal Medicaid requirements that are eligible for nonduplication. We, we break them out by the tabs that I list here on the slide, tab four, five, and six, by the different areas. And then NCQA, again, we go through every year, and we do an analysis of where NCQA accreditation standards meet, partially meet, or do not meet federal Medicaid requirements, right, in particular areas. So we're really trying to provide clear transparency around the alignment. So for those that answered earlier, about, being unsure of the alignment with, you know, different regulatory requirements and NCQA standards. We are always happy to do this type of work, and we do it for federal Medicaid so that you all have that transparent view into alignment with the different federal regulations. So states can then quickly identify areas where credit review can be used to help support EQR activities. Right? And it helps identify gaps where, again, that additional state review is needed or risk based targeting for, again, a more targeted oversight. So that's how you read it. If you go to the next slide for me, I talked a minute about how how to get to the toolkit. So it's on our website, but more specifically, there's a section of our website that's like the NCQA store. That's where all the publications and the standards are located. It's under other products, so kind of tuck towards the end there. And then, once you do the little drop down menu, you'll see that the, Medicaid managed toolkit is an option. Again, it's updated annually. The twenty six twenty twenty six version will be coming out in the next, week or so. So keep a a lookout for that, but this gives you a sense of, where you can get it, how you can just check it out in your, your cart, and it costs no money. And then you can start delving into where in the toolkit we want to utilize non duplication for. And, oh, I I think I included an additional bullet down there. That's often then where states put that into their quality strategies. You say, okay. We're gonna use it for these certain, EQR related activities, and we're gonna leverage this NCQA nonduplication option, for these areas. So that's how you use it. If you could go to the next slide for me, please, Maralena. I think here, my thinking was I wanna give you all an example of actually in the toolkit how to use it. Right? So on the left, you can see that there will be a federal Medicaid, requirement. Four thirty eight two zero eight. A particular provision is outlined specifically b three. Right? And it talks about doing an initial screening of members within ninety days of enrollment. Right? And then on the right hand side, that that, access to care requirement, that's eligible for non duplication. And on the right hand side, that's where we've built out specifically where we will review plan documentation to review and, determine, are they conducting screenings, for all new members within ninety days of enrollment? So then we provide the equivalency analysis at the end, which I kind of denoted with a a check mark there of we have a standard for that. It is the same standard as what's in the federal Medicaid requirements, so that is something that you could leverage, nonduplication for and a HIE review for. So that's an example. If you could go to the next slide for me. Our next polling question is how can we update the toolkit to make it more useful? So this is a free text answer field. I'll give folks maybe a little longer to write your thoughts out. Again, just, you know, think about how we can be more useful or how this analysis toolkit map document, how could it be made more useful for you? Give folks just a minute. We're not gonna review the results now, but we are going to take your feedback that you provide to us about what we can do to make it even more useful than perhaps already is. And we're gonna take that feedback to NCQA and work on future iterations of it to make sure that is the utmost useful document and analysis that we could provide to you as a state. Alright. With that, Marilyn, if we could go to the next slide, I think yep. So this is now where my colleague, Tom Curtis, will take over and talk about NCQA solutions for MacQRS. Take it away, Tom. Thank you, Alan. Good afternoon. There may be some of you still. Good morning. I actually want to pause for a second because there's a couple questions in the q and a. Alan, maybe you can answer this first one. Will you share the link to the Medicaid managed care toolkit? Or maybe and maybe you covered that since it was asked, but just wanna Yeah. Yeah. I I think we certainly can, provide that either either now or or afterwards when we provide the materials. We'll make sure you you all have a link. Not a problem. Yep. And did we say, or are we gonna say when the next one will be released? The next version of the toolkit? Yeah. I I think I alluded to you, that it's gonna be available at, like, the end of this week. Yep. Okay. Next week. Yeah. Friday. Thank you. Yep. And then, David, you, submitted a question. How does your toolkit address the use case where states include non HEDIS measures in their ECRO reporting? ECRO charges by plan, not by number of measures. So if there is even, one non HEDIS measure included, states still have to use ACROS. Do you have the do your documents address which non HEDIS measures can be covered by NCQA HPA? So, David, at this point, the only process covering non HEDIS measures is the MAC QRS process, where we have received approval from the steward the measure stewards to include collection of those three non HEDIS measures that are part of the mandatory QRS measure reporting in our audit and reporting process. So those are currently covered. That's separate from health plan accreditation, necessarily. So the other thing I'll mention here is p the PMV protocol for performance measure validation, or any measures that a state chooses to utilize for evaluating their Medicaid managed care program and and thusly including in their technical report submitted to CMS, does not have to include non HEDIS measures. If if a state wants to use a non HEDIS measure, they could do so for other purposes besides the technical report, and still, and and not therefore, not have to pay an ACRO to to implement that measure, and require their plans to do so. So it really goes back to a state's choice in what measures are being used to meet that ACRO technical report requirement and less so about NCQA and what it does and does not allow. So that's sort of the cost driver in in that question is what the state's choosing to incorporate in the PMV. Okay. So now and it looked like there was another oh, Amy, you're answering the the other question. Okay. So I'm gonna shift this into MacQRS discussion. So you can go right to the next slide. So what is MacQRS? So just in case, any of you have not heard much about this or we've had, two office hours for states over the last several months. And in case you haven't been able to make those, I'll do a quick run through. So MACURS is, Medicaid and CHIP quality rating system. It's a quality reporting program that's designed to allow beneficiaries, Medicaid beneficiaries, to compare and contrast and select health plans across a variety of quality measures. The intent is that these quality measure ratings or performance rates would be posted publicly by the state, for each health plan in their, in their Medicaid program. But this could be an MCO, a PIHP, or a PHP. So all three medic managed care entities types are subject to this rule, and the perform the quality ratings have to be published by December thirty first twenty twenty eight. Now the caveat there is states are allowed through the regulation to, request a one year extension of that deadline. So if that becomes the case, then, of course, the the deadline would be December thirty first twenty twenty nine. There is a mandatory measure set that CMS has, put out for states to follow. There are nineteen measures, in this mandatory measure list, and sixteen of those are HEDIS or CAPS measures that are allowed that are, being collected through the NCQA HEDIS process. States can include additional measures in their MAC QRS process, but they cannot remove any of the current nineteen mandatory measure set. Now there is a caveat there in the regulation because states do have the ability to assign certain measures to certain managed care entities or not based on what that managed care entity is responsible for providing for their population. So for example, if there was a, specialty behavioral health carve out PIHP, it wouldn't make sense to monitor that type of plan on breast cancer screening, because that plan is not paying for that type of, service. That that plan is not responsible for providing that type of service for the population. So there are caveats to to sort of excluding a plan from from requiring a certain measure. There is, components of the regulation that do allow states to discuss an alternative rating methodology with CMS, but that guidance has not yet been released. And there, to do to request that alternative methodology, states do have to follow that that guidance once it's released. Can go to the next slide. Alright. So, in in accordance with the regulation, CMS has also released an ECRO protocol ten. And so if you haven't seen this protocol or you're not familiar with it yet, I encourage you to reach out to your CMS contact. And you may also reach out to NCQA, we can provide the link, and we can also connect you with, folks at CMS that are really eager to talk through MAC QRS and the protocol ten with you all, at your at your convenience. And so we'd be happy to connect them to to, connect you with them. But what protocol ten essentially lays out is a decision tree, resource, that goes through what I just talked about, assigning mandatory measures to specific managed care entities based on the service set that that managed care entity is responsible for providing for their population. The as you get into this process, you're gonna wanna make sure the CAPS measures are are being taken are are reviewed closely for their applicability to a specific managed care entity. So for example, CAPS measure may say, timely my my doctor gave me timely care. And if it's a dental carve out for, as a PAHP, that may not necessarily be an applicable caps measure, but that would be at the discretion of the state to choose. And this decision tree sort of walks you through those types of decisions. There may be opportunities in the future for states to think about, joining or coordinating performance across these carve out type, managed care plans. So for example, while you may not, hold a Medicaid m c physical health MCO accountable for follow-up after hospitalization for mental illness, you may wanna think about doing that in the future because then you're coordinating the the performance of that MCO with that behavioral health specialty carve out plan, the PIHP. So one way to maybe start thinking about how to get these plans to work better together is to adopt these, some of these measures that may be carved out, but the plan should be coordinating on making sure that the member themselves are getting treated, in the best way. So there's those kinds of opportunities may exist in the future here. The protocol ten also lays out a performance measure rate versus a quality rating definition. So quality rating in the context of this MAP QRS system is a performance measure rate for a particular measure for a particular managed care plan. And that's what's being compared publicly across all of the health plans is what was the performance measure rate for the each mandatory measure, the QRS measure set. So it's not an an aggregated star rating. It is a performance measure rate. Now states have the authority to provide a quality rating definition for each health plan, and it could be, if there is a low denominator, for example. The quality rating itself could be, not applicable or, this it gets into this in the protocol ten, but states have that, also has have that authority to modify the quality rating definition where there are maybe data issues, or a a carve out a service carve out, for example. The protocol ten is pretty clear that managed care plans cannot validate their own data or their own performance rates. So I think that's pretty important because it distinguishes that that role in the implementation of protocol ten, must be left outside of the purview of the managed care plan. So the ECRO could do that, but what I'm about to get into here in a second with nonduplication is those types of requirements, the validation the data validation, are already covered in a HIE's audit and can be included as a non duplication activity in existing HIEDAS audit and HIEDAS submission processes for plans. And then one final note, about Medicare data in the ECRO protocol ten is that states, it highlights several instances where states have access or could create access to their own Medicare Advantage data for, duals in the state or Medicare fee for service data through data sharing and data use agreements with CMS directly. And NCQA is is supportive of this approach in states, gathering these Medicare data for dual members because providing these Medicare data back to their Medicaid MCOs really elicits an opportunity for care coordination across Medicaid and Medicare plans, in particular where there's, like, a Medicare Advantage Coordination only plan. So allowing the Medicaid MCO to really get, have access to these data both for reporting, but also for care coordination, we think strengthens the care coordination opportunity highlighted in the protocol ten and in this regulation. Conversely, if a state were to really go through ECCRO protocol ten, without a lens towards non duplication, and really focusing on implementing it in exactly the way the protocol, states that the ECRO should be and the roles and responsibilities the ECRO should be playing. It's really focused much more on performance measurement and less on care coordination and creating a series of dupe potential duplications of of efforts and infrastructure and process that's already out there, which is sort of the reason why we're about to go into the nonduplication part of what a mac mac URS allows. So next slide. Alright. So here's a snapshot of some some of the echo, protocol ten activities and some of the, those activities that represent a non duplication opportunity. So first and foremost, data collection. And in this case, I'm highlighting the data types that are outside of managed care encounter and claims. Right? Because those are the typical data that typical claims data and encounter data that managed care plans have and that states also have, in in a pretty robust fashion. But outside of that, Medicaid fee for service, Medicare fee for service, and Medicare Advantage data may also be applicable for a health plan's, performance rate, particularly when we're talking about including dual members in the reporting. And this, this may be done, by the state and by the health plan. The states have access to Medicare fee for service data through CMS. States can also get access to Medicare Advantage d dual data through using their state Medicaid agency contractor, SMAC. They may also require data sharing, of their Medicare Advantage d SNPs with their Medicaid MCOs also through that SMAC. So they wouldn't the state in this case wouldn't even have to be that middle that middle person necessarily. In the case of Medicaid fee for service data, there is likely already some of this data sharing in place and policy in states due to the transition of care or TOC policy that was required of Medicare, Medicaid managed care programs, several years ago. So in this case, if if and when a member transitions from Medicaid fee for service to medic Medicaid managed care or from one Medicaid managed care plan to another, then there were protocols or there needed to be protocols in place that were sharing a a history of claims data with that newly, newly enrolled, managed care plan. So those are kind of some examples of how these data, these supplemental data can be shared or provided to health plans so that then the health plan can go through the data validation process in total with all of the data, provided and available for these measurements as part of the HIE does audit. And the measure calculation can continue to be done by the health plan as it currently is done through the HIE does process. Measure validation and the ISCA completion, also completed through HIE does audit. Now I will say because, my colleagues will want me to to note this is that there isn't necessarily an ISCA itself provided through HIE's audit, but there is, an IT and information systems review done as part of the HIE DIS audit, but it's called the HIE DIS road map. Just in case, you are talking with your Medicaid plans and they call it something different, it's typically referred to as the HIE DIS, HIE DIS road map, sorry, as the HIE DIS audit process. So this is a non dupe use of non duplication, and it's leveraging existing workflows. It's leveraging existing roles, responsibilities, and investments in technology and data infrastructure. It would meet the requirements of protocol ten, and it would not require, an ECRO, for example, to purchase and create new processes, new data infrastructure, new data sharing, agreements, to utilize Medicare data. We wouldn't have to do that, if we were to take this non duplication route. And I will mention here that there are HIE does currently allows dual members to be included in a Medicaid health plan, submission, including for accreditation. That is allowed, and in some cases, plans do that. So so NCQA does have experience with Medicaid MCOs, including dual members in their submission, and it is allowed through the the submission that accounts for accreditation. And those same plans can include Medicare data into those, Medicaid submissions that are including their duals members. So that's all, allowed and is already happening in some cases, and it's accepted and acceptable, including for the accreditation submission for HIE. Next slide. So I'm just gonna try to do a quick summary of how this nonduplication can happen and and what states would sort of need to do to leverage this nonduplication opportunity. So Medicaid MCOs already undergo an audit, and they already submit HIE to this reporting to NCQA. That's pretty across the board in the country. We get HIE to submission from from every Medicaid MCO in the country. Some of them do include their duals members in their submission, And, we also have states and MCOs that carve out their chip population, and submit their chip population separately. That's also allowed. That separate submission wouldn't be counted in the accreditation submission. So those kinds of plans may have to do two submissions, but, in this case, those plans are already doing that across the country. So, it's possible. It's doable. It's happening now, and, it wouldn't be an additional burden in the context of MACQRS. The HIE does audit and the HIE does reporting process allows for validates, and approved supplemental data and inclusion of dual. So that's all that's all possible. It's already happening in many cases, and NCQA allows it, and it's covered by the current audit and reporting process. Those three non HEDIS measures that I talked about earlier, are now allowed to be submitted to NCQA. We worked with all of the measure stewards to do so. Those non HEDIS measures can be included in HEDIS audit and can be included in the submission to HEDIS. It would not affect the accreditation submission from plans. As I said, all of the existing infrastructure for data collection, including supplemental data like Medicare data for tools, audits, measure calculations, submission to NCQA. Medicare and CEOs already have that, that capacity. They already have those timelines built into how they run as an organization. They already have the staff, prepared and familiar and coordinating with NCQA to do this. So that's already in place. And so you NCQA can continue because we do this through different tools like the HEDIS data collection service, as well as the Quality Compass, but we can continue to make audited MCO rates available to states, including those three non HEDIS measures. And that is what really allows states to then, use those audited, validated rates, that include duals, on that can carve out chip, for their met meeting their met QRS requirements. So for states to leverage this opportunity, they would need to require their plans to utilize the NCQA met QRS process, which we've built in a way that meets those protocol ten requirements. And if you wanna talk more about that, I think at some point, we ask a question about who wants to chat with us. So we'd be happy to talk with you further one on one or invite you to our next office hours, and you can come with with a group of folks. We usually have about fifteen, nearly twenty states coming to our office hours, so we would welcome. If you haven't been able to come to one, we'd welcome you to join us there. Next slide. Let me before I go into that, let me check. Okay. We've got one new question, Alan. How can states share fee for service Medicaid data with plans for measure calculation if enrollees aren't enrolled in that plan? Well, no. You yeah. You wouldn't you wouldn't there would be no reason if the member is not enrolled in the plan to share those data, if I'm understanding your question correctly. Traditionally, states are responsible for fee for service Medicaid populations. How did ECRO protocol ten change this? Nope. So sorry. It would only be Medicaid fee for service data for, if a per if a member has transitioned onto a managed care plan. So what the purpose of that is to share data that happened during the fee for service period, that that Medicaid managed care plan could consider including, as a numerator hit, so to speak, in any of the mandatory measures. But if that member is not enrolled in the plan, then, no, there would be no reason to to share those data with them. So, hopefully, I understood the question correctly. But if not, you you are more than welcome to email us, and we can talk further. Okay. Polling questions. Alan, did you wanna do this, or you wanna do it? I'll I'll take it. I'll take it. Oh, okay. Alright. Yeah. Well, that's all I got, I think. Thanks, everybody. Thanks, Tom. Alright. So this is just a simple, are you interested in speaking with us? Right? Do you wanna speak with, us about accreditation? A, toolkit? B, nonduplication as a concept in general? C, or what Tom talked about towards the end of the presentation, MAC URS. So if you're interested in speaking with us about any of these, please choose an option. Maybe we should have considered an all of the above, but I'll give folks just a minute. Alright. Can go ahead and share the results, Maralena. Thank you. Alright. Yeah. So, I'm, not too surprised because MAC QRS is is kind of the new thing, right, at least from from the perspective of this this annual kind of webinar series. So, wonderful. Thank you for that feedback. That's really valuable to us. And so we'll do some we'll do some follow ups. With that, could you go to the next slide, please? Right. So any questions? We wanna just, give folks a minute or two. I talked at the very beginning. If you remember at the top of the presentation, if, you want to ask a verbal question, please raise your hand with the raise hand function in Zoom. We'll unmute you. If you have a question that you wanna talk through, happy to do so. So give a a minute or two, see if anybody's interested in doing that. Alan, I see one here about my confusing protocol ten non duplication slide. K. It says data collection activities can be managed by state or health plan. I guess you were referring to measure selection measure calculation for MA populations, which can be managed by plans, not field for serve. So it is confusing because their, states are, arranged differently. So sort of how this role responsibility for data collection and sharing would would shake out isn't, there isn't a one size fits all necessarily. But at the end of the day, it had it it has to be a state and health plan activity, to be carried out, and it would depend on, how their, DSNP program was was fashioned, for example, or how their Medicaid managed care program was fashioned and different populations that were carved in or carved out, duals, for example. And then lastly, how they, how they managed fee for service Medicaid and and how that transition to managed care was managed as well. And there are different time periods that that states, allow for and, sorry, and which services were applicable when to those managed care enrollees. So, yes, it it it is confusing. We don't have the answer in detail for our for states as if they were one answer, but, the the point that, hopefully, you take home is that states and health plans together can address the data collection issue or activity rather, in protocol ten if they work together, which is different than the way protocol ten writes it out because it writes it out as if the ECRO would be the one collecting all of the data, all of the Medicaid managed care claims and encounter data, all of the Medicaid fee for service, all of the Medicare fee for service, and Medicare Advantage data, collect all of that, then calculate rates separately from the plans, within the ECRO organization alone, and then provide those items back to the state. So that's with how the protocol sort of lines it out. And so maybe that helps clarify what I was trying to put on the slide is what I'm suggesting is something different in the context of nonduplication where the ECRO wouldn't do those things. The state and the helpline would do those things as they kind of do today. It would just be a newer data type in that process. Great. Thanks, Tom. Yep. And then there's another, do you have a linked protocol ten? Yes. Yep. We can send it. I'm I'm guessing we're doing a send out after the meeting to the group, and we can include that link, to protocol ten in in that send out. Yeah. I'm not seeing any other raised hands. Sorry. Another another question. Just Go ahead. Yeah. Great. No. Awesome. This is what, this is what we wanted. Yeah. Yes. We do contract with ECRO to calculate some HEDIS measures. Yep. And so, that is that is, one way to do it, and that's actually how the protocol sort of, outlines the protocol itself. And but if you look at all the protocols, it sort of lines it outlines it that same way where the ACRO is sort of the one doing all of the activities or the organization doing all of that the activities. What we're saying here is, non duplication, which is allowed in the regulations in the context of EPRO protocols, nonduplication would allow, organization to leverage existing processes. And in this case, HIE does audit, HIE does reporting to meet many of the MEC QRS requirements. We're about at Tom. So I wanna thank you, Tom, for that. Appreciate it. Thank you all for your questions. Marilyn, if you go to the next slide, I'm gonna last minute here. Just, real quick, we'll be hosting the Health Innovation Summit October fourth through seventh of this year in Atlanta, Georgia. We hope you all come. Next slide, please. Subscribe to our newsletter, our public policy notes. It's just for our public policies team, so please, please join that. Next slide, please. And we hope that we'll see some friendly faces from you all at some of these conferences that are coming up on on the screen, NASM, HPD, NCSL, and MESC, all coming up in DC, Chicago, and Portland. We hope to see you there. Next slide, please. And that's it. Thank you all very much for your time and attention today. We really appreciate all the feedback, questions, and joining us. We hope you have a wonderful rest of your day, and thank you again. Take care. Bye.