Yes. The W15 measure does not have exclusions and this data element was included in error. It will be deleted in future publications.
Exchange 2016
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12.15.2015 Well-Child Visits in the First 15 Months of Life (W15) The Data Elements table for the W15 measure includes a field for required exclusions. Is this a mistake?
12.02.2015 P4P Value Set Directory Were there any changes in the December 1, 2015 release of the P4P VSD that are not listed in the Summary of Changes spreadsheets?
Yes. The following changes were made and were not listed in the Summary of Changes spreadsheets.
- In the Acute Conditions value set, diagnosis codes that starts with a V were mislabeled “ICD9PCS.” The label was changed to “ICD9CM.”
- In the Potentially Planned Procedures value set, the ICD9 procedure codes were mislabeled “ICD9CM.” The label was changed to “ICD9PCS.”
IHA 2015
11.16.2015 Relative Resource Use for People With Asthma Will NCQA publicly report the Relative Resource Use for People With Asthma (RAS) measure for the Medicare product line for HEDIS 2016?
11.16.2015 Administrative-only Measures For administrative-only measures such as Disease-Modifying Anti-Rheumatic Drug Therapy for Rheumatoid Arthritis (ART), may organizations abstract medication information from the medical record to identify numerator hits?
For administrative-only measures, information abstracted from the medical record is considered nonstandard supplemental data and is subject to all requirements described in General Guideline 34. The supplemental data must include all data elements required by the measure specification. For pharmacy data, this means that all data elements from the NDC lists must be present: the generic name, strength/dose, route and date when the medication was dispensed to the member. Generic documentation in the medical record (e.g., that a patient “was prescribed” or “is taking” a medication) that does not include drug name, strength/dose and dispense date does not meet criteria.
HEDIS 2016
11.16.2015 Risk-Adjusted Measures There are duplicate diagnosis codes in the following tables used for risk adjustment: PCR-DischCC and CC-Comorbid. Is this correct?
Yes. The risk adjustment measures are based on the CMS Hierarchical Condition Categories (HCC) risk-adjustment methodology. The updates made to the model, combined with the addition of ICD-10 diagnosis codes, changed the way clinical conditions (CCs) are assigned. When there is a duplicate diagnosis code, it is assigned to multiple CCs. For example, ICD-10 diagnosis code I132 should be mapped to both CC-85 and CC-136. Therefore, CC-85 and CC-136 should both be used towards calculating comorbid weight. In addition, for the Plan All-Cause Readmissions measure, it is possible for members to have more than one discharge CC if the primary discharge diagnosis is assigned multiple CCs.
HEDIS 2016
10.15.2015 Off-Marketplace in Accreditation If Off-Marketplace plans are not required by CMS to be in QRS, are they still required to include their membership in commercial product line when submitting for health plan accreditation?
10.15.2015 P4P Overview In the draft version of the MY 2015 Value Based P4P Manual released on 9/1/2015, page 6 indicates that the PO deadline for supplemental data collection is February 15, 2016, and the supplemental data validation deadline is March 15, 2016. Under the Supplemental Data Validation Deadline Activity, the last sentence states “Primary source verification (PSV) for member-reported and nonstandard supplemental data must not occur prior to March 2 unless the organization finished all supplemental data processes, collection and entry.”
Should the last sentence be updated to say February 15 instead of March 2?
Yes, you are correct; the date in the last sentence under Supplemental Data Validation Deadline should state:
“Auditor finalizes approval of all supplemental data. Primary source verification (PSV) for member-reported and nonstandard supplemental data must not occur prior to February 15 unless the organization finished all supplemental data processes, collection and entry.”
We will update this for the final version of the MY 2015 Value Based P4P Manual, released on December 1, 2015.
IHA 2015
10.15.2015 Delegation revocation and documentation If an organization revokes delegation, may the organization receive “NA” scoring if the delegate does not provide the necessary documentation?
10.15.2015 Oral notification of expedited appeal decisions UM 5 allows organizations to provide initial oral notification for urgent requests, with written notification within three calendar days. Does this also apply to expedited appeal decisions in UM 9, Element B?
10.15.2015 Complaints and Appeals Analysis for Marketplace product line May an organization submit one report for all its product lines, including its Marketplace product line?
10.15.2015 Childhood Immunization Status When abstracting medical record data for the hepatitis B vaccine, must the rules for the newborn hepatitis B vaccination in the administrative specification be followed?
When abstracting hepatitis B vaccine data from the medical record, there is no requirement that one be a “newborn” vaccine specifically, and there are no date restrictions. For hybrid reporting, when all events come from the medical record, documentation of three hepatitis B vaccines administered on three different dates of service meets criteria.
The newborn hepatitis B vaccine instructions and value set are intended to be used only for administrative data. The rules for the newborn hepatitis B vaccine are in place because the code in the Newborn Hepatitis B Vaccine Administered Value Set is a generic code that indicates a vaccine was administered but it does not indicate which vaccine was administered (it is not specific to hepatitis B). If this code occurs during the eight-day period (date of birth plus 7 days) then it is appropriate to assume it was a hepatitis B vaccine that was administered (since this is the only vaccine that is routinely administered to all children before discharge from the hospital).
HEDIS 2016