SUMMARY: HEALTH PLANS
Data Reporting and Uses, by Product Line
Updated: June 17, 2020
| Medicare Advantage | Exchange | Commercial & Medicaid | |
|---|---|---|---|
| HEDIS Measurement Year 2019 | Reporting data to NCQA is not required, per CMS guidance. NCQA's HEDIS reporting systems and tools remain available to support internal plan quality improvement activities. | Reporting data to NCQA is not required, per CMS guidance. NCQA's HEDIS reporting systems and tools remain available to support internal plan quality improvement activities. | Plans should report data to NCQA. NCQA will work with plans whose ability to report data is compromised, in order to make accommodations. NCQA will abide by different states’ decisions about data reporting. |
| CAHPS | Not collected by NCQA. | QHP Enrollee Survey not collected by NCQA. | Plans should report data to NCQA. NCQA will work with plans whose ability to report data is compromised, in order to make accommodations. NCQA will abide by different states’ decisions about data reporting. |
| NCQA Health Plan Accreditation | Plans not required to report data to NCQA. Accreditation will not incorporate NCQA Health Plan Ratings in 2020. | Plans not required to report data to NCQA. N/A: Exchange not included in NCQA Health Plan Ratings. | Plans should report data to NCQA. Accreditation will not incorporate NCQA Health Plan Ratings in 2020. |
| NCQA Health Plan Ratings 2020 | Canceled | N/A | Canceled |
| Quality Compass 2020 | Canceled | N/A | HEDIS: Administrative and Hybrid measures will be reported within Quality Compass 2020. This will include plan-level performance and benchmarks (averages and percentiles) at the national, regional and state level. CAHPS: CAHPS survey results for individual plans will not be included in Quality Compass 2020, however, benchmarks (averages and percentiles) at the national, regional and state level will be included within the product. |
NCQA Quality Compass® 2020 (Measurement Year 2019) Update
Updated: June 22, 2020
NCQA evaluated preliminary reported data to assess the impact of COVID-19 on Quality Compass 2020 (Measurement Year 2019) products; specifically, to investigate by measure type whether COVID-19 disrupted MY2019 data reporting. Below is a summary of our findings and the subsequent decisions made regarding Quality Compass 2020.
Evaluation of Preliminary Data
HEDIS®
- Hybrid Measures: In March, NCQA realized that COVID-19 might have an effect on the HEDIS hybrid measures since the collection of medical record data was restricted by travel bans, quarantines and efforts to mitigate risk to staff. Therefore, NCQA permitted plans to report their audited HEDIS 2019 hybrid rate if it was better than their HEDIS 2020 hybrid rate. Our evaluation of preliminary data found that a large number of plans chose to report their previous year’s audited data.
- Administrative Measures: No allowances were permitted in March for administrative measures, as collection of these data were not expected to be materially affected by COVID-19 response. The number of submissions and benchmarks for these measures were found to be comparable and stable in our review of preliminary data.
CAHPS®
There were concerns about the impact of COVID-19 on CAHPS data collection and response rates, and the potential for response bias because members were asked to reflect on their health care experiences over the past year while simultaneously living through a pandemic. The preliminary evaluation found that there was a decrease in response rates among Medicaid CAHPS in particular and fewer plans were able to report valid rates.
Decisions
Consequently, as of June 18, the following decisions apply to Quality Compass 2020 commercial and Medicaid products, which reflect Measurement Year 2019 data:
- Administrative measures will be reported as usual.
- Hybrid measures will be reported for individual plan performance, as well as for national, regional and state benchmarks (averages and percentiles). Due to the large number of plans choosing to use their previous year’s audited data, the tool will contain appropriate contextual flags cautioning the use of data for improvement scoring and year-over-year trending.
- Quality Compass will not identify plans that chose to rotate results.
- CAHPS survey results will not be reported for individual plan performance; however, national, regional and state benchmarks (averages and percentiles) for reportable survey measures will be included for internal quality improvement purposes. The tool will contain appropriate contextual flags recommending against the use of data for improvement scoring and year-over-year trending.
- Per CMS guidance, Quality Compass 2020 Medicare products will not be reported or released. Similarly, File 5 will not be released as CAHPS survey results for individual plan performance will not be reported.
Anticipated Release Dates of Quality Compass 2020
- Quality Compass 2020: Commercial—Friday, August 14.
- Quality Compass 2020: Medicaid—Friday, September 25.
Ordering Quality Compass 2020:
Visit the NCQA store to preorder by check or credit card. If you require an invoice, please contact my.ncqa.org for assistance and label the product option of interest.
Users will receive access to the online tool upon payment and product availability. NCQA will send an email announcement about release dates to the identified “ship to” user on the order.
We appreciate your patience during this time! If you have questions, contact us via my.ncqa.org.
Quality Compass® is a registered trademark of the National Committee for Quality Assurance.
CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).
HEDIS and CAHPS
Measures Impacted by Telehealth Revisions
Updated: June 5, 2020
NCQA has updated telehealth guidance in 40 HEDIS measures for HEDIS Measurement Years 2020 and 2021.
The purpose of these changes is to:
- Support increased used of telehealth caused by the pandemic.
- Align with telehealth guidance from the Centers for Medicare & Medicaid Services and other stakeholders.
Updates to these 40 measures will be reflected in the HEDIS Volume 2 Technical Specifications, to be published on July 1, 2020. Telehealth revisions will be outlined in each measure specification’s “Summary of Changes” section.
Guidance will specify:
- How telehealth visits can be used (i.e., denominator, numerator, exclusion).
- What type of telehealth is permitted (e.g., synchronous telehealth visits, telephone visits or asynchronous e-visits or virtual check-ins).
| HEDIS Measure Name | Acronym |
|---|---|
| Follow-up Care for Children Prescribed ADHD Medication | ADD, ADD-E |
| Acute Hospital Utilization | AHU |
| Antidepressant Medication Management | AMM |
| Asthma Medication Ratio | AMR |
| Asthma Medication Ratio | AMR |
| Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics | APP |
| Disease-Modifying Anti-Rheumatic Drug Therapy for Rheumatoid Arthritis- Scheduled for Retirement | ART |
| Breast Cancer Screening | BCS, BCS-E |
| Care for Older Adults | COA |
| Controlling High Blood Pressure | CBP |
| Comprehensive Diabetes Care | CDC |
| Colorectal Cancer Screening | COL, COL-E |
| NEW MEASURE: Cardiac Rehabilitation | CRE |
| Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults | DMS-E |
| Depression Screening and Follow-up for Adolescents and Adults | DSF-E |
| Emergency Department Utilization | EDU |
| Follow-up After Emergency Department Visit for People with Multiple High-Risk Chronic Conditions | FMC |
| Follow-up After Hospitalization for Mental Illness | FUH |
| Follow-up After Emergency Department Visit for Mental Illness | FUM |
| Hospitalization Following Discharge from a Skilled Nursing Facility | HFS |
| Hospitalization for Potentially Preventable Complications | HPC |
| NEW MEASURE: Kidney Health Evaluation for Patients with Diabetes | KED |
| Mental Health Utilization | MPT |
| Osteoporosis Management in Women Who Had a Fracture | OMW |
| NEW MEASURE: Osteoporosis Screening in Older Women | OSW |
| Persistence of Beta-Blocker Treatment After a Heart Attack | PBH |
| Plan All-Cause Readmissions | PCR |
| Postpartum Depression Screening and Follow-up | PDS-E |
| Prenatal Depression Screening and Follow-up | PND-E |
| Prenatal and Postpartum Care | PPC |
| Adherence to Antipsychotic Medications for Individuals with Schizophrenia | SAA |
| Cardiovascular Monitoring for People with Cardiovascular Disease and Schizophrenia | SMC |
| Diabetes Monitoring for People with Diabetes and Schizophrenia | SMD |
| Use of Spirometry Testing in the Assessment and Diagnosis of COPD | SPR |
| Statin Therapy for Patients with Cardiovascular Disease | SPC |
| Statin Therapy for Patients with Diabetes | SPD |
| Diabetes Screening for People with Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medication | SSD |
| Transitions of Care | TRC |
| REVISED MEASURE: Well-Child Visits in the First 30 Months of Life1 | W30 |
| Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents | WCC |
| REVISED MEASURE: Child and Adolescent Well Care Visits2 | WCV |
1 The former Well-Child Visits in the First 15 Months of Life (W15) measure was revised to Well-Child Visits in the First 30 Months of Life (W30) for HEDIS MY 2020.
2 The former Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life (W34) and Adolescent Well-Care Visits (AWC) measures have been combined into Child and Adolescent Well-Care Visits (WCV) for HEDIS MY 2020.
Guidance on HEDIS and CAHPS Reporting
Updated: June 22, 2021
HEDIS MY 2020 data submission closed as planned on June 15. NCQA is now processing the data for use in Health Plan Ratings, Quality Compass and other programs. Other than the previously announced changes updating telehealth guidance in 40 HEDIS measures and implementing a special Overall Rating Policy, NCQA is not making other changes related to HEDIS/CAHPS data. We will continue to monitor and share insights on any effects the coronavirus pandemic may have had on results.
NCQA understands that the national priority at this time must be to allow the health care system to focus on addressing the COVID-19 crisis.
- See our November 24, 2020, memo for our policy regarding HEDIS measurement year 2020.
- NCQA collects the Medical Assistance With Smoking and Tobacco Use Cessation (MSC) measure in the HEDIS CAHPS Adult Commercial and Adult Medicaid surveys. MSC will continue to be calculated using a two year rolling average methodology. For HEDIS Measurement Year (MY) 2020, the two-year rolling average for MSC will be calculated using MY 2019 data for Year 1 and MY 2020 data for Year 2. Additional details for the MSC measure calculation are available in HEDIS MY 2020 & MY 2021 Volume 2.
Health Plan Report Cards and Health Plan Ratings
Updated: November 2, 2020
Due to changes in HEDIS and CAHPS reporting outlined above:
- The September 2020 Health Plan Report Card update will list all plans with Interim, Accredited or Provisional status, as applicable, based on existing status or standards performance for surveys on the HPA 2020 Standards. Note: As NCQA announced in the July 29, 2019 Policy Updates, NCQA eliminated the Excellent and Commendable accreditation statuses beginning July 1, 2020.
- There are no Health Plan Ratings in 2020. See our Health Plan Ratings Marketing and Advertising Guidelines for more information regarding the continued usage of 2019-2020 Health Plan Ratings for advertising and marketing purposes.
- NCQA will calculate the Health Plan Ratings for 2021. View the 2021 Ratings methodology and measure list.
Guidance on HEDIS for LTSS
Updated: April 28, 2020
HEDIS Long Term Services and Supports Measures Reporting
For Measurement Year 2020, NCQA is relaxing requirements that comprehensive assessments and care planning discussions must occur with members face-to-face or in the member’s home. Comprehensive assessments and care planning discussions with members may be conducted face-to-face in the member’s home or at alternate locations, or using synchronous methods (i.e., telephone visits or videoconferencing) for the following measures:
- Comprehensive Assessment and Update
- Comprehensive Care Plan and Update
- Re-assessment and Care Plan Update after Inpatient Discharge
Accreditation and Recognition
Accreditation Requirements
Updated: April 1, 2022 – NCQA’s COVID accommodations will not be extended beyond June 30, 2022. Virtual accreditation surveys will continue through 2022.
NCQA would like to express our support of everyone affected by the coronavirus (COVID-19) pandemic. We especially thank the clinicians and other caregivers who are on the front lines to protect us all.
NCQA implemented the exceptions noted below for the March 1, 2020 – June 30, 2022, time frame for all applicable products (e.g., HP, MBHO, UM-CR-PN).
NCQA’s COVID accommodations will not be extended beyond June 30, 2022, but organizations that come through a survey after June 30, 2022 will be eligible to receive NCQA COVID accommodations if the survey look-back period includes the March 1, 2020-June 30, 2022 period. Any further accommodations needed past the June 30, 2022 date will be handled by NCQA on a case-by-case basis.
Organizations that cannot meet NCQA requirements because of changes in operations due to COVID-19 must document modifications made for all applicable standards and file review elements in a disaster management plan. Find details on disaster management plans below.
To request survey accommodations, organizations will complete a COVID-19 Impact Tracker detailing the impact of COVID-19 to applicable elements, as well as any mitigation efforts. The tracker is available at the link below and is also housed in IRT in a COVID-19 link in the Organization Background section. Both the tracker and required disaster management plan will be uploaded to IRT, to be included with survey submissions.
Due to continued cautions related to business travel, NCQA will conduct all accreditation/certification surveys virtually through June 30, 2022.
We will give updates as needed and when new information becomes available.
Practitioners Who Provide Care During a Public Health Emergency
Organizations are not required to credential practitioners who are not part of their network or practice and are providing care to members/patients solely as part of a federal, state or local government emergency response team.
Organizations are not required to credential practitioners who are part of the organization’s emergency response efforts if it documents the disaster management plans that were implemented from March 1, 2020 – June 30, 2022 for allowing these practitioners to provide care for members.
CMS 1135 Waivers for State Licensing
CMS allows states to request a waiver that will temporarily allow out-of-state practitioners to provide services if they are licensed in another state. When credentialing these practitioners in a state that receives a waiver, NCQA will waive the requirement that the organization verify the license to practice for that state.
Accredited and Certified Organizations
For activities where challenges to timeliness may occur, NCQA is making the following changes, effective immediately:
- Extending the grace period 2 months to allow 16 months for annual requirements such as analysis, member communications and delegation oversight.
- Extending the look-back period for Credentialing Committee meeting minutes: If 3 sets of minutes are not available during the look-back period, NCQA will accept however many are available during the look-back period. If none are available during the look-back period, NCQA will accept 1 set of minutes prior to the look-back period.
- Extending the practitioner and provider recredentialing cycle 2 months, to 38 months.
- Extending provisional credentialing status from 60 calendar days to 180 calendar days.
- Removing files from the March 1, 2020 – June 30, 2022 time frame from credentialing, UM denial/appeal and complex case management file reviews for organizations impacted by COVID-19. Impacted organizations should remove those files from the universe that were implemented from March 1, 2020 – June 30, 2022 for credentialing, utilization management and case management and submit their disaster management plans.
- Organizations that were not affected by COVID-19 must include all applicable files, including delegate files, from March 1, 2020 – June 30, 2022 in the appropriate file review universe (CR, UM nonbehavioral denials, UM behavioral denials, UM pharmacy denials, UM appeals, complex case management) and are not required to submit a disaster management plan.
- Organizations that were affected by COVID-19 must submit a disaster management plan and complete the COVID-19 Impact Tracker. The organization’s decision to exclude files because of COVID-19 may differ by file review type (e.g., CR, UM or CCM) but it must exclude all files, including delegate files within the type/category for the impacted month. For months not impacted by COVID-19, all applicable files, including delegate files, must be included. For example, if an organization’s CR process was affected March – June 2020 but not its UM or CCM processes, it must exclude all CR files from the CR file universe for March-June and include all applicable UM and CCM files. Organizations must include or exclude all files for each month and may not remove individual files from a universe.
- Guidance for disaster management plans.
- Guidance for corrective action plan surveys.
- Guidance on analysis requirements that use HEDIS or CAHPS data for Accreditation.
- Additional exceptions pertaining to member/practitioner notification/communication.
- Additional exceptions pertaining to collection of data from members/practitioners.
- Guidance on policy allowances related to telehealth.
Organizations with a survey or evaluation during the COVID accommodation period in 2020-2022 should contact their Accreditation survey coordinator or Recognition account representative. NCQA will determine if additional accommodations (e.g., longer extensions, virtual surveys, shorter look-back periods) are necessary on a case-by-case basis. Please submit all other questions through My NCQA at my.ncqa.org.
NCQA’s goal is to support practices and organizations. We are monitoring the impact of COVID-19 on our customers, adjusting requirements as circumstances warrant and proactively assessing potential scenarios. As always, we will work with individual organizations to accommodate their unique situation.
Guidance on File Reviews Impacted by COVID-19
All surveys must undergo applicable file reviews in order to earn accreditation/certification status.
If files are impacted by COVID-19:
- Submit files from applicable look-back period based on the submission date, excluding full months of impacted files from March 1, 2020 – June 30, 2022. File review will be based on all available files, which may result in low denominators and affect the organization’s overall performance. Normal file review rules apply.
- Extend the look-back period by up to 6 months to capture eligible files. If the number of eligible files is still insufficient, work with your Accreditation Survey Coordinator (ASC) on options.
- Reschedule the file review for First Surveys up to 6 months after the submission date for an additional fee. Normal file review rules apply, and the organization’s status is contingent upon completion of the file review.
Recognition Requirements
Updated: April 1, 2021
NCQA would like to express our support of everyone affected by the COVID-19 pandemic. We especially thank the clinicians and other caregivers who are on the front lines.
Although federal guidance and local circumstances continue to evolve, NCQA is implementing look-back exceptions for March 1, 2020–December 31, 2021, for all evaluations that include this look-back period, for all applicable products.
NCQA understands that disruption to normal operations may affect practices’ ability to meet NCQA requirements and will be flexible in evaluating performance. At this time, NCQA is holding practices to their reporting/submission date. Organizations and practices that cannot meet NCQA Recognition program requirements because of changes in operations due to COVID-19 should contact their NCQA Representative through my.ncqa.org. NCQA will determine if additional accommodations are necessary on a case-by-case basis.
Note: Recognized entities may show evidence from any time in the past year to demonstrate that activities were routinely implemented. Practices are encouraged to consider shorter reporting periods covering time frames that experienced less disruption.
Submit all questions and requests for COVID-19 related accommodations at my.ncqa.org.
We are monitoring the impact of COVID-19 on our customers, adjusting requirements as circumstances warrant and proactively assessing potential scenarios. We know that patients and members are your priority, and NCQA’s goal is to support practices and organizations. As always, we will work with individual organizations to accommodate their unique situation. We will give updates as needed and when new information becomes available.
PUBLIC POLICY
State Briefing & Policy Discussion
Updated: May 8, 2020
The NCQA Public Policy team hosted a webinar for state officials on Wednesday, April 1 to explain how NCQA’s COVID-19 response affects state programs, and to take questions.