The MLD content is correct; the item in the MLD Update memo contains an error. Organizations should “Add Acetaminophen Hydrocodone 7.5 mg Medications List to the Medication Lists column and 7.5 mg to the Strength column.”
HEDIS 2021
FAQ Directory
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12.15.2020 Use of Opioids at High Dosage (HDO) The MLD Update Memo stated, “Add Acetaminophen Hydrocodone 7.5 MGPML Medications List to the Medication Lists column and 7.5 mg per mL to the Strength column.” However, this medication list is not included in the MLD (the MLD contains an Acetaminophen Hydrocodone 7.5 mg Medications List).
12.15.2020 Transitions of Care (TRC) May supplemental data be used for all four indicators in the Transitions of Care (TRC) measure?
Yes. Supplemental data may be used for all four indicators, including indicators that do not allow administrative reporting (Notification of Inpatient Admission and Receipt of Discharge Information).
Because there are no administrative codes to map to for the Notification of Inpatient Admission and Receipt of Discharge Information indicators, supplemental data must include all elements required by the measure's hybrid specifications for these indicators and once validated, the plan must determine how to get the results integrated for reporting. Plans should work with their vendors and this process should be reviewed and approved by the auditor.
HEDIS 2021
12.15.2020 Transitions of Care (TRC) Where in IDSS should supplemental data be reported when it is used for the Notification of Inpatient Admission and Receipt of Discharge Information indicators?
12.15.2020 Risk Adjusted Utilization Guideline 1 & Emergency Department Utilization (EDU) In the EDU measure, step 1 for the Calculation of Observed Events says to exclude ED visits that result in an inpatient stay or an observation stay. Should denied claims be used when looking for both an inpatient stay and an observation stay in this case?
Yes. When confirming that an ED visit does not result in an inpatient stay or an observation stay, all inpatient and observation stays must be considered, regardless of payment status (paid, suspended, pending, denied). Measure Certification will test this scenario to ensure all inpatient and observation stays are considered, regardless of payment status. For example, if an ED visit is paid but an inpatient stay is denied, the ED visit resulted in an inpatient stay and is not included in the Emergency Department Utilization measure when identifying observed ED visits.
HEDIS 2021
12.15.2020 Controlling High Blood Pressure (CBP) & Comprehensive Diabetes Care (CDC) - BP control (<140/90 mm Hg) Is the use of average blood pressure readings allowed?
12.15.2020 Appropriate Testing for Pharyngitis (CWP) Is the episode date excluded if the member does not receive antibiotics on or up to three days after the Episode Date?
12.15.2020 Corrective Action Process What is the corrective action process for organizations that do not meet a must-pass element?
A Corrective Action Plan (CAP) is required when an organization does not meet the minimum threshold for one or more must-pass elements. The CAP must be submitted to NCQA within 30 days after receipt of the final Accreditation status and must meet NCQA approval. The organization undergoes a CAP Survey that focuses on the failed must-pass elements (not at the factor level), i.e., all element factors, will be reviewed in addition to the factor(s) that failed the must-pass requirement.
NCQA schedules the CAP Survey for submission 6 months following the organization’s last full survey; the file review is 4 weeks later. The organization’s Accreditation status is noted “Under Corrective Action” status modifier noted on the report card during the corrective action period.
The fees for the CAP Survey can be found in the Pricing Exhibit on My NCQA. The look-back period is from the date of implementation of the corrective action up to the CAP Survey submission date and may be between 3 and 6 months before the CAP Survey submission.
After successful completion of the CAP Survey, the status modifier is removed from the organization’s status on the report card. The expiration date of the Accreditation status remains the same as the date specified in the decision that precipitated the CAP Survey. If a CAP Survey is unsuccessful, the Review Oversight Committee (ROC) may:
- Extend the CAP status modifier, or
- Reduce the organization’s status from Accredited to Provisional or from Provisional to Denied, or
- Issue a Denied Accreditation status.
HP 2019
12.15.2020 Corrective Action Plan Question: What is the corrective action process for organizations that do not meet a must-pass element?
A Corrective Action Plan (CAP) is required when an organization does not meet the minimum threshold for one or more must-pass elements. The CAP must be submitted to NCQA within 30 days after receipt of the final Accreditation status and must meet NCQA approval. The organization undergoes a CAP Survey that focuses on the failed must-pass elements (not at the factor level), i.e., all element factors, will be reviewed in addition to the factor(s) that failed the must-pass requirement.
NCQA schedules the CAP Survey for submission 6 months following the organization’s last full survey; the file review is 4 weeks later. The organization’s Accreditation status is noted “Under Corrective Action” status modifier noted on the report card during the corrective action period.
The fees for the CAP Survey can be found in the Pricing Exhibit on My NCQA. The look-back period is from the date of implementation of the corrective action up to the CAP Survey submission date and may be between 3 and 6 months before the CAP Survey submission.
After successful completion of the CAP Survey, the status modifier is removed from the organization’s status on the report card. The expiration date of the Accreditation status remains the same as the date specified in the decision that precipitated the CAP Survey. If a CAP Survey is unsuccessful, the Review Oversight Committee (ROC) may:
- Extend the CAP status modifier, or
- Reduce the organization’s status from Accredited to Provisional or from Provisional to Denied, or
- Issue a Denied Accreditation status.
UM-CR-PN 2019
12.15.2020 Use of Imaging Studies for Low Back Pain (LBP) Is a history of a kidney transplant a required exclusion for the measure?
Yes. In the seventh bullet of step 4 of the event/diagnosis, replace the seventh bullet with:
Major organ transplant. Major organ transplant (Organ Transplant Other Than Kidney Value Set; Kidney Transplant Value Set; History of Kidney Transplant Value Set) any time in the member’s history through 28 days after the IESD.
**This FAQ applies to QRS MY 2020.
Exchange 2020
12.15.2020 Appropriate Testing for Pharyngitis (CWP) Is the denominator for the measure based on episodes or members?
The denominator is based on episodes, not on members. Add the following Note to the event/diagnosis after step 7:
Note: The denominator for this measure is based on episodes, not on members. All eligible episodes that were not excluded remain in the denominator.
**This FAQ applies to QRS MY 2020.
Exchange 2020
12.15.2020 Follow-Up After Hospitalization for Mental Illness (FUH) What time frame should be used to identify acute and nonacute readmissions or direct transfers when identifying the event/diagnosis?
Use a 30-day period. Replace the reference to “7-day follow up period” with “30 days after discharge (the denominator event)” in both the “Acute readmission or direct transfer” and “Nonacute readmission or direct transfer” sections of the specification. This ensures that the same Eligible Population criteria are used for all organizations that report the FUH measure (regardless of product line).
**This FAQ applies to QRS MY 2020.
Exchange 2020