Count 82 days in the 232-day interval for a prescription of a 90-days supply dispensed on the 151st day.
**This FAQ applies only to HEDIS Volume 2 MY 2021.
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4.15.2021 Antidepressant Medication Management (AMM) For Effective Continuation Phase Treatment, how many days are counted in the 232-day interval if a prescription of a 90-days supply is dispensed on the 151st day?
4.15.2021 Persistence of Beta-Blocker Treatment After a Heart Attack (PBH) How many days are counted in the 180-day interval if a prescription of 90 days supply is dispensed on the 100th day?
4.15.2021 Provisional Status Triggers In what circumstances will an organization receive Provisional status?
An organization will receive Provisional status if it:
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Scores below 80% and above 55% of the maximum possible points in any Standards Category, or
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Does not achieve an element score of “Met” in three or more must-pass elements.
This applies to the following Programs and Years:
HP 2021, 20204.15.2021 Provisional Status Triggers In what circumstances will an organization receive Provisional status?
4.15.2021 Evaluation Options for PHM 6, Element B Does PHM 6, Element B apply to First Surveys?
4.15.2021 Vendor Relationship: ME 2, Element A Are all the requirements in ME 2, Element A considered a vendor relationship if the organization utilizes a mail vendor for distribution?
No. For ME 2, Element A, only the distribution component of the requirement is considered a vendor relationship.
As stated in the explanation, these elements may not be delegated. The organization must create the written information, but may distribute it through a mail vendor.
This applies to the following Programs and Years:
HP 20214.15.2021 Vendor Relationship: RR 3, Element A Are all the requirements in RR 3, Element A considered a vendor relationship if the organization utilizes a mail vendor for distribution?
No. For RR 3, Element A, only the distribution component of the requirement is considered a vendor relationship.
As stated in the explanation, these elements may not be delegated. The organization must create the written information, but may distribute it through a mail vendor.
This applies to the following Programs and Years:
MBHO 20213.15.2021 CVO 5, Element A: NTIS Verification Source Is the National Technical Information Service (NTIS) an acceptable verification source for DEA under the 2016 CVO Standards and Guidelines?
No. Effective November 17, 2020, NTIS is no longer an acceptable source to verify a practitioner's DEA certificate. This FAQ was addressed in the 2021 CVO updates on 11/23/2020. Please see https://dea.ntis.gov for more information.
This applies to the following Programs and Years:
CVO 20161.15.2021 Transitions of Care (TRC) Volume 2 states that for MY 2021 reporting, the organization may reduce the sample size using the prior year’s audited, product line-specific rate. Which rate should organizations use for sample size reduction?
1.15.2021 General Guideline 15 When a member has dual enrollment in Medicaid/Medicare how long must the member be enrolled in Medicare (PFFS or primary Medicare enrollment in another organization) to be removed from the Medicaid product line?
There is no minimum enrollment requirement. Per General Guideline 15, members must meet the measure’s continuous enrollment requirements and be considered dually enrolled based on continuous enrollment criteria or the service date.
Organizations must follow General Guideline 15 with regard to assessing coverage and should review enough data to meet the measure specification requirement.
This applies to the following Programs and Years:
HEDIS MY 2020, 20211.15.2021 General Guideline 15 What is the time frame for assessing dual enrollment?
As stated in the General Guideline 15, the time frame is assessed by measure. For measures with continuous enrollment, dual enrollment is determined as of the end of the continuous enrollment period, or the last enrollment segment, if there is a gap at the end of the continuous enrollment period.
For measures without a continuous enrollment requirement, members must have dual enrollment on the date of service or the date of discharge.
This applies to the following Programs and Years:
HEDIS MY 2020, 20211.15.2021 General Guideline 15 What type of Medicare enrollment counts when assessing members with dual Medicaid and Medicare enrollment?
General Guideline 15 includes language about Medicare contracts required to report HEDIS. These are meant to indicate Medicare Part C or Medicare Parts A and B. Having only Medicare Part D does not qualify as coverage for dual enrollment.