Yes, but only average readings that include separate values for systolic and diastolic blood pressure may be used for reporting.
HEDIS 2021
FAQ Directory
Here are some of the most frequently asked questions about NCQA’s various programs. If you don’t see what you are looking for in one of the entries below, you can ask a question through My NCQA.
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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 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
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 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 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 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
11.16.2020 Emergency Department Utilization (EDU) Will the EDU measure be publicly reported in MY 2020?
11.16.2020 Transition of Care (TRC) For the Medication Reconciliation Post-Discharge indicator, documentation of the current medications with evidence that the member was seen for post-discharge hospital follow-up with evidence of medication reconciliation or review meets criteria. Does documentation of a post-op/surgery follow-up visit, without reference to the hospital stay, count as evidence that the provider is aware of the hospitalization?
11.16.2020 VSD for the Quality Rating System The same OID is listed for the Systolic Greater Than or Equal To 140 Value Set and the Systolic Less Than 140 Value Set in the QRS Value Set Directory. Is this correct?
11.16.2020 Prenatal and Postpartum Care (PPC) Step 3 of the event/diagnosis states, “Determine if enrollment was continuous 43 days prior to delivery through 56 days after delivery, with no gaps.” Is this correct?
10.15.2020 Osteoporosis Screening in Older Women A dispensed dementia medication (Dementia Medications List) is listed as an exclusion in the eligible population. What time frame is required for the dispensing event?
The measure specification contains a formatting error and “A dispensed dementia medication (Dementia Medications List)” is intended to be a dash under the second bullet: “Any of the following during the measurement year or the year prior to the measurement year (count services that occur over both years).”
HEDIS 2021