No. Organizations may apply this exception (i.e., rotation of the audited HEDIS 2019 hybrid rate) to any or all hybrid measures as they deem necessary.
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3.26.2020 COVID-19 If organizations decide to report their audited HEDIS 2019 hybrid rate for one hybrid measure, are they required to do this for all hybrid measures?
3.26.2020 COVID-19 For measures where the data collection methodology can be decided at the indicator level (e.g., WCC, COA, CDC, TRC), may organizations choose to apply the exception (report audited HEDIS 2019 hybrid rate) to only one indicator?
No, because of limitations in IDSS organizations must report all indicators of a hybrid measure using the same year of data. For example, if the audited HEDIS 2019 hybrid data are being reported for CDC, then all indicators in CDC must be reported using audited HEDIS 2019 hybrid data. You may not just report audited HEDIS 2019 data for one indicator. This also applies to measures like WCC, COA, CDC and TRC.
This applies to the following Programs and Years:
HEDIS 20203.26.2020 Guidance and Exceptions to NCQA Programs Regarding Coronavirus Has NCQA issued guidance about exceptions or modifications to NCQA programs and requirements in response to the coronavirus?
Yes. NCQA posted guidance for HEDIS reporting and Accreditation/Recognition programs at https://www.ncqa.org/covid/. NCQA is monitoring the effects of the coronavirus on our customers; we will adjust requirements as circumstances warrant. Please continue to check this website frequently as the situation continues to evolve.
This applies to the following Programs and Years:
MBHO 2020, 2019|UM-CR-PN 2020, 2019|HP 2019, 2020|PHP 20193.25.2020 COVID-19 What retrieval rate are auditors verifying against to have the rate considered low?
3.25.2020 COVID-19 If organizations choose to report their audited HEDIS 2019 hybrid rate, what data elements should they report in IDSS?
3.17.2020 COVID-19 Where do organizations note in IDSS that they are reporting their audited HEDIS 2019 hybrid rate?
3.17.2020 COVID-19 If organizations report a HEDIS 2020 measure using the Administrative Method, may they use their audited HEDIS 2019 rate instead?
No, measures being reported using the Administrative Method should be reported following the HEDIS 2020 reporting requirements. Only measures being reported using the Hybrid Methodology may report the higher of the HEDIS 2020 hybrid rate or the audited HEDIS 2019 hybrid rate.
This applies to the following Programs and Years:
HEDIS 20203.17.2020 COVID-19 May organizations enter data manually in IDSS, and will it trigger a warning?
3.17.2020 COVID-19 Does NCQA have any guidance for MY 2020 reporting (June 15, 2021) and the impact COVID-19 will have on care delivery?
3.16.2020 Plan All-Cause Readmissions When an index hospital stay is discharged to skilled nursing care facilities (SNF) which date is used for reporting the measure?
The discharge date from the index hospital stay should be used for reporting. The PCR measure assesses the number of acute inpatient and observation stays during the measurement year that were followed by an unplanned acute readmission. SNFs are considered to be nonacute inpatient settings. Therefore, when a member is transferred from an acute inpatient setting to a SNF, only the acute inpatient stay is assessed for reporting.
For example, a member has an acute inpatient stay February 1 – 5 and was discharged to a SNF February 6 – 9 and then transferred back to acute inpatient care February 10 – 14. There are two acute inpatient stays which are assessed for the PCR measure and count as two index hospital stays for the denominator (Stay 1 is February 1 – 5, Stay 2 is February 10 – 14), provided they meet all other measure criteria. Stay 2 is a readmission for Stay 1, provided it meets all numerator criteria because it occurs within 30 days of the discharge date for Stay 1. Stay 1 counts as an index hospital stay discharged to a SNF.
This applies to the following Programs and Years:
HEDIS 20203.16.2020 Plan All-Cause Readmissions Which risk weights are assigned to index hospital stays discharged to skilled nursing care when calculating expected readmission rates for the Medicare product line?
For the Medicare product line only, a “Skilled Nursing Care Stratification” was added to highlight the readmission rate among non-outlier Medicare beneficiaries who were discharged from the hospital to skilled nursing care. An index hospital stay discharged to skilled nursing care experienced by a non-outlier Medicare beneficiary is reported in several places and receives two sets of risk weights.
The tables in the PDF (
https://www.ncqa.org/wp-content/uploads/2020/03/20200312_2020_PCR_Tables.pdf) illustrate assignment of risk weights for index hospital stays among two hypothetical Medicare beneficiaries meeting all other measure criteria (e.g. non-outlier, continuously enrolled, etc.). Index Hospital Stay #2 for member 1101 and Index Hospital Stays #1 and #2 for member 1202 are discharged to skilled nursing care.Table 1 shows that these index stays are assigned the standard set of risk weights for reporting in Table PCR-A-1/2/3 and Table PCR-B-3. Do not assign the skilled nursing care risk weights for the stays in Table PCR-A-1/2/3 and Table PCR-B-3.
Table 2 shows that these same index stays are assigned the skilled nursing care risk weights for reporting the “Skilled Nursing Care Stratification” in Table PCR-C-3. Do not assign the standard set of risk weights for the stays in Table PCR-C-3.
Index hospital stays that are not discharged to skilled nursing do not need to be assigned the skilled nursing care risk weights and are not reported in the “Skilled Nursing Care Stratification” in Table PCR-C-3. Index Hospital Stays #1 and #3 for member 1101 are examples of events that do not need to be assigned the skilled nursing care risk weights and are not reported in the “Skilled Nursing Care Stratification”. The “Skilled Nursing Care Stratification” applies to the Medicare product line only and index hospital stays among other product lines do not use the skilled nursing care risk weights.
This applies to the following Programs and Years:
HEDIS 20203.15.2020 Using Complaint Data to Supplement Surveys or Self-Reported Information In NET 2, Elements A–C, if an organization collects data using surveys or practitioner self-reported information, it must supplement the data with an analysis of complaints regarding access. Are organizations required to conduct a complete quantitative and qualitative analysis of complaint data?
No. Supplemental complaint data validates survey findings and self-reported information and assists in qualitative analysis of primary data. The organization is not required to conduct complete quantitative and qualitative analysis of supplemental data.
