Yes. The final reported hybrid rates for HEDIS 2020 (MY2019), regardless of rotation decision, can be used when applying sample size reduction rules for HEDIS MY2020 reporting.
HEDIS 2020
Although HEDIS/CAHPS results collected in 2020 reflect Measurement Year (MY) 2019, COVID-19 is impacting key aspects of HEDIS hybrid data collection and consumer experience nationally in 2020. The NCQA ratings methodology includes HEDIS/CAHPS measures and Accreditation status. While HEDIS/CAHPS reporting remains a required component of commercial and Medicaid Accreditation, we will not calculate an overall Health Plan Rating for MY 2019, because key aspects of data collection—especially consumer experience/CAHPS survey data—are understood to be compromised by the 2020 pandemic.
In addition to Accreditation, there are two components of Health Plan Ratings to consider when determining comparability for performance assessment: HEDIS and CAHPS results.
Considerations: Preliminary impact modeling using MY 2018 data has shown that approximately half of all plans’ overall ratings would be affected if Hybrid measures and/or CAHPS survey results were excluded from Health Plan Ratings. Given the uncertainty and likely variability of COVID-19’s impact on hybrid data collection efforts and consumer experience, NCQA will not calculate ratings for comparison of plans in 2020 for MY 2019. Ratings based on a reduced set of measures would not be comparable to previous Health Plan Ratings.
In addition, since NCQA will align with CMS guidance (https://www.federalregister.gov/documents/2020/04/06/2020-06990/medicare-and-medicaid-programs-policy-and-regulatory-revisions-in-response-to-the-covid-19-public), we will not require Medicare Advantage plans to submit data for Accreditation. In order to maintain alignment across all product lines, we want to recognize commercial and Medicaid plans for collecting and reporting data; however, we understand that some plans’ ability to submit HEDIS/CAHPS data might be compromised. We will work with these plans individually.
HEDIS 2020
CAHPS: CAHPS survey results will not be included in Quality Compass. We have concerns about the validity of CAHPS results because the survey is being fielded this year from February–May during the height of the pandemic as it continues to spread unevenly across the country, with wide regional variation.
HEDIS: We will continually assess the feasibility of using the data reported to us for other purposes, including Quality Compass, provided data meet our usual standards for validity, accuracy and completeness. No public reporting will be done on any measures failing to meet such criteria.
HEDIS 2020
NCQA’s Health Plan Accreditation program consists of three components that together uniquely evaluate a plan’s infrastructure, consistency, quality and compliance. In addition to structure and process standards, NCQA also requires plans to have a robust framework for gathering, reporting, analyzing and acting on member experience (CAHPS) data and health outcomes (HEDIS) measures.
Although compliance with our standards is reviewed every three years, HEDIS/CAHPS reporting is assessed annually. This assessment is two-fold: We evaluate reporting compliance and capabilities and we calculate performance outcomes for benchmarking with other plans. While we will not calculate a performance outcome by way of our Health Plan Ratings in 2020, we will still assess whether plans are maintaining their reporting and quality infrastructure.
HEDIS 2020
NCQA requires hybrid measures with multiple indicators to be reported using the same measurement year of data. Because of this requirement, if you report all CDC indicators hybrid last year (except for eye exam, which you reported administratively):
This is the only exception for using prior years’ administrative data.
HEDIS 2020
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.
HEDIS 2020