FAQ Directory: HEDIS

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12.16.2013 Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life Is a BMI growth chart sufficient for the physical requirement of the developmental history component?

No. Growth charts (height, weight, BMI or BMI percentile) do not meet criteria for physical developmental history for the W34 measure. The intent of the developmental history component (physical and mental) is to determine if the child was assessed for specific age-appropriate physical and mental developmental milestones, which are behaviors or physical skills seen in children as they grow and develop. For the W34 measure, examples of mental developmental milestones include ability to speak understandably, identify colors and define words appropriately. For the W34 measure, examples of physical developmental milestones include the ability to hop, throw a ball, draw and make a block tower. Documentation of "developing appropriately" or "normal development" meets criteria for both physical and mental development. Documentation of "growing appropriately" (without notation about "development") does not meet criteria for physical or mental developmental history.

Additional examples can be found in the Appendices of the Bright Futures Pocket Guide Guidelines for Health Supervision of Infants, Children, and Adolescents (http://brightfutures.aap.org/pdfs/bf3%20pocket%20guide_final.pdf).

HEDIS 2014

12.16.2013 General Guidelines Are HbA1c and LDL-C tests where the member collects a blood sample at home and sends it to a lab for results calculation allowed for HEDIS reporting?

No. Tests where the blood sample is collected by the member are considered self-administered tests and are not eligible for use in HEDIS reporting.

HEDIS 2014

12.16.2013 Cervical Cancer Screening In step 2 of the Administrative Specification, organizations identify women 30-64 years of age as of December 31 of the measurement year who had cervical cytology and a human papillomavirus (HPV) test, with service dates four or less days apart during the measurement year. When counting service dates, is the date of the cervical cytology considered day one or day zero of the four-day count?

The date of the cervical cytology is considered day zero. For example, if the service date for cervical cytology was December 1 of the measurement year, the HPV test must include a service date on or between December 1 and December 5 of the measurement year.

HEDIS 2014

12.16.2013 General Guidelines If an organization finds an undated lab result in a progress note, can the progress note date be used as the lab result date?

No. An undated lab result may not be used for HEDIS reporting. To be eligible for use, the date the test was performed (e.g., the date the sample was drawn) or the result date (e.g., the date the lab calculated the result) must be documented.

HEDIS 2014

11.15.2013 Volume 2 Technical Update In the Volume 2 Technical Update memo, the term "discharged alive" was replaced with "discharged" in measures that include discharges for AMI or CABG. Does this mean that members who died prior to discharge should be included in the measures?

No. Removal of the language "discharged alive" does not mean that deceased members should be included in measures. As with other HEDIS measures, deceased members who do not meet continuous enrollment or anchor date criteria should not be included in the measures Eligible Population. The term "discharged alive" was removed in order to make language consistent across AMI, CABG and PCI (the term had been removed from PCI in the July 1 release of the publication; NCQA received questions about why it was removed from PCI but not from AMI or CABG). In 2015, NCQA intends to remove the term "discharged alive" from all remaining references (i.e., PBH, FUH and all measure descriptions).

HEDIS 2014

11.15.2013 Value Set Directory The Summary of Changes spreadsheet in the HEDIS 2014 Volume 2 Value Set Directory lists LOINC code 72732-0 as added to the Sexual Activity Value Set, but that code is not in the Volume 2 Value Sets to Codes spreadsheet.

LOINC code 73732-0 was added to the Sexual Activity Value Set; it was entered incorrectly (as 72732-0) in the Summary of Changes spreadsheet. We apologize for the inconvenience.

HEDIS 2014

11.15.2013 General Guidelines Have the dates been extended for primary source verification (PSV) and final approval of supplemental data for HEDIS 2014?

Yes. Data collection and entry of all nonstandard and member-reported supplemental data must stop on March 3. PSV and final approval must be completed by March 14, for member-reported supplemental data, and by March 28, for nonstandard supplemental data. PSV may not occur before March 3 unless all supplemental data processes, collection and entry have stopped. Supplemental data approval and PSV may not occur, under any circumstances, before January 1 and receipt of the Roadmap.

HEDIS 2014

11.15.2013 General Guidelines If a member is included in a measure's denominator due to an incorrect code, may a corrected claim be submitted to remove the member from the measure?

It is not NCQA's policy to dictate an organization's claims submission process. Claims may be corrected or updated as necessary before the HEDIS reporting process begins. However, once the HEDIS reporting process has begun (i.e., the measures' eligible populations are identified and samples are drawn for hybrid reporting), the requirements specified in Volume 2 General Guidelines and Technical Specifications must be followed.

For administrative-only measures, members who meet the eligible population criteria for the measure should remain in the measure. If an organization refreshes data for administrative-only measures, the most accurate and current information must be used for reporting. Additionally, the organization must apply the refresh to all applicable measures.

For hybrid measures, members who are in the denominator due to inaccurate claims data may meet criteria for a valid data error. Valid data errors are identified only for hybrid measures during medical record review and may not be identified using supplemental data. In order to categorize a member as a valid data error (and replace the member with another member from the sample), the chart must show no evidence of the diagnosis and must include evidence to explain or substantiate the data error. As described in General Guideline 40, organizations that elect to refresh data for the sample may not use the refreshed data to change the hybrid sample after it has been selected. The auditor reviews all valid data error exclusions during Medical Record Review Validation.

HEDIS 2014

11.15.2013 Initiation and Engagement of Alcohol and Other Drug DependenceTreatment The list of code combinations to identify Initiation and Engagement visits do not include codes to identify inpatient admissions. Do inpatient admissions count as initiation and engagement of AOD treatment?

As stated in the paragraphs prior to the list of code combinations, an inpatient admission with a diagnosis of AOD meets criteria for both initiation and engagement. Because NCQA does not specify codes to identify inpatient admissions, inpatient admissions were not included in the list of code combinations. The lists of code combinations include only visits for which value sets exist (outpatient, intensive outpatient and partial hospitalization). Organizations should use their own methods for identifying inpatient admissions when identifying initiation and engagement visits.

HEDIS 2014

10.15.2013 Mental Health Utilization On page 302 of HEDIS 2014 Volume 2, in the Outpatient and ED section, the 5th bullet states "where the organization can confirm that the visit was in an intensive outpatient or partial hospitalization setting (POS 53 is not specific to setting)." Should the language be changed to reference an "outpatient" setting?

Yes. The language should read, "where the organization can confirm that the visit was in an outpatient setting (POS 53 is not specific to setting)." The intent is to include only codes where the organization can confirm that the visit was in an outpatient setting.

HEDIS 2014

10.15.2013 Identification of Alcohol and Other Drug Services On page 298 of HEDIS 2014 Volume 2, in the Outpatient and ED section, the 5th bullet states "where the organization can confirm that the visit was in an intensive outpatient or partial hospitalization setting (POS 53 is not specific to setting)." Should the language be changed to reference an "outpatient" setting?

Yes. The language should read, "where the organization can confirm that the visit was in an outpatient setting (POS 53 is not specific to setting)." The intent is to include only codes where the organization can confirm that the visit was in an outpatient setting.

HEDIS 2014

8.16.2013 Childhood Immunization Status On May 16, 2013, the Centers for Disease Control and Prevention (CDC) National Center for Immunization and Respiratory Diseases released a document based on Sanofi Pasteurs Pentacel (DTaP-IPV/Hib) and Daptacel (DTaP) vaccine shortage. Because these vaccines are expected to be in short supply through summer 2013, does NCQA plan any changes to the CIS measure for HEDIS 2014?

No. NCQA will not make any changes to the vaccine requirements for HEDIS 2014. As indicated by the CDC, "Single-component DTaP, IPV, HepB, and Hib vaccines and other age-appropriate licensed combination vaccines are available to complete series begun with Pentacel or Pediarix. Currently, there is a sufficient supply of these products to meet the anticipated demand." You can find additional information in the Guidance for Vaccinating Children during the 2013 Pentacel, Daptacel and Pediarix Shortage article at http://www.cdc.gov/vaccines/vac-gen/shortages/downloads/pentacel-guidance.pdf.

HEDIS 2014