Customers can find additional information about these topics (including FAQs specific to this data source and the DMS measure) at the following link, http://ncqa.org/ECDS.
HEDIS 2016
FAQ Directory: HEDIS
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7.16.2015 General Guidelines Where can customers find additional information about Electronic Clinical Data Systems (ECDS) and the Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults (DMS) measure for HEDIS 2016?
4.16.2015 Policy Clarification Support (PCS) Website URL Is there a new Web site URL for the PCS system?
Yes. The PCS system will be moved to a new Web site—http://my.ncqa.org—by the end of April. Customers who access the old PCS site will be automatically rerouted to the new site. The new site takes the same login and password; you will not need to change them.
HEDIS 2015
12.15.2014 CAHPS Health Plan Survey 5.0H, Child & Adult Version Has the CAHPS survey sample frame validation process changed?
Yes. Starting in reporting year 2015, NCQA requires that all Licensed Organizations apply a password lock to the validated and approved sample frame file used for conducting the commercial and Medicaid Child and Adult CAHPS and the Qualified Health Plan (QHP) Enrollee surveys. Survey vendors may not pull a sample from an unlocked file.
HEDIS 2015
11.14.2014 Osteoporosis Management in Women Who Had a Fracture CMS required the use of temporary HCPCS code Q2051 (Injection, Zoledronic acid, 1 mg) from July 1–December 31, 2013. This code is not included in the Osteoporosis Medications Value Set. May organizations map this code and use it for HEDIS 2015 reporting?
11.14.2014 CAHPS Health Plan Survey 5.0H, Child Version To collect results for Children With Chronic Conditions, more than 12 questions must be added to the CAHPS child survey. How can an organization collect results for the Children With Chronic Conditions (CCC) measure without exceeding 12 supplemental questions?
A version of the child survey that includes the CCC questions is part of HEDIS. If an organization uses the “With CCC” version of the questionnaire, the CCC items are considered part of the CAHPS 5.0H questionnaire and are not included in the count of 12 supplemental questions.
HEDIS 2015
10.15.2014 Flu Vaccinations for Adults Ages 18-64 Will NCQA publicly report the Flu Vaccinations for Adults Ages 18–64 (FVA) measure for the Medicaid product line for HEDIS 2015?
10.15.2014 Value Set Directory The October 1 version of the Value Set Directory (VSD) was rereleased on 10/8/14. What changed?
There were mislabeled columns on three of tabs on the October 1 release: Volume 2 Value Sets to Codes; Summary of Changes—Codes; Summary of Changes—Value Sets. In all of these spreadsheets, the first column should be labeled “Value Set Name,” not “Measure ID.” This was corrected in the updated VSD released on 10/8/14. No changes were made to the value sets or codes.
HEDIS 2015
10.15.2014 Relative Resource Use for People With Asthma Should the same change be made to the RAS measure that is also made to step 2 in the Event/Diagnosis section of the ASM, MMA and AMR measures in the HEDIS 2015 Volume 2: Technical Update?
Yes. In the Eligible Population section, replace the text in step 2 with the following: A member identified as having persistent asthma because of at least four asthma medication dispensing events, where leukotriene modifiers or antibody inhibitors were the sole asthma medication dispensed in that year, must also have at least one diagnosis of asthma (Asthma Value Set), in any setting, in the same year as the leukotriene modifier or antibody inhibitor (i.e., the measurement year or the year prior to the measurement year).
HEDIS 2015
10.15.2014 Controlling High Blood Pressure Must organizations confirm the diabetes flag through medical record review? Should only administrative data be used to assign the diabetes flag that is used to assess the numerator?
Organizations are not required to identify or confirm the diagnosis of diabetes through medical record review; only the hypertension diagnosis must be confirmed. Only administrative data should be used to assign the diabetes flag. The intent of the flag is to determine the appropriate BP threshold to use for the member during numerator assessment because the threshold for members with diabetes is different from the threshold for members without diabetes.
The only exception is if the member is flagged as a diabetic but medical record evidence contains information that classifies the member as a valid data error. To meet criteria as a valid data error, the medical record must contain no evidence of diabetes and include a notation that refutes the diagnosis, as described in Substituting Medical Records in the Guidelines for Calculations and Sampling. In this case, the diabetes flag may be changed to “not diabetic”, but the member may not be removed from the sample.
HEDIS 2015
9.15.2014 Osteoporosis Management in Women Who Had a Fracture Step 4 states to exclude members who received a dispensed prescription or had an active prescription to treat osteoporosis during the 365 days (12 months) prior to the IESD. Define “active prescription.”
An “active prescription” means that a member has a surplus of medication to take from a prescription dispensed previously. Therefore, in step 4 (required exclusions), the member is excluded if a prescription was dispensed during the 12 months prior to the IESD, or prior to that time frame if the member has remaining pills to take in the 12 months prior to the IESD.
HEDIS 2015
9.15.2014 Comprehensive Diabetes Care If a member is numerator negative for at least one indicator in the CDC measure, when may the optional exclusions be applied?
The optional exclusion criteria may be applied only if the member did not have a diagnosis of diabetes during the measurement year or the year prior to the measurement year. If the member was included in the measure based on claim or encounter data, as described in the event/diagnosis criteria, the optional exclusions do not apply because the member had a diagnosis of diabetes. If the member was included in the measure based on pharmacy data alone, the member may meet criteria for an optional exclusion if no diagnosis of diabetes was found in claim or encounter data or in the medical record.
For example, if a member was included in the measure based on pharmacy data but had a visit with a diagnosis of diabetes, the member does not meet optional exclusion criteria.
If a member was included in the measure based on pharmacy data alone and there was no claim or encounter with a diagnosis of diabetes, but medical record documentation indicated the member is a diabetic, the member does not meet optional exclusion criteria.
If a member was included in the measure based on pharmacy data alone and there was no claim or encounter with a diagnosis of diabetes and no evidence of diabetes in the medical record being reviewed, the member may meet optional exclusion criteria if there was a diagnosis of polycystic ovaries any time during the member’s history through December 31 of the measurement year, or a diagnosis of gestational diabetes or steroid-induced diabetes during the measurement year or the year prior to the measurement year.
HEDIS 2015
9.15.2014 Comprehensive Diabetes Care For the eye exam indicator, is documentation of hypertensive retinopathy treated differently from diabetic retinopathy? If there is documentation that a member was negative for hypertensive retinopathy in the year prior to the measurement year, is this compliant?
Although the two diagnoses are clinically different, hypertensive retinopathy is not treated differently from diabetic retinopathy for the CDC measure. The intent of the eye exam indicator is to ensure that members with evidence of any type of retinopathy have an eye exam annually, while members who remain free of retinopathy (i.e., the retinal exam was negative for retinopathy) are screened every other year. If it is clear that a retinal or dilated eye exam was performed by an eye care professional in the year prior to the measurement year and there is documentation indicating that the member is negative for hypertensive retinopathy, this can count as compliant.
HEDIS 2015