Because the SES assessment is new and requires files not normally used for NCQA’s measure calculations, we have explored options for reporting members with these scenarios, and we think there are options for these data.
NOTE: NCQA’s Certification program tests one record per member based on the MMDDF.
- Option 1: If you are using MMDDF and one month has multiple rows for a member with different values in one row or more, sum the values and use the result to compare to the other 3 months. Remember that what is important is whether the number is > 0 or it is < or = 0. See this example:
| Member | RunDate | LisPremiumSubsidy |
| 1 | 2018 10 12 | 0000.00 |
| 1 | 2018 10 12 | 0035.50 |
| 1 | 2018 11 08 | 0035.50 |
| 1 | 2018 11 08 | -0035.50 |
| 1 | 2018 11 08 | 0035.50 |
| 1 | 2018 12 08 | 0035.50 |
This member is counted as LIS eligible: the sum of October = 35.50, the sum of November = 35.5, and December = 35.50 (all months are >0).
- Option 2: If you have access to the LIS History (LISHIST) File, it can be used to determine LIS eligibility. CMS describes the file as the most complete picture of LIS eligibility over a period not to exceed 36 months. This data file includes LIS activity for past, present and future enrollees. A full copy of the Plan-Communications-User-Guide-v122-August-31-2018, which describes the file, can be found at https://www.cms.gov/Research-Statistics-Data-and-Systems/CMS-Information-Technology/mapdhelpdesk/Downloads/Plan-Communications-User-Guide-v122-August-31-2018.pdf. Below is an example of the corresponding records in the LISHIST file for the member shown above.
| Member | LowIncomePeriodStartDate | LowIncomePeriodEndDate | LipsPercentage | PremiumLisAmount | ContractYear |
| 1 | 2016 09 01 | 2016 12 31 | 100 | 36.00 | 2016 |
| 1 | 2017 01 01 | 2017 12 31 | 100 | 36.00 | 2017 |
| 1 | 2018 01 01 | 100 | 35.50 | 2018 |
This file clearly shows that the member was LIS eligible for the HEDIS 2019 measurement year (calendar year 2018). If you have access to this file, it may be the easiest, most accurate data to use.
NOTES:
- If the LowIncomePeriodEndDate is blank, the member is still eligible.
- Plans should use a copy of this file from December 2018 or later.
*This same FAQ was posted on November 15, 2018 but was updated in the December 2018 FAQ posting. In the above “NOTES” section, it used to read that plans should use a copy of the file from January 2019 or later. This date was corrected to December 2018 or later.
HEDIS 2019