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Noteworthy topics to consider during NCQA’s public comment period

The Nationwide Committee for High quality Assurance (NCQA) has launched proposed updates and modifications to HEDIS® measures for Measurement Yr 2023 (MY 2023) for public remark, with the remark interval ending this Friday, March 11. As a number of modifications have been proposed, Cotiviti has compiled a couple of specific matters for well being plans to think about when submitting suggestions.

Dental measures

In updates for MY 2023, NCQA proposed two new Dental High quality Alliance (DQA) measures to switch the Annual Dental Go to (ADV). The ADV measure that’s being retired was a dental profit measure, which means that Medicaid plans that didn’t have a dental profit may set this measure to “No Profit” when reporting. Nonetheless, one of many two proposed DQA measures to switch ADV, the Topical Fluoride for Youngsters measure, is proposed to permit for “Dental or Medical” profit. 

The desk labeled “Knowledge Components for Reporting” nonetheless signifies {that a} profit flag is offered for this measure, however the query stays whether or not NCQA will enable a plan with a medical profit and no dental profit to proceed setting this measure to “No Profit.” Profit necessities for measures don’t historically have an “or Medical” possibility, so this measure might require clarification.

Social Want Screening and Intervention (SNS-E)

This proposed new measure would focus extra carefully on social determinants of well being (SDoH). Taking a deeper dive into the written specification for SNS-E, well being plans ought to pay shut consideration to how NCQA is proposing to establish the suitable screenings and whether or not they have a constructive outcome. Inside this measure, there aren’t any proposed worth units to make use of to tug the screening data—it seems to be solely based mostly on the textual content names of the screenings themselves. Moreover, the information would wish to comprise not solely the screening identify, however the person screening questions and solutions as properly. 

To run a measure with this kind of text-based information, the information would wish to have constant, precisely spelled questions and responses to programmatically decide whether or not the screening was constructive. Nonetheless, even the present depression-related Digital Scientific Knowledge Methods (ECDS) measures don’t get right down to this stage of text-based matching, because the melancholy screenings have LOINC or SNOMED codes and tallied scores that decide constructive or unfavorable outcomes. These giving suggestions ought to contemplate the best way to supply this information and constantly guarantee its accuracy of their HEDIS engine to have the ability to produce the required outcomes for this measure. This digital measure might want to have some methodology of intaking and calculating these screening outcomes, however this stage of element shouldn’t be but out there to grasp NCQA’s expectations on how this information could be structured.

Emergency Division Visits for Hypoglycemia in Older Adults with Diabetes (EDH)

Inside the measure specification for this proposed new measure, pay shut consideration to the definition of Charge 2 for Members Receiving Basal Insulin. The Occasion/Analysis standards for this charge lacks particular particulars as to how the basal insulin allotting occasions must be tabulated to find out whether or not a member meets the anticipated standards. This brings a number of inquiries to thoughts, together with:

  • Ought to the measurement logic from July 1 within the yr prior via December 31 of the measurement yr be damaged into 180-day segments and validate that there’s at the least one allotting occasion inside every of these segments? 
  • Ought to the logic make sure that after the member’s first allotting occasion of basal insulin that the subsequent allotting occasion is inside 180 days from the prior allotting occasion? 
  • Is each day provide taken into consideration inside the calculations if a member fills a prescription early?

If there’s a particular methodology for calculating this occasion standards that involves thoughts, contemplate sharing these ideas with NCQA in your remark.

Able to remark?

NCQA is on the lookout for public feedback on these new proposed HEDIS measures, updates to current measures, proposed measure retirements, and new matters by 5:00 pm ET this Friday, March 11. Submit your feedback through the NCQA public remark web site.

Cotiviti’s High quality Intelligence measurement and reporting resolution units the usual for effectivity, integration, ease of use, and buyer satisfaction. With our totally NCQA-certified high quality measure logic, well being plans are in good fingers. Uncover what High quality Intelligence can do to your plan.

HEDIS® is a registered trademark of the Nationwide Committee for High quality Assurance (NCQA).

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