New HEDIS 2009 Measures
The HEDIS 2009 measurement set includes more than 70 quality indicators for commercial, Medicare, Special Needs Plan and Medicaid reporting. The following four hybrid measures are new for HEDIS 2009.
- Adult BMI Assessment
- Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents
- Care for Older Adults
- Medication Reconciliation Post-Discharge
HEDIS Reporting Requirements for SNPs
Beginning in 2008, Medicare Special Needs Plans (SNP) were required to report a subset of HEDIS measures for each SNP benefit package with 11 or more members as of January 1. For HEDIS 2009 reporting, the SNP measurement set will likely include the 13 SNP measures required for HEDIS 2008 reporting as well as the two new SNP-only measures: Care for Older Adults and Medication Reconciliation Post-Discharge.
New HEDIS Audit Requirements for FEHB Plans
For HEDIS 2009 reporting, the U.S. Office of Personnel Management (OPM) is requiring all Federal Employees Health Benefit (FEHB) plans to undergo a HEDIS Compliance Audit. Fee-for-service and PPO FEHB plans will report the same measures as last year, but will now be required to have their rates audited. For more information on Advent's audit program or the FEHB reporting and audit requirements, contact us at (877) 237-0190.
Redesigned Baseline Assessment Tool
NCQA has redesigned its baseline assessment tool (BAT) and renamed it the HEDIS Record of Administration, Data Management and Processes (HEDIS Roadmap). In addition to the elimination and rewording of questions, changes include combining of baseline and yearly questions, inclusion of vendor-specific sections, and reorganization of sections to align with audit standards. The HEDIS Roadmap is intended to “better fit the needs of the variety of organization participants and . . . more clearly define the systems and processes auditors need to understand when they perform an audit.”
Updated Comprehensive Diabetes Care Measure
In October 2008, NCQA released revised specifications for the Comprehensive Diabetes Care (CDC) measure. Changes include the following.
- Addition of a new HbA1c Control <8.0% indicator.
- Revision of the HbA1c<7 specifications to include required exclusions for this numerator only.
- Expansion of the sample size to 548, to allow for approximately 411 members for the HbA1c<7 denominator after required exclusions.
- Removal of CDC from the list of measures where sample size may be reduced for HEDIS 2009 reporting.
Both the HbA1c<8 and HbA1c<7 numerators are considered first-year measures and will not be publicly reported this year. Commercial and Medicaid plans that elect not to collect the HbA1c<7 numerator may use a sample of 411. Where state reporting requirements permit, they may also have the option of rotating the CDC measure. Medicare plans are not required to report the <7 indicator.
New Restrictions on Measure Rotation
Beginning with HEDIS 2009, NCQA is implementing new limitations on its measure rotation policy. As indicated last year, rotation of administrative rates for hybrid measures will no longer be permitted. Where state reporting requirements allow, commercial and Medicaid plans are eligible to rotate the following measures if the HEDIS 2008 rate was collected using the hybrid method and was audited and reportable.
- Childhood Immunization Status
- Colorectal Cancer Screening
- Cholesterol Management for Patients with Cardiovascular Conditions
- Comprehensive Diabetes Care
- Well-Child Visits in the First 15 Months of Life
- Well-Child Visits in the 3rd – 6th Years of Life
- Adolescent Well-Care Visits
Anticipated HEDIS 2010 Changes
The following changes are anticipated beginning with the HEDIS 2010 reporting year.
- Expansion of the hybrid methodology to PPO plans
- Revisions to the Childhood Immunization Status measure
- Introduction of the Immunizations for Adolescents measure
