HEDIS 2010 Reporting MeasuresFINAL with disclosure statement 5-28-2010

ATTACHMENT 1:
CMS Memorandum, “2010 HEDIS, HOS and
CHAPS Measures for Reporting by Medicare
Advantage Organizations”

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DEPARTMENT OF HEALTH & HUMAN SERVICES
Centers for Medicare & Medicaid Services
7500 Security Boulevard
Baltimore, Maryland 21244-1850

CENTER FOR DRUG and HEALTH PLAN CHOICE
TO:

Medicare Advantage Quality Contacts and Medicare Compliance Officers

FROM:

Cynthia G. Tudor, Ph.D., Director, Medicare Drug Benefit and C & D Data Group

SUBJECT:

2010 HEDIS, HOS and CAHPS Measures for Reporting by
Medicare Advantage Organizations

DATE:

OVERVIEW
This memorandum contains a list of HEDIS® measures required to be reported by all Medicare
Advantage Organizations in 2010. It also includes information about which plans are required to
participate in HOS and CAHPS®. Sections 422.152 and 422.516 of Volume 42 of the Code of
Federal Regulations (CFR) specify that Medicare Advantage plans must submit performance
measures as specified by the DHHS Secretary and CMS. These performance measures include
HEDIS, HOS, and CAHPS.

HEDIS 2010 Requirements
In 2010, NCQA will collect data for services covered in 2009. Detailed specifications for these
measures are in HEDIS 2010, Volume 2, Technical Specifications, published by the National
Committee for Quality Assurance (NCQA). All HEDIS 2010 measures must be submitted to
NCQA by 11:59 p.m. EDT on June 30, 2010. Late submissions will not be accepted. If a plan
submits their HEDIS data after June 30, 2010, they will automatically receive a rating of one star on
all of their required HEDIS measures for the data that are updated in the Fall 2010, on Medicare
Options Compare.
Medicare Advantage Organizations meeting CMS’s minimum enrollment requirements for 2009
must submit audited summary-level HEDIS data to NCQA. Table 1 includes information about
which organizational types need to report HEDIS, CAHPS and HOS data. Contracts with 1,000 or
more members enrolled as reported in the July 2009 Monthly Enrollment by Contract Report
(which can be found at
http://www.cms.hhs.gov/MCRAdvPartDEnrolData/MEC/list.asp#TopOfPage) must collect and
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submit HEDIS data to CMS. Closed cost contracts are required to report HEDIS regardless of
enrollment closure status. Patient-level data must be reported to HCD International. More
information on the patient-level data submission will be forthcoming in a separate memorandum.
The following is the OMB Disclosure Statement for Medicare HEDIS® data collection:
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a
collection of information unless it displays a valid OMB control number. The valid OMB control
number for this information collection is 0938-1028. The time required to complete this
information collection is estimated to average 320 hours to complete the annual Medicare HEDIS®
data collection, including the time to review instructions, to search existing data sources, to gather
the needed data, and to complete and to review the information collection.
If you have any comments concerning the accuracy of the time estimate(s) or suggestions for
improving this data collection, please write to: CMS, 7500 Security Boulevard, Attn: PRA
Clearance Officer, Mail Stop C4-26-05 Baltimore, Maryland 21244-1850.

Table 1 includes information about which organizational types need to report HEDIS, CAHPS and
HOS data.
Table 1: 2010 Performance Measure Reporting Requirements
2010 Performance Measure Reporting Requirements
Organization Type
CAHPS HEDIS HOS HOS-M
1876 Cost

 

Chronic Care

 

Demo

 

Employer/Union Only Direct Contract PDP

 

Employer/Union Only Direct Contract PFFS

 

HCPP-1833 Cost

 

Local CCP

 

MSA

 

National PACE

 

PDP

 

PFFS

 

POS Contractor

 

Regional CCP

 

RFB PFFS

 

 = Not required to report
 = Required to report
 = Optional reporting

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During the data year, if your HPMS contract status is listed as a consolidation, a merger, or a
novation, the surviving contract must report HEDIS data for all members of the contracts involved.
If a contract status is listed as a conversion in the data year, the contract must report if the new
organization type is required to report.
In 2010, CMS will also continue collecting audited data from all benefit packages designated as
Special Needs Plans (SNPs) and ESRD Demonstration Plans that had 30 or more members enrolled
as reported in the February 2009 SNP Comprehensive Report (which can be found at
http://www.cms.hhs.gov/MCRAdvPartDEnrolData/SNP/list.asp#TopOfPage).
Beginning with HEDIS 2010, PPO plan types have the option to report HEDIS using the Hybrid
Method for all measures, with the exception of the Colorectal Cancer Screening measure. Because
this measure is scored for NCQA accreditation using administrative benchmarks and thresholds, all
PPOs must continue to report the Colorectal Cancer Screening measure using the Administrative
Method.
PFFS and MSA plans may voluntarily collect and submit 2009 calendar year HEDIS data following
the HEDIS 2010 specifications. For calendar year 2010, PFFS and MSA plans are required to
collect data on only administrative HEDIS measures following the HEDIS 2011 Technical
Specifications and report the audited data to CMS in mid-2011.
For calendar year 2011, PFFS and MSA plans will be required to collect data on all HEDIS
measures and report the audited data to CMS during the subsequent year. PFFS and MSA plans
will be required to collect data on all HEDIS measures following the HEDIS 2012 Technical
Specifications and report the audited data to CMS in mid-2012.
In HEDIS 2011, the submission of Use of Service measures is subject to change as CMS moves to
submission of audited data for CMS Part C and D reporting requirements.
Medicare Advantage Organizations new to HEDIS must become familiar with the requirements for
data submissions to NCQA, and make the necessary arrangements as soon as possible. Information
about the HEDIS audit compliance program is available at:
http://www.ncqa.org/tabid/204/Default.aspx.
Please note that plans should refer to this memorandum for CMS reporting requirements, and not to
the NCQA website. The reporting requirements are summarized in Table 2. For further
information on HEDIS, please contact Lori Teichman, Ph.D. at [email protected]. For
information specific to the SNPs, please contact Heidi Arndt, MHA, at [email protected].

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Table 2: HEDIS 2010 Measures for Reporting by Organization Types
HEDIS 2010 Measures for Reporting

MA HMO &
PPO
Contracts

MA PFFS &
MSA*
Contracts

MA §1876
Cost
Contracts

SNPs, SNP
PPOS, &
ESRDs

Effectiveness of Care
ABA Adult BMI Assessment

X

BCS Breast Cancer Screening

X

COL Colorectal Cancer Screening

X**

GSO Glaucoma Screening in Older Adults

X

X
X
X

X
X

X**

X

X

COA Care for Older Adults (SNP-only measure)

X

Use of Spirometry Testing in the Assessment and
SPR Diagnosis of Chronic Obstructive Pulmonary
Disease (COPD)

X

X

X

X
X

PCE

Pharmacotherapy Management of COPD
Exacerbation

X

X

X

CMC

Cholesterol Management for Patients with
Cardiovascular Conditions

X

X1

X

CBP Controlling High Blood Pressure
PBH

X

Persistence of Beta-Blocker Treatment After a
Heart Attack

X

X
X

X

X

X

CDC Comprehensive Diabetes Care2

X

X3

X

Disease Modifying Anti-Rheumatic Drug Therapy
ART
in Rheumatoid Arthritis

X

X

X

X

X

X

X

AMM Antidepressant Medication Management

X

X

X

X

FUH Follow-up After Hospitalization for Mental Illness

X

X

X

X

Annual Monitoring for Patients on Persistent
MPM
Medications

X

X

X

X

X

X

X

X

X

X

X

X

OMW

DDE

Osteoporosis Management in Women Who Had
a Fracture

Potentially Harmful Drug-Disease Interactions in
the Elderly

DAE Use of High-Risk Medications in the Elderly
MRP

Medication Reconciliation Post-Discharge (SNPonly measure)

X

HOS Medicare Health Outcomes Survey
FRM

Falls Risk Management (collected in Medicare
Health Outcomes Survey)

X

X

X

X

X

X

X4
X4
X4

Management of Urinary incontinence in Older
MUI Adults (collected in Medicare Health Outcomes
Survey)

X

X

X

OTO

Osteoporosis Testing in Older Women (collected
in Medicare Health Outcomes Survey)

X

X

X

PAO

Physical Activity in Older Adults (collected in
Medicare Health Outcomes Survey)

X

X

X

(Refer to the Footnotes at the end of Table 2, Page 5)

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X4
X4

MA HMO &
PPO
Contracts

MA PFFS &
MSA*
Contracts

MA §1876
Cost
Contracts

FSO Flu Shots for Older Adults (collected in CAHPS)

X

X

X

Medical Assistance With Smoking Cessation
MSC
(collected in CAHPS)

X

X

X

X

X

X

HEDIS 2010 Measures for Reporting

PNU

Pneumonia Vaccination Status for Older Adults
(collected in CAHPS)
Access /Availability of Care

AAP

Adults’ Access to Preventive/Ambulatory Health
Services

X

X

X

IET

Initiation and Engagement of Alcohol and Other
Drug Dependence Treatment

X

X

X

CAB Call Abandonment

X

X

X

CAT Call Answer Timeliness

X

X

X

X

X

X

FSP Frequency of Selected Procedures

X

X

X

Inpatient Utilization --- General Hospital/Acute
IPU
Care

X

X

X

AMB Ambulatory Care

X

X

X

NON Inpatient Utilization-Non-Acute Care

X

X

X

MPT Mental Health Utilization

X

X

X

SNPs, SNP
PPOS, &
ESRDs

Health Plan Stability
TLM Total Membership

Use of Services5

IAD Identification of Alcohol and Other Drug Services

X

X

X

ORX Outpatient Drug Utilization

X

X

X

ABX Antibiotic Utilization

X

X

X

BCR Board Certification

X

X

X

ENP Enrollment by Product Line

X

X

X

EBS Enrollment by State

X

X

X

RDM Race/Ethnicity Diversity of Membership

X

X

X

LDM Language Diversity of Membership

X

X

X

Health Plan Descriptive Information
X

*PFFS and MSAs may voluntarily collect the HEDIS data for CY 2009.
**PPO plans may collect the Colorectal Cancer Screening measure using only the administrative method.
1
LDL-C Level is not required due to need for medical record review.
2
HbA1c Control <7% For a Selected Population is not required for Medicare contracts.
3
HbA1c control, LDL-C control or Monitoring for Diabetic Neuropathy and blood pressure control are not required
due to need for medical record review.
4
Contracts with exclusively SNP plan benefit packages – see specific HOS requirements in this memorandum.
5
1876 Cost Contracts do not have to report the inpatient measures if they do not have inpatient claims.

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2010 HOS and HOS-M REPORTING REQUIREMENTS
Plans that Must Report HOS
The following types of Medicare Advantage Organizations with Medicare contracts in effect on or
before January 1, 2009, are required to report the Baseline HOS in 2010, provided that they have
a minimum enrollment of 500 members:
 All Coordinated Care Plans, including health maintenance organizations (HMOs), local and
regional preferred provider organizations (PPOs) and contracts with exclusively SNP plan
benefit packages;
 Continuing cost contracts that held §1876 risk and cost contracts;
 Private Fee-for-Service (PFFS) plans; and,
 Medical Savings Account (MSA) plans.
In addition, all Medicare Advantage Organizations that reported a Cohort 11 Baseline Survey in
2008 are required to administer a Cohort 11 Follow-up Survey in 2010.
To report HOS, all plans must contract with a certified HOS survey vendor and notify NCQA of
their survey vendor choice no later than January 22, 2010. You will receive further
correspondence from NCQA regarding your HOS participation.
New in 2010 – PFFS and MSA Plans Must Report HOS
PFFS and MSA plans, with a minimum enrollment of 500 members, with Medicare contracts in
effect on or before January 1, 2009, are now required to report HOS in 2010.
Plans that Must Report HOS-M
The HOS-M is an abbreviated version of the Medicare Health Outcomes Survey (HOS). The
HOS-M assesses the physical and mental health functioning of the beneficiaries enrolled in PACE
Programs and certain Medicare Advantage Organizations to generate information for payment
adjustment.
All Programs of All Inclusive Care for the Elderly (PACE) Programs with Medicare contracts in
effect on or before January 1, 2009, are required by CMS to administer the HOS–M survey in 2010.
To report HOS-M, eligible plans must contract with Datastat, Inc., the certified HOS-M survey
vendor, no later than January 22, 2010. You will receive further correspondence from NCQA
regarding your HOS participation.
For additional information on 2010 HOS or HOS-M reporting requirements, please contact Chris
Haffer, Ph.D. at [email protected].

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CAHPS Survey Requirements
CMS has contracted with Thoroughbred Research Group (TRG) and the Center for the Study of
Services (CSS) to conduct the 2010 Medicare Consumer Assessment of Healthcare Providers and
Systems (CAHPS) survey.

The following types of Medicare Advantage Organizations are included in the CAHPS survey
administration provided that they have a minimum enrollment of 600 eligible members as of July
1, 2009:
 All Coordinated Care contracts, including local and regional preferred provider
organizations (PPOs) and contracts with exclusively SNP plan benefit packages, with
Medicare contracts in effect on or before January 1, 2009;
 Continuing cost contracts that held §1876 risk and cost contracts, with Medicare contracts in
effect on or before January 1, 2009; and,
 Private-Fee-For-Service and MSA Contracts in effect on or before January 1, 2009.
The Programs of All Inclusive Care for the Elderly (PACE), HCPP – 1833 cost and employer/union
only contracts are excluded from the CAHPS administration.
As a reminder, Medicare Advantage organizations will be required to contract next year for the
2011 survey administration with an approved MA & PDP CAHPS Survey Vendor. It is anticipated
that a list of approved survey vendors will be available by September 2010. Training for survey
vendors will take place in early Fall 2010.
For CAHPS, we have been collecting data from PFFS contracts for many years. CMS will be
conducting the survey for MSA contracts beginning in 2010. For 2011, like other types of MA
organizations, PFFS and MSA contracts will be required to contract with an approved MA and PDP
CAHPS Survey Vendor to collect the CAHPS data on their behalf.
CMS will be issuing additional HPMS memorandums about the CAHPS survey for 2010 and 2011.

For additional information on the CAHPS survey, please contact Ted Sekscenski, MPH, at
[email protected].

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