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1 TO: Interested Organizations FROM: Patrick Dahill, Assistant Vice President, Accreditation & Measures Policy DATE: September 19, 2016 RE: Measures for Accreditation Scoring in 2017 This communication gives advance notice about the measures that will be used for accreditation scoring in As stated in the 2016 Health Plan Accreditation Standards for organizations accredited under the 2015 standards and beyond, NCQA will recalculate accreditation scores annually on the set of measures identified for each new reporting year, instead of on the same measure set for the standards year under which the organization was surveyed. Organizations accredited under the 2014 standards or earlier will continue to be scored on the measure set in effect at the time of their accreditation survey. Appendix 2: and CAHPS Points for Reporting Year 2017 includes the 2017 measures and is attached to this memo. It replaces Appendix 2 for organizations surveyed on the 2016 standards at their annual reevaluation in 2017, and applies to organizations surveyed on the 2017 standards th Street, NW Suite 1000 Washington, DC phone fax

2 Effective for Reporting Year 2017

3 Appendix 2 and CAHPS Points for Reporting Year 2017

4 Effective for Reporting Year 2017

5 Appendix 2 and CAHPS Points for Reporting Year APPENDIX 2 AND CAHPS POINTS FOR REPORTING YEAR 2017 Key to Reporting Categories Access and Service AS Getting Better GB Qualified Providers QP Living With Illness LWI Staying Healthy SH 2017 Measure Standard Description 2017 HP Points Reporting Categories MEASURES REQUIRED FOR HP ACCREDITATION COMMERCIAL HMO/POS/PPO Adult BMI Assessment SH Antidepressant Medication Management (Both Rates) Appropriate Testing for Children With Pharyngitis GB Appropriate Treatment for Children With Upper Respiratory Infection GB Medication Management for People With Asthma (Medication Compliance 75% Rate only) Asthma Medication Ratio (Total Rate) Avoidance of Antibiotic Treatment in Adults With Acute Bronchitis GB Breast Cancer Screening SH Cervical Cancer Screening SH Childhood Immunization Status (Combination 10) SH Chlamydia Screening in Women (Total Rate) SH Colorectal Cancer Screening SH Comprehensive Diabetes Care (New Rate BP Control [<140/90], New Rate HbA1c Control [<8.0%] HbA1c Poor Control [>9.0%], Medical Attention for Nephropathy, Eye Exam) LWI Controlling High Blood Pressure Flu Vaccinations for Adults Ages SH Follow-Up After Hospitalization for Mental Illness (7-Day Rate only) Follow-Up for Children Prescribed ADHD Medication (Both Rates) Human Papillomavirus Vaccine for Female Adolescents 1 NA NA For display purposes, all points are rounded to four decimal places. The ISS determines the official score. 1 The HPV vaccination was added to the Immunizations for Adolescents (IMA) measure in For Accreditation 2017, HPV will be scored NA. Organizations will continue to be scored on the IMA Combination 1 rate. For Accreditation 2018, organizations will be scored on the IMA Combination 2 rate, which includes the HPV vaccination. Effective for Reporting Year 2017

6 2-2 Appendix 2 and CAHPS Points for Measure Standard Description 2017 HP Points MEASURES REQUIRED FOR HP ACCREDITATION COMMERCIAL HMO/POS/PPO Reporting Categories Immunizations for Adolescents (Combination 1) SH Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (Engagement of AOD Treatment Rate only) Medical Assistance With Smoking and Tobacco Use Cessation (Advising Smokers and Tobacco Users to Quit Rate only) AS GB Persistence of Beta-Blocker Treatment After a Heart Attack Pharmacotherapy Management of COPD Exacerbation (Both Rates) Plan All-Cause Readmissions GB Prenatal and Postpartum Care (Postpartum Care Rate only) SH Use of Imaging Studies for Low Back Pain GB Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (the total of all ages for each of the 3 rates) Total for Measures SH CAHPS 5.0H Getting Care Quickly AS CAHPS 5.0H Getting Needed Care AS CAHPS 5.0H Claims Processing AS CAHPS 5.0H Coordination of Care AS CAHPS 5.0H Customer Service AS CAHPS 5.0H Rating of Health Plan AS CAHPS 5.0H Rating of All Health Care QP CAHPS 5.0H Rating of Personal Doctor QP CAHPS 5.0H Rating of Specialist Seen Most Often QP Total for CAHPS Measures 13 Total for and CAHPS Measures 50 TOTAL STANDARDS AND MEASURES 100 MEASURES REQUIRED FOR ACCREDITATION MEDICARE HMO/POS/PPO Adult BMI Assessment SH Antidepressant Medication Management (Both Rates) LWI Breast Cancer Screening SH Colorectal Cancer Screening SH Comprehensive Diabetes Care (New Rate BP Control [<140/90], New Rate HbA1c Control [<8.0%] HbA1c Poorly Controlled [>9.0%], Eye Exam, Medical Attention for Nephropathy) LWI Controlling High Blood Pressure LWI Flu Vaccinations for Adults Ages 65 and Older SH Follow-Up After Hospitalization for Mental Illness (7-Day Rate only) LWI For display purposes, all points are rounded to four decimal places. The ISS determines the official score. Effective for Reporting Year 2017

7 Appendix 2 and CAHPS Points for Reporting Year Measure Standard Description 2017 HP Points MEASURES REQUIRED FOR ACCREDITATION MEDICARE HMO/POS/PPO Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (Engagement of AOD Treatment Rate only) Medical Assistance With Smoking and Tobacco Use Cessation (Advising Smokers and Tobacco Users to Quit Rate only) Reporting Categories LWI GB Osteoporosis Management in Women Who Had a Fracture LWI Persistence of Beta-Blocker Treatment After a Heart Attack LWI Pharmacotherapy Management of COPD Exacerbation (Both Rates) LWI Plan All-Cause Readmissions GB Pneumococcal Vaccination Status for Older Adults SH Potentially Harmful Drug-Disease Interactions in the Elderly (Total Rate) LWI Use of High-Risk Medications in the Elderly (Rate 1 only) SH Total Measures 37 CAHPS 5.0H Coordination of Care AS CAHPS 5.0H Getting Care Quickly AS CAHPS 5.0H Getting Needed Care AS CAHPS 5.0H Rating of Health Plan AS CAHPS 5.0H Rating of All Health Care QP CAHPS 5.0H Rating of Personal Doctor QP CAHPS 5.0H Rating of Specialist Seen Most Often QP Total for CAHPS Measures 13 Total and CAHPS Measures 50 TOTAL STANDARDS AND MEASURES 100 MEASURES REQUIRED FOR ACCREDITATION MEDICAID HMO/POS/PPO Adult BMI Assessment SH Annual Dental Visits (Total Rate) AS Antidepressant Medication Management (Both Rates) Appropriate Testing for Children With Pharyngitis GB Appropriate Treatment for Children With Upper Respiratory Infection GB Medication Management for People With Asthma (Medication Compliance 75% Rate only) Asthma Medication Ratio (Total Rate) Avoidance of Antibiotic Treatment in Adults With Acute Bronchitis GB Breast Cancer Screening SH Cervical Cancer Screening SH Childhood Immunization Status (Combination 10) SH Chlamydia Screening in Women (Total Rate) SH For display purposes, all points are rounded to four decimal places throughout. The ISS determines the official score. Effective for Reporting Year 2017

8 2-4 Appendix 2 and CAHPS Points for Measure Standard Description 2017 HP Points MEASURES REQUIRED FOR ACCREDITATION MEDICARE HMO/POS/PPO Comprehensive Diabetes Care (New Rate BP Control <140/90, New Rate HbA1c Control (<8.0%), HbA1c Poorly Controlled (>9.0%), Eye Examination, Medical Attention for Nephropathy) Reporting Categories LWI Controlling High Blood Pressure Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications Flu Vaccinations for Adults Ages SH Follow-Up After Hospitalization for Mental Illness (7-Day Rate only) Follow-Up for Children Prescribed ADHD Medication (Both Rates) Frequency of Prenatal Care ( 81 percent of expected visits only) SH Human Papillomavirus Vaccine for Female Adolescents 1 NA NA Immunizations for Adolescents (Combination 1) SH Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (Engagement of AOD Treatment Rate only) Medical Assistance With Smoking and Tobacco Use Cessation (Advising Smokers and Tobacco Users to Quit Rate only) GB Pharmacotherapy Management of COPD Exacerbation (Both Rates) Prenatal and Postpartum Care (Both Rates) SH Use of Imaging Studies for Low Back Pain GB Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (the total of all ages for each of the 3 rates) Total Measures SH CAHPS 5.0H Getting Care Quickly AS CAHPS 5.0H Getting Needed Care AS CAHPS 5.0H Coordination of Care AS CAHPS 5.0H Customer Service AS CAHPS 5.0H Rating of Health Plan AS CAHPS 5.0H Rating of All Health Care QP CAHPS 5.0H Rating of Personal Doctor QP CAHPS 5.0H Rating of Specialist Seen Most Often QP Total for CAHPS Measures 13 Total for and CAHPS Measures 50 TOTAL STANDARDS AND MEASURES 100 For display purposes, all points are rounded to four decimal places throughout. The ISS determines the official score. Effective for Reporting Year 2017

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