This letter explains our procedures for collecting Health Plan and Employer Data Information Set (HEDIS®) measures in 2004. HEDIS® is the most widely used set of performance measures in the managed care industry and is part of an integrated system to establish accountability in managed care. Once again, the National Committee for Quality Assurance (NCQA) will collect the HEDIS® data for us.

In order for plans to report HEDIS®, you must complete NCQA's annual Healthcare Organization Questionnaire on-line through the secure site area of the NCQA web site using a password. If you do not have a user ID or password, you should send an email to HOQ@ncqa.org. You must follow NCQA's procedures for HEDIS® 2004 reporting, including the HEDIS®Compliance Audit. If you have questions regarding technical assistance on the HEDIS® specifications or questions about the HEDIS® measures, you should use the Policy Clarification Support area of NCQA's web site to submit your questions. If you have general questions regarding HEDIS®, you can refer to the NCQA website, www.ncqa.org, or call NCQA Customer Support at 1-888-275-7585.

You must submit HEDIS® data if you are an HMO with 500 or more FEHB enrollees. If you already intend to report HEDIS® data to NCQA for non-OPM purposes, such as for other lines of business, you do not need to take any additional action. (You do not need to report separately to NCQA on FEHB enrollees.) We will receive the data directly from NCQA and will adhere to any agreements you have with NCQA regarding public reporting of data.

Below is the list of HEDIS® 2004 measures we will require for our data collection efforts. These measures are used by accrediting organizations for managed care and network accreditation purposes.

• Childhood Immunization Status
• Adolescent Immunization Status
• Breast Cancer Screening
• Cervical Cancer Screening
• Prenatal and Postpartum Care
• Medical Assistance with Smoking Cessation
• Beta Blocker Treatment After a Heart Attack
• Comprehensive Diabetes Care (eye examination rate, cholesterol screening rate, HbA1c screening rate, nephropathy monitoring)
• Follow Up After Hospitalization for Mental Illness (7 and 30 day rates)
• Cholesterol Management after Acute Cardiovascular Events (screening rate only)
• Antidepressant Medication Management (all 3 rates)
• Appropriate Medication for People with Asthma
• Controlling High Blood Pressure

The timeline for HEDIS® submissions is as follows:

• Scheduled for February 2, 2004: NCQA releases the 2004 Healthcare Organization Questionnaire on the Secure Site area of the NCQA web site.
• February 27, 2004: Deadline for plans to complete on-line Healthcare Organization Questionnaire.
• April 23, 2004: NCQA posts HEDIS® 2004 DST on the Secure Site of the NCQA web site for downloading.
• June 15, 2004: Deadline for plans to submit DST to NCQA web site. Deadline for plans to submit attestations to NCQA.

If you have any questions or would like more information, please contact Tanya Morrow at tmmorrow@opm.gov or by telephone at 202-606-0745.

Download this Letter as a PDF File (103K File)