U.S. Office of Personnel Management - Ensuring the Federal Government has an effective civilian workforce

Federal Employees Health Benefits Program

HEDIS^® Data Collection

This letter explains the Office of Personnel Management (OPM) procedures for collecting Health Plan and Employer Data Information Set (HEDIS^®) measures in 2005. 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 requesting a user ID or password to HOQ@ncqa.org. You must follow NCQA's procedures for HEDIS 2005 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 a Health Maintenance Organization (HMO) with 500 or more Federal Employees Health Benefits (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.)

Below is the subset of HEDIS 2005 measures OPM will require for our data collection efforts. We selected these measures because NCQA uses them for scoring its Managed Care Organizations (MCO) accreditation programs.

• Childhood Immunization Status
• Adolescent Immunization Status
• Breast Cancer Screening
• Cervical Cancer Screening
• Prenatal and Postpartum Care
• 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
• Cholesterol Management after Acute Cardiovascular Events (screening rate only)
• Antidepressant Medication Management
• Appropriate Medication for People with Asthma
• Controlling High Blood Pressure

The timeline for HEDIS submissions is as follows:

• February 28, 2005: Deadline for plans to complete NCQA's on-line Healthcare Organization Questionnaire.
• April 25, 2005: NCQA posts HEDIS 2005 Data Submission Tool (DST) on the Secure Site of the NCQA web site for downloading.
• June 15, 2005: 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 Dean Schleicher at ndschlei@opm.gov or by telephone at 202-606-4162.

Download this Letter as a PDF File