U.S. Office of Personnel Management www.opm.gov - Recruiting, Retaining and Honoring a World-Class Workforce to Serve the American People

Federal Employees Health Benefits Program

To assist Federal employees and their families in making educated choices by providing better comparative information, the Office of Personnel Management (OPM) is requiring Fee-for-Service plans to collect and report quality performance measures comparable to those currently required of health maintenance organizations. The Health Plan Employer Data and Information Set (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 healthcare.

In 2005, the Centers for Medicare and Medicaid Services (CMS) requested that the National Committee for Quality Assurance (NCQA) conduct pilot tests for HEDIS as applied to PPOs in which they would determine the feasibility of a number of measures through administrative data systems. A select number of hybrid measure rates were included in the tests using the administrative only method. NCQA completed those pilot tests and reported that the measures tested were feasible from administrative data sources. OPM has decided FEHB Fee-for-Service plans will collect a HEDIS dataset in 2007. The following HEDIS measures will be collected using the administrative only method and required for Fee-for-Service plans in 2007:

• Breast cancer screening;
• Cholesterol management for patients with cardiovascular conditions (LDL-C screening performed); and
• Comprehensive diabetes care (Hemoglobin A1c (HbA1c) testing; eye exam (retinal) performed; and LDL-C screening performed)

FEHB carriers will need to follow NCQA's procedures for HEDIS reporting, including the HEDIS Compliance Audit which can be found on their website at: www.ncqa.org. We are in the process of working out the specifications for reporting and will provide that information to you as soon as it is available. If you have any questions please contact Tanya Woodyard at Tanya.Woodyard@opm.gov or by telephone at 202-606-2397.

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