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Frequently Asked Questions Insurance

Will OPM continue to exempt FEHB health plans with fewer than 500 FEHB enrollees from HEDIS reporting requirements?

All FEHB health plan quality performance deserves recognition; therefore, we are removing the following language from the HEDIS 2015 carrier letter:
"Each Federal Employees Health Benefits (FEHB) Carrier must submit audited Healthcare Effectiveness Data and Information Set (HEDIS) metrics unless the plan has 500 or fewer FEHB enrollees as of the reporting period (calculated in March, annually)."
Although Carriers with fewer than 500 FEHB enrollees are exempt from HEDIS 2014 reporting, we encourage those health plans to submit OPM's selected HEDIS metrics (Attachment 1 of Carrier Letter 2013-22) to NCQA, and to prepare for the requirement beginning in HEDIS 2015. Voluntary reporting will not prompt any consequences, but will serve to open the lines of communication. FEHB health plans that have not previously reported HEDIS data to NCQA for FEHB or other purposes should inform OPM and contact NCQA for instructional information.

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