2022-19 |
12/5/2022 |
2022 Plan Performance Assessment Procedural Manual |
The purpose of this Carrier Letter is to transmit the attachments described below to all Carriers in the Federal Employees Health Benefits (FEHB) Program:
- Attachment 1: 2023 Plan Performance Assessment Procedure Manual
- Attachment 2: 2023 Planned HEDIS and CAHPS Reporting
- Attachment 3: 2023 CAHPS Code List
- Attachment 4: 2023 CAHPS Sample Crosswalk
- Attachment 5: 2023 Corrective Action Plan Template
- Attachment 6: 2023 Corrective Action Plan Follow-up Report
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Attachment 1: 2022 FEHB Plan Performance Assessment Procedure Manual |
Attachment 2: 2022 Planned HEDIS and CAHPS Reporting |
Attachment 3: 2022 CAHPS Code List |
Attachment 4: 2022 CAHPS Sample Crosswalk |
Attachment 5: 2022 Corrective Action Plan Template |
Attachment 6: 2022 Corrective Action Plan Follow Up Report |
2022-13 |
7/21/2022 |
Federal Employees Health Benefits Plan Performance Assessment 2024 Clinical Quality, Customer Service, and Resource Use (QCR) Measure Set |
This Carrier Letter announces the Clinical Quality, Customer Service, and Resource Use (QCR) measures, along with the priority level and measure weights that OPM will be scored under the 2024 Plan Performance Assessment (PPA). |
Attachment 1: 2024 Clinical Quality, Customer Service, and Resource Use (QCR) Measure Set |
2021-19 |
12/14/2021 |
2022 Plan Performance Assessment Procedural Manual |
The purpose of this Carrier Letter is to transmit the attachments described below to all Carriers in the Federal Employees Health Benefits (FEHB) Program:
- Attachment 1: 2022 Plan Performance Assessment Procedure Manual
- Attachment 2: 2022 Planned HEDIS and CAHPS Reporting
- Attachment 3: 2022 CAHPS Code List
- Attachment 4: 2022 CAHPS Sample Crosswalk
- Attachment 5: 2022 Corrective Action Plan Template
- Attachment 6: 2022 Corrective Action Plan Follow-up Report
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Attachment 1: 2022 FEHB Plan Performance Assessment Procedure Manual |
Attachment 2: 2022 Planned HEDIS and CAHPS Reporting |
Attachment 3: 2022 CAHPS Code List |
Attachment 4: 2022 CAHPS Sample Crosswalk |
Attachment 5: 2022 Corrective Action Plan Template |
Attachment 6: 2022 Corrective Action Plan Follow Up Report |
2021-18 |
11/22/2021 |
Federal Employees Health Benefits Plan Performance Assessment Postponement of All Lines of Business Benchmark Implementation |
This Carrier Letter supersedes Carrier Letters 2020-15 and 2020-20 in part, by updating the Federal Employees Health Benefits (FEHB) Plan Performance Assessment (PPA) methodology guidance to postpone All Lines of Business (ALOB) benchmark implementation until the 2022 plan year (measurement year 2021). |
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2021-11 |
5/24/2021 |
Announcement of the 2023 Clinical Quality, Customer Service, and Resource Use (QCR) Measure Set |
This Carrier Letter announces the Clinical Quality, Customer Service, and Resource Use (QCR) measures, along with the priority level and measure weights that OPM will score under the 2023 Plan Performance Assessment (PPA). |
Attachment 1: 2023 Clinical Quality, Customer Service and Resource Use Measure Set |
2020-20 |
12/22/2020 |
2021 Plan Performance Assessment Procedure Manual |
This Carrier Letter is to transmit the attachments described below to all Carriers in the Federal Employees Health Benefits (FEHB) Program:
Attachment 1: 2021 Plan Performance Assessment Procedure Manual
Attachment 2: Planned HEDIS and CAHPS Reporting Template
Attachment 3: 2021 CAHPS Code List
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Attachment 1: 2021 Plan Performance Assessment Procedure Manual |
Attachment 2: Planned HEDIS and CAHPS Reporting Template |
Attachment 3: 2021 CAHPS Code List |
2020-15 |
10/27/2020 |
Federal Employees Health Benefits (FEHB) Plan Performance Assessment Methodology |
The purpose of this Carrier Letter is to update the FEHB Plan Performance Assessment (PPA) methodology guidance. Carriers must reference the annual PPA Procedure Manual for operational instructions and specific measures that must be reported to OPM. |
2020-14 |
10/6/2020 |
Update on Plan Performance Assessment Scoring Due To COVID-19 Pandemic |
This Carrier Letter outlines OPM’s FEHB Plan Performance Assessment (PPA) response to the national emergency caused by the COVID-19 pandemic. |
2020-10 |
5/5/2020 |
Announcement of the 2022 Clinical Quality, Customer Service, and Resource Use (QCR) Measure Set |
This Carrier Letter announces the Clinical Quality, Customer Service, and Resource Use (QCR) measures, along with the priority level and measure weights that OPM will score under the 2022 Plan Performance Assessment (PPA). |
Attachment 1: 2022 Clinical Quality, Customer Service and Resource Use Measure Set |
2019-12 |
11/26/2019 |
2020 Plan Performance Assessment Procedure Manual |
The purpose of this Carrier Letter is to transmit the attachments described below to all carriers in the Federal Employees Health Benefits (FEHB) Program:
Attachment 1: 2020 Plan Performance Assessment Procedure Manual Attachment 2: 2020 CAHPS Carrier Subcode List
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Attachment 1: 2020 Plan Performance Assessment Procedure Manual
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Attachment 2: 2020 CAHPS Carrier Subcode List
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2019-09 |
9/06/2019 |
Consumer Assessments of Healthcare Providers and Systems (CAHPS) Surveys Oversampling |
OPM’s goal is to have enough CAHPS survey data reported so that FEHB Carrier contracts have performance indicators displayed on the OPM website for both quality and customer service measures. Performance data is valuable to FEHB enrollees, Agency Benefit Officers and others. Therefore, OPM is providing additional guidance to FEHB Carriers. |
2019-03 |
4/25/2019 |
Announcement of the 2021 Clinical Quality, Customer Service, and Resource Use Measure Set and Measures under Consideration for Addition to the 2020 Farm Team |
This Carrier Letter announces changes to the Clinical Quality, Customer Service, and Resource Use (QCR) measures and priority weights that will be scored under the 2021 Plan Performance Assessment. In addition, measures for potential inclusion in the 2020 Farm Team are presented. The full 2021 QCR measure set is shown in Attachment 1 of the Carrier Letter. |
Attachment 1: 2021 Clinical Quality, Customer Service and Resource Use Measure Set |
2018-15 |
10/25/2018 |
2019 Plan Performance Assessment Procedure Manual |
The purpose of this Carrier Letter is to transmit the attachments to all carriers in the Federal Employees Health Benefits (FEHB) Program. |
Attachment 1: 2019 Plan Performance Assessment Procedure Manual |
Attachment 2: 2019 CAHPS Carrier Subcode List |
2018-13 |
8/22/2018 |
Accreditation Requirements for FEHB Carriers |
This letter updates Federal Employees Health Benefits (FEHB) Program accreditation requirements pursuant to the FEHB Standard Contract, Section 1.9, which states "the Carrier shall continue to pursue and maintain accreditation according to the steps and timeframes outlined by OPM." |
2018-07 |
6/14/2018 |
2020 Clinical Quality, Customer Service, and Resource Use Measures |
This Carrier Letter announces changes to the Clinical Quality, Customer Service, and Resource Use (QCR) measures and priority weights that will be scored under the 2020 Plan Performance Assessment. The full 2020 QCR measure set is shown in Attachment 1 of the Carrier Letter. |
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Attachment 1: 2020 Clinical Quality Customer Service and Resource Use Measure Set |
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2018-02 |
2/12/2018 |
Technical Correction to Reporting Products and QCR Scoring |
Over the first two cycles of the Federal Employees Health Benefits Program (FEHB) Plan Performance Assessment scoring, the Office of Personnel Management (OPM) has encountered occasional situations that could affect the accurate choice of QCR benchmarks. After consulting with NCQA, OPM issued this Carrier Letter with the clarification, effective for benchmark comparison beginning in 2018 and going forward |
2017-15 |
12/14/2017 |
Federal Employees Health Benefits (FEHB) Plan Performance Assessment – Consolidated Methodology |
The purpose of this Carrier Letter is to simplify administration of the FEHB Plan Performance Assessment (PPA) by consolidating methodology guidance. The PPA was announced in 2014. Carrier payment based on PPA scoring began in 2016. This letter compiles all current guidance regarding the methodology. Carriers must reference the annual PPA Procedure Manual for operational instructions and specific measures that must be reported to OPM. |
2017-12 |
11/17/2017 |
2018 Plan Performance Assessment Procedure Manual and Corrective Action Plans for 2017 |
The purpose of this Carrier Letter is to transmit the following attachments to all carriers in the Federal Employees Health Benefits (FEHB) Program: |
Attachment 1: 2018 Plan Performance Assessment Procedure Manual |
Attachment 2: 2018 CAHPS Carrier Subcode List |
Attachment 3: Quality Improvement Corrective Action Plan Template for 2017 |
2017-11 |
11/16/2017 |
2019 Clinical Quality, Customer Service, and Resource Use Measures |
The purpose of this Carrier Letter is to announce the Clinical Quality, Customer Service, and Resource Use (QCR) measures to be utilized in the 2019 Plan Performance Assessment. A list of the 2019 QCR Measure Set is included in Attachment 1. |
Attachment 1: 2019 Clinical Quality, Customer Service and Resource Use Measure Set |
2017-10 |
10/27/2017 |
Plan Performance Assessment Best Practices Workgroup |
This carrier letter details policies and procedures pertaining to the Federal Employees Health Benefits (FEHB) Plan Performance Assessment Best Practices Workgroup. In this notice, it is hereafter referred as the "Best Practices Workgroup" or the "workgroup." |
2017-02 |
03/16/2017 |
Plan Performance Assessment Community Rated Adjustment |
Announced a proposed update to the Federal Employees Health Benefits (FEHB) Program Plan Performance Assessment for Community Rated Carriers. Beginning with the 2017 performance assessment period and for future rating periods a Community-Rated Adjustment (CRA) would be applied to the overall performance score (OPS) of community-rated carriers in the FEHB Program to incentivize high performance. |
2016-14 |
11/21/2016 |
2017 Plan Performance Assessment Carrier Manual and Corrective Action Plan Template for 2016 |
Released the 2017 Plan Performance Assessment Carrier Manual, Quality Improvement Corrective Action Plan Template for 2016, and the 2017 CAHPS Carrier Subcode List. The Carrier Letter provides specific guidance for the 2017 plan year on reporting HEDIS and CAHPS, Clinical Quality, Customer Service, and Resource Use (QCR) measures, Corrective Action Plans, QCR calculations and scoring policies, and other information Carriers need on FEHB Plan Performance Assessment. |
Attachment 1 – Attachment 1: Attachment 1: 2017 Plan Performance Assessment Carrier Manual |
Attachment 2 – Attachment 2: Quality Improvement Corrective Action Plan Template for 2016 |
Attachment 3 – Attachment 3: 2017 CAHPS Carrier Subcode List |
2016-11 |
08/01/2016 |
Plan Performance Assessment Improvement Increment |
Released the methodology for the FEHB Plan Performance Assessment Improvement Increment that OPM will implement as part of the Fall 2017 Clinical Quality, Customer Service, and Resource Use (QCR) calculation. |
Attachment 1: Example of Improvement Scoring Final |
Attachment 2: FAQs for the Improvement Increment Methodology |
2016-02 |
02/16/2016 |
2018 Clinical Quality, Customer Service, and Resource Use Measures for the Federal Employees Health Benefits (FEHB) Plan Performance Assessment |
These are the 2018 measures. Office of Personnel Management (OPM) gives two years notice on the measures scored. OPM has greater flexibility to delete a measure. |
2015-19 |
11/06/2015 |
Federal Employees Health Benefits (FEHB) Plan Performance Assessment – Measure Collection (Includes HEDIS and CAHPS) |
Outlines the process for collection and submission of measures to the OPM for the Federal Employees Health Benefits (FEHB) Plan Performance Assessment This combines HEDIS and CAHPS reporting info, and includes the data correction procedures. |
Attachment 1A: HEDIS 2015 Measures Contributing to Exemplary and Most Improved Statuses |
Attachment 2A: Carrier Subcode List |
Attachment 2B: 2016 CAHPS Survey Participation Form |
Attachment 2C: SAMPLE CROSSWALK |
2015-15 |
08/16/2015 |
2017 Clinical Quality, Customer Service, and Resource Use Measures for the Federal Employees Health Benefits (FEHB) Plan Performance Assessment |
Provide the FEHB Plan Performance Assessment Clinical Quality, Customer Service, and Resource Use (QCR) measures to be scored for 2017 evaluation. |
2015-10 |
06/05/2015 |
Federal Employees Health Benefits (FEHB) Plan Performance Assessment – Methodology |
Provide details on the OPM methodology for the FEHB Plan Performance Assessment (Performance Assessment). The Performance Assessment evaluation will begin in 2016. |
2014-28 |
12/03/2014 |
Additional Information on the Performance Areas for the Federal Employees Health Benefits (FEHB) Plan Performance Assessment |
Provides the full set of domains and components for the four proposed performance areas, including updates to the previously published measures and details of the Contract Oversight performance area, for 2016. |
Attachment 1: Revised Performance Assessment Measure Set |
Attachment 2: Contract Oversight Performance Area |
2014-19 |
08/07/2014 |
Initial Guidance on FEHB Plan Performance Assessment |
Provides information on the Federal Employees Health Benefits (FEHB) Health Plan Performance Assessment and to request carrier feedback on the proposed measures and timeline. |