SNP Training Topic 2: SNP Subset of HEDIS Measures

1
SNP Training Topic 2 SNP Subset of HEDIS
Measures

• March 18, 19, 20, 25 26, 2008

2
Overview

• Describe the SNP evaluation project NCQA is
  executing on behalf of CMS
• Review the SNP HEDIS reporting requirements
• Which measures do SNPs have to report?
• Who has to report?
• Overview of individual measures
• Descriptions
• Eligible population
• Numerator criteria

3
Introduction to SNP EvaluationBrett
KayDirector, SNP Assessment
4
Goal for SNP Evaluation Program

• Robust and comprehensive assessment strategy
• Applies to all SNPs
• Responsive to the special in SNP
• Can be implemented soon

5
Three-Year Strategy
6
Project Time Line Phase 1

• March 14 - Release final SP measures
• April 15 - Release ISS Data Collection Tool
• S P Measures
• April 25 - Release IDSS Data Collection Tool
• HEDIS Measures
• June 30 - HEDIS submissions and SP measures
  submissions due to NCQA
• Sept 30 - NCQA delivers SNP Assessment Report to
  CMS

7
Training Education

• Five training topic areas, focus is on content
  and data submission
• Introduction to NCQA HEDIS
• SNP Subset of HEDIS Measures
• Interactive Data Submission System (IDSS)
• Structure Process Measures
• Interactive Survey System (ISS)

8
Additional Resources

• NCQA SNP Web page www.ncqa.org/snp.aspx
• FAQs (HEDIS)
• Training descriptions schedule
• SP measures
• NCQA Policy Clarification Support (PCS)
• http//app04.ncqa.org/pcs/web/asp/TIL_Client
• Login.asp
• HEDIS Audit information
• http//www.ncqa.org/tabid/204/Default.aspx

9
NCQA Policy Clarification Support (PCS)

• Web address
• http//app04.ncqa.org/pcs/web/asp/TIL_ClientLogin
  .asp
• Link from SNP Web page
• www.ncqa.org/snp.aspx

10
PCS (contd)

• Under Standard Categories/HEDIS Domain, select
  one of the following options
• SNP General Reporting Guidance
• SNP HEDIS
• SNP Structure Process Measures
• Menu options under Standard/Measures
• If SNP General Reporting Guidance was
  selected
• Not Applicable

11
PCS (contd)

• Menu options under Standard/Measures
• If SNP HEDIS was selected
• (COL) Colorectal Cancer Screening
• (GSO) Glaucoma Screening in Older Adults
• (SPR) Use of Spirometry Testing in the Assessment
  and Diagnosis of COPD
• (PCE) Pharmacotherapy of COPD Exacerbation
• (CBP) Controlling High Blood Pressure
• (PBH) Persistence of Beta Blocker Treatment After
  a Heart Attack
• (OMW) Osteoporosis Management in Older Women
• (AMM) Antidepressant Medication Management
• (FUH) Follow-Up After Hospitalization for Mental
  Illness
• (MPM) Annual Monitoring for Patients on
  Persistent Medications
• (DDE) Potentially Harmful Drug-Disease
  Interactions
• (DAE) Use of High Risk Medication in the Elderly
• (BCR) Board Certification
• Other

12
PCS (contd)

• Menu options under Standard/Measures
• If SNP Structure Process was selected
• SNP 1 Complex Case Management
• SNP 2 Improving Member Satisfaction
• SNP 3 Clinical Quality Improvements
• Other

13
Contacts

• Brett KayDirector, SNP Assessment202-955-1722k
  ay_at_ncqa.orgCasandra MonroeAssistant Director,
  SNP Assessment202-955-5136monroe_at_ncqa.org

14
SNP HEDIS Reporting Requirements Mary
BramanDirector, Licensure Certification.
15
SNP HEDIS Reporting Requirements

• Required Measures
• (COL) Colorectal Cancer Screening
• (GSO) Glaucoma Screening in Older Adults
• (SPR) Use of Spirometry Testing in the
  Assessment and Diagnosis of COPD
• (PCE) Pharmacotherapy of COPD Exacerbation
• (CBP) Controlling High Blood Pressure
• (PBH) Persistence of Beta Blocker Treatment
  After a Heart Attack
• (OMW) Osteoporosis Management in Older Women
• (AMM) Antidepressant Medication Management
• (FUH) Follow-Up After Hospitalization for Mental
  Illness
• (MPM) Annual Monitoring for Patients on
  Persistent Medications
• (DDE) Potentially Harmful Drug-Disease
  Interactions
• (DAE) Use of High Risk Medication in the Elderly
• (BCR) Board Certification
• SNP benefit packages under PPO Contracts do not
  have to report these measures because these
  measures rely on medical record review.
• This first-year measure is optional for all MA
  reporting, including the SNP benefit packages.

16
General Reporting Requirements

• Who reports and what is the level of reporting?
• Every SNP benefit package (identified by the CMS
  Plan ID)
• Effective date of January 1, 2007
• Enrollment 11 members as of January 1, 2007

For each SNP benefit package, the MA plan must
report the HEDIS and Structure Process measures
17
Reporting Structure

• Question What are the HEDIS reporting
  requirements for MA plans and SNP benefit
  packages?
• Response See the chart below for details about
  the reporting requirements.

Organizations with SNP benefit packages that
have an enrollment of lt11 as of January 1, 2007
do not report HEDIS measures.
18
Audit Requirement

• Question Does every submission require an
  audit? 
• Response Yes, every SNP benefit package level
  submission must undergo a HEDIS Compliance Audit.

19
Patient-Level Detail File

• Question Does CMS require a Patient Level Detail
  File for each SNP benefit package submission?
• Response No, the plan does not need to create a
  separate patient-level file for each SNP
  submission. However, the patient-level data
  submitted for the larger Contract-level must
  include all MA members, including members
  enrolled in its SNP benefit packages. (See the
  Reporting Structure Chart above.)

20
Medicare Specifications

• Question Does the SNP submission use
  Medicare specifications for the measures? 
• Response Yes, for the 13 required measures, use
  the specifications in Volume 2, HEDIS
  Specifications.

21
Continuous Enrollment

• Question How is continuous enrollment calculated
  for the SNP benefit packages?
• Response Calculate continuous enrollment for SNP
  members according to the standard HEDIS
  requirement for Medicare products. Report members
  in the SNP they are enrolled in at the end of the
  continuous enrollment period. For measures with
  no continuous enrollment requirement, report
  members in the SNP they were in at the time of
  service.

22
Medicare Advantage

• Question If an MA plan has a SNP benefit
  package, does it report the members in the
  Medicare Contract submission AND the SNP
  submission?
• Response Yes, SNP members will be reported in
  two submissions the full Medicare submission at
  the Contract-level and the SNP benefit package in
  which they receive benefits.

23
Dual-Eligible SNP

• Question For Dual-Eligible SNP benefit packages,
  is a member reported to NCQA in the Medicare,
  Medicaid, and SNP submissions?
• Response Yes, in all three. All HEDIS
  guidelines about dual eligible members still
  apply, and these members are also included in the
  SNP-specific submission.

24
SNP- only Plan

• Question If a Medicare Advantage organization,
  which offers only SNP benefit packages, meets the
  HEDIS reporting threshold at the Contract level
  (1,000 members as of July 1, 2007), does it
  report all HEDIS measures required for
  Contract-level reporting or only the 13 SNP
  measures?
• Response A Medicare Advantage, SNP-only
  organization that meets the regular Medicare
  Advantage HEDIS reporting requirements must
  report all HEDIS MA measures and the subset of
  SNP measures for each benefit package.

25
Medicare Advantage Hybrid Method

• Question If an MA plan uses the hybrid method to
  report any measure, must they draw a separate
  sample for the SNP benefit packages?
• Response Yes, every submission is treated
  separately for example, if a plan reports
  Colorectal Cancer Screening for the full MA plan
  population and a SNP benefit package, two
  distinct samples must be drawn.

26
Medicare Advantage Hybrid Method

• Question If an MA plan draws a sample for the
  Controlling High Blood Pressure measure for the
  MA population and a separate sample for the same
  measure for the SNP benefit package, what does
  the plan do with the overlapping members?
• Response If there are SNP members in the sample
  for the full MA plan (main sample), the plan may
  use them for the SNP sample. For example, the
  main sample of 411 has 5 SNP members. The SNP
  sample has 250. Randomly select 5 members from
  the SNP sample and replace them with 5 SNP
  members in the main sample. The 5 SNP members
  are evaluated in both samples. All SNP members in
  the main sample must be used for the SNP sample,
  and the auditor must approve the process.

27
Small Denominators

• Question How are small denominators handled?
• Response To understand the performance of the
  entire SNP program, it is important that SNPs
  report a measure even when there are fewer than
  30 members in the measures denominator.
• Each SNP benefit package must collect data and
  report the required measures according to the
  specifications regardless of the denominator
  size.
• In the SNP Performance Report we produce for CMS,
  NCQA will include SNP-specific performance rates
  for only measures that have denominators of 30 or
  more members.
• Measures with fewer than 30 members in the
  denominator will be used for aggregated
  program-level reporting only.
• NCQAs Interactive Data Submission System (IDSS)
  will not calculate a rate for measures where the
  denominator is fewer than 30, but NCQA will use
  the reported measure numerators and denominators
  for aggregated reporting.

28
For Support

• Question How do I contact NCQA with a question
  about the SNP HEDIS reporting requirements or a
  specific HEDIS measure?
• Response You can get help at any of these Web
  site links
• NCQA SNP Webpage www.ncqa.org/snp.aspx
• FAQs (HEDIS)
• Training descriptions schedule
• Final HEDIS and SP measures
• NCQA Policy Clarification Support (PCS)
• http//app04.ncqa.org/pcs/web/asp/TIL_ClientLogi
  n.asp
• HEDIS Audit information
• http//www.ncqa.org/tabid/204/Default.aspx

29
Aisha T. Pittman, MPH

• Overview of SNP Subset of HEDIS Measures

30
HEDIS Measures for SNPs

• Selected in collaboration with SNP Technical
  Panel
• Excluded measures with upper age limit below 75
• Excluded measures focusing on management of one
  chronic condition
• Collected by SNP benefit package, regardless of
  size
• Will be reported in aggregate

31
HEDIS Measures FY 08
SNP benefit packages under PPO Contracts do not
have to report these measures because these
measures rely on medical record review. This
first-year measure is optional for all MA
reporting, including the SNP benefit packages.
32
HEDIS General Guidelines

• HEDIS 2008, Volume 2 Technical Specifications
• General Guidelines for Data Collection and
  Reporting (p. 11) apply to SNP reporting

33
Components of HEDIS Measures

• Measure Description
• Explains what the rate is capturing
• Definitions
• Intake Period- time period to identify eligible
  episodes
• Episode Date- date of event or service
• Index Episode Start Date (IESD)- the earliest
  episode date during the intake period
• Eligible Population
• The total population that meet the measure
  specifications -also referred to as the
  denominator
• Exclusions can be applied to the denominator if
  applicable

34
Components of HEDIS Measures

• Rate
• The rate is the numerator/eligible population
• The numerator is comprised of those people who
  received the treatment or service indicated in
  the measure
• Data Collection Methodology
• There are three possible methods
• Administrative
• Medical Record or Hybrid
• Survey

35
Eligible Population

• Product lines
• Commercial, Medicare, Medicaid
• Ages
• Continuous enrollment
• The time period during which a member must be
  continuously enrolled in the plan
• Allowable gap
• Gaps allowed during the continuous enrollment
  period
• Anchor date
• Enrollment date criteria for the eligible
  population
• Benefit
• The type of benefits the member must have to be
  included in the measure
• Event/diagnosis

36
Colorectal Cancer Screening (COL)

• The percentage of members 50 80 years of age
  who had appropriate screening for colorectal
  cancer
• Eligible Population
• Members 51-80 years as of 12/31 of the
  measurement year
• Continuously enrolled during the measurement year
  and the year prior
• No more than one 45 day gap in enrollment during
  each year of continuous enrollment
• Exclude members with diagnosis of colorectal
  cancer or total colectomy

37
Colorectal Cancer Screening (COL)

• Numerator Criteria
• One or more appropriate screenings defined by any
  one of the following criteria
• Fecal occult blood test (FOBT) during the
  measurement year
• Flexible sigmoidoscopy during the measurement
  year or the four years prior to the measurement
  year
• Double contrast barium enema (DCBE) or air
  contrast barium enema during the measurement year
  or the four years prior to the measurement year
• Colonoscopy during the measurement year or the
  nine years prior to the measurement year
• This measure can be collected using the hybrid
  method

38
Glaucoma Screening in Older Adults (GSO)

• The percentage of Medicare members 65 years and
  older who received a glaucoma eye exam
• Eligible Population
• Members 65 years as of 12/31 of the measurement
  year
• Continuously enrolled during the measurement year
  and year prior
• No more than one 45 day gap in enrollment during
  each year of continuous enrollment
• Exclude members with prior diagnosis of glaucoma
  or glaucoma suspect

39
Glaucoma Screening in Older Adults (GSO)

• Numerator criteria
• One or more eye exams for glaucoma by an eye care
  professional during the measurement year or the
  year prior

40
Use of Spirometry Testing in the Assessment and
Diagnosis of COPD (SPR)

• The percentage of members 40 years of age and
  older with a new diagnosis or newly active
  chronic obstructive pulmonary disease (COPD) who
  received appropriate spirometry testing to
  confirm the diagnosis
• Eligible Population
• Members 42 years or older as of 12/31 of the
  measurement year
• Continuously enrolled two years prior to IESD
  through 180 days after IESD
• No more than one 45-day gap in enrollment in each
  12-month period before IESD or 6-month period
  after IESD

41
Use of Spirometry Testing in the Assessment and
Diagnosis of COPD (SPR)

• Steps to Identify Eligible Population
• Identify all members with diagnosis of COPD
  during intake period
• Test for negative diagnosis history, exclude
  members with prior diagnosis of COPD
• Calculate continuous enrollment
• Numerator criteria
• At least one claim/encounter with spirometry in
  the two years before to 180 days after the IESD

42
Pharmacotherapy of COPD Exacerbation (PCE)

• The percentage of COPD exacerbations for members
  40 years of age and older who had an acute
  inpatient discharge or ED encounter between
  January 1December 1 of the measurement year and
  who were dispensed appropriate medications. Two
  rates are reported.
• Dispensed a systemic corticosteroid within 14
  days of the event
• Dispensed a bronchodilator within 30 days of the
  event
• First-year measure, optional measure for SNP
  reporting

43
Pharmacotherapy of COPD Exacerbation (PCE)

• Eligible Population
• Members 40 years or older as of 12/1 of the
  measurement year
• Continuously enrolled Episode Date through 30
  days after Episode date, no allowable gaps
• A COPD exacerbation indicated by acute inpatient
  discharge or ED encounter
• Note The eligible population for this measure is
  based on acute inpatient discharges and ED
  visits, not on members. It is possible for the
  denominator to include multiple events for the
  same individual
• Steps indicated to identify eligible population
• Numerator Criteria
• Rate 1 Prescription for systematic
  corticosteroid on or 14 days after Episode Date
• Rate 2 Prescription for bronchodilator on or 30
  days after Episode Date

44
Controlling High Blood Pressure (CBP)

• The percentage of members 1885 years of age who
  had a diagnosis of hypertension (HTN) and whose
  blood pressure (BP) was adequately controlled
  (lt140/90) during the measurement year
• Note The hybrid method must be used for this
  measure
• Eligible population
• Members 18-85 years as of 12/31 of the
  measurement year
• No more than one 45-day gap in enrollment during
  the measurement year
• At least one outpatient encounter with a
  diagnosis of hypertension in the first six months
  of the measurement year
• Note Hypertensive diagnosis must be confirmed in
  the medical record on or before June 30 of the
  measurement year
• Exclude members with ESRD, who are pregnant or
  were admitted to a non-acute inpatient setting
  (institutionalized)

45
Controlling High Blood Pressure (CBP)

• Numerator criteria
• Representative BP is adequately controlled
• Adequate control- representative systolic BPlt
  140mmHg and representative diastolic BP lt90mmHg
• Representative BP- the most recent BP during the
  measurement year after the hypertension diagnosis
• If there are multiple BPs on the same date use
  the lowest systolic and lowest diastolic
• If no BP is recorded assume the member is not
  controlled

46
Persistence of Beta Blocker Treatment After Heart
Attack (PBH)

• The percentage of members 18 years of age and
  older during the measurement year who were
  hospitalized and discharged alive from July 1 of
  the year prior to the measurement year to June 30
  of the measurement year with a diagnosis of acute
  myocardial infarction (AMI) and who received
  persistent beta-blocker treatment for six months
  after discharge

47
Persistence of Beta Blocker Treatment After Heart
Attack (PBH)

• Eligible population
• Members 18 and older as of 12/31 of the
  measurement year
• Continuously enrolled from discharge to 180 days
  after discharge
• Discharged alive from an acute inpatient setting
  with an AMI
• Exclude members with a contraindication to
  beta-blocker therapy or transferred to a nonacute
  care facility (institutionalized)
• Numerator Criteria
• A 180-day course of treatment of beta blockers
• Persistence of treatment must be at least 75 or
  135 days
• If members were on beta blockers prior to
  admission, take into account those prescriptions
  in determining adherence

48
Osteoporosis Management in Women Who Had a
Fracture (OMW)

• The percentage of women 67 years of age and older
  who suffered a fracture and who had either a bone
  mineral density (BMD) test or prescription for a
  drug to treat or prevent osteoporosis in the six
  months after the fracture

49
Osteoporosis Management in Women Who Had a
Fracture (OMW)

• Eligible population
• Women 67 years and older as of 12/31 of the
  measurement year
• Continuously enrolled 12 months prior to through
  6 months after IESD
• No more than one 45-day gap in enrollment during
  continuous enrollment period
• Evidence of a fracture
• Steps to identify eligible population
• Numerator Criteria
• A BMD test on the IESD or in the 180 day period
  after the IESD
• A BMD test during the inpatient stay for the
  fracture
• A dispensed prescription to treat osteoporosis

50
Antidepressant Medication Management (AMM)

• The following components of this measure assess
  different facets of the successful
  pharmacological management of major depression.
• Optimal Practitioner Contacts for Medication
  Management Percent of members with at least
  three follow-up contacts within 12 weeks of
  diagnosis
• Effective Acute Phase Treatment percent of
  members who remained on an antidepressant drug
  during the 84 days/12 weeks following diagnosis
• Effective Continuation Phase Treatment percent
  of members who remained on an antidepressant drug
  for at least 180 days/6 months

51
Antidepressant Medication Management (AMM)

• Eligible Population
• Members 18 years and older as of 4/30 of
  measurement year
• Continuously enrolled 120 days prior to IESD
  through 245 days after IESD
• Diagnosis of a new episode of major depressive
  disorder during the intake period
• No more than one 45-day gap in enrollment
• Steps to identify eligible population
• Numerator criteria
• Optimal practitioner contacts three face-to-face
  visits with a practitioner or two face-to-face
  visits and one telephone visit within 84 days
• Effective acute phase members who fulfilled a
  sufficient number of separate prescription/refills
  of antidepressant medication to have continuous
  treatment for 84 days
• Effective continuation phase a 180-day treatment
  with antidepressant medication

52
Follow-Up After Hospitalization for Mental
Illness (FUH)

• The percentage of discharges for members 6 years
  of age and older who were hospitalized for
  treatment of selected mental health disorders and
  who had an outpatient visit, an intensive
  outpatient encounter or partial hospitalization
  with a mental health practitioner. Two rates are
  reported.
• The percentage of members who received follow-up
  within 30 days of discharge
• The percentage of members who received follow-up
  within 7 days of discharge

53
Follow-Up After Hospitalization for Mental
Illness (FUH)

• Eligible Population
• Members 6 years and older as of discharge date
• Continuously enrolled from discharge date through
  30 days after discharge
• No gaps in enrollment allowed
• Discharged alive from an acute inpatient setting
  with a principal mental health diagnosis
• Note The denominator is based on discharges, not
  members
• Exclude members transferred directly to a
  nonacute facility for a non-mental health
  principal diagnosis (institutionalized)
• Numerator Criteria
• 30 day follow-up an outpatient visit, intensive
  outpatient encounter or partial hospitalization
  with a mental health practitioner within 30 days
  of discharge
• 7 day follow-up an outpatient visit, intensive
  outpatient encounter or partial hospitalization
  with a mental health practitioner within 7 days
  of discharge

54
Annual Monitoring for Patients on Persistent
Medications (MPM)

• The percentage of members 18 years of age and
  older who received at least a 180-days supply of
  ambulatory medication therapy for a select
  therapeutic agent during the measurement year and
  at least one therapeutic monitoring event for the
  therapeutic agent in the measurement year. For
  each product line, report each of the four rates
  separately and as a total rate.
• Annual monitoring for members on angiotensin
  converting enzyme (ACE) inhibitors or angiotensin
  receptor blockers (ARB)
• Annual monitoring for members on digoxin
• Annual monitoring for members on diuretics
• Annual monitoring for members on anticonvulsants
• Total rate (the sum of the four numerators
  divided by the sum of the four denominators)

55
Annual Monitoring for Patients on Persistent
Medications (MPM)

• Eligible Population
• Members 18 year and older as of 12/31 of the
  measurement year
• Continuously enrolled during the measurement year
• No more than one 45-day gap in enrollment during
  each year of enrollment
• 180-days supply of an ambulatory medication of
  interest
• Note Members with more than one persistent
  medication can appear in the measure multiple
  times (i.e., in each indicator for which they
  qualify)
• Note Members may switch therapies with any
  medication listed during the measurement year and
  have the days supply for each of those
  medications count towards the 180-days supply
• Exclude members with an inpatient stay in the
  measurement year
• Numerator Criteria
• ACEI/ARBs, Digoxin, Diuretics at least one serum
  potassium and either a serum creatinine or blood
  urea nitrogen therapeutic monitoring test
• Anticonvulsants at least one drug serum
  concentration level monitoring test for the
  described drug

56
Potentially Harmful Drug-Disease Interactions in
the Elderly (DDE)

• The percentage of Medicare members 65 years of
  age and older who have evidence of an underlying
  disease, condition or health concern and who were
  dispensed an ambulatory prescription for a
  contraindicated medication, concurrent with or
  after the diagnosis
• Report each of the three rates separately and as
  a total rate
• A history of falls and a prescription for
  tricyclic antidepressants, antipsychotics or
  sleep agents
• Dementia and a prescription for tricyclic
  antidepressants or anticholinergic agents
• Chronic renal failure and prescription for
  nonaspirin NSAIDs or Cox-2 Selective NSAIDs
• Total rate (the sum of the three numerators
  divided by the sum of the three denominators)
• For all three rates, a lower rate represents
  better performance

57
Potentially Harmful Drug-Disease Interactions in
the Elderly (DDE)

• Eligible population
• Members 67 years and older as of 12/31 of the
  measurement year
• Continuously enrolled the measurement year and
  the year prior
• No more than one 45-day gap in enrollment during
  each year of continuous enrollment
• At least one disease or condition or procedure in
  the measurement year or the year prior
• Note Members with more than one disease or
  condition can appear in the measure multiple
  times (i.e., in each indicator for which they
  qualify)
• Numerator criteria
• History of falls dispensed a tricyclic
  antidepressant
• Dementia dispensed a tricyclic antidepressant
• Chronic renal failure dispensed an NSAID or
  cox-2 selective NSAID

58
Use of High Risk Medications in the Elderly (DAE)

• The percentage of Medicare members 65 years of
  age and older who received at least one high risk
  medication
• The percentage of Medicare members 65 years of
  age and older who received at least two different
  high risk medications
• For both rates, a lower rate represents better
  performance

59
Use of High Risk Medications in the Elderly (DAE)

• Eligible population
• Members 67 years and older as of 12/31 of the
  measurement year
• Continuously enrolled during the measurement year
• No more than on 45-day gap in enrollment
• Numerator Criteria
• Rate 1 At least one high risk medication
  dispensed
• Rate 2 At least two high risk medications
  dispensed

60
Board Certification (BCR)

• The percentage of the following physicians whose
  board certification is active as of December 31
  of the measurement year.
• Family medicine physicians
• Internal medicine physicians
• Pediatricians
• OB/GYN physicians
• Geriatricians
• Other physician specialists
• Board certification refers to the various
  specialty certification programs of the American
  Board of Medical Specialties and the American
  Osteopathic Association.

61
Future HEDIS Measures for SNPs

• HEDIS 2009 Measures
• Care for Older Adults
• Functional Status Assessment
• Advance Care Planning
• Annual Medication Review
• Pain Screening
• Medication Reconciliation after Hospitalization
• Public Comment closed on March 14
• Currently analyzing the comments

62
Additional Resources

• NCQA SNP Website
• www.ncqa.org/snp.aspx
• FAQs (HEDIS)
• Training descriptions schedule
• Final HEDIS and SP measures (March 14)
• NCQA Policy Clarification Support (PCS)
• http//app04.ncqa.org/pcs/web/asp/TIL_ClientLogin.
  asp
• HEDIS Audit information
• http//www.ncqa.org/tabid/204/Default.aspx