HEDIS Hybrid Measure Medical Record Review (MRR)

Performance measures are indicators or metrics that are used to gauge program performance.  They provide information needed to measure the extent to which VT Medicaid is achieving its intended results/outcomes.

The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by more than 90 percent of America’s health plans to measure performance on important dimensions of care and service.  Altogether, HEDIS consists of 90+ measures across 16 domains of care.

VT Medicaid runs the full set of HEDIS administrative measures, and in 2020 is producing 5 hybrid measures.  Hybrid measures combine administrative claims data with data abstracted from member records during a medical record review.  The 5 hybrid measures are:

  • Adult BMI Assessment (ABA)
  • Controlling High Blood Pressure (CBP)
  • Comprehensive Diabetes Care (CDC)
  • Prenatal & Postpartum Care (PPC)
  • Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC)     

The VT Medicaid program reports many of the HEDIS measure results to our internal and external partners and stakeholders. Some of these measures are part of measure sets that we are required to report to Vermont’s Agency of Human Services (AHS) and the Centers for Medicaid & Medicare Services (CMS). For more information, see the links and other information below.


Important Notices

  • HEDIS hybrid record retrieval started on March 4, 2020. Cotiviti is the medical record retrieval contractor for VT Medicaid. Providers are required to participate (at no cost) as stated in your signed Provider Enrollment Agreement: During the State of Vermont State of Emergency for COVID-19. The Department of Vermont Health Access (DVHA) will not enforce a 10% withholding of all VT Medicaid payments for providers that do not submit the required medical records within five (5) business days. We encourage you to submit records timely. It is imperative that we obtain medical records in order to complete the HEDIS measures. If you have questions regarding submission of Medical records, please outreach Clark.Eaton@vermont.gov or 802-241-9313. (3/30/2020)
  • Cotiviti is the medical record retrieval contractor for VT Medicaid and will contact providers and request medical records to support the Medical Record Review (MRR).  Please note that providers are required to participate (at no cost) as stated in your signed Provider Enrollment Agreement: Article VI. Audit Inspection.  The Department of Vermont Health Access (DVHA) will enforce a 10% withholding of all VT Medicaid payments for all providers that do not submit the required medical records within five (5) business days (at no cost). (3/4/2020)

Notices & Information

Links:

Centers for Medicare & Medicaid Services (CMS) Reporting Requirements:

The Centers for Medicare & Medicaid Services (CMS) published an Initial Core Set of Measures via Federal Register Notice in 2012 signifying an important step toward better understanding, at both the State and national level, the quality of health care delivered to Medicaid covered adults. This measure set is now updated annually by CMS.  DVHA reported to CMS on 26 of these 32 measures in January 2019, for the 2018 measurement period.

The Children's Health Care Quality Measures for Medicaid and CHIP originated from the Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009.  Ultimately, the goals of this core measure set are to provide a national estimate of the quality of health care for children; facilitate comparative analyses across various dimensions of pediatric health care quality; and help identify racial, ethnic, and socioeconomic disparities.  DVHA reported to CMS on 20 of the 24 Children’s Core Measures in January 2019, for the 2018 measurement period.

A sub-set of the Adult Core Set consisting of the behavioral health measures and the Child Core Set will be mandatory for states to report to CMS starting in the year 2024. DVHA is currently reviewing all available resources particularly for hybrid measure reporting to create a longer term strategic reporting plan.

Department of Vermont Health Access

280 State Drive
Waterbury, Vermont 05671-1010
Phone: 802-879-5900
Fax: 802-241-0260

Contact List for staff email, telephone & fax numbers

Hours of Operation: Monday-Friday (Excluding Holidays) 7:45am - 4:30pm

Public Record Requests
Kelly Provost
DVHA Public Records Officer
AHS.DVHALegal@Vermont.gov
Visit the Agency of Administration site for the Public Records Database

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