Healthcare Effectiveness Data Information Set (HEDIS®) Summary Level Data Collection for Medicare Advantage

Background
The Centers for Medicare & Medicaid Services (CMS) is issuing a non-competitive contract to the National Committee for Quality Assurance (NCQA) to secure services for collecting and managing summary-level quality data for the Healthcare Effectiveness Data and Information Set (HEDIS).

This initiative is mandated under Section 1852(e) of the Social Security Act, which requires Medicare Advantage organizations to collect, analyze, and report data that measure health outcomes and quality indices. HEDIS summary-level data play a crucial role in the Medicare Advantage Star Ratings Program, which is publicly reported on the CMS website.

Work Details
The contractor will be responsible for the collection and management of the annual HEDIS® summary-level data submission for Medicare Advantage Organizations (MAOs). Key tasks include:
1. Collecting HEDIS® data using proprietary systems owned by NCQA.
2. Providing technical assistance to health plans and auditors regarding the use of HEDIS® measurements.
3. Convening interdisciplinary multi-stakeholder panels to ensure comprehensive stakeholder representation in the measurement process.
4. Developing and maintaining HEDIS data submission tools and detailed technical specifications.
5. Updating HEDIS® measures as necessary, ensuring compliance with industry standards established since its inception in 1993.