The recently adopted managed care rule contains a requirement for health maintenance organizations (HMOs) to annually submit to the Office of the Commissioner of Insurance (OCI), data elements specified by the Commissioner. This bulletin outlines the data collection requirements for calendar year 2001, which must be submitted to OCI no later than June 15, 2002.
Section Ins 9.40 (5), Wis. Adm. Code, specifies that HMOs are to submit data identified from the HEDIS data set as required by the Commissioner. A committee convened by OCI recommended the following data elements for collection during calendar year 2001.
From the HEDIS data set:
- Mammogram rates for women age 52-69
- Cervical cancer screening rates for women age 21-64
- Eye exam screening rates for Type 1 and Type 2 diabetics
- Rates of follow up following hospitalization for mental illness
- Access to primary care practitioner for children age 12-24 months
From the CAHPS questionnaire:
- Satisfaction with the time spent with the physician
- Overall satisfaction with the health plan
The HEDIS data should be collected according to HEDIS guidelines. However, an independent audit of the HEDIS data is not required. Only data from the insurer's commercial business should be submitted; data from the insurer's Medical Assistance population should not be included. At this time, HMOs are required to submit administrative data only. Plans may submit hybrid data; however, they must clearly identify the data as hybrid data.
The HMO should either follow NCQA guidelines for the CAHPS survey, or report any variations in its survey process. For example, the HMO could use oversampling as a variation rather than use the NCQA guideline of attempting to contact the enrollee in the sample up to four times.
Schedule for Submitting
Consistent with s. Ins 9.40, Wis. Adm. Code, the data form below and accompanying certification must be submitted to OCI no later than June 15, 2002, or the HEDIS submission deadline, for calendar year 2001 data.
(See HMO Data Collection page on this Web site.)
Please contact Barbara Belling at (608) 264-6224 if you have any questions.