Performance Measure Validation

HSAG conducts performance measure validation as part of our EQR services. The Balanced Budget Act of 1997 (BBA) requires that performance measures reported or calculated by state Medicaid agencies be validated for managed care organizations (MCOs) or prepaid inpatient health plans (PIHPs).

The performance measure validation processes:

• Evaluate the accuracy of the performance measures reported by or calculated on behalf of the MCOs.
• Determine the extent to which the performance measures were calculated according to specifications required by the state.

HSAG validates performance measures to evaluate their accuracy as reported by MCOs. In this capacity, HSAG reviews data management processes, evaluates algorithmic compliance, and verifies that specified performance measures are based on accurate source information.

HSAG conducts the validation activities as outlined in the Centers for Medicare & Medicaid Services (CMS) publication, Validating Performance Measures, A Protocol for Use in Conducting External Quality Review Activities, Final Protocol, Version 1.0, May 1, 2002. In addition, HSAG can tailor the CMS Information Systems Capabilities Assessment Tool (ISCAT) to meet each state agency's needs.

HSAG has extensive experience in conducting performance measure validation and currently conducts this activity in the following states: California, Colorado, Florida, Georgia, Hawaii, Illinois, Michigan, Nevada, New Mexico, Ohio, Tennessee, Vermont, and Washington.