Information Systems Capability Assessments

Conducted in coordination with EQR activities (i.e., Coordinated Care Organization [CCO] Compliance Monitoring Reviews, Validation of Performance Measures, Encounter Data Validation, and Delivery System Network Evaluations), ISCAs represent a review the CCOs’ information systems, data processing, and reporting procedures. A key purpose of an ISCA is to determine the extent to which the CCO maintains the capacity to collect, manage, report, and use valid and reliable data. Additionally, 42 CFR §438.242 requires that CCOs maintain health information systems that collect, analyze, integrate, and report data for areas including, but not limited to, utilization, grievances and appeals, and disenrollment. Although ISCAs are not specifically listed as a mandatory activity in the CFRs, completion of an ISCA is required as part of other mandatory and optional EQR-related activities (e.g., PMV, EDV) and the external quality review tehcnical report.

ISCAs are also important for ensuring the completeness and accuracy of data submitted to OHA for monitoring and reporting. Since 2019, ISCAs have been integrated into concurrent EQR activities to align complementary activities and reduce the administrative burden of CCOs. During each ISCA review, the EQRO works with OHA to develop customized review tools to facilitate the activities. All data collection tools are designed to assess and document each organization's compliance with certain federal Medicaid managed care regulations, contract with the CCOs, OARs, and other state requirements. 

Moving forward ISCAs will be integrated into concurrent EQR activities to align complementary activities and reduce the administrative burden on CCOs. In 2019, an ecounter data focused ISCA was performed on the CCOs in support of OHA's Encounter Data Validation Project while in 2022 an ISCA was performed to support HSAG evaluation of the CCO's compliance Health Information standards as part of the Compliance Monitoring Reviews.

The following table highlights the ISCA reviews conducted by HSAG:

For questions related to the Information Systems Capability Assessments activity, please contact:

       Thomas "Tom" Miller, MA
       Executive Director, State & Corporate Services
       Telephone: 602.341.4992
       Email: TMiller@hsag.com