If your question is not answered in the below Frequently Asked Questions, please send your query to: firstname.lastname@example.org
1. What are the Centers for Medicare & Medicaid Services (CMS) Protocols?
The CMS protocols for external quality review (EQR) activities were initially published in 2002. In September of 2012, CMS released revised versions of all EQR protocols. The link to the current version of the EQR protocols is available on the Resources page on this website.
2. What is the next step once the PIP Validation Tool is received by the Managed Care Organization (MCO)?
Once the MCO receives the PIP validation tool from Health Services Advisory Group (HSAG), the MCO should ensure that all Partially Met, Not Met and General Comments are addressed in the PIP Submission Form for the next validation cycle. The MCO will use its existing PIP Submission Form for the duration of the PIP. All new information should be dated, highlighted or bolded. The MCOs should strikethrough and date any information that is no longer pertinent.
Check with your specific AHCA contract manager for the timeframe for submitting PIPs for review.
3. How long does a PIP study continue until it is retired?
Typically, a PIP will continue until it has achieved statistically significant improvement and sustained improvement over baseline. In addition, AHCA can determine when a PIP should be retired.
4. What if I need PIP training...Where do I go?
PIP documents, including the submission form, completion instructions, and PIP 101 training information can be found on this website under the Validation of PIPs page. To schedule a technical assistance call, please contact Jenny Montano at email@example.com.
5. Where can I find information about HEDIS® if my PIP is a HEDIS-based improvement project?
For HEDIS-based PIPs, measures, NCQA provides HEDIS technical resource information on its website at: http://www.ncqa.org/HEDISQualityMeasurement.aspx.
6. When submitting data, should I include member level data?
No. When you submit data for your PIP, HSAG is only interested in aggregated rates for each measurement period. We do not want raw data or data that includes any personal health information.
7. Who do I contact at HSAG if I have questions about PIPs?
Christi Melendez, RN, CPHQ
Associate Executive Director, Performance Improvement Projects
1. What is the purpose of the performance measure validation activity?
The purpose of the performance measure validation activity is twofold: First, the process ensures that the MCO calculated the performance measures according to the state-required definitions and specifications, which allows MCO performance to be compared with other MCOs. Second, the process ensures that the performance measure results reported by an MCO are truly valid and accurate, and appropriately reflect the level of services provided by the MCO.
2. Is a HEDIS Compliance Audit™ considered to be a performance measure validation activity?
Yes. Medicaid Managed Care Rules require that the State, the State's agent, or the EQRO validate performance measures following a methodology that is consistent with CMS protocols. The HEDIS Compliance Audit process is determined to be consistent with the PMV protocol.
3. Where can I get a copy of the protocols?
The link to the CMS protocols for the validation of performance measures is posted on this website, on the Resources page.
4. What is an ISCAT?
The ISCAT is the Information Systems Capabilities Assessment Tool, which is Appendix V of the CMS protocols. The ISCAT is comparable to NCQA's Record of Administration, Data Management and Processes (Roadmap) and is intended to collect information about the information system practices that are used to collect performance measure data. The ISCAT is typically completed by the MCO annually as a part of the performance measure validation process.
5. Who can I contact with questions about the validation of performance measures?
For questions related to performance measure validation, please contact:
Mariyah Badani, JD, MBA, CHCA
Director: Audits, State and Corporate Services
Health Services Advisory Group, Inc.
O 602.801.6657 | C 602.432.2271 | firstname.lastname@example.org