NCQA_Synopsis_HEDIS Summary.pdf

Description

This is a Notice of Proposed Contract Action Synopsis: The Centers for Medicare & Medicaid Services (CMS) intends to issue a new non-competitive contract to the National Committee for Quality Assurance (NCQA) pursuant to the authority of FAR 8.405-6(a)(1)(i)(B), Only one source is capable of providing the supplies or services required at the level of quality required because the supplies or services are unique or highly specialized. This action is subject to the availability of funds.

CMS intends to extend the unique services of NCQA to continue the summary-level data collection and management of the annual Healthcare Effectiveness Data and Information Set (HEDIS) submission for Medicare Advantage Organizations (MAOs).

Collection and Management of the Annual HEDIS® Summary-level Data Submission for Medicare Advantage Contracts

NCQA owns the proprietary rights to the system that collects HEDIS® data. It is the only organization authorized to add measurements and to provide technical assistance to the health plans and auditors in the use of these measurements. NCQA performs this function by convening a number of interdisciplinary multi-stakeholder panels and groups. These groups are all widely respected by the managed care industry and have stakeholder representation. Since NCQA develops the measures and makes all of the updates to HEDIS®, it is uniquely qualified to provide the needed technical assistance to health plans and auditors during data collection.

As the organization that maintains and evolves HEDIS®, NCQA is the only responsible source for this activity. In 1993, NCQA released HEDIS® 2.0 that quickly became the “industry standard” performance measurement set. Originally designed for private employers' needs as purchasers of healthcare, HEDIS® has been adapted for use by public purchasers, Government compliance monitors, and managed care consumers. HEDIS data submission tools and detailed technical specifications are developed and maintained by NCQA. Since 1997, CMS has contracted with NCQA to develop additional HEDIS® performance measures to assess Medicare Advantage plan performance for quality assessment. As such, NCQA retains sole title and ownership of the HEDIS® Medicare HEDIS® data.

The contract's period of performance will be a base year plus four (4) option years. This notice is a notice of intent to negotiate and award a contract to NCQA and should not be considered a request for proposals. This synopsis should not be construed as commitment by the Government for any purpose other than market research. All responsible sources may submit a capability statement that will be considered by the agency. Such statements must demonstrate that the firm has the capability to perform the required work. All capability statements must be submitted via email to Megan Famodu at Megan.Famodu@cms.hhs.gov on or before the due date listed within the notice. Voice communications will not be entertained. A determination by the Government not to compete this proposed action based upon responses to this notice is solely within the discretion of the Government. Information received will be considered solely for the purpose of determining whether to conduct a competitive procurement. CMS will not reimburse costs for submission of capability information. All documentation shall become the property of the Government.

Please note: Any firm interested in this synopsis must be able to successfully perform summary-level data collection and management of the annual Healthcare Effectiveness Data and Information Set (HEDIS) submission for Medicare Advantage Organizations (MAOs).