CCSQ-393-2016-0275_SOW.docx

Scope of Work 2016 Quality Rating System Measure Set April 28, 2016

Background/Purpose

The purpose of this purchase order is to contract with the Pharmacy Quality Alliance (PQA) to provide measure specifications, measure maintenance and technical support to the following measures that are required as part of the 2016 implementation of the Qualified Health Plan (QHP) Quality Rating System (QRS).

Proportion of Days Covered (PDC) Measures – inclusive of three distinct therapeutic areas:

· Blood pressure (renin angiotensin system antagonists [RASA])

· Diabetes (non-insulin medications)

· Cholesterol (statins)

Requirements These measures are used to calculate medication adherence rates. In order to perform the calculation, a vendor or health plan needs both the PQA measure specifications and National Drug Code (NDC) lists. Services provided by PQA will include:

MEASURE SPECIFICATIONS

· PQA will provide the most up-to date measure specifications for the following measures of adherence to medications essential for chronic conditions:

Proportion of Days Covered (PDC) Measures – inclusive of three distinct therapeutic areas:

· Blood pressure (renin angiotensin system antagonists [RASA])

· Diabetes (non-insulin medications)

· Cholesterol (statins)

· Measure specifications will include all necessary data elements and NDC codes necessary for Qualified Health Plans to calculate the aforementioned measures.

MEASURE MAINTENANCE

· PQA will ensure that the PDC measures are updated as necessary to reflect new medications and clinical guidelines

· PQA will ensure that NDC code lists are updated at least annually

· PQA will maintain National Quality Forum (NQF) endorsement of the measure

· PQA will provide Center for Medicare and Medicaid Services (CMS) with annual measure updates along with NDC list updates upon request

· PQA will integrate feedback from software vendors and health plans into the measure updates, revisions and clarifications

TECHNICAL SUPPORT

· PQA will provide technical support to CMS, CMS contractors such as Booz Allen Hamilton and the National Committee for Quality Assurance, and QHPs which may include the following:

· provide technical manuals and training for CMS staff on PDC measures

· participate in live webinars or other educational offerings for QHPs regarding the Quality Rating System

· receive and answer questions from QHPs about the PDC measures with guaranteed turnaround of responses within 2 business days

· PQA will assist with the evaluation of the Quality Rating System and support of improvements of the QRS. This may include:

· Summary of questions received from QHPs and other stakeholders

· Updating a frequently asked question (FAQ) document with answers to the frequently asked questions

· Revisions and clarifications to technical guidance documents for CMS and QHPs