NCQA_Synopsis_2019_draft.docx

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 6.302-1, Only One Responsible Source and No Other Supplies or Services Will Satisfy Agency Requirements. This action is subject to the availability of funds.

CMS intends to extend the unique services of NCQA to: Continue the collection, reporting and management of Healthcare Effectiveness Data and Information Set (HEDIS®) Medicare Health Outcomes Survey (HOS) and scientific support of the Medicare HOS measures.

Collection and Management of HEDIS® Medicare Health Outcomes Survey

The Healthcare Effectiveness Data and Information Set (HEDIS) is a set of defined measures to assess the health care quality provided by managed care plans. Purchasers, especially large purchasers such as corporations, business coalitions, and government, use these data to evaluate plan performance. The HOS assesses the physical and mental health of Medicare beneficiaries enrolled in managed care over time. The HOS is administered to a random sample of enrollees from each Medicare managed care contract at the beginning and end of a two-year period. For each enrollee who completes a baseline and follow-up survey, a two-year change score is calculated. The enrollee’s physical and mental health status are each categorized as better, the same, or worse than expected. Summary results are calculated for each Medicare contract based on enrollee outcomes. The goal of the HOS program is to gather valid and reliable health status data in Medicare managed care for use in quality improvement activities, public reporting, plan accountability, and improvement of beneficiaries’ health.

Section 722 (a)(3)(A)(i) of the Medicare Prescription Drug Improvement Act of 2003 mandates the continued collection, analysis, and reporting of health outcomes information in Medicare managed care. The legislation also specifies that data collected on quality, outcomes, and beneficiary satisfaction to facilitate consumer choice and program administration must continue to use data sources in existence prior to November 1, 2003. Collected since 1998, the HEDIS Medicare HOS contains the only outcome measures in Medicare managed care and thus remains a critical part of assessing health plan quality. In addition, CMS reports Medicare HOS results in the Medicare Star Ratings on the Medicare Plan Finder (MPF) which are used to facilitate consumer choice and determine eligibility for Quality Bonus Payments (QBP).

Through this series of HEDIS Medicare Health Outcomes Survey contract requirements, including the current contract (HSM-500-2014-00229C), NCQA has been the only contractor qualified to provide the required technical support expertise. The reason that NCQA has been the sole source to support the above described requirement is that they own, support, and maintain HEDIS Medicare HOS, the survey which CMS authorizes to fulfill the statutory requirement to collect health outcomes data for all Medicare managed care plans.

NCQA owns the proprietary rights to the system that collects HEDIS data and is the only organization authorized to add measurements and to provide technical assistance to the health plans and auditors in the use of the 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. HEDIS 3.0 was released in 2007. 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 HOS measures. As such, NCQA retains sole title to and ownership of the HEDIS Medicare HOS data.

The contract's period of performance will be a base year plus four 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. The statement must demonstrate that the firm(s) has the capability to perform the required work. All capability statements must be submitted via email to Lakisha Holly at: Lakisha.Holly@cms.hhs.gov on or before close of business Friday, December 28, 2019. 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 that any firm interested in this synopsis must be able to successfully perform the collection, reporting and management of Healthcare Effectiveness Data and Information Set (HEDIS®) Medicare Health Outcomes Survey (HOS) and provide scientific support of the Medicare HOS measures.