PQA PO SOW FY23 CCSQ-393-2023-0338.docx

Scope of Work Marketplace Quality Rating System Measure Set August 03, 2023

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 for several quality measures including the following measures that are required as part of the implementation of the Marketplace Quality Rating System (QRS).

Requirements 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:

· 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)

· International Normalized Ratio Monitoring for Individuals on Warfarin (INR) measure

· Annual Monitoring for Persons on Long-term Opioid Therapy (AMO) measure

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

MEASURE MAINTENANCE

· PQA will ensure that the 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 Consensu-Based Entity (CBE) endorsement of the measures

· PQA will provide the Centers 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

· PQA will provide support and maintenance for additional select quality measures

TECHNICAL SUPPORT

· PQA will collaborate with the Marketplace QRS contractor and provide technical support to CMS related to several quality measures.

· Provide technical manuals and training for CMS staff on PDC, INR and AMO measures

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

· Receive and answer questions from stakeholders, such as Qualified Health Plans about the PDC measures, with guaranteed turnaround of responses within two (2) business days

· PQA will coordinate with the Marketplace QRS contractor and will assist with the evaluation of the Marketplace Quality Rating System and support program refinements. This may include:

· Providing to CMS summary of questions received from Qualified Health Plans and other stakeholders

· Updating a frequently asked question (FAQ) document with responses and clarifications

· Revisions and clarifications to technical guidance documents for CMS and other stakeholders such as Qualified Health Plans

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