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Dec 8 -- The Centers for Medicare & Medicaid Services (CMS) invites public comment by February 6, 2024 regarding the HEDIS Data Collection for Medicare Advantage.

Sections 422.152 and 422.516 of Volume 42 of the Code of Federal Regulations (CFR) specify that MAOs must submit quality performance measures as specified by the Secretary of the Department of Health and Human Services and by CMS. These quality performance measures include Healthcare Effectiveness Data and Information Set (HEDIS®). HEDIS® data are used in the Medicare Part C Star Ratings which are used to determine Quality Bonus Payments to Medicare Advantage contracts.

CMS requires MAOs, § 1876 cost contracts, and Medicare Medicaid Plans (MMPs or demonstrations) to submit HEDIS® data on an annual basis to (1) assess care that is provided to Medicare beneficiaries and (2) to provide information to Medicare beneficiaries to make more informed decisions when choosing a health plan.

The HEDIS® data collection supports the CMS strategic goals of advancing health equity and improving health outcomes for Medicare beneficiaries. The HEDIS® measures are part of the Medicare Part C Star Ratings as described at §§ 422.160, 422.162, 422.164, and 422.166. CMS publishes the Medicare Part C Star Ratings each year to: (1) incentivize quality improvement in Medicare Advantage (MA); and (2) assist beneficiaries in finding the best plan for them. The Star Ratings are used to determine MA Quality Bonus Payments.

Form Number: CMS–10219
Frequency: Yearly
Affected Public: Private Sector, Business or other for-profits and Not-for-profits institutions
Number of Respondents: 808

HEDIS: https://www.ncqa.org/hedis/
Draft data collection instrument and technical documentation: https://www.cms.gov/regulations-and-guidance/legislation/paperworkreductionactof1995/pra-listing-items/cms%253f10219
FRN: https://www.federalregister.gov/d/2023-27035

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