N.M. Admin. Code § 7.1.21.8

Current through Register Vol. 35, No. 21, November 5, 2024

Section 7.1.21.8 - HEALTH PLAN REPORT

A.Components of report: The health plan report required by this rule shall consist of the following components:

(1) the HEDIS reporting set; and

(2) an additional core set of performance measures specific to the needs of New Mexico consumers, as required by the commission.

B.Additional core set:

(1)Recommendations: The HIS advisory committee shall adopt a process for determining which performance measures, in addition to those in the HEDIS reporting set, should be included in a core set of performance measures to be regularly reported to the commission and provided to consumers as consumer health information. The HIS advisory committee shall evaluate and recommend to the commission the adoption of additional performance measures that are in accordance with the criteria in 7 NMAC 1.22.9.2 [now Subsection B of 7.1.22.9 NMAC] and relevant to the health status and needs of New Mexico health care consumers.

(2)Adoption: Upon recommendation of the HIS advisory committee, the commission may require reporting health plans to report a core set of performance measures in addition to those in HEDIS, provided that these measures shall be in accordance with the criteria in 7 NMAC 1.22.9.2 [now Subsection B of 7.1.22.9 NMAC] and relevant to the health status and needs of New Mexico health care consumers.

(3)Periodic review: The HIS advisory committee periodically shall review and recommend to the commission changes in the additional core set of performance measures, as appropriate. The HIS advisory committee and the commission shall endeavor to maintain the consistency of the additional core set over time for longitudinal comparison purposes.

C.Notification of required data:

(1)HEDIS reporting set: The HEDIS reporting version for the health plan reporting period shall serve as notice of the data that shall be provided to the commission in the HEDIS reporting set.

(2)Additional core set: The commission shall notify reporting health plans by August 1 of the year preceding the health plan reporting period of any additional performance measures that shall be reported in the health plan report. For performance measures that are complex or time-consuming to collect, the commission shall provide as much additional advance notice of the reporting requirement as reasonably necessary to afford reporting health plans sufficient time to comply while meeting the needs of New Mexico consumers for comparative health care data.

N.M. Admin. Code § 7.1.21.8

8-30-97; Recompiled 10/31/01