N.M. Admin. Code § 7.1.21.9

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

Section 7.1.21.9 - REPORTING REQUIREMENTS

A.Mandatory reporting: Reporting health plans shall submit to the commission a health plan report as follows:

(1) For the 1996 health plan reporting period, the health plan report shall be submitted by October 1, 1997 and shall consist of the HEDIS reporting set only.

(2) For all subsequent health plan reporting periods, the health plan report shall be submitted by August 1 of the year following the health plan reporting period. To illustrate, for the 1997 health plan reporting period the health plan report shall be submitted by August 1, 1998.

B.HEDIS data elements: Reporting health plans shall provide to the commission in the health plan report the HEDIS data elements for each reporting measure, to be used by the commission for data quality verification or policy and planning purposes as defined in Section 24-14A-3 of the Health Information System Act, Section 24-14A-1 et seq. NMSA 1978. The commission recommends that reporting health plans capture the data elements identified by NCQA in their HEDIS specifications.

C.Required specifications: In submitting the HEDIS reporting set component of the health plan report, reporting health plans shall use the complete HEDIS specifications, templates, electronic data submission formats and any other documents provided by the commission or made directly available to the plans by the NCQA, all of which shall be consistent with those published by the NCQA.

D.Submission to NCQA's quality compass: Reporting health plans that submit a HEDIS report to the quality compass program maintained by the NCQA may submit to the commission electronically or on electronic media a copy of that report. This submission shall meet the HEDIS reporting set requirements of this rule if the HEDIS report submitted to quality compass^SM is specific to New Mexico.

N.M. Admin. Code § 7.1.21.9

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