Part III. Duties of the Board and the Nonprofit Organization
12VAC5-407-100. Duties of the nonprofit organization.
The contract entered into by the board and the nonprofit organization pursuant to Chapter 7.2 (§ 32.1-276.2 et seq.) of Title 32.1 of the Code of Virginia shall provide:
1. The nonprofit organization shall compile, store, and make available to consumers the data submitted by HMOs.
2. The nonprofit organization shall assist the board in developing a summary plan and budget to collect and make available HMO HEDIS or any other quality of care performance information set results for consumers. The nonprofit organization shall present the summary plan and budget on a biennial basis to the board for approval. The commissioner, at his discretion, shall also review the summary plan on a periodic basis to determine its effectiveness.
3. The nonprofit organization shall collect the HEDIS data in the most cost-effective manner available.
4. The nonprofit organization shall prepare a biennial summary plan in identifying the measures selected for reporting. The summary plan shall include:
a. The rationale for selecting each measure to be made available to consumers;
b. The goal of reporting each measure;
c. The cost and benefit of collecting the measures and making them available to consumers; and
d. The scope of dissemination of information in paper or electronic format and the target audience.
5. The nonprofit organization shall prepare a biennial budget that includes a cost-benefit analysis of purchasing HEDIS data from NCQA or obtaining the information performance sets directly from the HMOs.
6. The nonprofit organization shall present the summary plan and budget to the board for review and approval on a biennial basis.
7. The nonprofit organization shall organize, present, and make available to consumers all data required by the board to be reported to the commissioner. This data shall also be available on the nonprofit's website.
Statutory Authority
§§ 32.1-12 and 32.1-276.5 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 19, Issue 26, eff. October 8, 2003; amended, Virginia Register Volume 32, Issue 8, eff. February 1, 2016.
12VAC5-407-110. Biennial evaluation.
A. The board shall evaluate biennially the impact and effectiveness of collecting and making available HEDIS or any other quality of care or performance information set and the appropriateness of the fee structure. This evaluation shall be completed by January 15.
B. As part of the biennial evaluation, the board may consult with the HMOs and the nonprofit organization to determine whether changes should be made to the HEDIS or any other quality of care or performance information set requirements.
Statutory Authority
§§ 32.1-12 and 32.1-276.5 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 19, Issue 26, eff. October 8, 2003.
12VAC5-407-120. (Repealed.)
Historical Notes
Derived from Virginia Register Volume 19, Issue 26, eff. October 8, 2003; repealed, Virginia Register Volume 32, Issue 8, eff. February 1, 2016.