SNP HEDIS 2014 (Summary) Documentation for Reporting Year 2013
General Information
This documentation presents (1) a description of each of the Special Needs Plan (SNP) HEDIS measures that 
CMS collected for 427 SNP plan benefit packages (PBPs) for health care provided in calendar year 2013 to 
Medicare SNP beneficiaries and (2) the location of the rates associated with each SNP HEDIS measure within 
the HEDIS workbook (HEDIS2014_SNP.XLS). CMS took the description and additional information for each 
measure from HEDIS 2014 Volume 2: Technical Specifications. This release contains only those rates, 
percentages, or averages for each measure and not the numerator or denominator used to create those 
measures.
CMS requires that all managed care organizations undergo an audit on all HEDIS measures. The summary 
data file includes all submitted data following the audit.
The HEDIS measure descriptions reprinted here are done so with the permission of the National Committee for 
Quality Assurance (NCQA). HEDIS is a registered trademark of NCQA, and a copyright for HEDIS 2014 is held 
by the National Committee for Quality Assurance, 1100 13th Street, NW, Suite 1000, Washington, DC 20005. 
All rights reserved.
Medicare SNP HEDIS Reporting 
The reporting unit for SNP HEDIS is the PBP. Each Medicare Advantage contract must have at least one PBP; 
many contracts offer more than one. SNP PBPs limit enrollment to special needs individuals, i.e., those who 
are dual-eligible, institutionalized, or have one or more severe or disabling chronic conditions. In 2014, CMS 
collected data from 215 Medicare Advantage contracts for health care delivered by 427 SNP PBPs in 2013. 
The "Service_Area" sheet in the SNP HEDIS workbook identifies the state(s) and counties where services are 
offered for that PBP.
HEDIS Technical Specifications
The description and related information provided for each measure in this documentation are taken from the 
HEDIS 2014 Technical Specifications, which are the specific instructions for calculating HEDIS measures that 
NCQA provides to Medicare managed care plans. For each measure, the Technical Specifications detail the 
precise method for sampling (when appropriate), identification of the numerator and denominator, measure 
calculation, and any other important considerations specific to that measure. The Technical Specifications also 
contain general guidelines that apply to all measures, such as the use of medical records and when a plan 
should not report a measure because its eligible membership is too small. Some measures require more 
detailed specifications than others. 
Missing Values
The HEDIS guidelines distinguish between three different types of missing values in the rate field: Not 
Applicable (NA), No Benefit (NB) and Not Reportable (NR). Health plans report NA when they: do not have a 
large enough population to calculate a representative rate (e.g., many measures require that rates be based on 
at least 30 members) or are not eligible for a measure (e.g., a health plan cannot calculate outpatient drug 
utilization if it does not offer an outpatient drug benefit; a health plan cannot calculate a measure requiring a 
year of continuous enrollment if its first enrollment began mid-way through the reporting year.) A value of NB is 
recorded when the health plan did not offer the health benefit required by the measure (e.g., Mental 
Health/Chemical Dependency). Health plans report NR when: they choose not to calculate and report a rate, or 
the health plans HEDIS Compliance Auditor determines that a rate is materially biased (applicable only to 
audited measures). 
For measures reported as a percentage, material bias is defined as a deviation of more than five percentage 
points from the true rate. For other measures (e.g., procedures per 1,000 member years), material bias exists if 
the number of counted procedures deviates by more than ten percent from the true number of procedures.

Suppression for Small Number
Under the Privacy Act, CMS cannot publish or otherwise disclose the data in a form raising unacceptable 
possibilities that an individual could be identified (i.e., the data must not be beneficiary-specific and must be 
aggregated to a level where no data cells have 10 or fewer beneficiaries). To ensure that no beneficiary can be 
identified, CMS has chosen not to report certain measures, specifically enrollment by age category, and has 
suppressed an extremely small number of rates. CMS has replaced suppressed rates with an NA.' Please see 
the section on missing values above for an explanation of missing value designations.
Additional Variables
CMS includes our record of enrollment as of December of the measurement year in the "GENERAL" sheet in 
the HEDIS workbook. The HEDIS reported value is adjusted for individuals with partial-year enrollment and 
reflects the entire contract's enrollment as well as the PBP enrollment.
We have included the Post Balanced Budget Amendment Naming of plan types as well as indicators if the 
contract offered a Special Needs benefit package or a Part D drug benefit in 2013. These values and others 
can be found on the sheet named "GENERAL". The full list of fields included on this sheet is described later in 
this document.
There is a separate sheet called "Service Area" in the SNP HEDIS workbook which contains the contract, 
state(s) and counties served by the PBPs reporting HEDIS. There is an additional field "EGHP" which indicates 
if the county is available only to beneficiaries in Employer Groups.
National Enrollment Weighted Average Score
CMS has calculated and included a weighted national average for all of the Effectiveness of Care (EOC) 
measures. These rates are reported on a separate sheet called "National Rates" in the SNP HEDIS workbook. 
The rate for each of the EOC measures was calculated using the following formula:
((En1/TotE)*Sn1)+((En2/TotE)*Sn2)++((Enx/TotE)*Snx)=National Enrollment Weighted Average Score
Where:	TotE = Total enrollment for all PBPs with a valid numeric rate in the measure 
En1 = Enrollment in the first PBP with a valid numeric rate 
Sn1 = Reported rate for the first PBP with a valid numeric rate 
Enx = Enrollment in the last PBP with a valid numeric rate 
Snx = Reported rate for the last PBP with a valid numeric rate


EOC010 - Followup after Hospitalization for Mental Illness
	DESCRIPTION - The percentage of discharges for members 6 years of age and older who were hospitalized for treatment of 
selected mental health disorders and who had an outpatient visit, an intensive outpatient encounter or partial hospitalization with a 
mental health practitioner. Two rates are reported.
	1 - The percentage of discharges for which the member received follow-up within 30 days of discharge
	2 - The percentage discharges for which the member received follow-up within 7 days of discharge
	(HEDIS 2014, Volume 2: Technical Specification, Pg. 181)
	REPORTING LEVEL - Contract
	EOC010-0011	Rate - 7 Days
	EOC010-0012	Rate - 30 Days
	EOC010-0021	Upper Confidence Interval - 7 Days
	EOC010-0022	Upper Confidence Interval - 30 Days
	EOC010-0031	Lower Confidence Interval - 7 Days
	EOC010-0032	Lower Confidence Interval - 30 Days
EOC030 - Antidepressant Medication Management
	DESCRIPTION - The percentage of members 18 years of age and older who were diagnosed with a new episode of major depression 
and treated with antidepressant medication, and who remained on an antidepressant medication treatment. Two rates are reported.
		Effective Acute Phase Treatment. The percentage of newly diagnosed and treated members who remained on an 
antidepressant medication for at least 84 days (12 weeks). 
		Effective Continuation Phase Treatment. The percentage of newly diagnosed and treated members who remained on an 
antidepressant medication for at least 180 days (6 months).
	(HEDIS 2014, Volume 2: Technical Specifications, Pg. 172)
	REPORTING LEVEL - Contract
	EOC030-0010	Rate - Effect.Continuation Phase Treat.
	EOC030-0020	Lower Confidence Interval - Effect.Continuation Phase Treat.
	EOC030-0030	Upper Confidence Interval - Effect.Continuation Phase Treat.
	EOC030-0040	Rate - Effect.Acute Phase Treatment
	EOC030-0050	Lower Confidence Interval - Effect.Acute Phase Treatment
	EOC030-0060	Upper Confidence Interval - Effect.Acute Phase Treatment
EOC035 - Controlling High Blood Pressure
	DESCRIPTION - The percentage of members 1885 years of age who had a diagnosis of hypertension (HTN) and whose BP was 
adequately controlled (<140/90) during the measurement year. Use the Hybrid Method for this measure. (HEDIS 2014, Volume 2: 
Technical Specification, Pg. 134)
	REPORTING LEVEL - Contract
	EOC035-0100	Rate - Total
	EOC035-0110	Lower Confidence Interval tot
	EOC035-0120	Upper Confidence Interval tot
EOC040 - Colorectal Cancer Screening
	DESCRIPTION - The percentage of members 5075 years of age who had appropriate screening for colorectal cancer. (HEDIS 
2014, Volume 2: Technical Specification, Pg. 85)
	REPORTING LEVEL - Contract
	EOC040-0010	Reported Rate
	EOC040-0020	Lower Confidence Interval
	EOC040-0030	Upper Confidence Interval
EOC045 - Osteoporosis Management in Women Who Had a Fracture
	DESCRIPTION - The percentage of women 67 years of age and older who suffered a fracture and who had either a bone mineral 
density (BMD) test or prescription for a drug to treat or prevent osteoporosis in the six months after the fracture. (HEDIS 2014, 
Volume 2: Technical Specification, Pg. 164)
	REPORTING LEVEL - Contract
	EOC045-0010	Reported rate
	EOC045-0020	Lower Confidence Interval
	EOC045-0030	Upper Confidence Interval
EOC050 - Glaucoma Screening in Older Adults
	DESCRIPTION - The percentage of Medicare members 65 years and older who received a glaucoma eye exam by an eye care 
professional for early identification of glaucomatous conditions. (HEDIS 2014, Volume 2: Technical Specification, Pg. 91)
	REPORTING LEVEL - Contract
	EOC050-0010	Reported Rate
	EOC050-0020	Lower Confidence Interval
	EOC050-0030	Upper Confidence Interval
EOC055 - Persistence of Beta-Blocker Treatment After a Heart Attack
	DESCRIPTION - The percentage of members 18 years of age and older during the measurement year who were hospitalized and 
discharged alive from July 1 of the year prior to the measurement year to June 30 of the measurement year with a diagnosis of AMI 
and who received persistent beta-blocker treatment for six months after discharge. (HEDIS 2014, Volume 2: Technical Specification, 
Pg. 139)
	REPORTING LEVEL - Contract
	EOC055-0010	Reported rate
	EOC055-0020	Lower Confidence Interval
	EOC055-0030	Upper Confidence Interval
EOC070 - Use of High-Risk Medications in the Elderly
	DESCRIPTION  
		The percentage of Medicare members 65 years of age and older who received at least one high-risk medication.
		The percentage of Medicare members 65 years of age and older who received at least two different high- risk medications.
	For both rates, a lower rate represents better performance.
	(HEDIS 2014, Volume 2: Technical Specification, Pg. 211)
	REPORTING LEVEL - Contract
	EOC070-0010	Rate - one prescription
	EOC070-0020	Lower Confidence Interval - one prescription
	EOC070-0030	Upper Confidence Interval - one prescription
	EOC070-0040	Rate - at least 2 prescriptions
	EOC070-0050	Lower Confidence Interval - at least 2 prescriptions
	EOC070-0060	Upper Confidence Interval - at least 2 prescriptions
EOC075 - Annual Monitoring for Patients on Persistent Medications
	DESCRIPTION - The percentage of members 18 years of age and older who received at least 180 treatment days of ambulatory 
medication therapy for a select therapeutic agent during the measurement year and at least one therapeutic monitoring event for the 
therapeutic agent in the measurement year. For each product line, report each of the four rates separately and as a total rate.
		Annual monitoring for members on angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB)
		Annual monitoring for members on digoxin
		Annual monitoring for members on diuretics
		Annual monitoring for members on anticonvulsants
		Total rate (the sum of the four numerators divided by the sum of the four denominators)
	(HEDIS 2014, Volume 2: Technical Specification, Pg. 198)
	REPORTING LEVEL - Contract
	EOC075-0010	Reported rate - ACE inhibitors or ARBs
	EOC075-0020	Lower Confidence Interval - ACE inhibitors or ARBs
	EOC075-0030	Upper Confidence Interval - ACE inhibitors or ARBs
	EOC075-0040	Reported rate - Digoxin
	EOC075-0050	Lower Confidence Interval - Digoxin
	EOC075-0060	Upper Confidence Interval - Digoxin
	EOC075-0070	Reported rate - Diuretics
	EOC075-0080	Lower Confidence Interval - Diuretics
	EOC075-0090	Upper Confidence Interval - Diuretics
	EOC075-0100	Reported rate - Anticonvulsants
	EOC075-0110	Lower Confidence Interval - Anticonvulsants
	EOC075-0120	Upper Confidence Interval - Anticonvulsants
	EOC075-0160	Rate - Total
	EOC075-0170	Lower Confidence Interval - Total
	EOC075-0180	Upper Confidence Interval - Total
EOC080 - Use of Spirometry Testing in the Assessment and Diagnosis of COPD
	DESCRIPTION - The percentage of members 40 years of age and older with a new diagnosis of COPD or newly active COPD, who 
received appropriate spirometry testing to confirm the diagnosis. (HEDIS 2014, Volume 2: Technical Specification, Pg. 112)
	REPORTING LEVEL - Contract
	EOC080-0010	Reported rate
	EOC080-0020	Lower Confidence Interval
	EOC080-0030	Upper Confidence Interval
EOC090 - Potentially Harmful Drug-Disease Interactions in the Elderly
	DESCRIPTION - The percentage of Medicare members 65 years of age and older who have evidence of an underlying disease, 
condition or health concern and who were dispensed an ambulatory prescription for a contraindicated medication, concurrent with or 
after the diagnosis.
	Report each of the three rates separately and as a total rate.
		A history of falls and a prescription for tricyclic antidepressants, antipsychotics or sleep agents
		Dementia and a prescription for tricyclic antidepressants or anticholinergic agents
		CRF and prescription for nonaspirin NSAIDs or Cox-2 Selective NSAIDs
		Total rate (the sum of the three numerators divided by the sum of the three denominators)
	Members with more than one disease or condition may appear in the measure multiple times (i.e., in each indicator for which they 
qualify). A lower rate represents better performance for all three rates.
	(HEDIS 2014, Volume 2: Technical Specification, Pg. 206)
	REPORTING LEVEL - Contract
	EOC090-0010	Rate - DDI Falls + Tricyclic Antidepress or Antipsych
	EOC090-0020	Lower Confidence Interval - DDI Falls + Tricyclic Antidepress or Antipsych
	EOC090-0030	Upper Confidence Interval - DDI Falls + Tricyclic Antidepress or Antipsych
	EOC090-0040	Rate - DDI Dementia + Tricyclic Antidepress or Anticholl
	EOC090-0050	Lower Confidence Interval - DDI Dementia + Tricyclic Antidepress or Anticholl
	EOC090-0060	Upper Confidence Interval - DDI Dementia + Tricyclic Antidepress or Anticholl
	EOC090-0070	Rate - DDI Chronic Renal Failure + Non Asp NSAIDs or Cox-2
	EOC090-0080	Lower Confidence Interval - DDI Chronic Renal Failure + Non Asp NSAIDs or Cox-2
	EOC090-0090	Upper Confidence Interval - DDI Chronic Renal Failure + Non Asp NSAIDs or Cox-2
	EOC090-0100	Rate - Total
	EOC090-0110	Lower Confidence Interval - Total
	EOC090-0120	Upper Confidence Interval - Total
EOC105 - Pharmacotherapy Management of COPD Exacerbation
	DESCRIPTION - The percentage of COPD exacerbations for members 40 years of age and older who had an acute inpatient 
discharge or ED encounter on or between January 1November 30 of the measurement year and who were dispensed appropriate 
medications. Two rates are reported. 
	1.	Dispensed a systemic corticosteroid within 14 days of the event
	2.	Dispensed a bronchodilator within 30 days of the event
	Note: The eligible population for this measure is based on acute inpatient discharges and ED visits, not on members. It is possible 
for the denominator to include multiple events for the same individual.
	(HEDIS 2014, Volume 2: Technical Specification, Pg. 114)
	REPORTING LEVEL - Contract
	EOC105-0010	Reported rate - Systemic corticosteroid
	EOC105-0020	Lower 95% confidence interval - Systemic corticosteroid
	EOC105-0030	Upper 95% confidence interval - Systemic corticosteroid
	EOC105-0040	Reported rate - Bronchodilator
	EOC105-0050	Lower 95% confidence interval - Bronchodilator
	EOC105-0060	Upper 95% confidence interval - Bronchodilator
?
EOC115 - Care for Older Adults
	DESCRIPTION - The percentage of adults 66 years and older who had each of the following during the measurement year.
	 Advance care planning
	 Medication review 
	 Functional status assessment
	 Pain screening
	(HEDIS 2014, Volume 2: Technical Specification, Pg. 93)
	REPORTING LEVEL - Plan Benefit Package
	EOC115-0010	Reported Rate - Advance Care Planning
	EOC115-0020	Lower Confidence Interval - Advance Care Planning
	EOC115-0030	Upper Confidence Interval - Advance Care Planning
	EOC115-0040	Reported Rate - Medication Review
	EOC115-0050	Lower Confidence Interval - Medication Review
	EOC115-0060	Upper Confidence Interval - Medication Review
	EOC115-0070	Reported Rate - Functional Status Assessment
	EOC115-0080	Lower Confidence Interval - Functional Status Assessment
	EOC115-0090	Upper Confidence Interval - Functional Status Assessment
	EOC115-0100	Reported Rate - Pain Assessment
	EOC115-0110	Lower Confidence Interval - Pain Assessment
	EOC115-0120	Upper Confidence Interval - Pain Assessment
EOC120 - Medication Reconciliation Post-Discharge
	DESCRIPTION - The percentage of discharges from January 1 - December 1 of the measurement year for members 66 years of 
age and older for whom medications were reconciled on or within 30 days of discharge.
	(HEDIS 2014, Volume 2: Technical Specification, Pg. 203)
	REPORTING LEVEL - Plan Benefit Package
	EOC120-0010	Reported Rate
	EOC120-0020	Lower Confidence Interval
	EOC120-0030	Upper Confidence Interval
PDI801 - Board Certification/Residency Completion
	DESCRIPTION - The percentage of the following physicians whose board certification is active as of December 31 of the 
measurement year. 
	 Family medicine physicians
	 Internal medicine physicians
	 Pediatricians
	 OB/GYN physicians
	 Geriatricians
	 Other physician specialists
	Board certification refers to the various specialty certification programs of the American Board of Medical Specialties and the 
American Osteopathic Association. Report each product separately as of December 31 of the measurement year.
	(HEDIS 2014, Volume 2: Technical Specification, Pg. 379)
	REPORTING LEVEL - Contract
	PDI801-0010	Family Medicine Board Cert Pct
	PDI801-0030	Oth Specialists Board Cert Pct
	PDI801-0050	Geriatricians Board Cert Pct
	PDI801-0060	Internal Medicine Board Cert Pct
	PDI801-0070	OB/GYN Provs Board Cert Pct
	PDI801-0080	Pediatrician Board Cert Pct
?
UOS524 - Plan All-Cause Readmissions
	DESCRIPTION - For members 18 years of age and older, the number of acute inpatient stays during the measurement year that 
were followed by an acute readmission for any diagnosis within 30 days and the predicted probability of an acute readmission. Data 
are reported in the following categories:
	1.	Count of Index Hospital Stays (IHS) (denominator)
	2.	Count of 30-Day Readmissions (numerator)
	3.	Average Adjusted Probability of Readmission
	(HEDIS 2014, Volume 2: Technical Specification, Pg. 314)
	REPORTING LEVEL - Contract
	UOS524-0010	Count of Index Stays (Denominator) Total 65-74 Num
	UOS524-0020	Count of 30-Day readmissions (Numerator) Total 65-74 Num
	UOS524-0025	Observed Readmission (Num/Den) Total 65-74
	UOS524-0030	Average Adjusted Probability Total 65-74 Num
	UOS524-0035	Total Variance Total 65-74
	UOS524-0040	Count of Index Stays (Denominator) Total 75-84 Num
	UOS524-0050	Count of 30-Day readmissions (Numerator) Total 75-84 Num
	UOS524-0055	Observed Readmission (Num/Den) Total 75-84
	UOS524-0060	Average Adjusted Probability Total 75-84 Num
	UOS524-0065	Total Variance Total 75-84
	UOS524-0070	Count of Index Stays (Denominator) Total 85+ Num
	UOS524-0080	Count of 30-Day readmissions (Numerator) Total 85+ Num
	UOS524-0085	Observed Readmission (Num/Den) Total 85+
	UOS524-0090	Average Adjusted Probability Total 85+ Num
	UOS524-0095	Total Variance Total 85+
	UOS524-0100	Count of Index Stays (Denominator) Total Total Num
	UOS524-0110	Count of 30-Day readmissions (Numerator) Total Num
	UOS524-0120	Observed Readmission (Num/Den) Total Total
	UOS524-0130	Average Adjusted Probability Total Total Num
	UOS524-0140	Total Variance Total Total
	UOS524-0150	Observed-to-Expected Ratio
	UOS524-0160	Lower Confidence Interval
	UOS524-0170	Upper Confidence Interval
	UOS524-0510	Count of Index Stays (Denominator) Total 18-44 Num
	UOS524-0520	Count of 30-Day readmissions (Numerator) Total 18-44 Num
	UOS524-0525	Observed Readmission (Num/Den) Total 18-44
	UOS524-0530	Average Adjusted Probability Total 18-44 Num
	UOS524-0535	Total Variance Total 18-44
	UOS524-0540	Count of Index Stays (Denominator) Total 45-54 Num
	UOS524-0550	Count of 30-Day readmissions (Numerator) Total 45-54 Num
	UOS524-0555	Observed Readmission (Num/Den) Total 45-54
	UOS524-0560	Average Adjusted Probability Total 45-54 Num
	UOS524-0565	Total Variance Total 45-54
	UOS524-0570	Count of Index Stays (Denominator) Total 55-64 Num
	UOS524-0580	Count of 30-Day readmissions (Numerator) Total 55-64 Num
	UOS524-0585	Observed Readmission (Num/Den) Total 55-64
	UOS524-0590	Average Adjusted Probability Total 55-64 Num
	UOS524-0595	Total Variance Total 55-64
	UOS524-0600	Count of Index Stays (Denominator) Total Total
	UOS524-0610	Count of 30-Day readmissions (Numerator) Total
	UOS524-0620	Average Adjusted Probability Total Total
	UOS524-0630	Observed Readmission (Num/Den) Total Total
	UOS524-0640	Total Variance Total Total
	UOS524-0650	Observed-to-Expected Ratio
	UOS524-0660	Lower Confidence Interval
	UOS524-0670	Upper Confidence Interval


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Measure	Measure Name/Measure Description/Field Name/Field Description
