Providers
Five Star Quality
Background/History
In early 2008, the Centers for Medicare & Medicaid Services (CMS) contracted with the National Committee for Quality Assurance (NCQA) to develop a strategy to evaluate the quality of care provided by SNPs. This strategy relies on a phased approach, beginning with defining and assessing desirable structural characteristics and followed by assessing processes and, eventually, outcomes. The evaluation approach includes several types of assessment.
- HEDIS® measures
- CAHPS measures
- HOS measures
- CMS specific measures
- Measures that evaluate structure and process requirements through submission of documentation
Objectives of CMS’s SNP Assessment Program
- Evaluate the quality of care SNPs provide
- Evaluate how SNPs address the special needs of their beneficiaries
- Provide data to CMS to allow plan-plan and year-year comparisons
Focus of quality measures
- Preventive care
- Up-to-date treatments for acute episodes of illness
- Chronic disease care
- Appropriate medication treatment
Five Star Quality Measures for 2012
The documents below show the current quality measures for CMS Five Star Quality Program for Medicare Advantage Plans.
2012 CMS Part-C 5-Star Rating Areas 2012 CMS Part-D 5-Star Measures
Independent Care Health Plan: 2011 Quality Results
See this link for 2011 quality results:
http://www.cms.gov/PrescriptionDrugCovGenIn/06_PerformanceData.asp#TopOfPage
Data Reporting
HEDIS 2011 data is reported in June 2011. Data reflects events that occurred January to December 2010 (per specs) HEDIS 2011 = 2010 data
More Information
http://www.ncqa.org/tabid/1265/default.aspx
https://www.cms.gov/SpecialNeedsPlans/04_SNPQuality.asp#TopOfPage
Notification:
By clicking the links above, you may be leaving the icare-wi.org website. Independent Care Health Plan (iCare) only provides these links and pointers for your information and convenience. When you select a link to an outside website, you are leaving the iCare.wi.org website. These external links are not the responsibility of, or under the control of iCare. Independent Care Health Plan disclaims responsibility for the content and privacy policies of the owners/sponsors of the outside websites.
Provider Resources
PDF Resources
Listing of CMS approved iCare Medicare publications, Medicaid publications, third-party preventive health brochures.
- Abridged Formulary/iCare Medicare Plan 2012
- Abridged Formulary/iCare Partnership 2012
- Annual Notice of Change (ANOC)/iCare Medicare Plan 2012
- Annual Notice of Change (ANOC)/iCare Partnership 2012
- Anti-Smoking Quit Line (English)
- Anti-Smoking Quit Line (Spanish)
- Caregiver Background Check Policy
- Claim Form LTC Professional Services - Trizetto
- Claim Form LTC Residential Services - Trizetto
- CMS Appointment of Representative Form
- Comprehensive Formulary/iCare Medicare Plan 2012
- Comprehensive Formulary/iCare Partnership 2012
- Emergency Room Brochure
- Enrollment Form/iCare Medicare Plan 2012
- Evidence of Coverage/iCare Medicare Plan 2012
- Evidence of Coverage/iCare Partnership 2012
- Family Care Partnership Provider Application
- FCP Provider Reference Manual
- First Tier, Downstream and Related Entities Fraud
- Formulary Change Notice (iCare Medicare Plan)
- Formulary Change Notice (iCare Partnership)
- HCFA Claim Required Fields
- Limited English Proficiency Policy/Procedures
- LIS Premium Summary Sheet 2012
- Member Handbook/BadgerCare Plus Core Plan
- Member Handbook/iCare Medicaid SSI
- Member Recertification Reminder/BadgerCare Plus Core
- Notice of Privacy Practices
- Part D Coverage Determination Request Form
- Part D Prior Authorization Criteria/iCare Medicare Plan 2012
- Part D Prior Authorization Criteria/iCare Partnership 2012
- Part D Redetermination Request Form
- Pharmacy Listing/iCare Medicare Plan 2012
- Pharmacy Listing/iCare Partnership 2012
- Plan Comparisons/iCare Partnership 2012
- Power of Attorney brochure
- Primary & Acute Care Information Form
- Prior Authorization List 4/19/12
- Prior Authorization List 4/19/12 pdf
- Program Brochure/Hmong/iCare Medicaid SSI
- Program Brochure/iCare BadgerCare Plus
- Program Brochure/iCare Medicaid SSI
- Program Brochure/iCare Partnership
- Program Brochure/Spanish/iCare Medicaid SSI
- Program Overview (Spanish)/iCare Medicaid SSI
- Program Overview (Spanish)/iCare Partnership
- Provider Directory/iCare Medicaid SSI-BadgerCare Plus_Expansion Counties
- Provider Directory/iCare Medicaid SSI-BadgerCare Plus_Original Counties
- Provider Directory/Pharmacy Directory/iCare Medicare Plan Expansion Counties 2012
- Provider Directory/Pharmacy Directory/iCare Medicare Plan Original Counties 2012
- Provider Information Form (other than Partnership Program)
- Provider Reference Manual 2012
- Provider/Pharmacy Directory - iCare Partnership 2012
- Recertification Reminder (flyer)/BadgerCare Plus
- Self-Directed Supports Program Overview/iCare Partnership
- Step Therapy Prescription Drug Criteria/iCare Medicare Plan 2012
- Step Therapy Prescription Drug Criteria/iCare Partnership 2012
- Summary of Benefits/iCare Medicare Plan 2012
- Summary of Benefits/iCare Partnership 2012
- Transition Process
- UB Claim Required Fields
- Value to the Family
Call 1-800-777-4376 (TTY: 1-800-947-3529), from 8:00 a.m to 8:00 p.m.,
7 days-a-week, for further information about iCare.
