To all that have contributed to the New Mexico Consumer Guide to Managed Care and to consumers who have relied on this guide for informed decision making on your care plans:

Historically, the New Mexico Health Policy Commission (HPC) has required that, by August 1st of each year, health plans submit HEDIS data pursuant to 7.1.21 NMAC and CAHPS survey results pursuant to 7.1.22.8 NMAC. From this data and information, the HPC has produced the New Mexico Consumer Guide to Managed Care. The data and information in this guide has been provided to assist consumers in evaluating health care services, health care providers, and making decisions regarding their health plan purchases.

Unfortunately, as a result of limited staff due to budget constraints, the HPC did not collect and report on HEDIS and CAHPS data in 2010. However, these data are still  available thanks to Blue Cross Blue Shield of NM-HMO, Lovelace Health Plan, Presbyterian Health Plan, and UnitedHealthcare who have provided their HEDIS and CAHPS data directly to the National Committee for Quality Assurance (NCQA) and the Agency for Healthcare Research and Quality (AHRQ).  

We are including links to the NCQA and the AHRQ here so that consumers may continue to access HEDIS and CAHPS data if they are interested. In the future the HPC may again publish our New Mexico Consumer Guide to Managed Care.

Consumers may also find helpful information at the HealthCare.Gov web site.

Thank you for your continued interest and support.

Appendix A

NOTICE TO ALL REPORTING FACILITIES

Wednesday, December 15, 2010

On behalf of the New Mexico Health Policy Commission (HPC), this letter is to inform you that the HPC has amended its rule entitled Data Reporting Requirements for Health Care Facilities, 7.1.4 NMAC and that the new rule became effective on December 1, 2010.  The amendment marks changes to the reporting of race and ethnicity, Point of Origin codes, Patient Discharge Status codes and the schedule for reporting.

The purpose of the rule change is to update our NM Hospital Inpatient Discharge Data (HIDD) reporting requirements to match other reporting formats that the hospitals are already using and to meet national standards of reporting.  The reporting requirements will take effect with the reporting of calendar year 2011 data.

The New Mexico Department of Health (DOH) and the HPC are working in coordination with the New Mexico Medical Review Association (NMMRA), the “Aligning Forces for Quality” (AF4Q) unit and the New Mexico Hospital Association (NMHA), through a U.S. Health and Human Services, Agency for Healthcare Research and Quality (AHRQ) grant, to support and assist the hospitals in moving towards this new collection.  You will be hearing from them regarding training that will be made available for your hospitals to standardize the collection of the race and ethnicity data for the purposes of the new reporting as described below. 

There are significant changes to the NM HIDD requirement for reporting and the standardized Electronic Record Layout, a brief explanation is provided here:

1. The patient ethnicity/race field is changed to reflect the national standards set forth by the Office of Management and Budget (OMB) in 1997.  There will no longer be just one combined field for race and ethnicity.  Race will be a separate field with a modified coding schema and allow for the reporting of multiple races.  Ethnicity will be a new field to indicate persons of either Hispanic/Latino origin or not of Hispanic/Latino origin.
2. An additional field was added to indicate up to five tribal affiliations from a list of 22 New Mexico tribes.
3. An additional code (21) for patient status at discharge was added to indicate that the patient was transferred to the courts, law enforcement or other detention facility.
4. The “Source of Admission” field has been replaced with “Point of Origin” field as recommended by the Uniform Billing Committee, effective July 1, 2010.
5. The total number of data fields has increased from 89 for 2009 and 2010 to 91 for 2011 data
6. The total record length has increased from 587 to 620 characters

Rule 7.1.4 NMAC also reflects the following changes:

1. Starting with 2011 data, the reporting schedule will revert back to quarterly reporting.
2. Language requiring the data to be reported as delimited by a vertical bar (pipe) was stricken.  The data file layout requires data fields to be placed in specific positions in the file (fixed-width file layout).
3. Language preferring the data be submitted in extensible markup language (XML) was stricken.  The data will only be accepted as an ASCII standard text file.

We appreciate your support in improving the quality of the New Mexico Hospital Inpatient Discharge Data. 

For additional information, you may contact me at (505) 476-3029, email: terry.reusser@state.nm.us.

Sincerely,

Terry Reusser
New Mexico Department of Health