Measuring Quality
CMS requires that Hometown Health meets certain standards to retain our contract for Senior Care Plus , a Medicare Advantage Prescription Drug Plan .
Our performance is monitored through healthcare quality measures known as the Healthcare Effectiveness Data and Information Set , or HEDIS . Hometown Health ’ s processes for reporting HEDIS quality indicators are audited by our external NCQA-certified vendor annually .
Hometown Health ’ s HEDIS data is reported to a number of regulatory and accreditation agencies , including : CMS ; NCQA ; and the State of Nevada Health Division .
To document our compliance with these standards , site reviews at our provider offices must be conducted .
During a site review , a number of criteria are evaluated , including the office ’ s compliance with Americans with Disabilities Act ( ADA ) accessibility requirements , a review medical records / chart inspection , and other relevant points .
The annual collection of HEDIS data in support of regulatory requirements will necessitate cooperation on the part of our providers , which may entail reviews by teams of our registered nurses , through onsite medical record review , or requests for records via fax .
Access to Records
Hometown Health may request copies of medical records or specific information as contained in any medical , financial or administrative records , to include , but not limited to : utilization / care management , quality improvement activities , HEDIS data collection , qualityof-care or complaint investigations , and other administrative obligations such as compliance with the terms provisions of the network participation agreement , contracts , appropriate billing practices , and other regulatory obligations . All requests for information will be made in accordance with applicable federal and state laws .
Additionally , our providers must provide access to any medical , financial , or administrative records related to the services you provide Hometown Health , Senior Care Plus , or third party administrated members , within fourteen ( 14 ) calendar days of our request , or sooner , as pertaining to fraud , waste , or abuse investigations ; member grievance or appeals ; or regulatory accreditation requirement . Note that the fourteen ( 14 ) day requirement may be superseded by any regulatory or accreditation requirements , or at the discretion of Hometown Health . Such records must be maintained in accordance with the more stringent federal or state guidelines as applicable , even after termination of any agreement with Hometown
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