Texas Administrative Code
Title 25 - HEALTH SERVICES
Part 1 - DEPARTMENT OF STATE HEALTH SERVICES
Chapter 421 - HEALTH CARE INFORMATION
Subchapter B - COLLECTION AND REPORTING OF HEALTH PLAN EMPLOYER DATA AND INFORMATION SET (HEDIS) FROM HEALTH MAINTENANCE ORGANIZATIONS (HMOS)
Section 421.22 - Definitions

Universal Citation: 25 TX Admin Code § 421.22

Current through Reg. 49, No. 38; September 20, 2024

The following words and terms, when used in this chapter, shall have the following meanings, unless the context clearly indicates otherwise.

(1) Council--The Texas Health Care Information Council.

(2) Executive director--The chief administrative officer of the Council, or, in the event the Council is without an executive director, the person designated by the chairperson of the Council to perform the functions and exercise the authority of the executive director.

(3) HEDIS--An acronym for the Health Plan Employer Data and Information Set, published by the National Committee for Quality Assurance. HEDIS is a set of standardized performance measures, designed to allow for the reliable comparison of the performance of managed care health plans. HEDIS covers a broad range of areas: effectiveness of care, accessibility/availability of care, satisfaction with the experience of care, cost of care, stability of the health plan, informed health care choices, use of services, and plan descriptive information. HEDIS is a registered trademark of NCQA.

(4) HEDIS data--The information the health maintenance organization collects and reports to the Council in accordance with the provisions of this chapter. Data are collected from January 1st through December 31st annually.

(5) HEDIS Guidelines - The version of the HEDIS reporting guidelines as specified by the Council.

(6) HMO--A health maintenance organization as defined in Texas Health Maintenance Organization Act, Texas Insurance Code, Article 20A.02(j), Texas Civil Statutes.

(7) NCQA--The National Committee for Quality Assurance, 2000 L Street, N.W., Suite 500, Washington, D.C.20036.

(8) Reporting set measures--Those measures specified as "Reporting Set Measures" in the HEDIS Guidelines.

(9) Service area- as defined in 28 TAC, Part 1, Chapter 11 Subchapter A §11.2(b)

(10) Service area division - An operation of a HMO corporation that meets one of the following conditions:

(A) a distinct and separate operation of a HMO corporation as opposed to other operations of the corporation serving other distinct and separate geographical service areas;

(B) a separate geographical area whereby the geographical location of an enrollee or a group contract holder is used in determining charges or rates; or

(C) a service area that crosses state lines or international boundaries is considered to have a separate divisional operation in each state or country and requires separate cost centers and reports.

(11) Single Service HMO--An HMO offering a single health care service as defined in Texas Health Maintenance Organization Act, Texas Insurance Code, Article 20A.02(r), Texas Civil Statutes.

(12) Testing set measures--Those measures specified as "Testing Set Measures" in the HEDIS Guidelines.

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