HEDIS/CAHPS Measures Required for HP AccreditationCommercial *The weight column indicates the weight of the item (maximum value = 3) in the overall score calculation. g'jQL[@tsho-0;F3a!~;F^MHFG"Y#HX@=<71AcL\oxdkw2& +i hbbd```b``"gIw ""7|-``qT3l0; fH0DHI@H_mj> _ (HEDIS) measures that assess quality of health care provided to Blue Shield Promise Medi-Cal members. 0000032016 00000 n Save your favorite pages and receive notifications whenever theyre updated. <> NCQA also revisedthedenominatortoreflectthenumberofmembers,ratherthanmemberyears, andtoincludementalhealthdisordercodesinanypositionratherthanbyprincipaldiagnosis.Recognizingthatmentalhealthdisordersmaybetreatedbyprimarycareandotherpractitioners,NCQAremovedthementalhealthpractitionerrequirementfromthenumerator. Intent:Advancecareplanningisassociatedwithimprovedqualityoflife,increasedprovidertrustanddecreasedhospitalization. HEDIS Measures for Diabetes are assessed to evaluate the effectiveness of the program. hb```b``{ B@16=(?6vl& $. Antibiotics prescribed for acute respiratory conditions are a large driver of antibiotic overuse. Table 7a: CHIP-MCO Results for 2022 (MY 2021) HEDIS Measures CHIP-MCO ) Copyright 2023 National Committee for Quality Assurance. As low as $16,810.25. VA has utilized data from NCQA's Quality Compass to establish regional averages for hospitals that fall within geographic boundaries that match areas covered by Veterans Integrated Service Networks (VISN). from January to May for the prior year. Health Plan Descriptive Information. %PDF-1.6 % IdentificationofAlcoholandOtherDrugServices/DiagnosedSubstanceUseDisorders. QI 1 and QI 2 utilize the HEDIS methodology for this measure. andaddedtwocross-cuttingexclusions:palliativecareandadvancedillness/frailty. This manual describes in detail only the NYS-specific measures. o GRs_$ [EN=_sRs 1F/T ? Each managed care plan's calculated rates for the NCQA HEDIS Measurement Year 2021 measure set were validated as part of the NCQA HEDIS Compliance Audit and assigned one of NCQA's outcome designations. 74,457 : 61.4% : 61.1% : 61.7% : 55.9% + 60.5% + >= 90th percentile PA . endstream endobj 30 0 obj <>stream To learn more. 65 years of age and older who were dispensed benzodiazepines and achieved a 20% decrease or greater in benzodiazepine dose during the measurement year. Two rates are reported. HEDIS 2022 Percentile : HEDIS : Annual Dental Visit (Ages 2-20 years) 121,271 . <> ?^>&d;ijSl+EPe7"z_?0Kx)uQ Heres how you know. HEDIS survey measures and standardized surveys from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) program. 0000004794 00000 n NCQAisretiringthefollowingmeasures/indicators: Formoreinformation,refertothefullmeasurespecificationsinHEDISMY2022Volume 2:Technical Specifications for HealthPlans. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S>> The Data Display (D2) tool provides a way for patients to compare the quality of care hospitals give. hb```f``2g`a`ad@ Arl`h\=g}8,{GzGKEGCE\ p10:ki> la Measures Reported Using Electronic Clinical Data Systems HEDIS Medicare Health Outcomes Survey endobj For the numerator, NCQA allowed follow-up visits with SUD indicated in any diagnosis position; and added pharmacotherapy for alcohol or opioid use disorder; and incorporated outpatient or telehealth visits, for a diagnosis of drug use or overdose; services defined as addressing substance use (per CPT code description), without a diagnosis requirement; visits where a behavioral health assessment or screening is performed; outpatient or telehealth visits with a mental health provider; and substance use services provided by a peer recovery support specialis. Immunization Schedules. Thismeasurewillallowplanstounderstandifadvancecareplanningisprovidedtobeneficiarieswhoaremostlikelytobenefitfromit. Follow-UpAfterEDVisitforSubstanceUse. AntibioticUtilizationforRespiratoryConditions. We dont take HEDIS updates and changes lightly: Measure development and updates follow a rigorous process that includes a public comment period and input from advisory panels. 1067 0 obj <> endobj Share sensitive information only on official, secure websites. %PDF-1.7 % 0000009685 00000 n 0000012465 00000 n akJ9d&'(o,N|cV& }3~_UEiP 0 * Measures from HEDIS and CAHPS used data from the 2020 Star Ratings (collected in 2019 and unaffected by the COVID-19 PHE). This table contains the measures and brief descriptions that are included in HEDIS MY 2022. 9745 36 trailer 0000002321 00000 n SUMMARY TABLE OF MEASURES, PRODUCT LINES AND CHANGES . 0000008982 00000 n xKK@ { a;;:/DCXlcf_YB^Q(przeq0)# 0y,-h6-2Y=Vf]+[eq[&ge1heucd;)CzGE"z&D%z`SS?I1ZOFb ?=xb =WV!Nfvb)e:R '$t^OWoM9o{$)GlCeSkftDJbR2$n{Y4O}0m$&pmT|yQ;x/8Z$[G@MY?mcwo;oN:p2 9 0 obj 8 0 obj (Example: COL, BCS measures). X `q@ A`J~m ]l b| 0jHX=x3||DqGTt|\V~Fu3c,$;$c9 -Kd"bv.CXb%*qS-J`}V1h(l1y|8Tr46hOJ 0000017889 00000 n You will be prompted to log in to your NCQA account. hbbd``b`$ $$zAm b1["A)@"|)k$@@Bv5#JQ' [@ D('@E$xVK`"P6 ?L dvC) ? Utilization and Risk Adjusted Utilization. Overview of the HEDIS measurement set and how the data are used. In January to May of 2023, data for 2022 continues to be submitted along with Medical Record review for Hybrid measures and final HEDIS 2022 rates and results are reported. You will be prompted to log in to your NCQA account. endstream endobj 27 0 obj <> endobj 28 0 obj <> endobj 29 0 obj <>stream Initiation and Engagement of Substance Use Disorder Treatment; changed the measurefrommember-basedtoepisode-based; changed thedenominatortolengthenthenegativeSUDhistoryperiodfrom60daysto194daysandremoveEDvisitsandmedicallymanagedwithdrawalfromthenegativeSUDhistoryperiod;removed the numerator requirementthatpsychosocialtreatmentaccompanypharmacotherapy; and revisedtheagestratificationstoreflectages1864yearsand65+years. _hRos0Tx|1Ug% 4 0 obj CMS released the Plan Year 2023 Nationwide Quality Rating System Public Use File (PUF) (ZIP) to outline underlying measure data as well as star ratings for all eligible Qualified Health Plan (QHP) issuers, operating in all Exchange types, that received QRS star ratings for Plan Year 2023. The technical specifications for organizations providing Medicaid long-term services and supports (LTSS). 0000002169 00000 n ThiseffortbuildsonNCQAsexistingworkdedicatedtotheadvancinghealthequityindataandqualitymeasurement. 0000008708 00000 n Auditsprotect results validity and reliability. Share this page with a friend or colleague by Email. Social Determinants: Our Statement with TJC, NQF Was Just the Start. [ How are rates calculated? Quality Rating System Measure Technical Specifications are unique to the issuers offering plans on the Exchange and participating in the CMS Quality Rating System (QRS). <> endobj SNPs have reported the following measures since HEDIS Measurement Year (MY) 2016: Please see the link below for the most recent SNP HEDIS Performance Report. t,f`$yF;zXytHo. Measurement Year 2020 UHCCP-RI 2022 CAHPS Measurement Year 2021 Quality Compass Measurement Year 2021 National Medicaid Benchmark (Met/Exceeded) Quality Compass Measurement Year 2021 National Medicaid Mean Rating of Health Plan1 86.6% 92.4% 86.8% 50th 86.48% Rating of All Health Care 95.0% 88.4% Small Sample Not Applicable 87.34% REQUIRED HEDIS1 AND CAHPS2 MEASURES FOR HEDIS REPORTING YEAR 2022 Summary of Changes to Measure List: Added the following measures. HEDIS is a source for data contained in the California Health Care Quality Report Cards obtained from Quality Compass2022 and is used with the permission of the National Committee for Quality Assurance (NCQA). HEDIS includes more than 90 measures across 6 domains of care: Under contract to CMS, NCQA supports the implementation of the HEDIS Medicare Health Outcomes Survey and the Medicare Health Outcomes Survey Modified. stream Visitors to this page often check HEDIS FAQs, QRS FAQs, or ask a question through MyNCQA. Other changes assure that HEDIS will be useful, valid and reliable for a new era of medicine. For HEDIS measures that report age cohorts beyond 19 years old, rates reported below only extend to 19 years old to align with CHIP enrollment and are noted as such. lock NCQAplanstoexpandtheraceandethnicitystratificationstoadditionalHEDISmeasuresoverseveralyearstohelpreducedisparitiesincareamongpatientpopulations. 2022 HEDIS AND FIVE-STAR QUALITY MEASURES REFERENCE GUIDE HEDIS STAR MEASURE AND REQUIREMENTS DOCUMENTATION NEEDED CPT/CPTII CODES Annual Wellness Exam Measure ID: AHA, PPE, COA Description: Measurement Year Lines: Age: Medicare 18yrs & Older Blood Pressure Control Measure ID: CBP or CDC9 Description: EVERY VISIT Lines: Age: Medicare 18yrs - 75yrs endstream endobj startxref 0000010811 00000 n NCQAintroducedraceandethnicitystratificationstofiveHEDISmeasures: Colorectal Cancer Screening, Controlling High Blood Pressure, Hemoglobin A1c Control for Patients with Diabetes, Prenatal and Postpartum Care, and Child and Adolescent Well Care Visits, NCQAplanstoexpandtheraceandethnicitystratificationstoadditionalHEDISmeasuresoverseveralyearstohelp, disparitiesincareamongpatientpopulations. . 0000107074 00000 n 0000047520 00000 n x Updated Guideline 7: Measurement Period Adjustments. ]c\RbKSTQ C''Q6.6QQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQ T " ND-)8^r|\q=.Kx.!J"G8IE As low as $6,835.25. Automatic . hb``` rB cc`ahpb`QN`|A(WY2c0Oeox%{$M94 NSqo C*@ep!%E#-nb4LM CMS contracts with NCQA to collect Healthcare Effectiveness Data and Information Set (HEDIS) measures from Medicare Special Need Plans (SNPs). Advanced Care Planning. P}^bGx{Q1F b~/>@ e# HEDIS measures performance in health care where improvements can make a meaningful difference in peoples lives. 0000011142 00000 n 0000006694 00000 n xPX]NG&)R.ng} (1$JMYpwV:] NCQAnowcollectsthenewAntibioticsforRespiratoryConditionsmeasure. 0000005411 00000 n HUG members are health care professionals who produce, report and interpret HEDIS data. Utilization and Risk Adjusted Utilization. Tables 1-3 below include . NCQA's Risk Adjustment Tables (the "Tables") and any related documentation (collectively, the "Product"). Plans must purchase the HEDIS 2022 Technical Specifications for Health Plans for specifications of the required HEDIS measures. !A 2527 0 obj <> endobj 0000004692 00000 n Measures relate to many significant public health issues such as cancer, heart disease, behavioral health and diabetes. 0000011150 00000 n ;(Y}e"XmT8,/l EP5ePVm8,&T2X, +|oM}> O~rEUnM~#jOicJ@2Yus 0000001035 00000 n For example, 2022 claims, encounters, and other HEDIS data are submitted throughout 2022. 2023 HEDIS Measures HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). 0000013541 00000 n endobj We do not share your information with third parties. } !1AQa"q2#BR$3br HEDIS data help identify performance gaps and establish realistic targets for improvement. Intent:The 2019 American Geriatrics Society Beers Criteria recommendthat benzodiazepinesbeavoidedinolderadults. Individual HEDIS Measures Sheets. .gov %PDF-1.6 % 0000010486 00000 n JFIF ` ` C Terms of Use, Patient-Centered Specialty Practice (PCSP), Credentials Verification Organization (CVO), Managed Behavioral Healthcare Organization (MBHO), Health Information Technology Prevalidation Programs, Virtual Seminars, Webinars and On-demand Training, Advertising and Marketing Your NCQA Status, HEDIS Electronic Clinical Data Systems (ECDS) Reporting, HEDIS Medicare Health Outcomes Survey and the Medicare Health Outcomes Survey Modified, NCQA collects HEDIS data from health plans. Bng vic tip tc s dng trang web ca chng ti, qu v ng vi Chnh Sch V Quyn Ring T v iu Khon S Dng ca chng ti.. OK Save your favorite pages and receive notifications whenever theyre updated. Recognizing that HEDIS measures have traditionally been specified for health plan reporting, NCQA developed the Rules for Allowable Adjustment of HEDIS to accommodate the application of HEDIS measures to various levels of the health care system for quality improvement initiatives. % Anticipated Release Date: September 2023. 0000044978 00000 n or 7 0 obj NCQAwillconcentrateeffortsontheoutcome-basedHbA1cControlforPatientsWithDiabetesmeasure. 3 0 obj Measure Changes Care for Older Adults (COA) - -Removed Advanced Care Planning indicator from COA . reportingforthreeHEDISmeasures:Childhood Immunization Status, Immunizations for AdolescentsandMetabolic Monitoring for ChildrenandAdolescents on Antipsychotics. 26 0 obj <> endobj Women 30-64 years of age who had cervical high-risk human papillomavirus (hrHPV) <> The approved method for auditing the HEDIS production process, including an information systems capabilities assessment, an evaluation of compliance with HEDIS specifications and standards that Certified HEDIS Compliance Auditors must use when conducting a HEDIS audit. Rate 1: Six or more well-child visits* 0 to 15 months. endstream endobj 31 0 obj <>stream 0000007450 00000 n HTn0*hk!4J[&5i7Y%I yf HEDIS Measures. HEDIS Measurement Year 2022 Measures Measure Description: The percentage of children newly prescribed attention-deficit/ hyperactivity disorder ADHD medication who had at least three follow-up care visits within a 10-month period, one of which was within 30 days of when the first ADHD medication was dispensed. means youve safely connected to the .gov website. 0000019234 00000 n cytology performed between 2020-2022. 0000008747 00000 n Height, weight, BMI percentile (use Z68.51-Z68.54) and nutrition (97802, 97803, 97804) and physical activity counseling (Z02.5, Z71.82) Lead Screening in Children: 1CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). Optum Managed Transplant Program. %%EOF 4950 0 obj <>stream 0000068208 00000 n Currently, HEDIS consists of 90 different measures across six domains of care: Effectiveness of Care Access/Availability of Care Experience of Care Utilization and Risk Adjusted Utilization Health Plan Descriptive Information Measures Reported Using Electronic Clinical Data Systems endobj SNPs reported the following measures in HEDIS 2016: Colorectal Cancer Screening Care for Older Adults Use of Spirometry Testing in the Assessment and Diagnosis of COPD Pharmacotherapy Management of COPD Exacerbation Controlling High Blood Pressure Persistence of Beta-Blocker Treatment After a Heart Attack Table 4 displays the HEDIS performance measures for MY 2021 for PCCP. 0000045019 00000 n To be able to identify andreduce disparitiesin care, the first step must be measuring and reportingon. Additionally,NCQA invites you to join HEDIS Users Group forinside information on HEDIS development and future directions. II . For the denominator, NCQA added ED visits for unintentional or undetermined overdose for commonly used drugs with addiction potential in any diagnosis position. Thismeasurewillallowplanstounderstandifadvancecareplanningisprovidedtobeneficiarieswhoaremostlikelytobenefitfromit. Care for Children Prescribed ADHD Medication Initiation and Continuation measures. endstream endobj 32 0 obj <>stream Encounter data is crucial for demonstrating accurate quality performance to the Department of Health Care Services (DHCS). 0000015971 00000 n Patient-Centered Specialty Practice (PCSP), Credentials Verification Organization (CVO), Managed Behavioral Healthcare Organization (MBHO), Health Information Technology Prevalidation Programs, Virtual Seminars, Webinars and On-demand Training, Advertising and Marketing Your NCQA Status. 0000016920 00000 n QLeRQ~{?$u>%)G7,]m?oaS`AD>O)>fC*b9Zj #b&=c;m4lYVy7&>c)|5+Z7Sw 3tUfQ|x]zZ>!B2P10d@9>UE*EE$6PZtegv:(J5#,ojt1mGL+9AYdeQ4ec`"omT2%^(_&/>~8_+7F]e*}1b>(Q}\4t0 0000001946 00000 n NCQA Communications Every year, NCQA updates and releases the Healthcare Effectiveness Data and Information Set (HEDIS). R'A@>r 5^[qLp.p*DB24V,mb66vA8kwFvM@gf` r 9745 0 obj <> endobj xref This process ensures that HEDIS measures remain relevant and feasible for implementation. 0000003369 00000 n ThenewestadditionstoHEDISaddresspatient-centered care, as well assafetyand appropriateness. 0000036100 00000 n 1311 0 obj <>stream the HEDIS Measurement Year (MY) 2020 & 2021 Volume 2 Technical Speciications. 2 Summary Table of Measures, Product Lines and Changes HEDIS MY 2023, Volume 2 HEDIS MY 2023 Measures Applicable to: Commercial Medicaid Medicare Changes for HEDIS MY 2023 Guidelines for Allowable Adjustments of HEDIS 9 9 9 x Updated Guideline 4: Exclusions to remove optional exclusions. hWO`06~@)N@&d.6l5@[)"$$dm29R1$2.K3LH(y ]3SISTM}~/'Ys9Z @ R M+[|Qs0@!| T8E#F>x=-g? CPT: 87070, 87071, 87081, 87430, 87650-87652, 87880 HEDIS Tip Sheet - Pediatric Measures Key HEDIS Factors to Consider Experience of Care. HSMk@WHM[Zl8 p ccwVrLCV{6GfP!Kh~&)/uY>ak9 The Centers for Medicare & Medicaid Services (CMS) uses a five- Diabetes blood sugar control Diabetes kidney function Discharge medication reconciliation Osteoporosis management Cardiovascular disease statin management Breast cancer screening Medication review Pain screening Colorectal cancer screening Controlling high blood pressure 0000050943 00000 n @_B^GR 0000008644 00000 n 0000035753 00000 n Trackingantibioticprescribingforallacute respiratory conditionswillprovide context about a healthplansoverall antibiotic use when viewedwiththree HEDIS measures ofappropriate. 0000022148 00000 n 0000004219 00000 n HEDIS digital future has begun. DeprescribingofBenzodiazepinesinOlderAdults. HEDIS includes measures for physicians, PPOs and other organizations. We do not share your information with third parties. Technical specifications for the Health Outcomes Survey (HOS). 2527 53 Copyright 2023 National Committee for Quality Assurance. 2579 0 obj <>stream NCQA screens, trains and certifies organizations that collect or audit data for health plans and providers. 0000015158 00000 n ElectronicClinicalDataSystem(ECDS)Reporting. The percentage of episodes for members 3 months of age and older with a diagnosis of a respiratory condition that resulted in an antibiotic dispensing event. 0000000016 00000 n 0 The information provided in this HEDIS QRG is to help you improve your practice's HEDIS rates. Laboratory Benefit Management. Table 1: Changes in Part C Measure Scores from 2021 to 2023 Star Ratings for MA Contracts 2 0 obj Thismeasurehas beenretired. 0000011691 00000 n 1343 0 obj <>/Filter/FlateDecode/ID[<2D87A2A235A2694FB1EEAE97FC4AEC75>]/Index[1320 39]/Info 1319 0 R/Length 109/Prev 246119/Root 1321 0 R/Size 1359/Type/XRef/W[1 3 1]>>stream We do not share your information with third parties. 0000006215 00000 n HSn0+THK[iF(P=2@oA.kY"cL@YG6u}(K]*-50 j"1J0B(E$akG) NCQArevisedthemeasurestructurefromutilizationtodiagnosed-prevalencementalhealthdisordersandupdatedthenameto. 0000011393 00000 n 0 NCQArevisedthemeasurestructurefromutilizationtodiagnosed-prevalenceofsubstanceuseandupdatedthenameto. Access/Availability of Care. That is why we publish what we learn from HEDIS in many forums and formats. Effective 2022, the Promise VIP Program is now called Promise Quality Performance Incentive (PQPI). 0000017732 00000 n DL U `j@ +Y&F] S-ppo>8w4Dg`` C 1105 0 obj <>/Filter/FlateDecode/ID[]/Index[1067 245]/Info 1066 0 R/Length 162/Prev 876729/Root 1068 0 R/Size 1312/Type/XRef/W[1 2 1]>>stream HEDIS SPECIFICATION OVERVIEW 2021 KEY: Indicates triple weight measure Revised January 2021 All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation. Visitors to this page often check HEDIS FAQs, QRS FAQs, or ask a question through My NCQA. 4940 0 obj <>/Filter/FlateDecode/ID[]/Index[4920 31]/Info 4919 0 R/Length 102/Prev 502761/Root 4921 0 R/Size 4951/Type/XRef/W[1 3 1]>>stream endstream endobj startxref NCQA revised this risk-adjusted outcome measure to exclude planned hospitalizations and updated it to remove separate Medical and Surgical reporting categories, retaining the Total rate (which includes medical and surgical admissions). Data from the 2020 measurement period (2022 Star Ratings) help us understand how the PHE impacted the care delivery system. ThisclinicaltopicisnowaddressedinthenewAdvanceCarePlanningmeasure. Every year,NCQA updates and releases the Healthcare Effectiveness Data and Information Set (HEDIS). b~GiQ">sTMj 2p1IcvIwsudr https:// . 0000018052 00000 n Rate 2: Two additional well-child visits 15 to 30 months. endstream NCQA collects HEDIS data from health plans and other health care organizations. 2022 MEDICAID HEDIS REFERENCE SHEET FOR PROVIDERS 3 PEDIATRIC HEDIS MEASURES HEDIS MEASURE AGE MEASURE DESCRIPTION BILLING CODES WELL-VISIT Well Child Visits 0-30 Months of Life (W30) 0-30 months Telehealth exclusion removed. HbA1c Testingindicator. endobj 7500 Security Boulevard, Baltimore, MD 21244, An official website of the United States government, Healthcare Effectiveness Data and Information Set (HEDIS), CMS contracts with NCQA to collect Healthcare Effectiveness Data and Information Set (HEDIS, Use of Spirometry Testing in the Assessment and Diagnosis of COPD, Pharmacotherapy Management of COPD Exacerbation, Persistence of Beta-Blocker Treatment After a Heart Attack, Osteoporosis Management in Women Who Had a Fracture, Follow-Up After Hospitalization for Mental Illness, Potentially Harmful Drug-Disease Interactions in Older Adults, Use of High-Risk Medications in Older Adults, Transitions of Care (Reporting began in HEDIS MY 2020), Chronic Condition Special Needs Plans (C-SNPs), Dual Eligible Special Needs Plans (D-SNPs), Institutional Special Needs Plans (I-SNPs).