Join us for a webinar on March 18 at 2:00 p.m. (ET) to learn more about the proposed changes.

About NCQA’s Public Comment

NCQA releases program updates for public comment to generate thoughtful feedback and suggestions from interested parties. Many comments result in updates to our standards and policies, helping to strengthen them for all stakeholders. NCQA asks respondents to evaluate whether the proposed requirements are feasible as written and clearly articulated, and to identify areas that may need clarification.

Summary of Proposed Changes

Below is a summary of the proposed changes to NCQA’s programs and standards. You can review the full details on NCQA’s website.

New Accreditation Program for Wellness and Condition Management

NCQA is launching a new Accreditation program— Wellness and Condition Management— using our Wellness and Health Promotion Accreditation program as the foundation. The new program will assess vendors’ ability to empower members to manage their own health across the risk continuum, accounting for risk factors and condition-specific needs. It will create a common quality framework for purchasers and vendors.

The program’s content was informed by robust customer and market engagement—which continues through our new learning collaborative—and reflects the increasing use of digital vendors by health plans, health systems and employers. It shifts from prescriptive requirements toward more flexible and transparent expectations, while still holding organizations accountable for quality, equity and measurable impact.

The new program will include core standards and two modules: Health Assessment and Digitally Enabled Engagement. Organizations may participate in one or both modules. The updated standards will be released in July 2026, with an effective survey date on or after January 2027.

Patient-Centered Medical Home (PCMH) Recognition Updates

Proposed updates to the PCMH Recognition program aim to align standards with the changing market landscape, stakeholder needs and regulatory requirements, and to assist organizations in their pursuit of high-quality care.

For surveys beginning January 1, 2027, NCQA proposes updates to three core criteria within the Care Management concept:

• CM 01: Identifying Patients for Care Management
• CM 02: Monitoring Patients for Care Management
• CM 04: Person-Centered Care Plans

We also propose the retirement of one elective criterion, which will be incorporated into CM 04:

• CM 07: Patient Barriers to Goals

Proposed updates address challenges some practices experience when applying current criteria across diverse clinical contexts (e.g., health conditions, populations, case mix). They are designed to better clarify the purpose and expected outcomes of the Care Management concept’s activities and to support individualized, meaningful care plans that reflect the varied needs of patient populations.

How to Participate in Public Comment

Visit My NCQA to submit comments through our new and improved public comment process. We’ve completely redesigned the experience by reducing clicks and organizing topics more logically. These updates enable NCQA to ask more meaningful questions and make it simpler for you to share feedback.

The public comment period ends at 11:59 p.m. (ET) on Friday, April 17. For details on proposed changes, visit the NCQA website.

Join our webinar, Updates to PCMH Recognition and the New Wellness and Condition Management Program, on March 18 at 2:00 p.m. (ET) to learn more.

The post NCQA Seeks Public Comment on a New Accreditation for Wellness and Condition Management and Updates to PCMH Recognition appeared first on NCQA.

NCQA seeks public feedback on proposed new HEDIS^® measures and changes to existing ones. Reviewers are asked to submit comments to NCQA in writing via the Public Comment website by 5:00 p.m. (ET), Friday, March 13. NCQA acknowledges that the healthcare policy environment is rapidly evolving, and we will consider all comments received, as well as any policy changes, as we prepare the final versions of these measures.

NCQA seeks comments on the following:

• Seven new HEDIS measures.
• Revisions to three existing HEDIS measures.

About HEDIS and Public Comment

HEDIS measures are based on scientific evidence. When new evidence emerges, NCQA reviews the measures to determine if changes may be needed. NCQA convenes multi-stakeholder advisory panels—including independent scientists, clinicians, health plans, purchasers, government and consumer groups—to ensure that measures meet and balance the high standards of relevance, scientific soundness and feasibility.

An important part of developing and updating HEDIS is gathering input from the public. NCQA reviews all comments received during the public comment period, and discusses results with stakeholder advisors.

HEDIS measures do not constitute clinical practice guidelines and should not be used to determine insurance or coverage.

Proposed New HEDIS Measures

Follow-Up After Positive Colorectal Cancer Non-Invasive Screening Test: Assesses the percentage of persons 45-85 years of age who received a colonoscopy for a positive colorectal cancer non-invasive screening test.

Importance: Colorectal cancer represents approximately 8% of all new cancer cases and is the third most commonly diagnosed cancer in the United States.¹ Screening and early detection have a significant role in reducing the impact of this preventable and treatable disease.

Continuous Glucose Monitoring (CGM) Utilization for Patients With Diabetes: Assesses the percentage of persons 18-75 years of age with diabetes who had evidence of CGM utilization during the measurement period.

Importance: Continuous glucose monitoring supports diabetes management and helps prevent hypoglycemic and hyperglycemic events and other life-threatening complications.² Continuous Glucose Monitoring Utilization for Patients With Diabetes is a utilization measure that provides visibility into CGM use patterns.

Intimate Partner Violence (IPV) Screening and Follow-Up: Assesses the percentage of persons 12-64 years of age who were screened for intimate partner violence using a standardized instrument, and who received follow-up care within 7 days of a positive intimate partner violence screening.

Importance: Intimate partner violence is a prevalent public health issue that harms individuals across every demographic group, with approximately 1 in 4 women and 1 in 7 men experiencing IPV in their lifetime in the U.S.³ Screening and follow-up for IPV provide a standardized manner for healthcare teams to collect information about potential safety concerns and identify when additional assessment, support or referrals may be needed.

Person-Centered Outcome Measures (3 Measures):

• Person-Centered Outcome–Goal Identification: Assesses the percentage of persons 18 years of age and older with a complex care need who set a person-centered outcome goal.
• Person-Centered Outcome–Goal Follow-Up: Assesses the percentage of persons 18 years of age and older with a complex care need who set a person-centered outcome goal and followed up on the goal.
• Person-Centered Outcome–Goal Achievement: The percentage of persons 18 years of age and older with a complex care need who set a person-centered outcome goal and achieved the goal.

Importance: There is broad agreement that an individual’s goals and priorities should guide care and the quality measures used to evaluate care.^4-6 For older adults with multiple chronic conditions and functional limitations, clinical guidelines have indicated the importance of providing goal-based care.^7,8 For this complex population, goal setting has been shown to reduce patient-reported treatment burden and unwanted care, and it correlates with greater physical and social well-being and higher care satisfaction.^9,10

Prenatal Syphilis Screening and Follow-Up: Assesses the percentage of deliveries that had a syphilis screening with a documented result during the first trimester, within 14 days of the first pregnancy diagnosis or prenatal visit, or within 30 days of enrollment in the organization, and the percentage of deliveries with a positive syphilis screen that received appropriate follow-up care.

Importance: The prevalence of congenital syphilis is increasing exponentially in the U.S., with a maternal-infant transmission rate of almost 90%. In 2024, 3,941 infants were born with congenital syphilis–a nearly 700% increase from 2015, when only 495 cases were reported.¹¹ Syphilis screening and timely follow-up during pregnancy have a significant role in reducing the impact of transmission and adverse health outcomes for both the pregnant person and baby.

Proposed Changes to Existing HEDIS Measures

Adult Immunization Status: Assesses the percentage of adults 19 and older who are up-to-date on recommended routine vaccines. The measure includes separate rates for influenza; tetanus and diphtheria (Td) or tetanus, diphtheria, and acellular pertussis (Tdap); zoster; pneumococcal; hepatitis B; and coronavirus disease (COVID-19).

NCQA proposes two updates to the pneumococcal indicator:

• Expanding the denominator age range from 65 and older to 50 and older.
• Adding an age stratification for 50-64 in addition to the existing 65 and older stratification.

Emergency Department Utilization: Assesses the risk-adjusted ratio of observed to expected emergency department visits during the measurement period. NCQA proposes to expand this measure into the Medicaid product line for persons 18-64 years of age.

Pharmacotherapy Management of COPD Exacerbation: Assesses whether appropriate medications were dispensed following a chronic obstructive pulmonary disease (COPD) exacerbation for people 40 years of age and older within Medicare, Medicaid and Commercial product lines. The measure includes two separate rates: one that assesses whether a systemic corticosteroid is dispensed within 14 days of a COPD exacerbation event, and one that assesses whether a bronchodilator is dispensed within 30 days of a COPD exacerbation event.

NCQA proposes the following modifications to the measure:

• Adding an exclusion for individuals with asthma.
• Updating the denominator to count people instead of events and including additional qualifying COPD exacerbation events.
• Updating the numerator to include only one rate and revising medication lists.

How to Participate in Public Comment

The public comment period ends at 5:00 p.m. (ET) on Friday, March 13. Visit My NCQA to submit comments. We’ve made some improvements to our site to make it easier for you to submit your comments.

For details on proposed changes, visit the NCQA website.

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA).

References

­¹American Cancer Society. (2023). Colorectal Cancer Facts & Figures 2023-2025. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/colorectal-cancer-facts-and-figures/colorectal-cancer-facts-and-figures-2023.pdf.

²American Diabetes Association. (2026). Continuous Glucose Monitors. https://diabetes.org/advocacy/cgm-continuous-glucose-monitors.

³Stylianou, M.A. (2018). Economic Abuse Within Intimate Partner Violence: A Review of the Literature. Violence and Victims, 33(1), 3. https://connect.springerpub.com/content/sgrvv/33/1/3.full.pdf.

⁴McGlynn, E. A., Schneider, E. C., & Kerr, E. A. (2014). Reimagining Quality Measurement. New England Journal of Medicine, 371(23), 2150–2153. https://doi.org/10.1056/NEJMp1407883.

⁵Reuben, D. B., & Tinetti, M. E. (2012). Goal-oriented patient care—An alternative health outcomes paradigm. The New England Journal of Medicine, 366(9), 777–779. https://doi.org/10.1056/NEJMp1113631.

⁶Tinetti, M. E., Naik, A. D., & Dodson, J. A. (2016). Moving From Disease-Centered to Patient Goals–Directed Care for Patients With Multiple Chronic Conditions: Patient Value-Based Care. JAMA Cardiology, 1(1), 9. https://doi.org/10.1001/jamacardio.2015.0248.

⁷American Geriatrics Society Expert Panel on the Care of Older Adults With Multimorbidity. (2012). Patient-centered care for older adults with multiple chronic conditions: A stepwise approach from the American Geriatrics Society: American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity. Journal of the American Geriatrics Society, 60(10), 1957–1968. https://doi.org/10.1111/j.1532-5415.2012.04187.x.

⁸The American Geriatrics Society Expert Panel on Person-Centered Care. (2016). Person-centered care: A definition and essential elements. Journal of the American Geriatrics Society, 64(1), 15–18. https://doi.org/10.1111/jgs.13866.

⁹Tinetti, M. E., Naik, A. D., Dindo, L., Costello, D. M., Esterson, J., Geda, M., Rosen, J., Hernandez-Bigos, K., Smith, C. D., Ouellet, G. M., Kang, G., Lee, Y., & Blaum, C. (2019). Association of Patient Priorities–Aligned Decision-Making With Patient Outcomes and Ambulatory Health Care Burden Among Older Adults With Multiple Chronic Conditions: A Nonrandomized Clinical Trial. JAMA Internal Medicine, 179(12), 1688–1697. https://doi.org/10.1001/jamainternmed.2019.4235.

¹⁰Kuipers, S. J., Cramm, J. M., & Nieboer, A. P. (2019). The importance of patient-centered care and co-creation of care for satisfaction with care and physical and social well-being of patients with multi-morbidity in the primary care setting. BMC Health Services Research, 19(1), 13. https://doi.org/10.1186/s12913-018-3818-y.

¹¹Centers for Disease Control and Prevention. (2025). Sexually transmitted infections surveillance, 2024 (provisional).

The post HEDIS® Public Comment Period Is Now Open appeared first on NCQA.

Public comment is your opportunity to weigh in on the relevance, scientific soundness and feasibility of new and revised measures for HEDIS. Your feedback helps us determine changes to our programs, procedures and processes.

This year’s public comment is open February 13–March 13.

What Are We Seeking Feedback On?

We’d like input on:

• Seven new HEDIS measures.
• Revising three HEDIS measures.

Why Should You Comment?

NCQA measures are based on published clinical guidelines and scientific evidence. When guidelines change or new evidence becomes available in scientific literature, NCQA reviews measures to determine if measure changes may be needed.

NCQA convenes multi-stakeholder advisory panels—including independent scientists, clinicians, health plans, purchasers, government and consumer groups—to ensure that measures meet and balance the high standards of relevance, scientific soundness and feasibility.

Public review and comment is an important part of developing and updating HEDIS measures. NCQA reviews all comments received during public comment and presents results to advisory panels and to the NCQA Committee on Performance Measurement for deliberation.

How Can You Comment?

This year’s public comment will go live Friday, February 13, at 9:00a.m. ET.

We’ll post the link and more details here, so check back on February 13.

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA).

The post Heads Up: HEDIS® Public Comment Opens Next Week appeared first on NCQA.

Physician and Hospital Quality Certification

This program evaluates how well health plans measure and report the quality and cost of physicians and hospitals. NCQA seeks feedback on updates that align standards with the changing market landscape and stakeholder needs.

• Update Scoring. NCQA proposes to convert element scoring to “Met,” “Partially Met” and “Not Met” to align with the scoring in Health Plan Accreditation and other recently updated products.
• Retire Program Change Reviews. This will alleviate the burden of submitting documentation between survey cycles for minor program changes.
• Modify Standards. For PQ 1, Element A, expand the list of acceptable standardized measures, revise outdated references and sources and update the list of performance-based designation programs. Retire PQ 3, Element D, because organizations do not often receive consumer complaints about quality reporting programs, and do not have files available for review.

Health Equity Accreditation/Plus

NCQA seeks feedback on changes to these programs for surveys beginning July 1, 2026. Proposed changes reflect potential new content, as well as updates to existing content.

Recommendations: New Content

NCQA proposes new content to reflect industry priorities, challenges and needs to identify health disparities and best practices, extend activities to additional populations and help Renewal customers demonstrate the value of sustaining program activities after Initial Survey.

• Disability. In Health Equity Accreditation, add 5 new elements and 17 new factors focused on data collection, measure stratification, training or education and population-level interventions. Some requirements apply across all program segments (e.g., plans, hospitals); others are intended for use by care delivery organizations at the point of care.
• Geographic Classification. In Health Equity Accreditation, include 1 new element and 1 new factor focused on standardized collection, classification and measure stratification for geographic data for use in identifying disparities.
• Community Health Workers. In Health Equity Accreditation Plus, include 4 new elements under a new standard category, Integration of Community Health Workers, to incentivize health care organizations to either implement rigorous, evidence-based and community-involved community health worker programs or to partner with community-led programs.
• Demonstrating Mature Analytics and Measurement. In Health Equity Accreditation/Plus, replace 1 existing element and add 4 new elements to show how organizations analyze data—including social needs screening—to identify, prioritize and act on opportunities to reduce health disparities.

Recommendations: Updates to Existing Content

NCQA is updating existing standards to align with emerging best practices, adapt to the evolving policy environment, provide flexibility for states and organizations seeking accreditation and improve clarity and effectiveness of the survey process.

• Updates to Align With Emerging Best Practices. These include revisions to standards for collecting data on race and ethnicity to reflect OMB 2024 response options.
• Updates to Provide Flexibility. These seek to provide flexibility for organizations to select data types and measures that are feasible and meaningful to their population and regulatory context without lowering current performance expectations.
• Updates to Adapt to the Evolving Policy Environment. These seek to mitigate challenges that Health Equity Accreditation/Plus customers may experience due to federal or state limitations on permissible terminology or activities.
• Updates to Improve Surveyability and Clarity. These streamline requirements and revise language to resonate with care delivery organizations.

Updates to Other Programs to Align With 2026 Health Equity Accreditation

NCQA proposes updates to the following programs for 2026 surveys to reframe activities that require diversity or demographic representation, in alignment with HE 1: Organizational Readiness in Health Equity Accreditation.

• Health Plan Accreditation
• Behavioral Health Accreditation (formerly MBHO Accreditation)
• Distinction in Long-Term Services and Supports (LTSS)
• Accreditation of Case Management for LTSS
• Wellness and Health Promotion Accreditation/Certification

About NCQA’s Public Comment

Many comments lead to changes in our standards and policies, and the review process makes our standards stronger for all stakeholders. NCQA asks reviewers to consider whether the proposed requirements are feasible as written and are clearly articulated, and to highlight areas that might need clarification.

How to Participate in Public Comment

The public comment period ends at 11:59 p.m. (ET), September 5. Visit My NCQA to submit comments. For details on proposed changes, visit the NCQA website.

NCQA welcomes comments and input from individuals and community-based organizations that might not frequently interact with our products and programs. If you have questions, or need help navigating the public comment process, please contact us by email at 2025PublicComment@ncqa.org.

The post NCQA Seeks Public Comment on Health Equity Accreditation, Physician and Hospital Quality Certification appeared first on NCQA.

The public comment period includes the following programs and topics:

• Health Plan Accreditation.
• Long-Term Services and Supports (LTSS) Distinction for Health Plans.
• Utilization Management (UM) Accreditation.
• Managed Behavioral Healthcare Organization (MBHO) Accreditation.
• Patient-Centered Medical Home (PCMH) Recognition.
• Use of AI in Health Care.

About NCQA’s Public Comment

NCQA shares updates for public comment to generate thoughtful commentary and suggestions from interested parties. Many comments lead to changes in our standards and policies, and the review process makes our standards stronger for all stakeholders. NCQA asks respondents to consider whether the proposed requirements are feasible as written and are clearly articulated, and to highlight areas that might need clarification.

Summary of Proposed Changes

Below is a summary of the proposed changes to NCQA’s programs and standards. You can review the full details on NCQA’s website.

Health Plan Accreditation

Proposed updates to Health Plan Accreditation aim to align standards with the changing market landscape, stakeholder (states, employers, CMS, consumers) needs and regulatory requirements, and to assist organizations in their pursuit of quality care.

NCQA proposes updates to Health Plan Accreditation for 2026 in following areas:

• Data exchange and usability (QI).
• Payer-practitioner collaboration (PHM).
• Alternative payment model adoption (PHM).
• Utilization management and prior authorization (UM).
• Behavioral health network adequacy (NET).

Long Term Services and Supports Distinction for Health Plans

NCQA proposes to require organizations with LTSS Distinction in Health Plan Accreditation to annually submit data for four HEDIS LTSS measures, beginning June 2028, for surveys on or after July 1, 2027:

• LTSS Comprehensive Assessment and Update (LTSS-CAU).
• LTSS Comprehensive Care Plan and Update (LTSS-CPU).
• LTSS Shared Care Plan with Primary Care Practitioner (LTSS-SCP).
• LTSS Reassessment/Care Plan Update After Inpatient Discharge (LTSS-RAC).

NCQA does not propose to rate or compare organizations based on their performance on the measures at this time.

Utilization Management Accreditation

NCQA’s UM standards align across three programs—UM Accreditation, Health Plan Accreditation and MBHO Accreditation—especially related to delegation of UM functions.

NCQA will organize UM Accreditation standards into two categories: core requirements that apply to any entity pursuing UM Accreditation, and distinct evaluation options that allow organizations to select the types of UM services they offer.

MBHO Accreditation

Rising demand for—and lack of access to—effective behavioral health services is a significant challenge for patients and clinicians. In response to this crisis, NCQA proposes updates to MBHO Accreditation to better define how organizations create accessible and available networks that meet the needs of organization members and to measure the quality of care and services provided.

NCQA proposes to update the program name from “Managed Behavioral Healthcare Organization Accreditation” to “Behavioral Health Accreditation,” and update the standard categories to more closely align with Health Plan Accreditation, as follows:

• Create a separate category for Network Adequacy.
• Integrate Care Coordination into Quality Improvement and Management.
• Create a Population Health Management category.
• Rename “Members’ Rights and Responsibilities” to “Member Experience.”

Patient-Centered Medical Home Recognition

This program recognizes primary care practices that focus on improved communication and coordination in the medical neighborhood. NCQA proposes the following modifications for the 2026 year:

• Add 9 new elective criteria centered on virtual care.
• Retire 9 criteria that no longer drive significant improvement.
• Add 46 cadence thresholds to ensure that transformation is incorporated into the practice model, rather than as a one-time expectation.
• Implement a corrective action process to give practices the opportunity to rectify deficiencies without losing Recognition status.
• Align with Health Plan Accreditation to better facilitate payer-provider collaboration.

AI Evaluation

AI is widely adopted in the health care industry. Many frameworks provide guidance on its safe and ethical use, and NCQA intends to develop actionable standards that build on these. There is a gap in measuring and evaluating how organizations apply AI principles and demonstrate that their use of AI is effective and is monitored with a focus on quality improvement, outcomes and patient safety.

NCQA is presenting a set of AI questions in the following domains:

• Auditing/Monitoring/Validation.
• Error Handling/Incident Management in Production.
• Mitigating Bias.
• Transparency.

Public feedback will inform next steps in integrating AI expectations into NCQA’s programs, where applicable.

How to Participate in Public Comment

The public comment period ends at 5:00 p.m. (ET) on Tuesday, March 25. Visit My NCQA to submit comments. For details on proposed changes, visit the NCQA website.

The post NCQA Seeks Public Comment on Five Programs and the Use of AI in Health Care appeared first on NCQA.

NCQA seeks public feedback on proposed new measures, changes to existing measures and measure retirements, and NCQA acknowledges that the health care policy environment is rapidly evolving at this time. Reviewers are asked to submit comments to NCQA in writing via the Public Comment website by 5:00 p.m. (ET), Thursday, March 13. NCQA will take into account all comments received and the evolving environment as NCQA moves forward to prepare the final versions of these measures.

NCQA seeks comments on the following:

• Three new HEDIS measures.
• Revising six HEDIS measures.
• Retiring one HEDIS measure.
• Cross-cutting item for HEDIS to align with federal standards for race and ethnicity.
• Three new measures for the Diabetes Recognition Program.

About HEDIS and Public Comment

HEDIS measures of clinical quality and patient experience are based on scientific evidence. When new evidence becomes available, NCQA reviews the measures to determine if changes may be needed. NCQA convenes multi-stakeholder advisory panels—including independent scientists, clinicians, health plans, purchasers, government and consumer groups—to ensure that measures meet and balance the high standards of relevance, scientific soundness and feasibility.

An important part of developing and updating HEDIS is hearing from the public. NCQA reviews all comments received during public comment and discusses results with stakeholder advisors.

HEDIS measures do not constitute clinical practice guidelines and should not be used to determine insurance or coverage.

Proposed New HEDIS Measures

Follow-Up After Acute Care Visits for Asthma. Assesses the percentage of acute visits (urgent care, ED, inpatient or observation stays) for asthma in members 5–64 years of age who had a corresponding outpatient follow-up visit within 30 days.

• Importance: Studies show that individuals with asthma frequently utilize acute care for asthma exacerbations, which is an indicator of poorly controlled asthma. Guidelines recommend patients follow up with their primary care doctor after an acute asthma event to assess asthma control and review medication.

Tobacco Use Screening and Cessation Intervention: Assesses the percentage of members 12 years of age and older who were screened for tobacco use once or more during the measurement period and received tobacco cessation intervention during the measurement period, or the 180 days prior to the measurement period, if identified as a tobacco user.

• Importance: Tobacco use among adolescents and adults is widespread in the U.S. and causes severe morbidity and mortality. Appropriate screening for tobacco use and cessation intervention has been shown to reduce tobacco use and improve health outcomes.

Disability Description of Membership: Assesses the count of members 15 years of age and older enrolled any time during the measurement year, with disability status information by data source and disability type.

• Importance: Individuals with disabilities experience significant gaps in care, which can eventually lead to worse health outcomes. Collecting disability status data is the initial step to identifying this population and the disparities that they face, but current efforts to compile the data can be limited and/or incomprehensive. A quality measure that aims to improve the completeness and standardization of these data could address disparities that affect individuals with disabilities.

Proposed Changes to Existing HEDIS Measures

Social Need Screening and Intervention: Assesses the percentage of members who were screened for unmet food, housing and transportation needs using prespecified instruments, or assessed by a provider, at least once during the measurement period, and who received a corresponding intervention after a positive screen. NCQA proposes adding Healthcare Common Procedure Coding System (HCPCS) G and International Classification of Diseases, Tenth Revision (ICD-10) Z codes to the measure to improve health plans’ ability to report performance data. NCQA also proposes removing assessments from the list of allowable interventions and related value sets.

Adult Immunization Status: Assesses whether adults 19 years of age and older are up to date on routine immunizations. Includes separate rates for influenza; tetanus, diphtheria and acellular pertussis (Tdap) or tetanus and diphtheria (Td); zoster; pneumococcal; and hepatitis B immunization. NCQA proposes adding a new indicator to assess COVID-19 immunization status for adults 19 and older.

Lead Screening in Children: Assesses the percentage of members 2 years of age who had one or more capillary or venous lead blood test for lead poisoning by their second birthday. NCQA proposes transitioning this measure to be reported using only the Electronic Clinical Data Systems (ECDS) reporting method.

Follow-Up After High-Intensity Care for Substance Use Disorder: Assesses the percentage of discharges for members 13 years of age and older who had an inpatient hospitalization, residential treatment or withdrawal management event for treatment of substance use disorder, and had a follow-up visit for substance use disorder. NCQA proposes modifications to the numerator for this measure that update follow-up options and expand diagnosis position.

Statin Therapy for Patients with Cardiovascular Disease (SPC) and Statin Therapy for Patients with Diabetes (SPD): These measures assess whether members with either established atherosclerotic cardiovascular disease (ASCVD) or diabetes received appropriate statin therapy and achieved a medication adherence rate of 80%. Both measures will be transitioned to the Electronic Clinical Data Systems (ECDS) reporting method. For both SPC and SPD, NCQA proposes updates to the approach for identifying members with ASCVD and the removal of the exclusion for members enrolled in an I-SNP or living long-term in an institution. Specific to SPC, NCQA recommends the removal of sex-specific age bands to include all members aged 21-39 and the inclusion of members aged 76-85.

HEDIS Measure Retirement

Asthma Medication Ratio: The percentage of members 5–64 years of age who were identified as having persistent asthma and had a ratio of controller medications to total asthma medications of ≥0.50 during the measurement period.

Cross-Cutting Item for HEDIS

Alignment with Updated Federal Standards for Race and Ethnicity: NCQA seeks public comment on the proposed alignment of the HEDIS race and ethnicity stratification with 2024 updates to the Office of Management and Budget Statistical Policy Directive No. 15: Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity. Planned updates include adding “Middle Eastern or North African” as a minimum reporting category; updating terminology describing race/ethnicity options; combining race and ethnicity into a single reporting unit; and including a category to capture the quality of care provided to multiracial/multiethnic members.

Proposed New Measures for the Diabetes Recognition Program

Diabetes Recognition Program—Statin Therapy Prescription: This provider-level performance measure in the Diabetes Recognition Program assesses the percentage of patients 40–75 years of age with diabetes who had evidence of statin therapy during the measurement period.

• Importance: Individuals with diabetes are at increased risk of high levels of low-density lipoprotein (LDL) cholesterol. Reduction in LDL cholesterol lowers the risk of heart disease, stroke and atherosclerotic cardiovascular disease.

Diabetes Recognition Program—Depression Screening and Follow-Up: This provider-level performance measure in the Diabetes Recognition Program assesses the percentage of patients 18–75 years of age with diabetes who received appropriate screening and follow-up for clinical depression during the measurement period.

• Importance: Individuals with diabetes are 2–3 times more likely to experience depression than those without diabetes. Identification and treatment of clinical depression can improve patients’ treatment adherence and reduce depression-related health outcomes.

Diabetes Recognition Program—Continuous Glucose Monitoring Utilization: This provider-level utilization measure in the Diabetes Recognition Program assesses the percentage of patients 18–75 years of age with evidence of continuous glucose monitoring (CGM) utilization during the measurement period. CGM utilization is assessed in two measure rates: Individuals with type 1 diabetes; individuals not captured in rate 1 with use of basal insulin, multiple daily injections or continuous insulin infusion.

• Importance: CGM devices provide real-time monitoring of glucose levels, enabling patients to take timely corrective actions when needed. Assessing CGM utilization enhances data collection and provides valuable insights into the populations utilizing CGM devices.

How to Participate in Public Comment

The public comment period ends at 5:00 p.m. (ET) on Thursday, March 13. Visit My NCQA to submit comments. For details on proposed changes, visit the NCQA website.

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA).

The post HEDIS® Public Comment Period Is Now Open appeared first on NCQA.

Public comment is your opportunity to weigh in on the relevance, scientific soundness and feasibility of new and revised measures for HEDIS, with a special item for the Diabetes Recognition Program. The feedback NCQA receives helps us determine changes to our programs, procedures and processes.

This year’s public comment is open Thursday, February 13–Thursday, March 13.

What Are We Seeking Feedback On?

We’d like input on:

• Three new HEDIS measures.
• Revising six HEDIS measures.
• Retiring one HEDIS measure.
• Cross-cutting HEDIS updates to the race and ethnicity stratifications.
• Three new measures for the Diabetes Recognition Program.

Why Should You Comment?

NCQA measures are based on published clinical guidelines and scientific evidence. When guidelines change or new evidence becomes available in the scientific literature, NCQA reviews measures to determine if measure changes may be needed.

NCQA convenes multi-stakeholder advisory panels—including independent scientists, clinicians, health plans, purchasers, government and consumer groups—to ensure that measures meet and balance the high standards of relevance, scientific soundness and feasibility.

Public review and comment is an important part of developing and updating NCQA measures. NCQA reviews all comments received during public comment and presents results to advisory panels and to the NCQA Committee on Performance Measurement for deliberation.

How Can You Comment?

This year’s public comment will go live Thursday, February 13, 9:00a.m. ET.

We’ll post the link and more details here, so check back.

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA).

The post Heads Up: HEDIS® Public Comment Opens Next Week appeared first on NCQA.

NCQA seeks comments on proposed measure changes for:

• 2025 Health Plan Ratings, using results from HEDIS Measurement Year 2024.
• 2026 Health Plan Ratings, using results from HEDIS Measurement Year 2025.

About Health Plan Ratings and Public Comment 

NCQA’s Health Plan Ratings evaluate the quality of care provided by commercial, Medicare Advantage and Medicaid health plans. Ratings are updated annually, and provide health consumers with vital, transparent and current information about health plan performance and plans’ commitment to ongoing improvement.

A critical issue for any quality rating tool is the certainty of judgment—we want to be sure that plans assigned a higher value deserve their rating.

NCQA uses comprehensive measure selection criteria to determine which HEDIS^® and CAHPS^® measures are proposed for inclusion in or removal from Health Plan Ratings. Criteria ensure that all measures exhibit desirable statistical properties, are used in programs and value-based payment initiatives, address risk-adjusted health care utilization and eliminate redundancy.

An important part of developing and updating NCQA Health Plan Ratings is hearing from the public. NCQA reviews all public comments with our internal and external advisors.

Proposed Changes for Health Plan Ratings 2025 

Remove the following measures:  

Proposed changes are based on results from HEDIS Measurement Year 2024.   

Proposed Changes for Health Plan Ratings 2026 

Revise the following measures by replacing existing measures with ECDS measures: 

Remove the following measures:  

Add the following new measures:  

How to Participate in Public Comment 

The public comment period ends at 11:59 p.m. (ET) on December 17. To submit comments, go to http://my.ncqa.org and enter your email address and password. Once logged in, scroll down and click Public Comments.

In your comments, please consider whether the requirements are feasible as written and are clearly articulated, and highlight any areas that may need clarification.

For details on proposed changes, visit the NCQA website.

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA).

CAHPS^® is a registered trademark of the Agency for Healthcare Research and Quality.

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What is the USCDI+ Maternal Health dataset?

The United States Core Data for Interoperability Plus (USCDI+) focuses on areas of health care requiring more detailed or specialized data. It was developed by ONC and federal partners to standardize and advance interoperable data elements beyond the core USCDI.  

The USCDI+ Maternal Health dataset provides a set of standardized data elements to enhance maternal health research. It covers various stages of maternal health care, including prenatal visits, delivery outcomes and postpartum care, to support better maternal health management and promote equitable health outcomes. 

How does the dataset support maternal health & birth equity?

By leveraging data from EHRs and other health systems, and establishing health IT standards for better data exchange, the USCDI+ Maternal Health dataset strengthens health care delivery, fuels research and informs policies to improve maternal health and elevate birth equity. 

Many USCDI+ Maternal Health data elements will be integral to high-priority measure concepts in our work with the Reproductive Health Learning Network. Over the next 5 years, we’ll develop, validate and implement an actionable set of quality measures that aim the health care system toward birth equity. 

NCQA’s recommendations for dataset improvements

 NCQA plans to utilize USCDI and USCDI+ datasets in our digital future. We want to maintain consistency and coordination across all USCDI+ datasets while also aligning with USCDI. 

NCQA offered the following recommendations for improved dataset completeness and specificity: 

• Medication Data Class. Enhance medication data elements to include “Medication Dispensed” and “Medication Administration.” This will ensure complete medication information is available to assess maternal health and prenatal/postpartum care quality. 

• Behavioral Health Data Class. Expand behavioral health data to include elements like “Instances of Self-Harm in the Last 30 Days” and “Instances of Suicidal Ideation in the Last 30 Days.” History of self-injury is vital for early suicide prevention and can be an indicator of mental health conditions or substance use disorders that require further evaluation and treatment.  

• Patient Demographics Data Class. Refine patient demographic data by aligning race and ethnicity data elements with OMB revisions to the Statistical Policy Directive No. 15 to improve the accuracy and utility of these data across federal standards and health information exchange frameworks, like FHIR®. 

• Future Considerations. Integrate data elements that capture psychological traumatic events in the stages of prenatal, labor/delivery and postpartum care, along with data on physical trauma and its significant, long-term effects.  

For more details, read the full comment letter. 

Earlier this year, NCQA also responded to ONC’s request for feedback on the USCDI+ Behavioral Health Draft Dataset. 

NCQA Public Policy regularly submits comment letters to federal and state entities on a range of health care topics. Find our most recent comment letters here. 

The post NCQA Responds to ONC USCDI+ Maternal Health Draft Dataset appeared first on NCQA.

Public comment is your opportunity to weigh in on the relevance, scientific soundness and feasibility of new and revised HEDIS measures. Your feedback helps us determine changes to our content and programs.

NCQA seeks comments on the following:

• Five new measures.
• Revisions to five existing measures.
• Two cross-cutting topics on advancing gender-inclusion measurement and race and ethnicity stratifications.

About HEDIS and Public Comment

HEDIS measures of clinical quality and patient experience are based on scientific evidence. When new evidence becomes available, NCQA reviews the measures to determine if changes may be needed. NCQA convenes multi-stakeholder advisory panels—including independent scientists, clinicians, health plans, purchasers, government and consumer groups—to ensure that measures meet and balance the high standards of relevance, scientific soundness and feasibility.

An important part of developing and updating HEDIS is hearing from the public. NCQA reviews all comments received during public comment, and discusses results with stakeholder advisors.

HEDIS measures do not constitute clinical practice guidelines, and should not be used to determine insurance or coverage.

Proposed New Measures

Acute Hospitalization Following Outpatient Surgery: Assesses the risk adjusted ratio of observed-to-expected outpatient procedures (colonoscopy, general surgery, orthopedic procedures, urology procedures) for Medicare members 65 and older that were followed by an unplanned acute hospitalization within 15 days (inpatient and observation stays) for any diagnosis.

Importance: Most surgeries now take place in an outpatient setting. Health plans have an important role in providing services to prevent adverse outcomes and ensure proper care coordination during the post-surgical period.

Blood Pressure Control for Patients With Hypertension: Assesses the percentage of adults 18–85 years of age who had a diagnosis of hypertension and whose most recent blood pressure was under control during the measurement period. Blood pressure control is assessed in two measure rates: Blood Pressure <140/90 mm Hg; . Blood Pressure <130/80 mm Hg

Importance: Controlling high blood pressure, known as hypertension, reduces cardiovascular events and mortality.

Documented BI-RADS Assessment After Mammogram: Assesses the percentage of mammograms with appropriate documentation in the form of a BI-RADS assessment for members 40–74 years of age.

Importance: Standardized and timely documentation of breast cancer screening results is crucial to ensure appropriate follow-up after abnormal assessment results.

Follow-Up After Abnormal Breast Cancer Assessment: Assesses the percentage of inconclusive or high-risk BI-RADS assessments for eligible members 40–74 years of age that received appropriate follow-up within 90 days of assessment.

Importance: Successful identification of cancer relies on appropriate follow-up of abnormal results; failure to complete timely diagnostic testing can undermine the significance of screening.

Cervical Cancer Screening and Follow-Up: Assesses the percentage of members 21–64 years of age with possible or confirmed higher-risk cervical cancer screening results who receive appropriate and timely follow-up.

Importance: Cervical cancer causes a significant disease burden in the U.S., but is also one of the most successfully treated cancers if detected early through screening and follow-up. Failure to complete timely follow-up can undermine the ability of screening to prevent development and progression of cervical cancer.

Proposed Changes to Existing Measures

Acute Hospital Utilization: Assesses the risk-adjusted ratio of observed-to-expected acute inpatient and observation stay discharges for members 18 years of age and older. NCQA proposes to expand this measure into the Medicaid product line for members 18–64.

Adult Immunization Status: Assesses whether adults 19 years of age and older are up to date on routine immunizations, and includes separate rates for influenza; tetanus, diphtheria and acellular pertussis (Tdap) or tetanus and diphtheria (Td); zoster; and pneumococcal immunization. NCQA proposes: 1.) adding a new indicator for hepatitis B immunization for adults 19–59; 2.) changing the pneumococcal denominator to start at age 65 rather than 66 (resulting in changes to age stratification cutoffs for the influenza, Td/Tdap and zoster indicators 3.) removing the herpes zoster live vaccine as a numerator option in the zoster indicator.

Follow-Up After Emergency Department Visit for Mental Illness: Assesses the percentage of ED visits for members 6 years of age and older with a principal diagnosis of mental illness or intentional self-harm who had a follow-up visit for mental illness. NCQA proposes modifications to the numerator and denominator for this measure that expand diagnoses allowed and follow-up options.

Follow-Up After Hospitalization for Mental Illness: Assesses the percentage of discharges for members 6 years of age and older who were hospitalized for treatment of selected mental illness or intentional self-harm diagnoses and who had a follow-up visit with a mental health provider. NCQA proposes modifications to the numerator and denominator for this measure that expand diagnoses allowed and follow-up options.

Potentially Harmful Drug-Disease Interactions in Older Adults: Assesses the rate in which Medicare members 65 years and older with certain high-risk diseases and/or conditions (history of falls, dementia, chronic kidney disease) are prescribed drugs that may have potentially harmful interactions with their existing condition. NCQA proposes a change to align with the latest American Geriatrics Society Beers Criteria recommendations and to retire the total rate.

Cross-Cutting Topics

Gender-Inclusive Measurement in HEDIS: NCQA seeks public comment on proposed gender-inclusive changes to the Chlamydia Screening in Women measure. The changes aim to ensure everyone who should get routine chlamydia screening is included in the measure—specifically, transgender and gender-diverse members. This is part of a larger effort to make NCQA’s measures inclusive, gender affirming and address care for all populations.

Race-Ethnicity Stratifications: NCQA seeks public comment on the proposed removal of the data source reporting requirement from HEDIS measures stratified by race and ethnicity in MY 2025, in order to reduce stratification reporting burden. NCQA will retain the data source reporting requirement in the Race and Ethnicity Diversity of Membership descriptive measure only, to allow transparency into types of race and ethnicity data health plans leverage.

How to Participate in Public Comment

The public comment period ends at 5:00 p.m. (ET) on March 13. Visit https://my.ncqa.org/ to submit comments. For details on proposed changes, visit the NCQA website.

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA).

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