Overview of the HEDIS measurement set and how the data are used.
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PDF 2022 Star Ratings Fact Sheet Measures relate to many significant public health issues such as cancer, heart disease, behavioral health and diabetes. hb```@(1iNlpiK
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Individual HEDIS Measures Sheets.
ThenewestadditionstoHEDISaddresspatient-centered care, as well assafetyand appropriateness. Formoreinformation,refertothefullmeasurespecificationsinHEDISMY2022. 0000022148 00000 n
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. 51 0 obj
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Annual Technical Report, Calendar Year 2022 2023 HEDIS Measures HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). NCQA also revised themeasuredenominatortoreflectthenumberofmembers,ratherthanmemberyears, andtoincludesubstanceusedisordercodes; andrevisedtheagegroupsforreportingto1317,1864and65+.
The UB Codes contained in the HEDIS specifications may be used by health plans and other health care delivery organizations for the purpose of calculating and reporting HEDIS measure results or using HEDIS measure results for their internal quality improvement purposes. endobj
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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 6 0 obj
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NCQA Proposed Measure Changes for HEDIS 2022 - Ciox 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. https:// performance reported in the 2022 Quality Compass (measurement year 2021) for all lines of business that reported measurement year 2021 . 4920 0 obj
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PDF 2022 Medicaid Hedis Reference Sheet for Providers SUMMARY TABLE OF MEASURES, PRODUCT LINES AND CHANGES . HEDIS data help identify performance gaps and establish realistic targets for improvement. VA outpatient measures closely follow the specifications set forth by the National Committee for Quality Assurance (NCQA), Healthcare Effectiveness Data and Information Set (HEDIS). endstream
HEDIS Tip Sheet - Pediatric Measures -Look back period: July 1 of the year prior to June 30 of the measurement year.
NCQA > HEDIS MY 2023 Risk Adjustment Tables
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Rate 1: Six or more well-child visits* 0 to 15 months. 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. hbbd```b``"gIw
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PDF HEDIS Benchmarks and Coding Guidelines for Quality Care Thismeasurehas beenretired. 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. 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. .gov lock
PDF 2023 Annual Call for Quality Measures Fact Sheet - Centers for Medicare !9g=SW[h ,3%`~,Z-"3b~lv?.cKQZLHJ*??Y$t)mvdQZt6F^_"g&Oa}t%&QZ./w|PCZE9vG2{m!miVv| Q@?\ti+3#{lgi Find Doctors, Drugs and Facilities. Share sensitive information only on official, secure websites. The complete MIPS Quality Measures List published after the PFS final rule does not include Qualified Clinical Data Registry (QCDR) measures as such measures are proposed and selected through a separate process. Visitors to this page often check HEDIS FAQs, QRS FAQs, or ask a question through MyNCQA. 3 0 obj
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). Several clinical guidelinesrecommend deprescribing benzodiazepinesslowlyandsafely, rather thanstopping use immediately,tominimizewithdrawalsymptomsandimprovepatientoutcomes. endstream
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QARR List of Required Measures (Table 1) lists by product the measures required for submission. 0000004219 00000 n
Access/Availability of Care. HEDIS Technical Specifications include a complete list of new and updated HEDIS measures with instructions on data collection and guidelines for calculations and sampling. HbA1c Testingindicator. HTn0*hk!4J[&5i7Y%I yf 0000011393 00000 n
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Copyright 2023 National Committee for Quality Assurance. For more information regarding future quality measure consideration and selection, please visit Measure Selection | CMS MMS Hub. 0000068137 00000 n
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PDF Required HEDIS and CAHPS Measures for HEDIS Reporting Year 2022 Tables 1-3 below include . Follow-UpAfterEmergencyVisitDepartmentVisitforAlcoholandOtherDrugDependence/Follow-UpAfterEDVisitforSubstanceAbuse. Secure .gov websites use HTTPSA You will be prompted to log in to your NCQA account. 1320 0 obj
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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. 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. endobj
InitiationandEngagementofAlcoholandOtherDrugAbuseorDependence. hXmTW3`IBH5@) ZmmP)pZA;H)Tt=lM"VPH`[[Z?j]MTz NCQArevisedthemeasurestructurefromutilizationtodiagnosed-prevalencementalhealthdisordersandupdatedthenameto. xPX]NG&)R.ng}
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Sorry, this page could not be found. | Wellcare 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. \\R4G_$g$T!7(9 <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S>>
HEDIS Measures and Technical Resources - NCQA HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). Intent:The 2019 American Geriatrics Society Beers Criteria recommendthat benzodiazepinesbeavoidedinolderadults. P}^bGx{Q1F b~/>@ e#
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Thismeasurewillallowplanstounderstandifadvancecareplanningisprovidedtobeneficiarieswhoaremostlikelytobenefitfromit. 0000002321 00000 n
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PDF HEDIS Tip Sheet - Pediatric Measures - Sunshine Health NCQA screens, trains and certifies organizations that collect or audit data for health plans and providers. 0000008074 00000 n
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Withthisdeprescribing measure, there isan opportunityto promote harm reduction by assessing progress in appropriately reducing benzodiazepine use in the older adult population. Sign up to get the latest information about your choice of CMS topics.
HEDIS: General Guidelines and Measure Descriptions Outpatient Compare Data | Veterans Affairs NCQA > Quality Compass 2023 (MY 2022) - Data and Reports HEDIS 2022: See What's New, What's Changed and What's Retired
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Encounter data is crucial for demonstrating accurate quality performance to the Department of Health Care Services (DHCS). 0000021981 00000 n
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2022 Value Based Payment Reporting Requirements - New York State Health Plan Descriptive Information. 0000047019 00000 n
(Example: COL, BCS measures). The Rules for Allowable Adjustments are included in the HEDIS Volume 2 publication after the applicable HEDIS measure specifications. endstream
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The Inventory lists each measure by program, reporting measure specifications including, but not limited to, numerator, denominator, exclusion criteria, Meaningful Measures domain, measure type, and National Quality Forum (NQF) endorsement status. Utilization and Risk Adjusted Utilization. Quality Compass 2023 Commercial Premier Edition-Trended Data (MY 2022, MY 2021, MY 2020) with Data Exporter.
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[ That makes HEDIS one of health cares most widely used performance improvement tools. @_B^GR %%EOF
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HEDIS Measures for Diabetes are assessed to evaluate the effectiveness of the program. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. Utilization and Risk Adjusted Utilization. To learnmore, clickherefor a discussion ofthe stratification, how we arrived atthiscurrentpoint andFAQs. HSn0+THK[iF(P=2@oA.kY"cL@YG6u}(K]*-50 j"1J0B(E$akG) 0000086512 00000 n
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Table 7a: CHIP-MCO Results for 2022 (MY 2021) HEDIS Measures CHIP-MCO Visitors to this page often checkHEDIS FAQsor ask a question throughMyNCQA. 0000016920 00000 n
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New digital measures reduce the burden of reporting quality results. _hRos0Tx|1Ug% xref
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Table 1: Changes in Part C Measure Scores from 2021 to 2023 Star Ratings for MA Contracts 0000035489 00000 n
For example, 2022 claims, encounters, and other HEDIS data are submitted throughout 2022. 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. 0000036100 00000 n
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How are rates calculated? 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 Three of the four diabetes measures rate at the CMS contracts with NCQA to collect Healthcare Effectiveness Data and Information Set (HEDIS) measures from Medicare Special Need Plans (SNPs). 2527 0 obj
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performance reported in the 2022 Quality Compass (measurement year 2021) . 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% HEDIS CHEAT SHEET 2022 - 2023 Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents: Documented yearly for ages 3-17. List and define all quantifiable measures used in this activity. 0000044978 00000 n
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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. m){w&;9l F*\JR4d87=dkh
Members can access the latest news about measuring performance and gain insight into how HEDIS evolves. The 90th percentile is the benchmark for the HEDIS measures. 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, Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC), Appropriate Testing for Pharyngitis (CWP), Use of Spirometry Testing in the Assessment and Diagnosis of COPD (SPR), Pharmacotherapy Management of COPD Exacerbation (PCE), Persistence of Beta-Blocker Treatment After a Heart Attack (PBH), Statin Therapy for Patients With Cardiovascular Disease and Diabetes (SPC, SPD), Kidney Health Evaluation for Patients With Diabetes (KED), Osteoporosis Testing and Management in Older Women (OMW), Antidepressant Medication Management (AMM), Follow-Up Care for Children Prescribed ADHD Medication (ADD), Follow-Up After Hospitalization for Mental Illness (FUH), Follow-Up After Emergency Department Visit for Mental Illness (FUM), Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence (FUA), Diabetes and Cardiovascular Disease Screening and Monitoring for People With Schizophrenia or Bipolar Disorder (SSD, SMD, SMC), Adherence to Antipsychotic Medications for Individuals With Schizophrenia (SAA), Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM), Pharmacotherapy for Opioid Use Disorder (POD), Follow-Up After High-Intensity Care for Substance Use Disorder (FUI), Follow-Up After Emergency Department Visit for People With Multiple High-Risk Chronic Conditions (FMC), Non-Recommended Cervical Cancer Screening in Adolescent Females (NCS), Non-Recommended PSA-Based Screening in Older Men (PSA), Appropriate Treatment for Upper Respiratory Infection (URI), Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis (AAB), Use of Imaging Studies for Low Back Pain (LBP), Medication Management in Older Adults (DDE, DAE), Use of Opioids from Multiple Providers (UOP), Management of Urinary Incontinence in Older Adults (MUI), Medical Assistance with Smoking and Tobacco Use Cessation (MSC), Pneumococcal Vaccination Status for Older Adults (PNU), Adults Access to Preventive/Ambulatory Health Services (AAP), Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment (IET), Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics (APP), Child and Adolescent Well-Care Visits (W30, WCV), Identification of Alcohol and Other Drug Services (IAD), Hospitalization Following Discharge From a Skilled Nursing Facility (HFS), Hospitalization for Potentially Preventable Complications (HPC), Follow-Up Care for Children Prescribed ADHD Medication (ADD-E), Depression Screening and Follow-Up for Adolescents and Adults (DSF-E), Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults (EMS-E), Depression Remission or Response for Adolescents and Adults (DRR-E), Unhealthy Alcohol Use Screening and Follow-Up (ASF-E), Prenatal Depression Screening and Follow-up (PND-E), Postpartum Depression Screening and Follow-up (PDS-E), Order the HEDIS MY 2023 Digital Measures Bundle, HEDIS MY 2023 Medication List Directory (NDC codes), HEDIS Electronic Clinical Data System (ECDS), HEDIS for the Quality Rating System Value Set Directory, HEDIS for the Quality Rating System Technical Specifications, Technical Specifications Update for the Quality Rating System, Order the HEDS MY 2022 Digital Measures Bundle (includes HEDIS Volume 2), HEDIS MY 2022 Medication List Directory (NDC codes), HEDIS MY 2022 Measure Trending Determinations, MY 2022 Validated Member-Level File Layout, HEDIS MY 2021 Measure Trending Determinations, MY 2021 Validated Member-Level File Layout, HEDIS MY 2020 Volume 2 Technical Specifications Update, NCQA HEDIS Measurement Year (MY) 2020 Requirements and COVID-19, HEDIS MY 2020 Medication List Directory (NDC codes), HEDIS MY 2020 Measure Trending Determinations, MY 2020 Quality Rating System Value Set Directory, MY 2020 Quality Rating System: Technical Update, MY 2020 Volume 3 Technical Specifications Update, Volume 3 MY 2020 Validated Member-Level File Layout, HEDIS Volume 2 & Digital Measures Bundles Comparison, HEDIS 2020 (MY 2019) Vol. 0000050943 00000 n
from January to May for the prior year. <>
Measure Changes Care for Older Adults (COA) - -Removed Advanced Care Planning indicator from COA . w !1AQaq"2B #3Rbr
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To be able to identify andreduce disparitiesin care, the first step must be measuring and reportingon. B. Quantifiable Measures. 0000015971 00000 n
NCQA collects HEDIS data from health plans and other health care organizations. High-qualityhealthcaremustbeequitablehealthcare. Terms of Use, Every year,NCQA updates and releases the Healthcare Effectiveness Data and Information Set (HEDIS. Data from the 2020 measurement period (2022 Star Ratings) help us understand how the PHE impacted the care delivery system. You will be prompted to log in to your NCQA account. 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. NCQAisretiringthefollowingmeasures/indicators: Formoreinformation,refertothefullmeasurespecificationsinHEDISMY2022Volume 2:Technical Specifications for HealthPlans. For full specifications, visit the NCQA store. . NCQAexpandedtheupperagelimitfrom50to75;addedreportingfortheMedicareproductline;addedfourclinicalexclusionsforosteoporosis. Quality Compass 2022 includes certain CAHPS data. This process ensures that HEDIS measures remain relevant and feasible for implementation.
Dominique Crenn Daughters,
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