PDF Rhode Island Medicaid Managed Care Program Tufts Health Public Plan PDF Measure Name Abbreviation Measure Description EFFECTIVENESS OF CARE 0000035753 00000 n HUG members are health care professionals who produce, report and interpret HEDIS data. Quality Compass 2023 Commercial-Trended Data (MY 2022, MY 2021, MY 2020) As low as $7,690.25. The HEDIS measurement set is sponsored, supported and maintained by NCQA. 0000002938 00000 n 26 0 obj <> endobj Np1W>?,Y{ 2022 MEDICAID HEDIS REFERENCE SHEET FOR PROVIDERS 3 PEDIATRIC HEDIS MEASURES HEDIS MEASURE AGE MEASURE DESCRIPTION BILLING CODES WELL-VISIT Well Child Visits 0-30 Months of Life (W30) 0-30 months Telehealth exclusion removed. HEDIS: General Guidelines and Measure Descriptions 4950 0 obj <>stream Automatic . HEDIS measures performance in health care where improvements can make a meaningful difference in peoples lives. endstream endobj 30 0 obj <>stream vzp`}jArJ;,-r1cb?>~XVU(pAi-Im kC#)}i^_ eMRNxz;e~FOL:epYMit *9(66a?`4 /[2u0@G5Q^+NDV&h$!~_sO {9oHp3N)I4BP5N1K0Up ]%x2P1xvk?7?]k'a HEDIS digital future has begun. As low as $6,835.25. 0000021981 00000 n performance. * Measures from HEDIS and CAHPS used data from the 2020 Star Ratings (collected in 2019 and unaffected by the COVID-19 PHE). Thismeasurewillallowplanstounderstandifadvancecareplanningisprovidedtobeneficiarieswhoaremostlikelytobenefitfromit. As low as $16,810.25. 0000004757 00000 n In these cases, age stratifications will differ from HEDIS MY 2021 technical specifications. G-3245 Beecher Road Flint, Michigan 48532 For more information regarding future quality measure consideration and selection, please visit Measure Selection | CMS MMS Hub. Access/Availability of Care. Utilization and Risk Adjusted Utilization. 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. %%EOF endstream endobj startxref II. <> 0000000016 00000 n 0000003808 00000 n For example, 2022 claims, encounters, and other HEDIS data are submitted throughout 2022. 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 Three of the four diabetes measures rate at the Thismeasurehas beenretired. 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 9745 36 2 Technical Specifications Update, HEDIS 2020 (MY 2019) Risk Adjustment Tables, HEDIS 2020 Measure Trending Determinations, Quality Rating System 2020 Technical Specifications Update, Volume 3 2020 Technical Specifications Update, Volume 3 2020 Validated Member-Level File Layout, HEDIS MY 2023 Measure Trending Determinations, MY 2023 Validated Member-Level File Layout (, Order this publication (anticipated release date: May 2024). NCQAalsorevisedthechildandadolescentagegroupsforreportingto117. %PDF-1.4 % HEDIS includes measures for physicians, PPOs and other organizations. CJ)8kPqQy!h\ADICp%F$NhG-EL'nU%mQ*1HPl. Copyright 2023 National Committee for Quality Assurance. You will be prompted to log in to your NCQA account. That makes HEDIS one of health cares most widely used performance improvement tools. Optum Managed Transplant Program. To learnmore, clickherefor a discussion ofthe stratification, how we arrived atthiscurrentpoint andFAQs. 2022 Value Based Payment Reporting Requirements - New York State 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. endstream endobj startxref 0000047520 00000 n R'A@>r 5^[qLp.p*DB24V,mb66vA8kwFvM@gf` r AdvanceCarePlanningIndicator. 0000002169 00000 n 0000029366 00000 n $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ? HEDIS is a source for data contained in the California Health Care Quality Report Cards obtained from Quality Compass2022 and is used with the permission of the National Committee for Quality Assurance (NCQA). Intent:Antibiotics prescribed for acute respiratory conditions are a large driver of antibiotic overuse. Terms of Use, Every year,NCQA updates and releases the Healthcare Effectiveness Data and Information Set (HEDIS. 2527 0 obj <> endobj Save your favorite pages and receive notifications whenever theyre updated. Volume 2:Technical Specifications for HealthPlans. Share this page with a friend or colleague by Email. Table 1: Changes in Part C Measure Scores from 2021 to 2023 Star Ratings for MA Contracts 1358 0 obj <>stream The Healthcare Effectiveness Data and Information Set (HEDIS) is one of health cares most widely used performance improvement tools. Technical specifications for the Health Outcomes Survey (HOS). 2 Summary Table of Measures, Product Lines and Changes HEDIS MY 2023, Volume 2 HEDIS MY 2023 Measures Applicable to: Commercial Medicaid Medicare Changes for HEDIS MY 2023 Guidelines for Allowable Adjustments of HEDIS 9 9 9 x Updated Guideline 4: Exclusions to remove optional exclusions. How are rates calculated? PDF MY 2023 Summary Table of Measures Product Lines Changes _hRos0Tx|1Ug% 9 0 obj HEDIS/CAHPS Measures Required for HP AccreditationCommercial *The weight column indicates the weight of the item (maximum value = 3) in the overall score calculation. gbv[Dp[,tkg`h`PR``46R @0ft@ ublH$`@K WH@uX^$28C23n`Rbts&H-dpo]n0ch K$l7@ LD%@H00r'UvU h# 0000004949 00000 n HEDIS nonsurvey measures for organizations; instructions on data collection for each measure; general guidelines for calculations and sampling. 0000022424 00000 n PDF 2022-23 Health Plan Report Card - HEDIS Scoring Documentation %PDF-1.6 % 0000011142 00000 n Trackingantibioticprescribingforallacute respiratory conditionswillprovide context about a healthplansoverall antibiotic use when viewedwiththree HEDIS measures ofappropriatetesting and inappropriate prescribing for upper respiratory infections, pharyngitis and acute bronchitis. For full specifications, visit the NCQA store. Effective 2022, the Promise VIP Program is now called Promise Quality Performance Incentive (PQPI). 7 0 obj . 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. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. UseofImagingStudiesforLowBackPain. Data from the 2020 measurement period (2022 Star Ratings) help us understand how the PHE impacted the care delivery system. 0000003369 00000 n Anticipated Release Date: September 2023. PDF 2023 HEDIS Measures - McLaren Health Plan t,f`$yF;zXytHo. Antibiotics prescribed for acute respiratory conditions are a large driver of antibiotic overuse. ThisclinicaltopicisnowaddressedinthenewAdvanceCarePlanningmeasure. 0000006215 00000 n % 0000006694 00000 n 3 0 obj X `q@ A`J~m ]l b| 0jHX=x3||DqGTt|\V~Fu3c,$;$c9 -Kd"bv.CXb%*qS-J`}V1h(l1y|8Tr46hOJ PDF 2022 Hedis (Measurement Year) Medicaid Reference Sheet 0000107074 00000 n . 0000016920 00000 n CPT: 87070, 87071, 87081, 87430, 87650-87652, 87880 HEDIS Tip Sheet - Pediatric Measures Key HEDIS Factors to Consider endstream endobj startxref ThiseffortbuildsonNCQAsexistingworkdedicatedtotheadvancinghealthequityindataandqualitymeasurement. 0000010486 00000 n Health Insurance Marketplace Quality Initiatives | CMS Rate 2: Two additional well-child visits 15 to 30 months. 0000024625 00000 n {+Ed. Table 7a: CHIP-MCO Results for 2022 (MY 2021) HEDIS Measures CHIP-MCO 0000004562 00000 n List and define all quantifiable measures used in this activity. 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: PDF Hedis Cheat Sheet 2022 - 2023 For the denominator, NCQA added ED visits for unintentional or undetermined overdose for commonly used drugs with addiction potential in any diagnosis position. 0000008708 00000 n 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. Copyright 2023 National Committee for Quality Assurance. We do not share your information with third parties. 0000032016 00000 n Withthisdeprescribing measure, there isan opportunityto promote harm reduction by assessing progress in appropriately reducing benzodiazepine use in the older adult population. 0000035489 00000 n startxref 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. The Data Display (D2) tool provides a way for patients to compare the quality of care hospitals give. Rates for the HEDIS measures were compared to corresponding Medicaid percentiles; comparison results are provided in the tables. Visitors to this page often check HEDIS FAQs, QRS FAQs, or ask a question through MyNCQA. The information provided in this HEDIS QRG is to help you improve your practice's HEDIS rates. Secure .gov websites use HTTPSA HSn0+THK[iF(P=2@oA.kY"cL@YG6u}(K]*-50 j"1J0B(E$akG) II . ThenewestadditionstoHEDISaddresspatient-centered care, as well assafetyand appropriateness. Share this page with a friend or colleague by Email. stream Social Determinants: Our Statement with TJC, NQF Was Just the Start. 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 ComprehensiveDiabetesCare/HemoglobinA1cControlforPatientsWithDiabetes,EyeExamPerformedforPatientsWithDiabetes,BloodPressureforPatientsWithDiabetes. 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. Ylyr2fi4vVDlhV]Zk:6d,,y+kQ. Immunization Schedules. Tobacco Cessation Program. 0000004219 00000 n Outpatient Compare Data | Veterans Affairs hb```f``2g`a`ad@ Arl`h\=g}8,{GzGKEGCE\ p10:ki> la Include a goal or benchmark for each measure. 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. |@Z-Q 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. We do not share your information with third parties. b~GiQ">sTMj 2p1IcvIwsudr More than 200 million people are enrolled in plans that report HEDIS results. 0000009893 00000 n 0000011969 00000 n Specifications outline measure definition and details, which outline the specifications required to evaluate the recommended standards of quality for the element(s) in the measure. ,wBInd!d98{9|/.Y1&7wULt~s`GgvXT\/T}[_}bVT=TXk;e*ZkQXH#7hUxQ"zZdP> 0000008644 00000 n MY 2002 was the yearfirst that follow-up rates were reported. 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 NCQAwillconcentrateeffortsontheoutcome-basedHbA1cControlforPatientsWithDiabetesmeasure. andaddedtwocross-cuttingexclusions:palliativecareandadvancedillness/frailty. performance reported in the 2022 Quality Compass (measurement year 2021) . A list of potential measures for initial stratification in MY2022 are as follows: Controlling High Blood Pressure (CBP) Comprehensive Diabetes Care (CDC) Antidepressant Medication Management (AMM) Follow-Up After Emergency Department Visit for People with Multiple High-Risk Chronic Conditions (FMC) 65 years of age and older who were dispensed benzodiazepines and achieved a 20% decrease or greater in benzodiazepine dose during the measurement year. HEDIS Measures and Technical Resources - NCQA 74,457 : 61.4% : 61.1% : 61.7% : 55.9% + 60.5% + >= 90th percentile PA . For MY 2022, HEDIS added three new measures, retired three measures/indicators and changed seven existing measures and two cross-cutting topics that address enhancements across multiple measures. The PA-specific indicators were added to include services with high utilization in the BH Program that could HC not be mapped to any of the standard coding used in the HEDIS measure to identify follow-up office visits. MentalHealthUtilization/DiagnosedMentalHealthDisorders. JFIF ` ` C 0000133309 00000 n 0000047019 00000 n Intent:The 2019 American Geriatrics Society Beers Criteria recommendthat benzodiazepinesbeavoidedinolderadults. 9745 0 obj <> endobj xref PDF 2022 Star Ratings Fact Sheet ]c\RbKSTQ C''Q6.6QQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQ T " Anticipated Release Date: September 2023. 0000022148 00000 n Annual Technical Report, Calendar Year 2022 0000015158 00000 n HEDIS CHEAT SHEET 2022 - 2023 Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents: Documented yearly for ages 3-17. lock <> Anticipated Release Date: September 2023. NCQA defines how data can be collected for a measure: The 90th percentile is the benchmark for the HEDIS measures. PDF HEDIS MY2022 Hybrid Measure Quick Guide NCQArevisedthemeasurestructurefromutilizationtodiagnosed-prevalencementalhealthdisordersandupdatedthenameto. Formoreinformation,refertothefullmeasurespecificationsinHEDISMY2022. 0000002663 00000 n NCQAplanstoexpandtheraceandethnicitystratificationstoadditionalHEDISmeasuresoverseveralyearstohelpreducedisparitiesincareamongpatientpopulations. 42 0 obj <>/Filter/FlateDecode/ID[]/Index[26 26]/Info 25 0 R/Length 83/Prev 96543/Root 27 0 R/Size 52/Type/XRef/W[1 2 1]>>stream Official websites use .govA 1320 0 obj <> endobj HEDIS Measure - Term for how each domain of care is further broken down. The Rules for Allowable Adjustments are included in the HEDIS Volume 2 publication after the applicable HEDIS measure specifications. or HEDIS survey measures and standardized surveys from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) program. HEDIS MY 2022 includes 96 measures across 6 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 NCQA > Quality Compass 2023 (MY 2022) - Data and Reports 0000010141 00000 n ). NCQA collects HEDIS data from health plans and other health care organizations. You will be prompted to log in to your NCQA account. the HEDIS Measurement Year (MY) 2020 & 2021 Volume 2 Technical Speciications. REQUIRED HEDIS1 AND CAHPS2 MEASURES FOR HEDIS REPORTING YEAR 2022 Summary of Changes to Measure List: Added the following measures.
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