Each year, NCQA publishes a list of measure updates, additions, and deletions for future HEDIS® measurement years. With big changes slated for the future as NCQA aims to fully transition to digital-only reporting by 2030, the public comment period allows plans the opportunity to weigh in on the relevance and feasibility of the proposed changes and ask questions of relevant stakeholders.
Read our summary of NCQA’s latest proposed changes for Measurement Year (MY) 2026 as NCQA seeks feedback from health plans.
Register for our 30-minute webinar on Thursday, March 6 at 1 pm ET or sign up for the on-demand recording.
NCQA has proposed three new HEDIS measures:
This measure would assess the percentage of acute visits for asthma in members from 5–64 years old who had a corresponding outpatient follow-up visit within 30 days. It aims to improve asthma control and reduce acute exacerbations, which often indicate poorly managed asthma. NCQA proposes retiring the Asthma Medication Ratio (AMR) measure, which assesses the percentage of members from 5–64 years old with a ratio of controller medications to total asthma medications greater than or equal to 0.50, replacing it with this new asthma measure.
This measure would focus on members 12 years and older, assessing the rate of members screened for tobacco use and the provision of cessation interventions for tobacco users. Given the significant health risks associated with tobacco use, this measure aims to enhance screening and intervention efforts. This measure is proposed to replace the Medical Assistance with Smoking and Tobacco Use Cessation (MSC) measure captured via Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey responses.
This measure would track the collection of disability status information for members 15 years and older, aiming to improve the completeness and standardization of data on disabilities. More comprehensive documentation on disability data would assist in identifying care disparities, allowing for the development of more targeted measures to address care gaps in persons with disabilities.
NCQA proposes revisions to six existing HEDIS measures:
The proposed changes include adding HCPCS G codes to identify screenings and interventions, adding ICD-10 Z codes to identify members with social needs, as well as removing assessments from the allowable interventions.
A new indicator for COVID-19 immunization status would be added for adults 19 years and older, following a similar timeframe for compliance as the existing Influenza indicator.
NCQA had initially proposed that the LSC measure would transition to administrative-only reporting in MY 2026 on its blog. With the public comment period, it now proposes to transition this measure to using only the Electronic Clinical Data Systems (ECDS) reporting method, following several other measures that have transitioned to ECDS-only amid NCQA’s aim to fully digitize quality measurement by 2030.
Proposed numerator changes include allowing the substance use diagnosis to be in any diagnosis position, adding peer support services, and removing pharmacotherapy events.
Both measures would transition from administrative reporting to the ECDS reporting method, though this transition is specifically not up for public comment. For both measures, NCQA proposes updates to identifying members with ASCVD and removing the exclusion of members enrolled in an I-SNP or living in a long-term institution. For SPC, NCQA would remove the sex-specific age criteria including all members from 21–39 years old, as well as expanding to include members 76–85 years old.
NCQA seeks comments on aligning HEDIS race and ethnicity stratification with updated federal standards introduced in March 2024. This includes updates to reporting categories and terminology, combining race and ethnicity into a single reporting unit, and adding a category for Middle Eastern or North African members.
Included with the public comment materials are a list of changes to expect for MY 2025 and MY 2026 that are not up for public comment. These changes include:
Health plans have until Thursday, March 13 to submit comments on the proposed changes via NCQA’s portal.
Join us for the second installment of our 2025 Quality Decoded webinar series on Thursday, March 6 at 1 pm ET as we break down what you need to know about the latest public comment period for MY 2026.
Listen in as Cotiviti experts:
Don’t miss this opportunity to gain strategic insight into HEDIS measure changes and prepare for industry challenges with expert best practices. If you can’t attend the live webinar, be sure to register so we can email you the on-demand recording.
Stay informed with our Quality Decoded series providing information about key topics, measure changes, and announcements from NCQA and CMS throughout the year. Check out our future webinars tackling Star Ratings, HEDIS technical specifications, and more.
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