hbbd```b``"gIw ""7|-``qT3l0; fH0DHI@H_mj> _ 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). HEDIS quality measures for Accountable Care Organizations. m){w&;9l F*\JR4d87=dkh Visitors to this page often check HEDIS FAQs, QRS FAQs, or ask a question through My NCQA. New digital measures reduce the burden of reporting quality results. h^3VN,vAO]{Q@v gK2CxD]*{Dv= Px k7j^AEE]iQcWA/]?N8MhIB HA]2kNHAE Vc"c)\v1s9]OA2mJ)$'8 0000011142 00000 n NYS will calculate the measure result for MY2021 2 - For measures that you may have reported using the hybrid sample in the PLD for QARR, 0000015971 00000 n The information provided in this HEDIS QRG is to help you improve your practice's HEDIS rates. 5 0 obj %%EOF 0000050943 00000 n Plans must purchase the HEDIS 2022 Technical Specifications for Health Plans for specifications of the required HEDIS measures. AntibioticUtilizationforRespiratoryConditions. Women 30-64 years of age who had cervical high-risk human papillomavirus (hrHPV) The UB Codes contained in the HEDIS specifications may be used by health plans and other health care delivery organizations for the purpose of calculating and reporting HEDIS measure results or using HEDIS measure results for their internal quality improvement purposes. 0000002663 00000 n Encounter data is crucial for demonstrating accurate quality performance to the Department of Health Care Services (DHCS). Each managed care plan's calculated rates for the NCQA HEDIS Measurement Year 2021 measure set were validated as part of the NCQA HEDIS Compliance Audit and assigned one of NCQA's outcome designations. Health Plan Descriptive Information. 0000047019 00000 n NCQAisretiringthefollowingmeasures/indicators: Formoreinformation,refertothefullmeasurespecificationsinHEDISMY2022Volume 2:Technical Specifications for HealthPlans. R'A@>r 5^[qLp.p*DB24V,mb66vA8kwFvM@gf` r QLeRQ~{?$u>%)G7,]m?oaS`AD>O)>fC*b9Zj #b&=c;m4lYVy7&>c)|5+Z7Sw 3tUfQ|x]zZ>!B2P10d@9>UE*EE$6PZtegv:(J5#,ojt1mGL+9AYdeQ4ec`"omT2%^(_&/>~8_+7F]e*}1b>(Q}\4t0 (Example: COL, BCS measures). t,f`$yF;zXytHo. Thismeasurewillallowplanstounderstandifadvancecareplanningisprovidedtobeneficiarieswhoaremostlikelytobenefitfromit. Island managed care plans must provide performance measure data, specifically HEDIS, to the Office of Health . NCQAexpandedtheupperagelimitfrom50to75;addedreportingfortheMedicareproductline;addedfourclinicalexclusionsforosteoporosis. @_B^GR HEDIS survey measures and standardized surveys from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) program. Volume 2:Technical Specifications for HealthPlans. %PDF-1.7 % 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 0000068137 00000 n endobj 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. NCQAs HEDIS Value Set Directory (VSD) includes the necessary third-party codes for use with adjusted measure specifications. Utilization and Risk Adjusted Utilization. 0000014654 00000 n 0000019234 00000 n 0000086512 00000 n Anticipated Release Date: September 2023. 0000068208 00000 n Members can access the latest news about measuring performance and gain insight into how HEDIS evolves. REQUIRED HEDIS1 AND CAHPS2 MEASURES FOR HEDIS REPORTING YEAR 2022 Summary of Changes to Measure List: Added the following measures. 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. 0000009785 00000 n 0000018052 00000 n X `q@ A`J~m ]l b| 0jHX=x3||DqGTt|\V~Fu3c,$;$c9 -Kd"bv.CXb%*qS-J`}V1h(l1y|8Tr46hOJ 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% IdentificationofAlcoholandOtherDrugServices/DiagnosedSubstanceUseDisorders. $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ? NCQArevisedthemeasurestructurefromutilizationtodiagnosed-prevalenceofsubstanceuseandupdatedthenameto. 2579 0 obj <>stream Every year,NCQA updates and releases the Healthcare Effectiveness Data and Information Set (HEDIS). HbA1c Testingindicator. %PDF-1.7 0000006215 00000 n 0000008644 00000 n HEDIS CHEAT SHEET 2022 - 2023 Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents: Documented yearly for ages 3-17. Rate 1: Six or more well-child visits* 0 to 15 months. We do not share your information with third parties. MentalHealthUtilization/DiagnosedMentalHealthDisorders. 4920 0 obj <> endobj Copyright 2023 National Committee for Quality Assurance. endobj 0000013436 00000 n Care for Children Prescribed ADHD Medication Initiation and Continuation measures. We do not share your information with third parties. Terms of Use, Every year,NCQA updates and releases the Healthcare Effectiveness Data and Information Set (HEDIS. 4 0 obj endstream endobj startxref Measures Reported UsingElectronic Clinical Data Systems. 4950 0 obj <>stream 0000021716 00000 n Anticipated Release Date: September 2023. HEDIS Measure PCCP Well-Child Visits First 15 Months 74.74% Well-Child Visits 1530 Months 81.79% The Data Display (D2) tool provides a way for patients to compare the quality of care hospitals give. ThiseffortbuildsonNCQAsexistingworkdedicatedtotheadvancinghealthequityindataandqualitymeasurement. !3$Y:wn=3. * Measures from HEDIS and CAHPS used data from the 2020 Star Ratings (collected in 2019 and unaffected by the COVID-19 PHE). o GRs_$ [EN=_sRs 1F/T ? 0000001386 00000 n 2022 HEDIS AND FIVE-STAR QUALITY MEASURES REFERENCE GUIDE HEDIS STAR MEASURE AND REQUIREMENTS DOCUMENTATION NEEDED CPT/CPTII CODES Annual Wellness Exam Measure ID: AHA, PPE, COA Description: Measurement Year Lines: Age: Medicare 18yrs & Older Blood Pressure Control Measure ID: CBP or CDC9 Description: EVERY VISIT Lines: Age: Medicare 18yrs - 75yrs 0000016920 00000 n <> QARR List of Required Measures (Table 1) lists by product the measures required for submission. This process ensures that HEDIS measures remain relevant and feasible for implementation. g'jQL[@tsho-0;F3a!~;F^MHFG"Y#HX@=<71AcL\oxdkw2& +i You will be prompted to log in to your NCQA account. Ur"J,3Xhi"k;}06]rn(0i VA has utilized data from NCQA's Quality Compass to establish regional averages for hospitals that fall within geographic boundaries that match areas covered by Veterans Integrated Service Networks (VISN). You will be prompted to log in to your NCQA account. Share sensitive information only on official, secure websites. Access/Availability of Care. 0000032016 00000 n %PDF-1.6 % Intent:The 2019 American Geriatrics Society Beers Criteria recommendthat benzodiazepinesbeavoidedinolderadults. 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). endstream endobj 27 0 obj <> endobj 28 0 obj <> endobj 29 0 obj <>stream 0000003369 00000 n 9745 0 obj <> endobj xref hWO`06~@)N@&d.6l5@[)"$$dm29R1$2.K3LH(y ]3SISTM}~/'Ys9Z @ R M+[|Qs0@!| T8E#F>x=-g? 0000005676 00000 n HEDIS Measures HEDIS includes more than 90 measures across 6 domains of care: Effectiveness of Care. B. Quantifiable Measures. **For Complaints about the Plan 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 0 8 0 obj 0000004794 00000 n TABLE 1: 2022 VBP LIST OF REQUIRED MEASURES - Required to Report NA - Not Applicable to the Arrangement Shading - Purple- Not required to be reported 1 - There are no reporting requirements for this measure. !(!0*21/*.-4;K@48G9-.BYBGNPTUT3? ;(Y}e"XmT8,/l EP5ePVm8,&T2X, +|oM}> O~rEUnM~#jOicJ@2Yus %%EOF Most measure score changes between the 2022 and 2023 Star Ratings were small overall in both directions. Additionally,NCQA invites you to join HEDIS Users Group forinside information on HEDIS development and future directions. Other changes assure that HEDIS will be useful, valid and reliable for a new era of medicine. Thismeasurewillallowplanstounderstandifadvancecareplanningisprovidedtobeneficiarieswhoaremostlikelytobenefitfromit. Additionally,NCQA invites you to join HEDIS Users Group forinside information on HEDIS development and future directions. 0000022148 00000 n Accountable health care requires both measurement and transparency. 0000012465 00000 n HEDIS data help identify performance gaps and establish realistic targets for improvement. More than 200 million people are enrolled in plans that report HEDIS results. Withthisdeprescribing measure, there isan opportunityto promote harm reduction by assessing progress in appropriately reducing benzodiazepine use in the older adult population. hXmTW3`IBH5@) ZmmP)pZA;H)Tt=lM"VPH`[[Z?j]MTz NCQA collects HEDIS data from health plans and other health care organizations. endstream endobj startxref gbv[Dp[,tkg`h`PR``46R @0ft@ ublH$`@K WH@uX^$28C23n`Rbts&H-dpo]n0ch K$l7@ LD%@H00r'UvU h# . 0000009685 00000 n To learn more, click here for a discussion of this new measure. MY 2002 was the yearfirst that follow-up rates were reported. 0000007450 00000 n m="=jVvyNc{ endobj 0000006694 00000 n The HEDIS measurement set is sponsored, supported and maintained by NCQA. 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. 1343 0 obj <>/Filter/FlateDecode/ID[<2D87A2A235A2694FB1EEAE97FC4AEC75>]/Index[1320 39]/Info 1319 0 R/Length 109/Prev 246119/Root 1321 0 R/Size 1359/Type/XRef/W[1 3 1]>>stream means youve safely connected to the .gov website. More than 200 million people are enrolled in plans that report HEDIS results. {+Ed. 0000001946 00000 n endobj 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. endstream endobj 30 0 obj <>stream endstream endobj startxref HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). HtTYO@~e/wysRx MHS leadership and healthcare providers continually assess clinical performance data to ensure beneficiaries receive safe, high quality care in military treatment facilities (MTFs) and TRICARE network hospitals. Secure .gov websites use HTTPSA ). Part D measures are displayed in Tables 2 and 3 for MA-PD and PDP contracts, respectively. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. SUMMARY TABLE OF MEASURES, PRODUCT LINES AND CHANGES . 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. 0000004562 00000 n That is why we publish what we learn from HEDIS in many forums and formats. . (7/1/prior yr. - 6/30/measurement year). 0000016906 00000 n Three of the four diabetes measures rate at the JFIF ` ` C from January to May for the prior year. endobj An official website of the United States government 0000022424 00000 n 0000000016 00000 n ,wBInd!d98{9|/.Y1&7wULt~s`GgvXT\/T}[_}bVT=TXk;e*ZkQXH#7hUxQ"zZdP> 0000008673 00000 n . hb```@(1iNlpiK Y_LjV_0`II:~|=0f8+~'8eW!Izw(I~>rIq9NM>8>N7*ksO6Qg4h%&. %%EOF G-3245 Beecher Road Flint, Michigan 48532 Table 1: Changes in Part C Measure Scores from 2021 to 2023 Star Ratings for MA Contracts 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 click here for a discussion of this new measure. ?^>&d;ijSl+EPe7"z_?0Kx)uQ Intent:Advancecareplanningisassociatedwithimprovedqualityoflife,increasedprovidertrustanddecreasedhospitalization. NCQA defines how data can be collected for a measure: xPX]NG&)R.ng} (1$JMYpwV:] 0000004692 00000 n <> 1 0 obj ThiseffortbuildsonNCQAsexistingworkdedicatedtotheadvancinghealthequityindataandqualitymeasurement. }{7wi\vLU#)J1i#} ;?0L1$Zh\D#$M},[Na_MxQ~+EYs}VgeWPL;hhWs, k>^c-sNWAOHKd3:o For the numerator, NCQA allowed follow-up visits with SUD indicated in any diagnosis position; and added pharmacotherapy for alcohol or opioid use disorder; and incorporated outpatient or telehealth visits, for a diagnosis of drug use or overdose; services defined as addressing substance use (per CPT code description), without a diagnosis requirement; visits where a behavioral health assessment or screening is performed; outpatient or telehealth visits with a mental health provider; and substance use services provided by a peer recovery support specialis. Anticipated Release Date: July 2023. To learnmore, clickherefor a discussion ofthe stratification, how we arrived atthiscurrentpoint andFAQs. Advancecareplanningisassociatedwithimprovedqualityoflife,increasedprovidertrustanddecreasedhospitalization. 0000009572 00000 n ("$e 0)*[sNwL(((((()#(1/I\HlQ3F7n6 e#+}:~9'M]Fn*m(jfe Z)TRPQZWV+9F x_O. For the denominator, NCQA added ED visits for unintentional or undetermined overdose for commonly used drugs with addiction potential in any diagnosis position. 51 0 obj <>stream For example, 2022 claims, encounters, and other HEDIS data are submitted throughout 2022. 26 0 obj <> endobj 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. 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. HEDIS MY2022. akJ9d&'(o,N|cV& }3~_UEiP VA outpatient measures closely follow the specifications set forth by the National Committee for Quality Assurance (NCQA), Healthcare Effectiveness Data and Information Set (HEDIS). Pn MS% 9W4=9Hu-]Sy+G'5} I!Orx*YtK5"Y"}w l_Zqypx -kind&gW%dj56u|x;cIInF7J^u$SqISS:th6 m%64SxllMjD(oh+z As low as $6,835.25. 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 Communications Every year, NCQA updates and releases the Healthcare Effectiveness Data and Information Set (HEDIS). In January to May of 2023, data for 2022 continues to be submitted along with Medical Record review for Hybrid measures and final HEDIS 2022 rates and results are reported. } !1AQa"q2#BR$3br [ That makes HEDIS one of health cares most widely used performance improvement tools. Ylyr2fi4vVDlhV]Zk:6d,,y+kQ. HUG members are health care professionals who produce, report and interpret HEDIS data. 0000051029 00000 n ComprehensiveDiabetesCare/HemoglobinA1cControlforPatientsWithDiabetes,EyeExamPerformedforPatientsWithDiabetes,BloodPressureforPatientsWithDiabetes. You can decide how often to receive updates. 0000017889 00000 n NCQAwillconcentrateeffortsontheoutcome-basedHbA1cControlforPatientsWithDiabetesmeasure. To be able to identify andreduce disparitiesin care, the first step must be measuring and reportingon. Sign up to get the latest information about your choice of CMS topics. 0000133484 00000 n lock Quality Compass 2022 includes certain CAHPS data. xKK@ { a;;:/DCXlcf_YB^Q(przeq0)# 0y,-h6-2Y=Vf]+[eq[&ge1heucd;)CzGE"z&D%z`SS?I1ZOFb ?=xb =WV!Nfvb)e:R '$t^OWoM9o{$)GlCeSkftDJbR2$n{Y4O}0m$&pmT|yQ;x/8Z$[G@MY?mcwo;oN:p2 0000011393 00000 n 1067 0 obj <> endobj 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. HEDIS Tip Sheet - Pediatric Measures -Look back period: July 1 of the year prior to June 30 of the measurement year. Save your favorite pages and receive notifications whenever theyre updated. _hRos0Tx|1Ug% The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. 2021 Cigna INT_21_96354_C 919034 c 0000011969 00000 n CJ)8kPqQy!h\ADICp%F$NhG-EL'nU%mQ*1HPl. Follow-UpAfterEmergencyVisitDepartmentVisitforAlcoholandOtherDrugDependence/Follow-UpAfterEDVisitforSubstanceAbuse. (HEDIS) measures that assess quality of health care provided to Blue Shield Promise Medi-Cal members. Copyright 2023 National Committee for Quality Assurance. 2 0 obj 2527 0 obj <> endobj To learnmore, clickherefor a discussion ofthe stratification, how we arrived atthiscurrentpoint andFAQs. Heres how you know. HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). The complete MIPS Quality Measures List published after the PFS final rule does not include Qualified Clinical Data Registry (QCDR) measures as such measures are proposed and selected through a separate process. 1358 0 obj <>stream 1CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). <> 0000035489 00000 n performance. 0000011691 00000 n 0000011150 00000 n endstream endobj 33 0 obj <>stream x Updated Guideline 7: Measurement Period Adjustments. Several clinical guidelinesrecommend deprescribing benzodiazepinesslowlyandsafely, rather thanstopping use immediately,tominimizewithdrawalsymptomsandimprovepatientoutcomes. NCQArevisedthemeasurestructurefromutilizationtodiagnosed-prevalencementalhealthdisordersandupdatedthenameto. hbbd```b``akA$%Xd6dbe`X,,r, f_k0yDV[I vS _"A8^FO 0 E %PDF-1.7 % endobj 9745 36 website belongs to an official government organization in the United States. 0000044978 00000 n 0000010486 00000 n 0000024625 00000 n 0000002938 00000 n 9 0 obj 0000002169 00000 n %PDF-1.6 % 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) SNPs can use HEDIS performance data to identify opportunities for improvement, monitor the success of quality improvement initiatives, track improvement and provide a set of measurement standards that allow comparison with other plans. %PDF-1.6 % Optum Managed Transplant Program. 0000007996 00000 n 0000045019 00000 n <<1EA954AB0783464B894F5E09E2AC546B>]/Prev 295107/XRefStm 1946>> 0000014293 00000 n 0000008708 00000 n Np1W>?,Y{ 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. The Rules for Allowable Adjustments are included in the HEDIS Volume 2 publication after the applicable HEDIS measure specifications. endstream HEDIS Measure - Term for how each domain of care is further broken down. The 90th percentile is the benchmark for the HEDIS measures. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). HEDIS measures performance in health care where improvements can make a meaningful difference in peoples lives. DeprescribingofBenzodiazepinesinOlderAdults. CMS contracts with NCQA to collect Healthcare Effectiveness Data and Information Set (HEDIS) measures from Medicare Special Need Plans (SNPs). 0000000016 00000 n hb``` rB cc`ahpb`QN`|A(WY2c0Oeox%{$M94 NSqo 6 0 obj 1311 0 obj <>stream <> HEDIS MY 2022 Measures Applicable to: Commercial Medicaid Medicare Changes for HEDIS MY 2022 General Guidelines for Data Collection and Reporting ( Avoidance of Antibiotic Use. ND-)8^r|\q=.Kx.!J"G8IE 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. HEDIS Measures. 0000107074 00000 n 1105 0 obj <>/Filter/FlateDecode/ID[]/Index[1067 245]/Info 1066 0 R/Length 162/Prev 876729/Root 1068 0 R/Size 1312/Type/XRef/W[1 2 1]>>stream Utilization and Risk Adjusted Utilization. Quality Compass 2023 Medicaid-Trended Data (MY 2022, MY 2021) As low as $5,220.25. HEDIS Technical Specifications include a complete list of new and updated HEDIS measures with instructions on data collection and guidelines for calculations and sampling. This process ensures that HEDIS measures remain relevant and feasible for implementation. InitiationandEngagementofAlcoholandOtherDrugAbuseorDependence. 0000036100 00000 n NCQAnowcollectsthenewAntibioticsforRespiratoryConditionsmeasure. HSn0+THK[iF(P=2@oA.kY"cL@YG6u}(K]*-50 j"1J0B(E$akG) stream Follow-UpAfterEDVisitforSubstanceUse. endobj Table 4: PCCP HEDIS Performance Measures - MY 2021 . II . HSMk@WHM[Zl8 p ccwVrLCV{6GfP!Kh~&)/uY>ak9 HEDISpublicationsareavailableas electronic publications. Quality Compass 2023 Medicaid-Trended Data (MY 2022, MY 2021) with Data Exporter. For full specifications, visit the NCQA store. the HEDIS Measurement Year (MY) 2020 & 2021 Volume 2 Technical Speciications. Official websites use .govA 0000015158 00000 n 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. 0 endstream endobj startxref endobj 0000010005 00000 n Quality Rating System Measure Technical Specifications are unique to the issuers offering plans on the Exchange and participating in the CMS Quality Rating System (QRS). S/K[ AOIp stream 0000017732 00000 n <> All other uses of the UB Codes require a license from the AHA. ElectronicClinicalDataSystem(ECDS)Reporting. NCQA screens, trains and certifies organizations that collect or audit data for health plans and providers. Healthcare Efectiveness Data and Information Set (HEDIS ) rates can be calculated in two ways: administrative data or hybrid data. 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. 0 hb```b``{ B@16=(?6vl& $. Wellcare dng cookie. Initiation and Engagement of Substance Use Disorder Treatment; changed the measurefrommember-basedtoepisode-based; changed thedenominatortolengthenthenegativeSUDhistoryperiodfrom60daysto194daysandremoveEDvisitsandmedicallymanagedwithdrawalfromthenegativeSUDhistoryperiod;removed the numerator requirementthatpsychosocialtreatmentaccompanypharmacotherapy; and revisedtheagestratificationstoreflectages1864yearsand65+years. The rules provide flexibility for evaluating different populations without altering measures clinical intent (e.g., removal of continuous enrollment or product-line criteria). NCQAintroducedraceandethnicitystratificationstofiveHEDISmeasures: Colorectal Cancer Screening, Controlling High Blood Pressure, Hemoglobin A1c Control for Patients with Diabetes, Prenatal and Postpartum Care, and Child and Adolescent Well Care Visits, NCQAplanstoexpandtheraceandethnicitystratificationstoadditionalHEDISmeasuresoverseveralyearstohelp, disparitiesincareamongpatientpopulations. endstream endobj 4921 0 obj <. 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:
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