Rhode Island Medicaid Managed Care Page 48 of 69 2021 External Quality Review Technical Report . [ HEDIS CHEAT SHEET 2022 - 2023 Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents: Documented yearly for ages 3-17. Anticipated Release Date: September 2023. Optum Managed Transplant Program. NCQArevisedthemeasurestructurefromutilizationtodiagnosed-prevalenceofsubstanceuseandupdatedthenameto. 0000007996 00000 n Rate 2: Two additional well-child visits 15 to 30 months. Updates on HEDIS Measures MY2022. As low as $16,810.25. X `q@ A`J~m ]l b| 0jHX=x3||DqGTt|\V~Fu3c,$;$c9 -Kd"bv.CXb%*qS-J`}V1h(l1y|8Tr46hOJ For MY 2022, HEDIS added three new measures, retired three measures/indicators and changed seven existing measures and two cross-cutting topics that address enhancements across multiple measures. We do not share your information with third parties. The UB Codes contained in the HEDIS specifications may be used by health plans and other health care delivery organizations for the purpose of calculating and reporting HEDIS measure results or using HEDIS measure results for their internal quality improvement purposes. Quality Compass 2022 includes certain CAHPS data. 0000068208 00000 n Patient-Centered Specialty Practice (PCSP), Credentials Verification Organization (CVO), Managed Behavioral Healthcare Organization (MBHO), Health Information Technology Prevalidation Programs, Virtual Seminars, Webinars and On-demand Training, Advertising and Marketing Your NCQA Status. The 90th percentile is the benchmark for the HEDIS measures. <> b~GiQ">sTMj 2p1IcvIwsudr Follow-UpAfterEmergencyVisitDepartmentVisitforAlcoholandOtherDrugDependence/Follow-UpAfterEDVisitforSubstanceAbuse. 0000008982 00000 n This process ensures that HEDIS measures remain relevant and feasible for implementation. Advancecareplanningisassociatedwithimprovedqualityoflife,increasedprovidertrustanddecreasedhospitalization. Table 7a: CHIP-MCO Results for 2022 (MY 2021) HEDIS Measures CHIP-MCO cytology performed between 2020-2022. Quality Compass 2023 Medicaid-Trended Data (MY 2022, MY 2021) with Data Exporter. 1105 0 obj <>/Filter/FlateDecode/ID[]/Index[1067 245]/Info 1066 0 R/Length 162/Prev 876729/Root 1068 0 R/Size 1312/Type/XRef/W[1 2 1]>>stream ?^>&d;ijSl+EPe7"z_?0Kx)uQ endobj <> hUYk@+R=`;Q&8[[Ewfq= F$\ S4x2$ !\DDFk-bG,"imAsL]KA$D1UdlG:ibkz3OvDn svD~0${xH4XMs\x-'IkMg51za#A3h!7O,-0Yn "71*~sK(_~KutedF},&KVL}Ve>Yj`SQC}OWpt\c7Ij][ K=[> 2527 0 obj <> endobj 0000004794 00000 n HEDIS measures performance in health care where improvements can make a meaningful difference in peoples lives. hbbd```b``"gIw ""7|-``qT3l0; fH0DHI@H_mj> _ Follow-UpAfterEDVisitforSubstanceUse. Terms of Use, Every year,NCQA updates and releases the Healthcare Effectiveness Data and Information Set (HEDIS. %%EOF Healthcare Efectiveness Data and Information Set (HEDIS ) rates can be calculated in two ways: administrative data or hybrid data. endstream 0000016906 00000 n Rates for the HEDIS measures were compared to corresponding Medicaid percentiles; comparison results are provided in the tables. 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 The information provided in this HEDIS QRG is to help you improve your practice's HEDIS rates. This table contains the measures and brief descriptions that are included in HEDIS MY 2022. 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. 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 hb```@(1iNlpiK Y_LjV_0`II:~|=0f8+~'8eW!Izw(I~>rIq9NM>8>N7*ksO6Qg4h%&. Most measure score changes between the 2022 and 2023 Star Ratings were small overall in both directions. You can decide how often to receive updates. 0000044978 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. 0000022424 00000 n II. 0000001386 00000 n This manual describes in detail only the NYS-specific measures. 0000010005 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. 0000015971 00000 n A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. Overview of the HEDIS measurement set and how the data are used. 0000050943 00000 n 9745 36 * Measures from HEDIS and CAHPS used data from the 2020 Star Ratings (collected in 2019 and unaffected by the COVID-19 PHE). To learn more. %PDF-1.6 % 5 0 obj Immunization Schedules. 8 0 obj II . NCQAs HEDIS Value Set Directory (VSD) includes the necessary third-party codes for use with adjusted measure specifications. %%EOF 0000006694 00000 n } !1AQa"q2#BR$3br For MY 2022, HEDIS added three new measures, retired three measures/indicators and changed seven existing measures and two cross-cutting topics that address enhancements across multiple measures. We do not share your information with third parties. 0000004562 00000 n Copyright 2023 National Committee for Quality Assurance. Additionally,NCQA invites you to join HEDIS Users Group forinside information on HEDIS development and future directions. hbbd```b``akA$%Xd6dbe`X,,r, f_k0yDV[I vS _"A8^FO 0 E For example, 2022 claims, encounters, and other HEDIS data are submitted throughout 2022. Intent:Advancecareplanningisassociatedwithimprovedqualityoflife,increasedprovidertrustanddecreasedhospitalization. andaddedtwocross-cuttingexclusions:palliativecareandadvancedillness/frailty. stream 0000032016 00000 n For full specifications, visit the NCQA store. %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz startxref 0000010840 00000 n HEDIS nonsurvey measures for organizations; instructions on data collection for each measure; general guidelines for calculations and sampling. reportingforthreeHEDISmeasures:Childhood Immunization Status, Immunizations for AdolescentsandMetabolic Monitoring for ChildrenandAdolescents on Antipsychotics. ComprehensiveDiabetesCare/HemoglobinA1cControlforPatientsWithDiabetes,EyeExamPerformedforPatientsWithDiabetes,BloodPressureforPatientsWithDiabetes. InitiationandEngagementofAlcoholandOtherDrugAbuseorDependence. 0000004692 00000 n HEDIS Measure - Term for how each domain of care is further broken down. (HEDIS) measures that assess quality of health care provided to Blue Shield Promise Medi-Cal members. % Access/Availability of Care. HSMk@WHM[Zl8 p ccwVrLCV{6GfP!Kh~&)/uY>ak9 {+Ed. <> 1320 0 obj <> endobj 0000016920 00000 n Formoreinformation,refertothefullmeasurespecificationsinHEDISMY2022. Visitors to this page often checkHEDIS FAQsor ask a question throughMyNCQA. akJ9d&'(o,N|cV& }3~_UEiP Health Plan Descriptive Information. 0000007305 00000 n %PDF-1.7 % AdvanceCarePlanningIndicator. performance reported in the 2022 Quality Compass (measurement year 2021) . More than 200 million people are enrolled in plans that report HEDIS results. 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. Visitors to this page often check HEDIS FAQs, QRS FAQs, or ask a question through My NCQA. High-qualityhealthcaremustbeequitablehealthcare. hWO`06~@)N@&d.6l5@[)"$$dm29R1$2.K3LH(y ]3SISTM}~/'Ys9Z @ R M+[|Qs0@!| T8E#F>x=-g? DeprescribingofBenzodiazepinesinOlderAdults. endobj 9745 0 obj <> endobj xref h^3VN,vAO]{Q@v gK2CxD]*{Dv= Px k7j^AEE]iQcWA/]?N8MhIB HA]2kNHAE Vc"c)\v1s9]OA2mJ)$'8 0000014654 00000 n %PDF-1.6 % 0000018052 00000 n 0000011150 00000 n HEDIS Measures. 7 0 obj UseofImagingStudiesforLowBackPain. NCQArevisedthemeasurestructurefromutilizationtodiagnosed-prevalencementalhealthdisordersandupdatedthenameto. 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. 0000008708 00000 n NCQA's Risk Adjustment Tables (the "Tables") and any related documentation (collectively, the "Product"). List and define all quantifiable measures used in this activity. endstream endobj startxref click here for a discussion of this new measure. NCQA revised this risk-adjusted outcome measure to exclude planned hospitalizations and updated it to remove separate Medical and Surgical reporting categories, retaining the Total rate (which includes medical and surgical admissions). To be able to identify andreduce disparitiesin care, the first step must be measuring and reportingon. 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 HUG members are health care professionals who produce, report and interpret HEDIS data. HtTYO@~e/wysRx 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. Initiation and Engagement of Substance Use Disorder Treatment; changed the measurefrommember-basedtoepisode-based; changed thedenominatortolengthenthenegativeSUDhistoryperiodfrom60daysto194daysandremoveEDvisitsandmedicallymanagedwithdrawalfromthenegativeSUDhistoryperiod;removed the numerator requirementthatpsychosocialtreatmentaccompanypharmacotherapy; and revisedtheagestratificationstoreflectages1864yearsand65+years. 0000004757 00000 n 0000009251 00000 n 0000012465 00000 n hb```b``{ B@16=(?6vl& $. 0000009685 00000 n S/K[ AOIp Trackingantibioticprescribingforallacute respiratory conditionswillprovide context about a healthplansoverall antibiotic use when viewedwiththree HEDIS measures ofappropriatetesting and inappropriate prescribing for upper respiratory infections, pharyngitis and acute bronchitis. Volume 2:Technical Specifications for HealthPlans. 0000001035 00000 n Withthisdeprescribing measure, there isan opportunityto promote harm reduction by assessing progress in appropriately reducing benzodiazepine use in the older adult population. the HEDIS Measurement Year (MY) 2020 & 2021 Volume 2 Technical Speciications. o GRs_$ [EN=_sRs 1F/T ? Technical specifications for the Health Outcomes Survey (HOS). Table 1: Changes in Part C Measure Scores from 2021 to 2023 Star Ratings for MA Contracts %%EOF Copyright 2023 National Committee for Quality Assurance. 0000047019 00000 n Ylyr2fi4vVDlhV]Zk:6d,,y+kQ. Pn MS% 9W4=9Hu-]Sy+G'5} I!Orx*YtK5"Y"}w l_Zqypx -kind&gW%dj56u|x;cIInF7J^u$SqISS:th6 m%64SxllMjD(oh+z In these cases, age stratifications will differ from HEDIS MY 2021 technical specifications. Automatic . C*@ep!%E#-nb4LM xKK@ { a;;:/DCXlcf_YB^Q(przeq0)# 0y,-h6-2Y=Vf]+[eq[&ge1heucd;)CzGE"z&D%z`SS?I1ZOFb ?=xb =WV!Nfvb)e:R '$t^OWoM9o{$)GlCeSkftDJbR2$n{Y4O}0m$&pmT|yQ;x/8Z$[G@MY?mcwo;oN:p2 Visitors to this page often check HEDIS FAQs, QRS FAQs, or ask a question through MyNCQA. Members can access the latest news about measuring performance and gain insight into how HEDIS evolves. lock t,f`$yF;zXytHo. !3$Y:wn=3. inappropriate prescribing for upper respiratory infections, pharyngitis and acute bronchitis. The technical specifications for organizations providing Medicaid long-term services and supports (LTSS). 4950 0 obj <>stream 26 0 obj <> endobj means youve safely connected to the .gov website. xref hb``` rB cc`ahpb`QN`|A(WY2c0Oeox%{$M94 NSqo 0000011142 00000 n P}^bGx{Q1F b~/>@ e# 2579 0 obj <>stream (7/1/prior yr. - 6/30/measurement year). 0000014293 00000 n NCQA screens, trains and certifies organizations that collect or audit data for health plans and providers. 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. Thismeasurewillallowplanstounderstandifadvancecareplanningisprovidedtobeneficiarieswhoaremostlikelytobenefitfromit. 0000010320 00000 n Medicaid benchmarks displayed in these tables come from NCQA's 2022 Quality Compass for measurement year 2021. ) . HEDIS includes measures for physicians, PPOs and other organizations. Share this page with a friend or colleague by Email. endobj 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. 0000010811 00000 n z.XM)Z- b#|UX&)E#T"5Y2]AmiJR Ju:'GVx w9E,*343P@moN$33XN}jl^F-|]}Z{lRt~wOr$.-ks>:599_zrapw)?OqKTa^th>LM _R`]~%Qyqx` 1~ !9g=SW[h ,3%`~,Z-"3b~lv?.cKQZLHJ*??Y$t)mvdQZt6F^_"g&Oa}t%&QZ./w|PCZE9vG2{m!miVv| Q@?\ti+3#{lgi HEDISpublicationsareavailableas electronic publications. performance reported in the 2022 Quality Compass (measurement year 2021) for all lines of business that reported measurement year 2021 . Measure Changes Care for Older Adults (COA) - -Removed Advanced Care Planning indicator from COA . You will be prompted to log in to your NCQA account. Measures Reported UsingElectronic Clinical Data Systems. 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.
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