NCQA invites the public to comment on proposed changes to the required measures list for 2025 and 2026 Health Plan Ratings.
NCQA Health Plan Ratings evaluate commercial, Medicare and Medicaid health plans based on the quality of care patients receive, patient satisfaction with their care and health plans’ efforts to continuously improve. Ratings are updated annually to ensure consumers have the most accurate information about health plan quality and performance to make informed choices about their care.
A key concern for any quality rating tool is the certainty of its judgment—we want to ensure that plans assigned a higher value truly deserve it. If the rating system includes redundant measures, or measures with poor statistical properties, it may risk rewarding random variation over true quality differences.
NCQA uses comprehensive measure selection criteria to determine which HEDIS® and CAHPS® measures are proposed for inclusion in or removal from Health Plan Ratings. These criteria ensure that all measures exhibit desirable statistical properties, are utilized in programs and value-based payment initiatives, address risk-adjusted health care utilization and eliminate redundancy.
We now seek the public’s feedback on these proposed changes.
Submit CommentsRecommendations for Health Plan Ratings 2025
- Remove the following measures:
| Measure | Commercial | Medicare | Medicaid |
|---|---|---|---|
| Medical Assistance With Smoking and Tobacco Use Cessation (MSC)—Advising Smokers and Tobacco Users to Quit | Remove | ||
| Pharmacotherapy for Opioid Use Disorder (POD) | Keep | Remove | Keep |
| Hospitalization Following Discharge From a Skilled Nursing Facility (HFS)—30-Day | Remove |
Proposed changes are based on results from HEDIS measurement year 2024.
Recommendations for Health Plan Ratings 2026
- Revise the following measures:
| Replace Measure… | With… | Commercial | Medicare | Medicaid |
|---|---|---|---|---|
| Childhood Immunization Status (CIS)— Combination 10 | Childhood Immunization Status (CIS-E)—Combination 10 | |||
| Immunizations for Adolescents (IMA)—Combination 2 | Immunizations for Adolescents (IMA-E)—Combination 2 | |||
| Cervical Cancer Screening (CCS) | Cervical Cancer Screening (CCS-E) |
- Remove the following measures:
| Measure | Commercial | Medicare | Medicaid | |
|---|---|---|---|---|
| AMM | Antidepressant Medication Management | |||
| CAHPS | Rating of Personal Doctor | |||
| CAHPS | Rating of Specialist Seen Most Often | |||
| CWP | Appropriate Testing for Pharyngitis | |||
| URI | Appropriate Treatment for Upper Respiratory Infection | |||
| PCE | Pharmacotherapy Management of COPD Exacerbation—Systemic Corticosteroid | |||
| Pharmacotherapy Management of COPD Exacerbation—Systemic Corticosteroid | ||||
| PSA | Non-Recommended PSA-Based Screening in Older Men | |||
| OSW | Osteoporosis Screening in Older Women | |||
| LBP | Use of Imaging Studies for Low Back Pain | |||
- Add the following new measures:
| Measure | Commercial | Medicare | Medicaid | |
|---|---|---|---|---|
| W30 | Well-Child Visits in the First 30 Months of Life—Well-Child Visits in the First 15 Months | |||
| Well-Child Visits in the First 30 Months of Life—Well-Child Visits for Age 15 Months–30 Months | ||||
| WCV | Child and Adolescent Well-Care Visits | |||
Proposed changes are based on results from HEDIS measurement year 2025.
Documents:
- 2025/2026 Health Plan Ratings Overview Memo.
- Appendix 1: Proposed 2026 Health Plan Ratings Measure List.
What Is Public Comment?
NCQA shares these updates for public comment to generate thoughtful commentary and constructive suggestions from interested parties. Many comments lead to changes in our standards and policies, and the review process makes our standards stronger for all stakeholders. NCQA asks respondents to consider whether the requirements are feasible as written and are clearly articulated, and to highlight areas that might need clarification.
How to Comment
NCQA reviews all feedback submitted during the public comment period. Submit all comments through NCQA’s public comment website. NCQA does not accept comments via mail, email or fax.
- Go to My NCQA.
- Once logged in, click to select Public Comments.
- Click Add Comment to open the comment box.
- Select the following from the drop-down box:
- 2025 and 2026 Health Plan Ratings
- Click the Instructions link to view public comment materials, including instructions and proposed measure specifications.
- Click to select the Topic and Element (measure) on which you want to comment.
- Click to select your support option (e.g., Support, Do not support, Support with modifications.
Note: If you chose Do not support , include the reason in the text box. If you chose Support with modifications, enter suggested modifications in the text box. - Enter your comments in the Comments box.
Note: Comments may not be more than 2,500 characters. We suggest you develop comments in Word to check your character limit and save a copy for reference. Use the “cut and paste” function to copy your comment into the Comments box. - Click Submit after each comment. After you have submitted all comments, click Close. You will be able to view and download all your submitted comments.
Submit comments by 11:59p.m. (ET) Tuesday, December 17.
Visit My NCQA to submit comments.