HEDIS® Public Comment Period Is Now Open

February 10, 2022 · NCQA Communications

NCQA’s public comment period is open and ready for your input.

Public comment is an opportunity to weigh in on the relevance, scientific soundness and feasibility of new or revised measures for HEDIS.

NCQA seeks comments on the following:

• New HEDIS measures assessing dental care, social need screening and intervention, diabetes care for older adults.
• Revisions to two measures.
• Retirement of four measures.
• Expansion of race and ethnicity stratifications in select HEDIS measures.

About HEDIS and Public Comment

HEDIS comprises measures of clinical quality and patient experience that are based on published scientific evidence. When new evidence becomes available, NCQA reviews HEDIS measures to determine whether changes may be needed. NCQA convenes multi-stakeholder advisory panels—including independent scientists, clinicians, health plans, purchasers, government and consumer groups—to ensure that measures meet and balance the high standards of relevance, scientific soundness and feasibility.

An important part of developing and updating HEDIS is hearing from the public. NCQA reviews every comment received during public comment and discusses results with stakeholder advisors.

NCQA’s HEDIS measures do not constitute clinical practice guidelines and should not be used to determine insurance or coverage.

Proposed New Measures

Topical Fluoride for Children: Assesses the percentage of children in Medicaid who received at least two topical fluoride applications during the year as a dental or oral health service.

Importance: Topical fluoride helps strengthen teeth and decreases the risk of cavities.

Oral Evaluation, Dental Services: Assesses the percentage of children in Medicaid who received a comprehensive or periodic oral evaluation by a dental provider.

Importance: Good oral health is a key component of a child’s overall health. A primary goal of dental or oral health care is to prevent tooth decay (cavities) caused by dental caries.

Social Need Screening and Intervention: Assesses the percentage of members who were screened for unmet food, housing and transportation needs and received a corresponding intervention if needed.

Importance: Unmet social needs are closely linked to poorer access to care and worse clinical outcomes. It is important to assess for and address social needs to improve overall patient well-being.

Emergency Department Visits for Hypoglycemia in Older Adults With Diabetes: Calculates a risk adjusted ratio of observed-to-expected ED visit

s for hypoglycemia in adults 65 and older with diabetes.

Importance: Older adults are more likely to experience severe hypoglycemia (low blood sugar), leading to fall-related events and fractures, increased risk of cardiovascular events and cognitive decline. Clinical practice guidelines for the treatment of older adults with diabetes emphasize that prevention of hypoglycemia is paramount to patient safety and encourage avoidance of intensive glycemic control.

Proposed Changes to Existing Measures

Adult Immunization Status: Assesses whether adults are up to date on routine immunizations for influenza; tetanus, diphtheria and acellular pertussis (Tdap) and/or tetanus and diphtheria (Td); zoster; and pneumococcal disease. NCQA proposes updating the pneumococcal indicator to include two new vaccines and expanding the age range for reporting across commercial, Medicaid and Medicare plans in accordance with vaccination guidelines (18 and older for influenza and Td/Tdap, 50 and older for zoster and 65 and older for pneumococcal).

Deprescribing of Benzodiazepines in Older Adults: Assesses the percentage of adults 65 and older who were prescribed benzodiazepines and experienced a decrease in benzodiazepine dose. NCQA proposes adding logic to the measure to account for members who achieve 100% discontinuation and may not be currently captured by the ≥20% reduction threshold.

Proposed Measures for Retirement

Frequency of Selected Procedures: Summarizes the utilization of 14 frequently performed procedures that often show variation and have highlighted potential under/overutilization across a range of clinical procedures.

Rationale: Stakeholders have suggested that this long-standing measure may no longer be a useful tool in supporting quality due to reasons such as low use and usability, and high resource burden.

Select CAHPS Measures:

• Flu Vaccination for Adults Ages 18–64: Assesses the percentage of adults 18 and older who self-reported receiving an influenza vaccine within the measurement period.
• Flu Vaccinations for Adults Ages 65 and Older: Assesses the percentage of adults 65 and older who received an influenza vaccination from September–December of the year.
• Pneumococcal Vaccination Status for Older Adults: Assesses the percentage of adults 65 and older who ever received a pneumococcal vaccination.

Rationale: Adult Immunization Status (AIS-E) will be publicly reported in MY 2022, which presents an opportunity to streamline adult immunization measures in HEDIS. Stakeholders have indicated a preference for focusing on the AIS-E indicators and retiring the three CAHPS immunization measures, which rely on patient recall of receiving vaccines.

Cross-Cutting Topic

Expansion of Race and Ethnicity Stratifications in HEDIS: NCQA seeks public comment on expanding race and ethnicity stratifications, specifically, on the set of proposed HEDIS measures to which stratification may be added. NCQA will continue expanding the stratification to additional measures in future years to help increase transparency on differences in quality and reduce disparities in care among patient populations. This effort builds on NCQA’s work dedicated to the advancement of health equity in data and quality measurement.

How to Participate in Public Comment

The public comment period begins at 9:00 a.m. (ET) on February 11 and ends at 5:00 p.m. (ET) on March 11. Visit https://my.ncqa.org/ to submit comments. For details on proposed changes, visit the NCQA website.

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA).

CAHPS^® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).