HEDIS® Public Comment Period Is Now Open

February 13, 2025 · NCQA Communications

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

NCQA seeks public feedback on proposed new measures, changes to existing measures and measure retirements, and NCQA acknowledges that the health care policy environment is rapidly evolving at this time. Reviewers are asked to submit comments to NCQA in writing via the Public Comment website by 5:00 p.m. (ET), Thursday, March 13. NCQA will take into account all comments received and the evolving environment as NCQA moves forward to prepare the final versions of these measures.

NCQA seeks comments on the following:

• Three new HEDIS measures.
• Revising six HEDIS measures.
• Retiring one HEDIS measure.
• Cross-cutting item for HEDIS to align with federal standards for race and ethnicity.
• Three new measures for the Diabetes Recognition Program.

About HEDIS and Public Comment

HEDIS measures of clinical quality and patient experience are based on scientific evidence. When new evidence becomes available, NCQA reviews the measures to determine if 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 all comments received during public comment and discusses results with stakeholder advisors.

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

Proposed New HEDIS Measures

Follow-Up After Acute Care Visits for Asthma. Assesses the percentage of acute visits (urgent care, ED, inpatient or observation stays) for asthma in members 5–64 years of age who had a corresponding outpatient follow-up visit within 30 days.

• Importance: Studies show that individuals with asthma frequently utilize acute care for asthma exacerbations, which is an indicator of poorly controlled asthma. Guidelines recommend patients follow up with their primary care doctor after an acute asthma event to assess asthma control and review medication.

Tobacco Use Screening and Cessation Intervention: Assesses the percentage of members 12 years of age and older who were screened for tobacco use once or more during the measurement period and received tobacco cessation intervention during the measurement period, or the 180 days prior to the measurement period, if identified as a tobacco user.

• Importance: Tobacco use among adolescents and adults is widespread in the U.S. and causes severe morbidity and mortality. Appropriate screening for tobacco use and cessation intervention has been shown to reduce tobacco use and improve health outcomes.

Disability Description of Membership: Assesses the count of members 15 years of age and older enrolled any time during the measurement year, with disability status information by data source and disability type.

• Importance: Individuals with disabilities experience significant gaps in care, which can eventually lead to worse health outcomes. Collecting disability status data is the initial step to identifying this population and the disparities that they face, but current efforts to compile the data can be limited and/or incomprehensive. A quality measure that aims to improve the completeness and standardization of these data could address disparities that affect individuals with disabilities.

Proposed Changes to Existing HEDIS Measures

Social Need Screening and Intervention: Assesses the percentage of members who were screened for unmet food, housing and transportation needs using prespecified instruments, or assessed by a provider, at least once during the measurement period, and who received a corresponding intervention after a positive screen. NCQA proposes adding Healthcare Common Procedure Coding System (HCPCS) G and International Classification of Diseases, Tenth Revision (ICD-10) Z codes to the measure to improve health plans’ ability to report performance data. NCQA also proposes removing assessments from the list of allowable interventions and related value sets.

Adult Immunization Status: Assesses whether adults 19 years of age and older are up to date on routine immunizations. Includes separate rates for influenza; tetanus, diphtheria and acellular pertussis (Tdap) or tetanus and diphtheria (Td); zoster; pneumococcal; and hepatitis B immunization. NCQA proposes adding a new indicator to assess COVID-19 immunization status for adults 19 and older.

Lead Screening in Children: Assesses the percentage of members 2 years of age who had one or more capillary or venous lead blood test for lead poisoning by their second birthday. NCQA proposes transitioning this measure to be reported using only the Electronic Clinical Data Systems (ECDS) reporting method.

Follow-Up After High-Intensity Care for Substance Use Disorder: Assesses the percentage of discharges for members 13 years of age and older who had an inpatient hospitalization, residential treatment or withdrawal management event for treatment of substance use disorder, and had a follow-up visit for substance use disorder. NCQA proposes modifications to the numerator for this measure that update follow-up options and expand diagnosis position.

Statin Therapy for Patients with Cardiovascular Disease (SPC) and Statin Therapy for Patients with Diabetes (SPD): These measures assess whether members with either established atherosclerotic cardiovascular disease (ASCVD) or diabetes received appropriate statin therapy and achieved a medication adherence rate of 80%. Both measures will be transitioned to the Electronic Clinical Data Systems (ECDS) reporting method. For both SPC and SPD, NCQA proposes updates to the approach for identifying members with ASCVD and the removal of the exclusion for members enrolled in an I-SNP or living long-term in an institution. Specific to SPC, NCQA recommends the removal of sex-specific age bands to include all members aged 21-39 and the inclusion of members aged 76-85.

HEDIS Measure Retirement

Asthma Medication Ratio: The percentage of members 5–64 years of age who were identified as having persistent asthma and had a ratio of controller medications to total asthma medications of ≥0.50 during the measurement period.

Cross-Cutting Item for HEDIS

Alignment with Updated Federal Standards for Race and Ethnicity: NCQA seeks public comment on the proposed alignment of the HEDIS race and ethnicity stratification with 2024 updates to the Office of Management and Budget Statistical Policy Directive No. 15: Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity. Planned updates include adding “Middle Eastern or North African” as a minimum reporting category; updating terminology describing race/ethnicity options; combining race and ethnicity into a single reporting unit; and including a category to capture the quality of care provided to multiracial/multiethnic members.

Proposed New Measures for the Diabetes Recognition Program

Diabetes Recognition Program—Statin Therapy Prescription: This provider-level performance measure in the Diabetes Recognition Program assesses the percentage of patients 40–75 years of age with diabetes who had evidence of statin therapy during the measurement period.

• Importance: Individuals with diabetes are at increased risk of high levels of low-density lipoprotein (LDL) cholesterol. Reduction in LDL cholesterol lowers the risk of heart disease, stroke and atherosclerotic cardiovascular disease.

Diabetes Recognition Program—Depression Screening and Follow-Up: This provider-level performance measure in the Diabetes Recognition Program assesses the percentage of patients 18–75 years of age with diabetes who received appropriate screening and follow-up for clinical depression during the measurement period.

• Importance: Individuals with diabetes are 2–3 times more likely to experience depression than those without diabetes. Identification and treatment of clinical depression can improve patients’ treatment adherence and reduce depression-related health outcomes.

Diabetes Recognition Program—Continuous Glucose Monitoring Utilization: This provider-level utilization measure in the Diabetes Recognition Program assesses the percentage of patients 18–75 years of age with evidence of continuous glucose monitoring (CGM) utilization during the measurement period. CGM utilization is assessed in two measure rates: Individuals with type 1 diabetes; individuals not captured in rate 1 with use of basal insulin, multiple daily injections or continuous insulin infusion.

• Importance: CGM devices provide real-time monitoring of glucose levels, enabling patients to take timely corrective actions when needed. Assessing CGM utilization enhances data collection and provides valuable insights into the populations utilizing CGM devices.

How to Participate in Public Comment

The public comment period ends at 5:00 p.m. (ET) on Thursday, March 13. Visit My NCQA to submit comments. For details on proposed changes, visit the NCQA website.

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