Public Comment Open: Changes to 2025 and 2026 Health Plan Ratings
November 15, 2024 · NCQA Communications
NCQA’s public comment period is open and ready for your input on proposed measure updates for Health Plan Ratings. Submit your comments by 11:59 p.m. (ET) on December 17.
NCQA seeks comments on proposed measure changes for:
- 2025 Health Plan Ratings, using results from HEDIS Measurement Year 2024.
- 2026 Health Plan Ratings, using results from HEDIS Measurement Year 2025.
About Health Plan Ratings and Public Comment
NCQA’s Health Plan Ratings evaluate the quality of care provided by commercial, Medicare Advantage and Medicaid health plans. Ratings are updated annually, and provide health consumers with vital, transparent and current information about health plan performance and plans’ commitment to ongoing improvement.
A critical issue for any quality rating tool is the certainty of judgment—we want to be sure that plans assigned a higher value deserve their rating.
NCQA uses comprehensive measure selection criteria to determine which HEDIS® and CAHPS® measures are proposed for inclusion in or removal from Health Plan Ratings. Criteria ensure that all measures exhibit desirable statistical properties, are used in programs and value-based payment initiatives, address risk-adjusted health care utilization and eliminate redundancy.
An important part of developing and updating NCQA Health Plan Ratings is hearing from the public. NCQA reviews all public comments with our internal and external advisors.
Proposed Changes 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.
Proposed Changes for Health Plan Ratings 2026
Revise the following measures by replacing existing measures with ECDS 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—Bronchodilator | ✓ | ✓ | ✓ | |
| 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 | ✓ | ✓ | |
How to Participate in Public Comment
The public comment period ends at 11:59 p.m. (ET) on December 17. To submit comments, go to http://my.ncqa.org and enter your email address and password. Once logged in, scroll down and click Public Comments.
In your comments, please consider whether the requirements are feasible as written and are clearly articulated, and highlight any areas that may need clarification.
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.
