FAQ Directory: HEDIS

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9.15.2020 Childhood Immunization Status (CIS) Does the live attenuated influenza vaccine (LAIV) vaccination have to be given on the child’s second birthday?

Yes. The LAIV vaccination only counts if it is administered on the child’s second birthday. The minimum age for LAIV is 2 years, so vaccines given before that age do not meet criteria. You can view the recommendation guidelines on the CDC website (https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf).

HEDIS MY 2021

9.15.2020 Controlling High Blood Pressure (CBP) and Comprehensive Diabetes Care (CDC) Do BP readings taken by the member need to meet the member-reported requirements included in General Guideline 39?

No. BPs taken by the member do not need to meet requirements for member-reported data described in General Guideline 39 (collected by a PCP or other specialist while taking the patient’s history). If the BP result is documented in the member’s medical record, it may be used to assess numerator criteria if the BP does not meet any exclusion criteria (bullets at the bottom of page 157 and 195 in HEDIS MY 2020 and MY 2021 Volume 2).

HEDIS MY 2021

9.15.2020 Well-Child Visits in the First 30 Months of Life (W30) & Child and Adolescent Well-Care Visits (WCV) Given that the hybrid reporting option was retired from the W30 and WCV measures, what are the required data elements for supplemental data?

Because W30 and WCV are administrative only, the services and documentation in the supplemental data (e.g., medical record) must be clinically synonymous with the codes in the measure’s administrative specification. The organization determines this and it is reviewed by the auditor. Supplemental data must adhere to requirements in General Guideline 31 of the HEDIS Volume 2 MY 2020 & MY 2021 specifications.

HEDIS MY 2021

9.15.2020 Well-Child Visits in the First 30 Months of Life (W30) & Child and Adolescent Well-Care Visits (WCV) When reporting the W30 and WCV measures using supplemental data, may organizations combine documentation from multiple visits to meet criteria?

No. Combining documentation from multiple visits is not allowed. Medical record data must come from a single date of service and must indicate that a well-care visit occurred that was equivalent to the definition of one of the codes in the Well-Care Value Set.
 

HEDIS MY 2021

8.19.2020 Data Elements Table When reporting a measure as hybrid, should the data element “Number of numerator events by administrative data in eligible population (before exclusions)” be equal to the sum of “Numerator events by administrative data” and “Numerator events by supplemental data”?

Yes. This is true if the organization loads its supplemental data before approval. If the organization does not load its supplemental data until after approval is complete then “Number of numerator events by administrative data in eligible population (before exclusions)” will be equal to “Numerator events by administrative data.”
Appendix 4—Data Element Definitions of the MY 2020 & 2021 Volume 2 Technical Specifications includes an explanation of the data elements and how they are reported.

**This FAQ applies to HEDIS Volume 2 MY 2020 & MY 2021.

HEDIS MY 2021

8.19.2020 Data Elements Table When reporting a measure as hybrid, should the data element “Number of numerator events by administrative data in eligible population (before exclusions)” be equal to the sum of “Numerator events by administrative data” and “Numerator events by supplemental data”?

Yes. This is true if the organization loads its supplemental data before approval. If the organization does not load its supplemental data until after approval is complete then “Number of numerator events by administrative data in eligible population (before exclusions)” will be equal to “Numerator events by administrative data.”
Appendix 4—Data Element Definitions of the MY 2020 & 2021 Volume 2 Technical Specifications includes an explanation of the data elements and how they are reported.

**This FAQ applies to HEDIS Volume 2 MY 2020 & MY 2021.

HEDIS MY 2020

8.19.2020 Prenatal and Postpartum Care If a member has multiple enrollment segments without any gaps leading up to the delivery date, should we use the beginning of the first such segment as the start of the last enrollment segment?

Yes. Use the beginning of the first segment as the start of the last enrollment segment. For HEDIS Volume 2 MY 2020 & 2021, multiple enrollment segments with no gaps are treated the same as one enrollment segment with no gaps.

**This FAQ applies to HEDIS Volume 2 MY 2020 & MY 2021.

HEDIS MY 2021

8.19.2020 Prenatal and Postpartum Care Do telehealth visits meet criteria for both rates and for both data collection methods?

Yes. Services provided during a telephone, e-visit or virtual check-in are eligible for use in reporting for both rates (Timeliness of Prenatal Care and Postpartum Care) and for both data collection methods (administrative and hybrid).

**This FAQ applies to HEDIS Volume 2 MY 2020 & MY 2021.

HEDIS MY 2021

8.19.2020 Weight Assessment and Counseling for Nutrition and Physical Activity for Children/ Adolescents Do telehealth visits meet criteria for the components of the BMI percentile indicator?

Yes. Member-reported biometric values (height, weight, BMI percentile) collected during a telephone visit, e-visit or virtual check-in that meet the requirements of General Guidelines 39: Member-Reported Services and Biometric Values are eligible for use in reporting. 

**This FAQ applies to HEDIS Volume 2 MY 2020 & MY 2021.

HEDIS MY 2021

8.19.2020 Controlling High Blood Pressure Does the medical record documentation need to state the BP was taken with a digital device?

Documentation does not need to specifically state the BP was taken with a digital device or that it was not taken with a manual blood pressure cuff and stethoscope.

**This FAQ applies to HEDIS Volume 2 MY 2020 & MY 2021.

HEDIS MY 2021

8.19.2020 Palliative Care Exclusion May supplemental and medical record data be used to identify members for the Palliative Care exclusion?

Yes. Although the required palliative care exclusion is intended to be identified using administrative data, medical record and supplemental data may also be used. If a member is identified as being in palliative care during hybrid medical record review, the member must be removed from the sample and replaced with a member from the oversample. Count the member in the “Number of medical records excluded because of valid data errors” data element.

If organizations use supplemental data to remove members in palliative care from administrative-only measures or hybrid measures, they must follow the supplemental data guidelines (General Guideline 31). Count these members in the “Number of required exclusions” data element.

**This FAQ applies to HEDIS Volume 2 MY 2020 & MY 2021.

HEDIS MY 2021

4.28.2020 COVID-19 If an organization opts not to report for HEDIS 2020, may it use its HEDIS 2019 (MY 2018) audited reportable hybrid rates when considering sample size reduction for HEDIS MY 2020 reporting?

Yes. Due to changes in reporting requirements because of COVID-19, organizations that do not report HEDIS 2020 results this year may use their audited HEDIS 2019 (MY 2018) reportable hybrid rates when considering sample size reduction rules for HEDIS MY 2020 reporting. In addition, if an organization is required to report their MY2019 administrative rate for HEDIS 2020, they will still be able to use their audited HEDIS 2019 (MY 2018) reportable hybrid rates when considering sample size reduction.

 

HEDIS 2020