NCQA will add optional sample frame variables to the end of the adult and child HEDIS®[1] CAHPS®[2] sample frame layouts starting in MY 2025:
- Preferred spoken language.
- Claim or encounter with health plan during the MY.[3]
- Whether a member has a primary care provider.[4]
- Whether a member has had at least one visit with a specialty care doctor.[5]
- Member race and ethnicity.[6]
These changes will only impact Medicaid and commercial HEDIS CAHPS sample frames; Medicare sample frames will not be affected. Changes will also be documented in HEDIS MY 2025 Volume 3: Specifications for Survey Measures.
Data collected from these optional variables will be used to help NCQA understand the representativeness of survey respondents. NCQA will use the data to:
- Widen the focus on health equity data quality by comparing plan-provided race and ethnicity data with self-reported data. NCQA will examine the level of agreement (concordance) between the race and ethnicity data provided by health plans with the self-reported race and ethnicity data provided by HEDIS CAHPS survey respondents.Plans that meet reportability criteria (e.g., minimum of 100 respondents per item) will receive a beta report with analysis results in fall 2026.Plans can use this concordance value to assess the quality of their administrative race and ethnicity data. A high level of agreement may indicate that the source of the plan-provided data more accurately represents member self-report, while a low level of agreement could indicate that the plan needs to improve how it obtains race and ethnicity data.
- Examine HEDIS CAHPS nonrespondents and identify potential enhancements to the HEDIS CAHPS data collection protocol. NCQA will analyze the sample frame variables of survey respondents and nonrespondents. This analysis will help NCQA understand the representativeness of respondents compared to non-respondents, and determine whether changes to the HEDIS CAHPS protocol should be considered or implemented to enhance CAHPS data collection (e.g., revisions to sampling).
Although the new variables are optional, NCQA strongly encourages health plans to submit data for the new data elements.
We look forward to partnering with you on this important initiative to improve the HEDIS CAHPS protocol.
Frequently Asked Questions
Why is NCQA asking for these new variables?
NCQA wants to examine the representativeness of respondents to the HEDIS CAHPS survey. The additional variables will provide insight into characteristics of sampled members who participated in the survey vs. those who did not participate. NCQA will use the information to determine changes to the HEDIS CAHPS data collection process, if needed.
What information will we get in return for providing these variables?
NCQA will provide a beta report for plans that meet reportability criteria. We plan to calculate the concordance between the race and ethnicity data provided by plans in the sample frame and the race and ethnicity reported by respondents to the HEDIS CAHPS survey. The concordance value can be used to define the level of agreement between the provided by plans and the self-reported information on the HEDIS CAHPS survey, and help us understand the quality of health plan race and ethnicity data sources.
Are we required to submit these new variables to NCQA?
No. Submission is optional, but we encourage plans to submit any available data. If you do not want to provide the variables to NCQA, please leave the fields blank.
What if I don’t have data available for all my members?
Participating health plans are encouraged to submit data for as many members and variables as are available.
Will health plans be penalized if they submit data for the new variables in the sample frame layout?
No. The fields are currently optional, although NCQA highly encourages plans to submit the variables. NCQA will use the data to evaluate our data collection process.
How will NCQA receive the data for these new variables?
Health plans will submit variables in their HEDIS CAHPS sample frame layout. The sample frame will be provided to the HEDIS Compliance Auditor (if applicable) for review. Once it is validated by the auditor, it will be locked and returned to the plan.
Health plans will securely provide the audited and locked sample frame to their designated survey vendor. After data collection, the survey vendor will append the sample frame data variables to the collected survey data, and submit the data to NCQA via the Interactive Data Submission System (IDSS).
How should we code race and ethnicity data if we don’t know if a member is of a specific race/ethnicity, if the member declined to answer the question or if we don’t have any race/ethnicity data available for the member?
In all these instances, code the data as 9 = Missing/Unknown.
How can we ensure that member confidentiality will be maintained during this process?
All HEDIS CAHPS survey vendors are expected to maintain the confidentiality of sampled members. Survey vendors may not provide the names of members selected for the survey, or any other identifiable enrollee information, to health plans. To further maintain the confidentiality of sampled members, the new data variables will not be included in the de-identified member-level file plans download from IDSS.
When will we receive the beta report?
Beta reports will be distributed to plans in fall 2026, following MY 2025 data submission.
How will the beta report be distributed?
Plans that meet the minimum reporting criteria will receive a beta report through My NCQA.
Will the Medicare population be affected by these changes?
No. The updates will only impact the Medicaid and commercial HEDIS CAHPS.
Contact NCQA
If you have any questions about the new data elements, please refer to the FAQs below, or send your question to the Policy Clarification Support (PCS) system via My NCQA.
[1] HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
[2] CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).
[3] Health care claims or equivalent encounter information transaction will be defined as:
- A request to obtain payment, and the necessary accompanying information from a health care provider to a health plan, for health care, or
- Transmission of encounter information for the purpose of reporting health care, if there is no direct claim.
[4] A primary care provider is a physician or nonphysician (e.g., nurse practitioner, physician assistant, certified nurse midwife) who offers primary care medical services. Licensed practical nurses and registered nurses are not considered primary care providers.
[5] Specialists are defined in alignment with the HEDIS CAHPS survey as surgeons, heart doctors, allergy doctors, skin doctors, and other doctors who specialize in one area of health care.
[6] Member race and ethnicity variables may change in response to the OMB Statistical Policy Directive 15 Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity guidance. Updates to the variable will align with HEDIS MY 2026 Volume 2 (anticipated release August 2025) and published in HEDIS MY 2025 Volume 3 (anticipated release September 2025).