HEDIS

HEDIS MY 2026: What’s New, What’s Changed, What’s Retired

August 1, 2025 · NCQA Communications

The Healthcare Effectiveness Data and Information Set (HEDIS^®) is continuously evolving to represent clinical best practices and support the needs of organizations delivering and coordinating care.

For HEDIS Measurement Year 2026, NCQA updated the measure format, added seven measures, retired two measures, transitioned four measures into Electronic Clinical Data Systems (ECDS) reporting and made smaller changes across multiple measures.

New Year, New Look!

The first feature is the most noticeable: The technical specifications have a new format that aligns with the FHIR^® data standard and is similar to current HEDIS ECDS reported measures. Users have all the information they need to calculate a HEDIS measure, in addition to these updates:

Integration of the clinical evidence base and general guidelines, reducing the need to reference multiple resources.
Adoption of new terms, for consistency with FHIR and to reflect how measures are used; for example:

- We replaced “eligible population” with initial population.
- We replaced “required exclusions” with denominator exclusions.
- We replaced “measurement year” with measurement period.
- We replaced “member” with person.

What’s Not Changing?

We didn’t modify the measures’ intent or requirements. Changes should not affect performance results.

New HEDIS Measures

The newest additions to HEDIS address acute hospitalizations following outpatient surgeries, health plan disability membership make-up, follow-up after acute and urgent care visits for asthma and tobacco use screening and cessation.

Four Risk Adjusted Utilization Measures

Acute Hospitalizations Following Outpatient Orthopedic Surgery (HFO).
Acute Hospitalizations Following Outpatient General Surgery (HFG).
Acute Hospitalizations Following Outpatient Colonoscopy (HFC).
Acute Hospitalizations Following Outpatient Urologic Surgery (HFU).

These measures evaluate the risk-adjusted ratio of observed-to-expected unplanned acute hospitalizations (inpatient and observation stays) for any diagnosis within 15 days of an outpatient surgical procedure, for persons 65 years of age and older. Each measure focuses on a targeted outpatient surgical procedure.

Intent: Most surgeries are performed in outpatient settings. Health plans can provide services that help ensure proper care coordination during the critical post-surgical period. NCQA sees this as a quality measurement gap to fill, and developed these new measures to assess the quality of care provided by health plans after surgery.

One Health Plan Descriptive Measure

Disability Description of Membership (DDM). An unduplicated count and percentage of members enrolled at any time during the measurement year, by disability status and disability status source.

Intent: People with disabilities are more likely to report poorer overall health and have less access to adequate health care. In recognition of the need to advance equitable care and outcomes for people with disabilities, NCQA conducted an environmental scan and engaged with the disability and disability advocacy community to develop this measure. The measure intent is to encourage collection of disability information from members, which will enable future strategies for assessing quality of care for people with disabilities, such as measure stratification, risk adjustment and targeted measure development.

Two ECDS Reported Measures

Follow-Up After Acute and Urgent Care Visits for Asthma (AAF-E). The percentage of persons 5–64 years of age with an urgent care visit, acute inpatient discharge, observation stay discharge or ED visit, with a diagnosis of asthma, who had a corresponding outpatient follow-up visit, with a diagnosis of asthma, within 30 days.

Intent: Studies show that individuals with asthma frequently utilize acute and urgent care to address exacerbations, which are indicators of poorly controlled asthma. Clinical guidelines recommend follow-up with an outpatient care provider to assess asthma control and review medication use. This measure’s intent is to incentivize coordination of follow-up care in an appropriate time frame for patients experiencing asthma exacerbations.

Tobacco Use Screening and Cessation Intervention. The percentage of persons 12 years of age and older who were screened for commercial tobacco product use at least once during the measurement period, and received tobacco cessation intervention after being identified as a tobacco user. Two rates are reported:

1. Tobacco Use Screening. The percentage of persons who were screened for tobacco use.
2. Cessation Intervention. The percentage of persons who were identified as a tobacco user and received tobacco cessation intervention (counseling or pharmacotherapy).

Intent: Commercial tobacco use is the leading cause of preventable disease, disability and death in the United States. Smoking cessation can reduce the risk of negative health effects, regardless of age or how long someone has been smoking. This measure expands NCQA’s focus on wellness and prevention, which aligns with national health care priorities. For more information, refer to the Tobacco Cessation blog post.

Changes to Existing HEDIS Measures

Follow-Up After High-Intensity Care for Substance Use Disorder (FUI). Updated the measure to allow substance use disorder diagnoses in any position on the follow-up claim. The measure expanded the numerator to include peer support services as an appropriate follow-up visit.
Statin Therapy for Patients With Cardiovascular Disease (SPC-E) and Statin Therapy for Patients With Diabetes (SPD-E). Updated the cardiovascular measure to remove sex-specific age bands. Both measures removed the “I-SNP or long-term institutional (LTI) care” exclusion, and the approach for identifying atherosclerotic cardiovascular disease (ASCVD) was updated.
Adult Immunization Status (AIS-E). Added a COVID-19 indicator to the measure that targets persons 65 and older.
Social Need Screening and Intervention (SNS-E). Updated the measure to add codes to identify screening numerator events and intervention denominator and numerator events, and updated the I-SNP and LTI exclusions to include all ages.

Cross-Cutting Topics

Removed SSoRs from ECDS Data Elements Tables. NCQA no longer requires HEDIS measure data in ECDS reporting to be submitted by each source system of record (SSoR) accessed to produce the measure result. As NCQA expands the list of measures available for ECDS reporting, this update will simplify reporting and enable the transition to digital quality measurement. For additional information, refer to the ECDS webpage.
Race and Ethnicity Stratification Reporting. NCQA incorporated the following updates to align the Race and Ethnicity Stratifications with the Office of Management and Budget’s Statistical Policy Directive No. 15: Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity:

- Added Middle Eastern or North African as a minimum reporting category.
- Updated narrative terminology for category descriptions to modernize and improve clarity.

ECDS Reporting

NCQA will allow voluntary ECDS reporting for the Blood Pressure Control for Patients With Diabetes (BPD-E) measure.
NCQA retired the Administrative and Hybrid reporting methods for Lead Screening in Children (LSC), Statin Therapy for Patients With Cardiovascular Disease (SPC) and Statin Therapy for Patients With Diabetes (SPD). Only the ECDS reporting method will be used for these measures.

Click here for information about the transition to ECDS reporting.

Retirement

NCQA is retiring the following measures in order to reduce burden and evolve HEDIS.

Asthma Medication Ratio (AMR). This measure distinguishes between asthma controller and reliever medications, and calculating dispensed units of each. This approach does not align with clinical guidelines, which recommend combined maintenance and reliever therapy that includes both controller and reliever medications. In addition, AMR only includes individuals with persistent asthma, as defined by a proxy definition based on health care utilization and medication dispensing. This restricts the eligible population to patients with high levels of health care access or who use health services frequently. The numerator is calculated using a complex methodology based on medication package and unit size information. This information is not consistently available for all medications, posing a barrier to accurate calculation of health plan performance.
Medical Assistance With Smoking and Tobacco Use Cessation (MSC). This survey measure only addresses current adult tobacco users, and does not include screening rates or adolescents. It is being replaced by the new ECDS measure Tobacco Use Screening and Cessation Intervention, which assesses screening for commercial tobacco product use in persons 12 and older and evidence-based cessation strategies for current tobacco users.

Learn More

Get the HEDIS MY 2026 Volume 2: Technical Specifications in the NCQA Store.
Click here for more information about the updates to the format of HEDIS measures.
Visit the Digital Quality Hub to learn about the transition to digital quality measurement.

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

HL7^® and FHIR^® are the registered trademarks of Health Level Seven International and their use does not constitute endorsement by HL7.

Citations:

National Asthma Education and Prevention Program (NAEPP) Coordinating Committee Expert Working Group. 2020. 2020 Focused Updates to the Asthma Management Guidelines. https://www.nhlbi.nih.gov/resources/2020-focused-updates-asthma-management-guidelines
McIvor A., Kaplan A. 2020. “A Call to Action for Improving Clinical Outcomes in Patients with Asthma.” npj Primary Care Respiratory Medicine 30(54)
Global Initiative for Asthma (GINA). 2024. Global Strategy for Asthma Management and Prevention. https://ginasthma.org/wp-content/uploads/2024/05/GINA-2024-Strategy-Report-24_05_22_WMS.pdf
National Asthma Education and Prevention Program (NAEPP) Coordinating Committee Expert Working Group. 2020. 2020 Focused Updates to the Asthma Management Guidelines. https://www.nhlbi.nih.gov/resources/2020-focused-updates-asthma-management-guidelines.