Here are some of the most frequently asked questions about NCQA’s various programs. If you don’t see what you are looking for in one of the entries below, you can ask a question through My NCQA.
The Colorectal Cancer Screening (COL-E) measure is based on the US Preventive Services Task Force (USPSTF) guidelines for colorectal cancer screening. The guidelines do not recommend serum (blood) testing (e.g., blood-based biomarker) and for this reason it does not meet criteria for the HEDIS measure. NCQA continually monitors clinical practice guidelines as they are updated.
HEDIS 2025
No. Organizations are still required to monitor for system controls. The NA for the system controls policies and procedures requirement (e.g., UM 12, Element A, factor 7, in Health Plan Accreditation) does not affect an organization’s ability to meet the corresponding system controls monitoring requirement (e.g., UM 12, Element B in Health Plan Accreditation); it means the organization is not required to describe the monitoring process in its policies and procedures, but must monitor that its systems are protecting data from unauthorized modifications. Also, as noted in “Related information” in the monitoring requirements (e.g., UM 12, Element B in Health Plan Accreditation), NCQA only reviews specific components for monitoring (e.g., for UM, NCQA reviews that the organization monitored receipt and notification dates).
Note: The referenced memo is on the NCQA website at https://www.ncqa.org/wp-content/uploads/2025-Retroactive-Changes-Memo_Final.pdf. It applies to the 2024/2025 standards year only; no exceptions (NA scores or other changes) will be made for the 2023 or prior standards years. Surveys conducted on standards prior to 2024 standards will be reviewed and scored accordingly; any corrective actions issued prior to the 2024 standards still apply
HP 2024
The OMB is requiring “Middle Eastern or North African” for the race/ethnicity combination list. If you do not have “Middle Eastern or North African” as a race only option (if you are collecting race and ethnicity separately), it is ok.
We are instructing practices to work with their vendor to include the “Middle Eastern or North African” option to the combination race/ethnicity category so practices can transition to the OMB race/ethnicity combo for future collection.
PCMH
| KM 09: Diversity | Added “Middle Eastern or North African” to the race/ethnicity combined category. Also, added this note, “The OMB updated the combined Race and Ethnicity categories in 2024 to include the Middle Eastern or North African population; this is reflected in the publications. If this option is not yet available, work with your vendor to ensure compliance with the OMB.” |
| CC 16: Post-Hospital/ED Visit Follow-Up | Added a note, "All discharged patients should be contacted, although not every patient may require a follow-up in the primary care practice." |
| AR-QI 1: Clinical Quality Measures and AR-QI 2: Resource Stewardship Measures | Added this note, “Practices should review measure data before submission, to ensure data are captured accurately and that numbers reflect practice performance and patient population.” |
| AR-QI 1: CQMs | Removed three retired measures. CMS 127: Pneumococcal vaccination status for older adults; CMS 147: Influenza immunization; CMS 161: Adult major depressive disorder: Suicide risk assessment. Adult practices may submit a custom immunization measure and pediatrics practices must select CMS 117: Childhood immunization status: Combination 10. Adult practices do not need to submit a request for a custom immunization measure. |
| AR-QI 1C: Chronic/Acute Clinical Quality Measure | Pediatric practices do not need to submit a request via My NCQA to request a custom measure if they were granted a custom chronic/acute measure in 2024. |
| AR-QI 1: CQMs | Two new eCQM measures added. CMS 314v1: HIV Viral Suppression (chronic/acute) and CMS 1188v1: Sexually Transmitted Infection Testing for People with HIV (other preventive). |
| Appendix 6: MAC Policy | Changed contact email to rpsig@ncqa.org and removed the mailing address. |
PCMH 2017
| KM 06: Diversity | Added “Middle Eastern or North African” to the race/ethnicity combined category. Also, added this note, “The OMB updated the combined Race and Ethnicity categories in 2024 to include the Middle Eastern or North African population; this is reflected in the publications. If this option is not yet available, work with your vendor to ensure compliance with the OMB.” |
| AR-QI 1: Clinical Quality Measures and AR-QI 2: Resource Stewardship Measures | Added this note, “Practices should review measure data before submission, to ensure data are captured accurately and that numbers reflect practice performance and patient population.” |
| Appendix 4: MAC Policy | Changed contact email to rpsig@ncqa.org and removed the mailing address. |
PCSP 2019
No, unless otherwise stated in the specifications, quality measures do not have thresholds that must be met.
With that said, CMS 68 is similar to KM-15 (core): Maintaining an up-to-date list of medications for more than 80% of patients. Both sets of data require the same action of updating the medication list. However, they differ in that CMS 68 is for patients age 18+ and must be captured at every visit, whereas KM-15 is for all patients at any given time. It is unlikely that there would be a large variance between CMS 68 and KM-15. NCQA requests a note be added in QPASS if CMS 68 differs greatly from KM-15's 80% requirement. This is to provide context to the Review Oversight Committee to better understand your practice and environment.
If your practice is in Annual Reporting, practices attest that they are in compliance with all core criteria and could provide evidence that they are meeting the more than 80% requirement of KM-15.
PCMH 2017
No. Although the Asthma Controller and Reliever Medication List includes RxNorm codes, they should not be used to identify dispensing events for this required exclusion. Only use pharmacy data (NDC codes) when assessing asthma controller or reliever medication dispensing events for this required exclusion. Because a dispensing event is required to calculate the numerator, members who had no dispensing events should be removed from the measure.
HEDIS 2024
Yes, as described in the Guidelines for Risk Adjusted Utilization Measures, organizations must use the Inpatient Stay Value Set for the risk adjustment comorbidity category determination (use the Inpatient Stay Value Set to identify acute and nonacute inpatient discharges with a discharge date during the classification period). The value set was mistakenly deleted from the EDH measure in the VSD. Because the guidelines clearly state that the value set must be used, NCQA does not intend to reissue the VSD.
HEDIS 2024
