FAQ Directory

The measures approved for HEDIS MY 2027 retirement were:

• Documented Assessment After Mammogram (DBM-E)
• Oral Evaluation, Dental Services (OED)
• Topical Fluoride for Children (TFC)
• Diagnosed Mental Health Disorders (DMH)
• Diagnosed Substance Use Disorders (DSU)
• Diabetes Monitoring for People With Diabetes and Schizophrenia (SMD)
• Cardiovascular Monitoring for People With Cardiovascular Disease and Schizophrenia (SMC)
• Use of Opioids at High Dosage (HDO)
• Risk of Continued Opioid Use (COU)
• Language Description of Membership (LDM)

This applies to the following Programs and Years:

No. For NCQA Health Plan Accreditation, NCQA reviews and scores UM 1, Elements B–H separately for each product line brought forward for Accreditation. Organizations may not combine any product lines—including commercial and Exchange—when reporting and evaluating UM rates for UM 1, Elements B–H.

Applicable standards: 

• Health Plan Accreditation: UM 1, Elements B-H. 

FAQ ID #25919

This applies to the following Programs and Years:

The retired measures will be removed in the HEDIS MY 2027 Technical Specification Update release on March 31, 2027.

This applies to the following Programs and Years:

Although HEDIS measures may reflect data from multiple sources, organizations must provide evidence demonstrating how the required data sources listed in the factors are integrated. Presenting HEDIS measure results alone does not demonstrate this integration.

• Health Plan Accreditation – PHM 2, Element A
• Behavioral Health Accreditation – PHM 2, Element A

FAQ ID #26220

This applies to the following Programs and Years:

NCQA is finalizing the subset of measures that will be released in the updated format for MY 2028. Additional information will be provided before publication of the HEDIS MY 2028 Volume 2 specifications.

This applies to the following Programs and Years:

The updated specification structure is intended to organize and align information with its FHIR-based digital equivalent and is not intended to change current reporting expectations. Organizations should continue following existing HEDIS reporting guidance and audit requirements.

If questions arise regarding a specific measure or implementation scenario, NCQA welcomes questions or comments through My NCQA, utilizing the MY 2028 Preview: Measure Specification Enhancements option within the 'General Content Area' dropdown under the HEDIS option within the 'Product/Program Type' dropdown.

This applies to the following Programs and Years:

No. Traditional HEDIS reporting remains supported. The updated structure introduces terminology and structure that align with FHIR-based digital measures, but it does not require organizations to adopt Digital HEDIS or change their current reporting approach. Organizations may continue using their existing reporting methods while gaining visibility into how those specifications align with future digital quality measurement models.

This applies to the following Programs and Years:

No. Because the updates do not change measure intent, calculation logic, reporting requirements or audit expectations, NCQA does not anticipate an impact on performance results or historical trending. Organizations should continue reporting using the same processes they use today.

This applies to the following Programs and Years:

No. Organizations can continue using their current systems, reporting processes, workflows and operational practices. The updates do not introduce new reporting requirements or require changes to existing implementations. The updated structure is designed to help organizations that choose to pursue digital quality measurement in the future, while preserving current reporting expectations.

This applies to the following Programs and Years:

Organizations may notice:
•    More detailed descriptions of data sources.
•    Terminology aligned with the FHIR® data model.
•    Timing and status language that aligns with FHIR®-based digital measures.
•    A connection between narrative specifications and digital measure specifications.

The updated structure is intended to help organizations understand how existing narrative specifications align with their digital equivalents. It is not intended to change reporting requirements for current HEDIS submissions.

This applies to the following Programs and Years:

NCQA is continuing its efforts to support organizations in the transition to digital quality measurement. The MY 2028 updates are non-substantive, structural changes to select narrative measure specifications. These updates create a connection between the narrative specification and its FHIR^®-based digital equivalent while maintaining current reporting and audit practices. Organizations that are not pursuing Digital HEDIS can continue their current reporting approach without modification.

This applies to the following Programs and Years:

The specification structure updates do not change:
•    Measure intent.
•    Calculation logic.
•    Reporting requirements.
•    Data element reporting requirements.
•    Audit expectations.
•    Existing workflows and operational processes.
•    Performance rates or trending assumptions.

Organizations can continue using the same codes, data sources, timing guidance, workflows and audit practices they rely on today.

This applies to the following Programs and Years: