FAQ Directory

Yes. Organizations may use the same sample for all measures, the same sample for two measures and a different sample for the third measure, or different samples for the three diabetes measures (GSD, EED, BPD).

HEDIS 2024

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

Yes. Adult practices can submit one of these as a custom immunization measure. Since neither of these have 2024 specifications in the eCQI Resource Center, you will need to enter the  numerator/denominator definitions along with your data.
 

PCMH

PCMH 2017

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

Yes, replace Total Score LOINC Code “55758-7” with “89208-3” in the Depression screening instrument table for the Instruments for Adolescents (≤17 years), Beck Depression Inventory-Fast Screen (BDI-FS)®.

Exchange 2024

Yes, as described in the Required exclusions section of the CCS measure, use LOINC code 76689-9 to exclude members with a sex assigned at birth of male any time in the patient’s history. The code was mistakenly removed from the CCS measure in the 4-1-2024 release of the VSD (Direct Reference Code spreadsheet). Because the information needed for reporting is in the measure specification NCQA does not intend to reissue the VSD.

Exchange 2024

Yes, as described in the Required exclusions section of the CCS measure, use LOINC code 76689-9 to exclude members with a sex assigned at birth of male any time in the patient’s history. The code was mistakenly removed from the CCS measure in the 4-1-2024 release of the VSD (Direct Reference Code spreadsheet). Because the information needed for reporting is in the measure specification NCQA does not intend to reissue the VSD.

HEDIS 2024