FAQ Directory: HEDIS for the Quality Rating System

The changes made to the CCS/CCS-E continuous enrollment criteria for QRS MY 2024 was made in error. Use the following continuous enrollment criteria for MY 2024, which align with previous measurement years: 

CCS:

Continuous enrollment: The measurement year.

CCS-E:

The member was enrolled with a medical benefit throughout the participation period.

NCQA certified organizations were tested using the accurate continuous enrollment criteria.

EXCHANGE MY 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 MY 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 MY 2024

When only a single code exists for a service or condition, it is included directly in the measure specification, and referred to as a Direct Reference Code (DRC). It is a best practice to not create value sets that include only a single code; some code systems prohibit this because it results in assigning another code (an OID) to a concept that already has a code.
DRCs are listed in the measure specifications and in a Direct Reference Codes spreadsheet in the value set directory.
For MY 2024, a number of single code value sets were converted to DRCs. The Summary of Changes – Value Sets spreadsheet indicates the value set was deleted. The Summary of Changes – Codes spreadsheet indicates the code was added as a DRC (filter Column A on “Direct Reference Code”).

EXCHANGE MY 2024

Yes. Replace the reference to “46-49” with “46-50,” and replace the reference to “50-75” with “51-75” in the age stratification and in Table COL-E-A-4: Data Elements for Colorectal Cancer Screening.

EXCHANGE MY 2023

No. There are no Medicare member exclusions. Remove the second bullet from Exclusion 1, which reads:

• Medicare members 66 years of age and older by the end of the measurement period who meet either of the following:
  • Enrolled in an Institutional SNP (I-SNP) any time during the measurement period.
  • Living long-term in an institution any time during the measurement period, as identified by the LTI flag in the Monthly Membership Detail Data File. Use the run date of the file to determine if a member had an LTI flag during the measurement period.

EXCHANGE MY 2023

Yes. The 12-17 years age stratification is reported for the Follow-Up on Positive Screen numerator and should be added to the age stratification on page 240 of MY 2023 HEDIS for QRS Version.

EXCHANGE MY 2023

Yes. Although LOINC codes were removed from the INR Test Value Set, organizations should use laboratory claims and data for this value set, in addition to medical claims. This value set should be listed in General Guideline 28 with other value sets that do not contain LOINC codes.

EXCHANGE MY 2023

Yes. Although LOINC codes were removed from the Drug Test Value Set, organizations should use laboratory claims and data for this value set. This value set should be listed in General Guideline 28 with the other value sets that do not contain LOINC codes but should use laboratory claims and data.

**This FAQ applies to QRS MY 2022.

EXCHANGE MY 2022

Yes. Disregard the “N” in Table 1. Organizations may reduce the sample size for the CIS measure using the prior year’s rate or the current year’s administrative rate.

**This FAQ applies to QRS MY 2022.

EXCHANGE MY 2022

The fifth bullet in the Numerator is missing value set references. Replace the bullet text with:
A community mental health center visit (Visit Setting Unspecified Value Set; BH Outpatient Value Set; Observation Value Set; Transitional Care Management Services Value Set) with (Community Mental Health Center POS Value Set).

**This FAQ applies to QRS MY 2020.

EXCHANGE MY 2020

Yes, the episode date is excluded. Add the following text to the event/diagnosis after step 3:
Exclude Episode Dates if the member did not receive antibiotics on or up to three days after the Episode Date.

**This FAQ applies to QRS MY 2020.

EXCHANGE MY 2020