FAQ Directory: HEDIS

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11.16.2020 Utilization Measures Are members with unknown or third gender excluded from member months tables that only designate binary gender?

Yes. Members with non-binary gender are excluded from only the utilization measures that require a specific gender (male or female). NCQA continues to track industry standards for nonbinary gender.

HEDIS MY 2021

11.16.2020 Emergency Department Utilization (EDU) Will the EDU measure be publicly reported in MY 2020?

No. The EDU measure was given first-year status for MY 2020 due to significant changes, including exclusion of high-frequency utilizers.

HEDIS MY 2021

11.16.2020 Transition of Care (TRC) For the Medication Reconciliation Post-Discharge indicator, documentation of the current medications with evidence that the member was seen for post-discharge hospital follow-up with evidence of medication reconciliation or review meets criteria. Does documentation of a post-op/surgery follow-up visit, without reference to the hospital stay, count as evidence that the provider is aware of the hospitalization?

No. Documentation of “post-op/surgery follow-up” without a reference to “hospitalization,” “admission” or “inpatient stay” does not imply there was a hospitalization and is not considered evidence that the provider was aware of the hospitalization.

HEDIS MY 2021

10.15.2020 Osteoporosis Screening in Older Women A dispensed dementia medication (Dementia Medications List) is listed as an exclusion in the eligible population. What time frame is required for the dispensing event?

The measure specification contains a formatting error and “A dispensed dementia medication (Dementia Medications List)” is intended to be a dash under the second bullet: “Any of the following during the measurement year or the year prior to the measurement year (count services that occur over both years).”

HEDIS MY 2021

9.15.2020 Childhood Immunization Status (CIS) Does the live attenuated influenza vaccine (LAIV) vaccination have to be given on the child’s second birthday?

Yes. The LAIV vaccination only counts if it is administered on the child’s second birthday. The minimum age for LAIV is 2 years, so vaccines given before that age do not meet criteria. You can view the recommendation guidelines on the CDC website (https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf).

HEDIS MY 2021

9.15.2020 Controlling High Blood Pressure (CBP) and Comprehensive Diabetes Care (CDC) Do BP readings taken by the member need to meet the member-reported requirements included in General Guideline 39?

No. BPs taken by the member do not need to meet requirements for member-reported data described in General Guideline 39 (collected by a PCP or other specialist while taking the patient’s history). If the BP result is documented in the member’s medical record, it may be used to assess numerator criteria if the BP does not meet any exclusion criteria (bullets at the bottom of page 157 and 195 in HEDIS MY 2020 and MY 2021 Volume 2).

HEDIS MY 2021

9.15.2020 Well-Child Visits in the First 30 Months of Life (W30) & Child and Adolescent Well-Care Visits (WCV) Given that the hybrid reporting option was retired from the W30 and WCV measures, what are the required data elements for supplemental data?

Because W30 and WCV are administrative only, the services and documentation in the supplemental data (e.g., medical record) must be clinically synonymous with the codes in the measure’s administrative specification. The organization determines this and it is reviewed by the auditor. Supplemental data must adhere to requirements in General Guideline 31 of the HEDIS Volume 2 MY 2020 & MY 2021 specifications.

HEDIS MY 2021

9.15.2020 Well-Child Visits in the First 30 Months of Life (W30) & Child and Adolescent Well-Care Visits (WCV) When reporting the W30 and WCV measures using supplemental data, may organizations combine documentation from multiple visits to meet criteria?

No. Combining documentation from multiple visits is not allowed. Medical record data must come from a single date of service and must indicate that a well-care visit occurred that was equivalent to the definition of one of the codes in the Well-Care Value Set.
 

HEDIS MY 2021

8.19.2020 Data Elements Table When reporting a measure as hybrid, should the data element “Number of numerator events by administrative data in eligible population (before exclusions)” be equal to the sum of “Numerator events by administrative data” and “Numerator events by supplemental data”?

Yes. This is true if the organization loads its supplemental data before approval. If the organization does not load its supplemental data until after approval is complete then “Number of numerator events by administrative data in eligible population (before exclusions)” will be equal to “Numerator events by administrative data.”
Appendix 4—Data Element Definitions of the MY 2020 & 2021 Volume 2 Technical Specifications includes an explanation of the data elements and how they are reported.

**This FAQ applies to HEDIS Volume 2 MY 2020 & MY 2021.

HEDIS MY 2021

8.19.2020 Data Elements Table When reporting a measure as hybrid, should the data element “Number of numerator events by administrative data in eligible population (before exclusions)” be equal to the sum of “Numerator events by administrative data” and “Numerator events by supplemental data”?

Yes. This is true if the organization loads its supplemental data before approval. If the organization does not load its supplemental data until after approval is complete then “Number of numerator events by administrative data in eligible population (before exclusions)” will be equal to “Numerator events by administrative data.”
Appendix 4—Data Element Definitions of the MY 2020 & 2021 Volume 2 Technical Specifications includes an explanation of the data elements and how they are reported.

**This FAQ applies to HEDIS Volume 2 MY 2020 & MY 2021.

HEDIS MY 2020

8.19.2020 Prenatal and Postpartum Care If a member has multiple enrollment segments without any gaps leading up to the delivery date, should we use the beginning of the first such segment as the start of the last enrollment segment?

Yes. Use the beginning of the first segment as the start of the last enrollment segment. For HEDIS Volume 2 MY 2020 & 2021, multiple enrollment segments with no gaps are treated the same as one enrollment segment with no gaps.

**This FAQ applies to HEDIS Volume 2 MY 2020 & MY 2021.

HEDIS MY 2021

8.19.2020 Prenatal and Postpartum Care Do telehealth visits meet criteria for both rates and for both data collection methods?

Yes. Services provided during a telephone, e-visit or virtual check-in are eligible for use in reporting for both rates (Timeliness of Prenatal Care and Postpartum Care) and for both data collection methods (administrative and hybrid).

**This FAQ applies to HEDIS Volume 2 MY 2020 & MY 2021.

HEDIS MY 2021