When reporting CCS-E, all three methods may be used, using any data source. When reporting CCS, use only administrative data (Administrative Gender of Female [AdministrativeGender code F] any time in the member’s history) to determine members recommended for routine cervical cancer screening.
Where supplemental data may be used for CCS remains the same for MY 2024. Supplemental data may not be used for denominator criteria, except in required exclusions.
HEDIS MY 2024
Yes. We anticipate the laboratory claim exclusion will be added to the following measures and value sets in the Technical Update memo:
AMR: Step 2 of the event/diagnosis (Asthma Value Set)
GSD: Numerators (HbA1c Test Result or Finding Value Set)
EED: Event/diagnosis (Diabetes Value Set)
OMW: Step 2 of the event/diagnosis (Fractures Value Set)
SSD: Numerator (HbA1c Test Result or Finding Value Set)
SMD: Numerator (HbA1c Test Result or Finding Value Set; LDL-C Test Result or Finding Value Set)
SMC: Numerator (LDL-C Test Result or Finding Value Set)
IET: Step 2 of the event/diagnosis (Alcohol Abuse and Dependence Value Set; Opioid Abuse and Dependence Value Set; Other Drug Abuse and Dependence Value Set)
APM-E: Numerators (HbA1c Test Result or Finding Value Set; LDL-C Test Result or Finding Value Set)
DSF-E: Exclusions 1 (Bipolar Disorder Value Set; Other Bipolar Disorder Value Set; Depression Value Set)
DMS-E: Exclusions 1 (Bipolar Disorder Value Set; Other Bipolar Disorder Value Set; Personality Disorder Value Set; Psychotic Disorders Value Set; Pervasive Developmental Disorder Value Set)
DRR-E: Exclusions 1 (Bipolar Disorder Value Set; Other Bipolar Disorder Value Set; Personality Disorder Value Set; Psychotic Disorders Value Set; Pervasive Developmental Disorder Value Set)
ASF-E: Exclusions 1 (Alcohol Use Disorder Value Set; Dementia Value Set)
HEDIS MY 2024
Although HEDIS digital measure logic references “Explanation of Benefit (EOB),” this is not referenced as a data source in HEDIS Volume 2. In FHIR, the EOB resource represents claims that have been adjudicated, and includes data elements from both Claim and ClaimResponse. The digital logic was written to include the Claim/ClaimResponse resource for claims that are still processing; the ExplanationOfBenefit resource is for claims that are adjudicated.
HEDIS MY 2024
The KED measure provides actionable information for chronic kidney disease identification and management. General guidance from our experts is that tests included in the measure should align with guideline recommendations from the American Diabetes Association and the National Kidney Foundation. For this reason, only quantitative uACR tests are allowed and semi-quantitative tests are not considered measure compliant. Removing LOINC code 32294-1 from the value set maintains these coding parameters.
HEDIS MY 2024
No. Members with documentation of “hysterectomy” and documentation indicating that they no longer need Pap testing/cervical cancer screening must remain in the measure for MY 2023 reporting. Members with documentation of a “vaginal pap smear” and documentation of “hysterectomy” must also remain in the measure for HEDIS MY 2023 reporting. This is because the documentation must match the clinical specificity of the codes in the value sets and there are no codes that are clinically synonymous with these examples.
There must be evidence of a hysterectomy with no residual cervix, cervical agenesis or acquired absence of cervix in order to meet required exclusion criteria for MY 2023 reporting.
Documented “vaginal hysterectomy” or “complete/total/radical hysterectomy” that matches a definition in applicable value sets may be used to meet criteria, subject to auditor approval.
HEDIS MY 2023
For measures with hybrid reporting methodology (HBD, BPD, EED), members who have not had a diagnosis of diabetes but receive diabetes medications for conditions other than diabetes (e.g., weight loss, heart failure) may be identified as valid data errors and replaced with a member from the oversample.
To meet criteria for a valid data error for these measures, the medical record must contain no evidence of diabetes and must contain evidence to substantiate the data error (how the member wound up in the measure, why it is incorrect). It is expected that the medical record will not contain evidence of diabetes, and will contain documentation that the patient is on the medication, and why. This documentation, in combination with no other documentation of diabetes in the medical record, meets criteria for a valid data error. Valid data errors are subject to review by the auditor.
Valid data errors work for the Hybrid Method only because medical record data are used to ensure that the member does not have diabetes. For the administrative method, these members remain in the measure as medical records are considered supplemental data that may not be used for identifying valid data errors, or when reporting the HBD, BPD and EED measures using the administrative method, or the KED, SMD, EDH and SPD measures, which are administrative-only measures.
We are working to refine the diabetes denominator related to off-label medication use. The next annual HEDIS public comment period is planned for February–March 2023, but organizations may submit comments on any measure, at any time, through PCS (you do not need to wait until February).
*This FAQ applies to the following measures: Hemoglobin A1c Control for Patients With Diabetes (HBD), Blood Pressure Control for Patients With Diabetes (BPD), Eye Exam for Patients With Diabetes (EED), Kidney Health Evaluation for Patients With Diabetes (KED), Statin Therapy for Patients With Diabetes (SPD), Diabetes Monitoring for People With Diabetes and Schizophrenia (SMD), and Emergency Department Visits for Hypoglycemia in Older Adults With Diabetes (EDH)
HEDIS MY 2022
