HEDIS Measures and Technical Resources

Prevention and Screening

• Adult BMI Assessment
• Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents
• Childhood Immunization Status
• Immunizations for Adolescents
• Lead Screening in Children
• Breast Cancer Screening
• Cervical Cancer Screening
• Colorectal Cancer Screening
• Chlamydia Screening in Women
• Care for Older Adults

Respiratory Conditions

• Appropriate Testing for Children With Pharyngitis
• Use of Spirometry Testing in the Assessment and Diagnosis of COPD
• Pharmacotherapy Management of COPD Exacerbation
• Medication Management for People With Asthma and Asthma Medication Ratio

Cardiovascular Conditions

• Controlling High Blood Pressure
• Persistence of Beta-Blocker Treatment After a Heart Attack
• Statin Therapy for Patients With Cardiovascular Disease and Diabetes

Diabetes

• Comprehensive Diabetes Care

Musculoskeletal Conditions

• Disease-Modifying Anti-Rheumatic Drug Therapy for Rheumatoid Arthritis
• Osteoporosis Testing and Management in Older Women

Behavioral Health

• Antidepressant Medication Management
• Follow-Up Care for Children Prescribed ADHD Medication
• Follow-Up After Hospitalization for Mental Illness
• Follow-Up After Emergency Department Visit for Mental Illness
• Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence
• Diabetes and Cardiovascular Disease Screening and Monitoring for People With Schizophrenia or Bipolar Disorder
• Adherence to Antipsychotic Medications for Individuals With Schizophrenia
• Metabolic Monitoring for Children and Adolescents on Antipsychotics

Medication Management and Care Coordination

• Annual Monitoring for Patients on Persistent Medications
• Medication Reconciliation Post-Discharge
• Transitions of Care
• Follow-Up After Emergency Department Visit for People With Multiple High-Risk Chronic Conditions

Overuse/Appropriateness

• Non-Recommended Cervical Cancer Screening in Adolescent Females
• Non-Recommended PSA-Based Screening in Older Men
• Appropriate Treatment for Children With Upper Respiratory Infection
• Avoidance of Antibiotic Treatment in Adults With Acute Bronchitis
• Use of Imaging Studies for Low Back Pain
• Use of Multiple Concurrent Antipsychotics in Children and Adolescents
• Medication Management in the Elderly
• Use of Opioids at High Dosage
• Use of Opioids from Multiple Providers

Measures Collected Through the Medicare Health Outcomes Survey

• Fall Risk Management
• Management of Urinary Incontinence in Older Adults
• Physical Activity in Older Adults

Measures Collected Through the CAHPS^® Health Plan Survey

• Flu Vaccinations
• Medical Assistance with Smoking and Tobacco Use Cessation
• Pneumococcal Vaccination Status for Older Adults

• Adults’ Access to Preventive/Ambulatory Health Services
• Children and Adolescents’ Access to Primary Care Practitioners
• Annual Dental Visit
• Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment
• Prenatal and Postpartum Care
• Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics

• Child and Adolescent Well-Care Visits
• Frequency of Selected Procedures
• Identification of Alcohol and Other Drug Services
• Mental Health Utilization
• Antibiotic Utilization
• HAI Standard Infection Ratio

• Plan All-Cause Readmissions
• Acute Hospital Utilization
• Emergency Department Utilization
• Hospitalization for Potentially Preventable Complications

• Depression Screening and Follow-Up for Adolescents and Adults
• Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults
• Depression Remission or Response for Adolescents and Adults
• Unhealthy Alcohol Use Screening and Follow-Up
• Pneumococcal Vaccination Coverage for Older Adults

Vol. 1: Narrative

Overview of the HEDIS measurement set and how the data are used.

• Order the HEDIS Volumes
• HEDIS 2019 Measures (pdf)

Vol. 2: Technical Specifications for Health Plans

HEDIS nonsurvey measures for organizations; instructions on data collection for each measure; general guidelines for calculations and sampling.

• Order the HEDIS Volumes
• Technical Specifications Update – Will be posted October 1, 2018
• HAI Standard Infection Ratio (SIR) Final Table – Will be posted January 10, 2019
• Risk Adjustment Tables – Will be posted November 2, 2018
• Risk Adjustment Tables for the Plan All-Cause Readmission Measure for HEDIS 2020 – Will be posted November 1, 2018
• Medication List Directory (NDC codes) – Will be posted November 1, 2018 (also used for ACO, QRS and Physician Measurement reporting)
• HEDIS 2019 Measure Trending Determinations – Will be posted spring 2019
• Rules for Allowable Adjustments for HEDIS Memo (pdf) – Posted July 2, 2018
• HEDIS Electronic Clinical Data System (ECDS)

Technical Specifications for Physician Measurement

HEDIS quality and cost of care measures for physician-level measurement.

• Order the HEDIS Volumes
• Technical Specifications Update – Will be posted October 1, 2018

HEDIS Measures Included in the 2019 Quality Rating System (QRS)

Quality Rating System Measure Technical Specifications are unique to the issuers offering plans on the Exchange and participating in the CMS Quality Rating System (QRS).

• HEDIS for the Quality Rating System Value Set Directory
• HEDIS for the Quality Rating System Technical Specifications
• Technical Specifications Update – Will be posted October 1, 2018

Technical Specifications for ACO Measurement

HEDIS quality measures for Accountable Care Organizations.

• Order the HEDIS Volumes

Vol. 3: Specifications for Survey Measures

HEDIS survey measures and standardized surveys from the Consumer Assessment of Healthcare Providers and Systems (CAHPS^®) program.

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• CAHPS^® 5.0H Survey Certification
• 2019 Validated Member-Level File Layout – Will be posted January 2019

Specifications for the CAHPS PCMH Survey

Technical specifications and standardized questionnaires for the CAHPS survey for the patent-centered medical home (PCMH).

• Order the HEDIS Volumes
• CAHPS Survey for PCMH Vendor Certification Program

Vol. 5: HEDIS Compliance Audit™: Standards, Policies and Procedures

The approved method for auditing the HEDIS production process, including an information systems capabilities assessment, an evaluation of compliance with HEDIS specifications and standards that Certified HEDIS Compliance Auditors must use when conducting a HEDIS audit.

• Order the HEDIS Volumes
• HEDIS Compliance Audit
• Specification Updates – Will be posted December 2018

Vol. 6: The Medicare Health Outcomes Survey Manual

Technical specifications for the Health Outcomes Survey (HOS).

• Order the HEDIS Volumes
• Medicare Health Outcomes Survey

Vol. 1: Narrative

Overview of the HEDIS measurement set and how the data are used.

• Order the HEDIS Volumes
• HEDIS 2018 Measure Changes (pdf)

Vol. 2: Technical Specifications for Health Plans

HEDIS nonsurvey measures for organizations; instructions on data collection for each measure; general guidelines for calculations and sampling.

• Order the HEDIS Volumes
• Technical Specifications Update (pdf) – Posted October 2, 2017
• HAI Standard Infection Ratio (SIR) Final Table – Posted January 10, 2018
• Risk Adjustment Tables – Posted March 28, 2018
• Medication List Directory (NDC codes) – Posted February 8, 2018 (also used for ACO, QRS and Physician Measurement reporting)
• HEDIS 2018 Measure Trending Determinations (pdf) – Posted March 26, 2018
• Note: The HEDIS 2018 Relative Resource Use (RRU) measures are suspended and will not be collected. Due to their suspended status, the specifications, Value Set Directories (VSD) and Standard Pricing Tables (SPT) are not included in HEDIS 2018. Complete RRU specifications are available in the HEDIS 2017 Technical Specifications.

Technical Specifications for Physicians

HEDIS quality and cost of care measures for physician-level measurement.

• Order the HEDIS Volumes
• HEDIS 2018 Physician Measures  (pdf)

HEDIS Measures Included in the 2018 Quality Rating System (QRS)

Quality Rating System Measure Technical Specifications are unique to the issuers offering plans on the Exchange and participating in the CMS Quality Rating System (QRS).

• HEDIS for the Quality Rating System Value Set Directory
• HEDIS for the Quality Rating System Technical Specifications
• Technical Specifications Update (pdf)

Technical Specifications for Accountable Care Organization Measurement

HEDIS quality measures for Accountable Care Organizations.

• Order the HEDIS Volumes

Vol. 3: Specifications for Survey Measures

HEDIS survey measures and standardized surveys from the Consumer Assessment of Healthcare Providers and Systems (CAHPS^®) program.

• Order the HEDIS Volumes
• CAHPS^® 5.0H Survey Vendor Certification Program
• 2018 CAHPS Member-Level Data File Layout – Header Record  (pdf)
• 2018 CAHPS Member-Level Data File Layout- Member Level Record  (pdf) – Posted January 9, 2018

Specifications for the CAHPS^® PCMH Survey

Technical specifications and standardized questionnaires for the CAHPS survey for the patent-centered medical home (PCMH).

• Order the HEDIS Volumes
• CAHPS Survey for PCMH Vendor Certification Program
• HEDIS 2018 Publication Status Update (pdf)

Vol. 5: HEDIS Compliance Audit™: Standards, Policies and Procedures

The approved method for auditing the HEDIS production process, including an information systems capabilities assessment, an evaluation of compliance with HEDIS specifications and standards that Certified HEDIS Compliance Auditors must use when conducting a HEDIS audit.

• Order the HEDIS Volumes
• HEDIS Compliance Audit
• Specification Updates (pdf)

Vol. 6: The Medicare Health Outcomes Survey Manual

Technical specifications for the Health Outcomes Survey (HOS).

• Order the HEDIS Volumes
• Medicare Health Outcomes Survey

HEDIS 2017

• HEDIS 2017 Measures (pdf)
• HEDIS 2017 Physician Measures (pdf)
• HEDIS 2017 Vol. 2 Technical Specifications Update (pdf) - Posted October 3, 2016
• HAI Standard Infection Ratio (SIR) Final Table  (.xls) – Posted  January 4, 2017
• HAI Hospital/Provider ID File (.xls) - Posted  January 4, 2017
• Risk Adjustment Tables - Posted November 1, 2016
• National Drug Code List (NDC) - Posted November 1, 2016
• Relative Resource Use Measures will not be collected for HEDIS 2017 (pdf) – Posted January 27, 2017
• HEDIS 2017 Measure Trending Determinations (pdf) – Posted March 2, 2017
• Quality Rating System: Technical Specifications Update (pdf) – Posted October 3, 2016
• 2017 ACO Memo (pdf)- Posted November 15, 2016
• Vol. 3: Technical Specifications Update  (pdf) – Posted November 16, 2016
• 2017 Validated Member-Level File Layout (pdf) – Posted January 21, 2017
• HEDIS 2017 P4P & Vol. 5 Specification Updates (pdf) – Posted December 28, 2016

HEDIS 2016

• HEDIS 2016 Measures (pdf)
• HEDIS 2016 Physician Measures (pdf)
• HEDIS 2016 Vol. 2 Technical Specifications Update  (pdf) – Posted October 1, 2015
• Standard Pricing and Risk Adjustment Tables - Updated December 4, 2015
• National Drug Code List (NDC) - Updated December 4, 2015
• HEDIS 2016 Measure Trending Determinations (pdf) – Posted May 3, 2016
• HEDIS 2016 HEDIS for the Quality Rating System Technical Specifications Update (pdf) – Posted October 1, 2015
• 2016 Validated Member-Level File Layout (.xls) - Posted January 26, 2016
• HEDIS 2016 Specifications for the CAHPS PCMH Survey Publication Status Update (pdf)
• HEDIS 2016 P4P & Vol. 5 Specification Updates