CAHPS 5.1H Survey Updated Fall 2020
- Reflects increased use of telehealth.
- Revises some questions to include phone and video visits.
- Uses wording tested with consumers.
- Will be part of Health Plan Accreditation—as CAHPS has been for years.
HEDIS Measures
HEDIS® measures performance in health care where improvements can make a meaningful difference in people’s lives.
Effectiveness of Care
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
Musculoskeletal Conditions
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
- Medication Management in Older Adults
- Use of Opioids at High Dosage
- Use of Opioids from Multiple Providers
- Risk of Continued Opioid Use
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
Access/Availability of Care
- 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
Utilization
Risk Adjusted Utilization
Measures Collected Using Electronic Clinical Data Systems
- 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
- Adult Immunization Status
- Prenatal Immunization Status
- Prenatal Depression Screening and Follow-up
- Postpartum Depression Screening and Follow-up
HEDIS Technical Resources
HEDIS Technical Specifications include a complete list of new and updated HEDIS measures with instructions on data collection and guidelines for calculations and sampling.
HEDIS Measurement Year 2021
Vol. 1: Narrative
Overview of the HEDIS measurement set and how the data are used.
- Order the HEDIS Volumes
- HEDIS MY 2020 & MY 2021 (pdf) (Updated July 16, 2020)
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 this publication
- Technical Specifications Update – (Will be posted March 31, 2021)
- HEDIS MY 2021 Risk Adjustment Tables (Will be posted March 31, 2021)
Note: The Risk Adjustment Tables will be available for free order in the NCQA Store. Once ordered, the Risk Adjustment Tables will be made available in the “My Downloads” tab at My.NCQA. - HEDIS MY 2021 Medication List Directory (NDC codes) (Will be posted March 31, 2021)
Note: The Medication List Directory will be available for free order in the NCQA Store. Once ordered, the Medication List Directory will be made available under the My Downloads section in My.NCQA. - HEDIS MY 2021 Measure Trending Determinations (Anticipated Release Date: TBD)
- HEDIS Electronic Clinical Data System (ECDS)
- HEDIS FAQs
HEDIS Measures Included in the 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).
- Order this publication (Anticipated Release Date: TBD)
- Technical Specifications Update (Anticipated Release Date: TBD)
Technical Specifications for ACO Measurement
HEDIS quality measures for Accountable Care Organizations.
Vol. 3: Specifications for Survey Measures
HEDIS survey measures and standardized surveys from the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) program.
- Order this publication (Anticipated Release Date: September 2021)
- CAHPS 5.1H Survey
- Survey Vendor Certification Program
- MY 2021 Validated Member-Level File Layout (Will be posted January 2022)
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 this publication (Anticipated Release Date: October 2021)
- HEDIS Compliance Audit
- Specification Updates (Will be posted December 2021)
Vol. 6: The Medicare Health Outcomes Survey Manual
Technical specifications for the Health Outcomes Survey (HOS).
- Order this publication (Anticipated Release Date: February 2022)
- Health Outcomes Survey
HEDIS Technical Specifications for Long-Term Services and Support Measures
The technical specifications for organizations providing Medicaid long-term services and supports (LTSS).
HEDIS Measurement Year 2020
Vol. 1: Narrative
Overview of the HEDIS measurement set and how the data are used.
- Order the HEDIS Volumes
- HEDIS MY 2020 & MY 2021 (pdf) (Updated July 16, 2020)
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 this publication
- Technical Specifications Update – (Posted October 1, 2020)
- HEDIS MY 2020 Risk Adjustment Tables (Posted November 2, 2020)
Note: The Risk Adjustment Tables are available for free order in the NCQA Store. Once ordered, the Risk Adjustment Tables will be made available in the “My Downloads” tab at My.NCQA. - NCQA HEDIS Measurement Year (MY) 2020 Requirements and COVID-19
(Posted December 4, 2020) - HEDIS MY 2020 Medication List Directory (NDC codes) (Posted November 2, 2020)
Note: The Medication List Directory are available for free order in the NCQA Store. Once ordered, the Medication List Directory will be made available under the My Downloads section in My.NCQA. - HEDIS MY 2020 Measure Trending Determinations (Will be posted Spring 2021)
- HEDIS Electronic Clinical Data System (ECDS)
- HEDIS FAQs
HEDIS Measures Included in the 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 – Posted October 1, 2020
- HEDIS for the Quality Rating System FAQs
Technical Specifications for ACO Measurement
HEDIS quality measures for Accountable Care Organizations.
Vol. 3: Specifications for Survey Measures
HEDIS survey measures and standardized surveys from the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) program.
- Order this publication
- CAHPS 5.1H Survey
- Survey Vendor Certification Program
- Technical Specifications Update (Posted November 16, 2020)
- MY 2020 Validated Member-Level File Layout (Posted January 3, 2021)
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 this publication (Posted October 19, 2020)
- HEDIS Compliance Audit
- Specification Updates (Posted December 14, 2020)
Vol. 6: The Medicare Health Outcomes Survey Manual
Technical specifications for the Health Outcomes Survey (HOS).
- Order this publication (Anticipated Release Date: February 2021)
- Health Outcomes Survey
HEDIS Technical Specifications for Long-Term Services and Support Measures
The technical specifications for organizations providing Medicaid long-term services and supports (LTSS).
HEDIS 2020 (Measurement Year 2019)
Vol. 1: Narrative
Overview of the HEDIS measurement set and how the data are used.
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.
- Telehealth Updates Due to COVID-19
- Order the HEDIS Volumes
- HEDIS Volume 2 & Digital Measures Bundles Comparison
- Technical Specifications Update – (Posted October 1, 2019)
- Risk Adjustment Tables (Posted November 1, 2019)
- HEDIS and COVID-19 (Posted March 13, 2020)
- Medication List Directory (NDC codes) (Updated March 6, 2020)
Note: Available for free order in the NCQA Store. Once ordered, the Medication List Directory will be made available under the My Downloads section in My.NCQA.
- HEDIS 2020 Measure Trending Determinations (Posted February 10, 2020)
- HEDIS Electronic Clinical Data System (ECDS)
- HEDIS FAQs
HEDIS Measures Included in the 2020 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 (Posted October 1, 2019)
- HEDIS for the Quality Rating System FAQs
Technical Specifications for ACO Measurement
HEDIS quality measures for Accountable Care Organizations.
Vol. 3: Specifications for Survey Measures
HEDIS survey measures and standardized surveys from the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) program.
- Order this publication
- CAHPS 5.0H Survey
- Survey Vendor Certification Program
- Technical Specifications Update (Posted November 15, 2019)
- 2020 Validated Member-Level File Layout (Posted November 23, 2020)
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 this publication
- HEDIS Compliance Audit
- Specification Updates (Posted December 10, 2019)
Vol. 6: The Medicare Health Outcomes Survey Manual
Technical specifications for the Health Outcomes Survey (HOS).
HEDIS Technical Specifications for Long-Term Services and Support Measures
The technical specifications for organizations providing Medicaid long-term services and supports (LTSS).
HEDIS Archives
HEDIS 2019 (Measurement Year 2018)
- HEDIS 2019 Measures (pdf)
- HEDIS 2019 Vol. 2 Technical Specifications Update – Posted October 1, 2018
- HEDIS 2019 ECDS Technical Update – Posted December 12, 2018
- HEDIS 2019 Risk Adjustment Tables – Updated April 2, 2019
- Risk Adjustment Tables for the Plan All-Cause Readmission Measure for HEDIS 2020 – Posted November 1, 2018
- HEDIS 2019 Medication List Directory (NDC codes) – Posted November 1, 2018 (also used for ACO, QRS and Physician Measurement reporting)
- HEDIS 2019 Measure Trending Determinations – Posted April 9, 2019
- HEDIS 2019 Rules for Allowable Adjustments for HEDIS Memo (pdf) – Posted July 2, 2018
- HEDIS 2019 Allowable Adjustments RxNorm List (.xslx) – Posted November 13, 2018
- Quality Rating System Technical Specifications for Physician Measurement Memo – Posted November 14, 2018
- Quality Rating System Technical Specifications Update – Posted October 1, 2018
- 2019 CAHPS Validated Member-Level File Layout – Posted June 14, 201
- HEDIS 2019 Volume 5 Specification Updates
HEDIS 2018 (Measurement Year 2017)
- HEDIS 2018 Measure Changes (pdf)
- HEDIS 2018 Volume 2 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
- HEDIS 2018 Physician Measures (pdf)
- Quality Rating System Technical Specifications Update (pdf)
- 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
- HEDIS 2018 CAHPS Survey for PCMH Publication Status Update (pdf)
- HEDIS 2018 Volume 5 Specification Updates (pdf)
Rules for Allowable Adjustments of HEDIS
Recognizing that HEDIS measures have traditionally been specified for health plan reporting, NCQA developed the Rules for Allowable Adjustment of HEDIS to accommodate the application of HEDIS measures to various levels of the health care system for quality improvement initiatives. The rules provide flexibility for evaluating different populations without altering measures’ clinical intent (e.g., removal of continuous enrollment or product-line criteria).
The Rules for Allowable Adjustments are included in the HEDIS Volume 2 publication after the applicable HEDIS measure specifications. NCQA’s HEDIS Value Set Directory (VSD) includes the necessary third-party codes for use with adjusted measure specifications.
HEDIS FAQ
Visitors to this page often check HEDIS FAQs or ask a question through MyNCQA.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).