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
• Adult Immunization Status
• Prenatal Immunization Status
• Prenatal Depression Screening and Follow-up
• Postpartum Depression Screening and Follow-up

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.

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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).

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• Long-Term Services and Supports Programs

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. 
• 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.

• Order this publication

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 (Will be posted January 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 (Will be posted December 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).

• Order this publication
• Long-Term Services and Supports Programs

Vol. 1: Narrative

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

• Order the HEDIS Volumes
• HEDIS 2020 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.

• 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.

• Order this publication

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).

• Order this publication
• 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).

• Order this publication
• Long-Term Services and Supports Programs

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)