NCQA HEDIS® Measurement Year (MY) 2020 Requirements and COVID-19

Updated: November 24, 2020

NCQA continues to monitor the impact of the coronavirus pandemic on health plan business operations, including its potential effect on medical record data collection due to imposed travel bans, limited access to provider offices, quarantines and risk to staff. NCQA will keep this in mind as we review results for MY 2020 and will make additional exceptions and modifications to programs, products or benchmarks if needed.

In response to customer inquiries, NCQA has initiated discussions with organizations that require HEDIS reporting to stay informed on stakeholder concerns and decisions made in the quality arena. While NCQA is not changing any data collection methods or reporting deadlines at this time, the health and well-being of health care workers and customers is our top priority. If medical record procurement is critical to an organization’s hybrid strategy, NCQA encourages methods that do not require travel or entering offices, such as virtual reviews or remote access.

To support increased use of telehealth, NCQA updated telehealth guidance in 40 HEDIS measures for MY 2020 and MY 2021. Find a complete list of these measures on our website. We will not make further updates to MY 2020/MY 2021 measure specifications. This will ensure that effects of the coronavirus pandemic on patient care are brought to light.

For Health Plan Ratings 2021, NCQA will implement a special Overall Rating Policy for NCQA-Accredited plans: Ratings will display the higher of the Overall Rating score between HPR 2021 and HPR 2019 for plans with current Accreditation as of June 30, 2021. Individual measures, composites and subcomposites will continue to be scored and displayed using HPR 2021 performance (i.e., MY 2020) for all plans. For more information about the ratings, including how they are calculated, visit our ratings page.

We will continue to assess public health guidelines related to the pandemic to determine if changes are needed, and we will provide updates as needed in early 2021. If you have any questions, contact us through My NCQA. Log in and select My Questions > Ask A Question > PCS > Product/Program Type: HEDIS  > General Content Area: COVID-19.

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