HEDIS Measurement Year 2020: Medicaid summary of changes from NCQA
- The former Well-Child Visits in the First 15 Months of Life (W15) measure was revised to Well Child Visits in the First 30 Months of Life (W30). It includes two indicators:
- Well-child visits in the first 15 months – children who turned 15 months during the measurement year with six or more well-child visits
- Well-child visits for ages 15 to 30 months – children who turn 30 months during the measurement year with two or more well-child visits
- The former Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life (W34) and Adolescent Well-Care Visits (AWC) measures have been combined into Child and Adolescent Well-Care Visits (WCV):
- The percentage of members 3 to 21 years of age who had at least one comprehensive well-care visit with a PMP or an OB/GYN practitioner during the measurement year
Key measure changes
- Controlling High Blood Pressure (CBP and CDC-CBP) – Telephone visits, e-visits and virtual check-ins are now acceptable settings for blood pressure (BP) readings. Digital BP readings reported by the member are considered numerator compliant.
- Telehealth updates – NCQA has updated telehealth guidance in 40 HEDIS® measures for HEDIS measurement years 2020 and 2021. The purpose of these changes is to:
- Support increased use of telehealth caused by the pandemic.
- Align with guidance from Centers for Medicare & Medicaid Services and other stakeholders.
A list of the 40 measures can be found on the NCQA COVID-19 website at ncqa.org/covid.
New Medicaid measures
- Kidney Health Evaluation for Patients With Diabetes (KED) – The percentage of members 18 to 85 years of age with diabetes (type 1 and type 2) who received a kidney health evaluation, defined by an estimated glomerular filtration rate (eGFR) and a uACR identified by both a quantitative urine albumin test and a urine creatinine test with service days four or less days apart during the measurement year
- Cardiac Rehabilitation (CRE) – The percentage of members 18 years and older who attended cardiac rehabilitation following a qualifying cardiac event, including myocardial infarction, percutaneous coronary intervention, coronary artery bypass grafting, heart and heart/lung transplantation, or heart valve repair/replacement; four rates are reported:
- Initiation – The percentage of members who attended two or more sessions of cardiac rehabilitation within 30 days after a qualifying event
- Engagement 1 – The percentage of members who attended 12 or more sessions of cardiac rehabilitation within 90 days after a qualifying event
- Engagement 2 – The percentage of members who attended 24 or more sessions of cardiac rehabilitation within 180 days after a qualifying event
- Achievement – The percentage of members who attended 36 or more sessions of cardiac rehabilitation within 180 days after a qualifying event
Retired Medicaid measures
- Comprehensive Diabetes Care (CDC) retired sub-measures –
- Medical Attention for Nephropathy (retired for Commercial and Medicaid)
- HbA1c control (< 7.0%) for a selected population
- Adult BMI Assessment (ABA)
- Medication Management for People With Asthma (MMA)
- Children’s and Adolescents’ Access to Primary Care Practitioners (CAP)
Measure change summary
For a complete summary, go to tinyurl.com/NCQA-measures.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
March 2021 Anthem Provider News - Indiana