HEDIS measurement year 2023 documentation for Childhood Immunization Status (CIS)

Healthcare Effectiveness Data Information Set (HEDIS^®) is a widely used set of performance measures developed and maintained by NCQA. These are used to drive improvement efforts surrounding best practices.

HEDIS 2023 documentation for Childhood Immunization Status (CIS).

Measure description:

The percentage of children 2 years of age in the measurement year who had the following on or before their second birthday:

• Four DTaP (diphtheria, tetanus, and acellular pertussis)
• Three IPV (polio)
• One MMR (measles, mumps, and rubella)
• Three HiB (haemophilus influenza type B)
• Three Hep B (hepatitis B)
• One VZV (chickenpox)
• Four PCV (pneumococcal conjugate)
• One Hep A (hepatitis A)
• Two or three RV (rotavirus)
• Two flu (influenza)

The measure calculates a rate for each vaccine and three combination rates.

HEDIS 2023 documentation for Immunizations for Adolescents (IMA) Measure description: The percentage of adolescents 13 years of age in the measurement year who had the following:

• One MenACWY (meningococcal)
• One Tdap (tetanus, diphtheria toxoids, and acellular pertussis)
• Two or three HPV (human papillomavirus)

The measure calculates a rate for each vaccine and two combination rates.

HEDIS measurement year 2023 documentation for Lead Screening in Children (LSC) Measure description: The percentage of children 2 years of age who had one or more capillary or venous lead blood tests for lead poisoning by their second birthday.

What we are looking for in provider medical records:

• Immunization records from birth (Department of Health immunization records are acceptable).
• If available, newborn inpatient records documenting Hep B.
• For those immunizations not recorded on the immunization record, provide progress notes for the immunizations administered and the patient’s history of disease (chickenpox, Hep A, Hep B, measles, mumps, rubella).
• Anaphylaxis due to the DTaP, IPV, MMR, HIB, Hep B, VZV, PCV, Hep A, RV, or Influenza vaccines.
• Encephalitis due to the DTaP vaccine.
• Diagnosis of severe combined immunodeficiency, immunodeficiency, HIV, lymphoreticular cancer, multiple myeloma, leukemia, or intussusception.
• Meningococcal vaccine with a date of service on or between the member’s 11th and 13th birthdays.
• Tdap vaccine with a date of service on or between the member’s 10th and 13^th birthdays.
• At least two HPV vaccines on or between the member’s ninth and 13th birthdays and with dates of service at least 146 days apart, or at least three HPV vaccines with different dates of service on or between the member’s ninth and 13^th birthdays.
• Lead testing results and date (capillary or venous) on or before the child’s second birthday.
• Evidence of hospice services in 2023.
• Evidence patient expired in 2023.

Helpful hints:

• Childhood immunizations and lead blood tests must be completed by the child’s second birthday.
• Assess immunization needs at every clinical encounter, including sick visits and when indicated, immunize.
• Ensure immunization records include all vaccines that were ever given, including hospitals, health departments, and all former providers, including refusals and contraindications.
• FluMist (LAIV) vaccination (only approved for ages 2 to 49) may be used for the second vaccination; however, it must be given on the child’s second birthday to be compliant.

We look forward to working together to achieve improved outcomes.