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HEDIS MY 2023: Noteworthy topics to consider during NCQA’s public comment period


HEDIS MY 2023: Noteworthy topics to consider during NCQA’s public comment period

The National Committee for Quality Assurance (NCQA) has released proposed updates and changes to HEDIS® measures for Measurement Year 2023 (MY 2023) for public comment, with the comment period ending this Friday, March 11. As several changes have been proposed, Cotiviti has compiled a few particular topics for health plans to consider when submitting feedback.

Dental measures

In updates for MY 2023, NCQA proposed two new Dental Quality Alliance (DQA) measures to replace the Annual Dental Visit (ADV). The ADV measure that is being retired was a dental benefit measure, meaning that Medicaid plans that did not have a dental benefit could set this measure to “No Benefit” when reporting. However, one of the two proposed DQA measures to replace ADV, the Topical Fluoride for Children measure, is proposed to allow for “Dental or Medical” benefit. 

The table labeled “Data Elements for Reporting” still indicates that a benefit flag is available for this measure, but the question remains whether NCQA will allow a plan with a medical benefit and no dental benefit to continue setting this measure to “No Benefit.” Benefit requirements for measures don’t traditionally have an “or Medical” option, so this measure may require clarification.

Social Need Screening and Intervention (SNS-E)

This proposed new measure would focus more closely on social determinants of health (SDoH). Taking a deeper dive into the written specification for SNS-E, health plans should pay close attention to how NCQA is proposing to identify the appropriate screenings and whether they have a positive result. Within this measure, there are no proposed value sets to use to pull the screening information—it appears to be solely based on the text names of the screenings themselves. Additionally, the data would need to contain not only the screening name, but the individual screening questions and answers as well. 

To run a measure with this type of text-based data, the files would need to have consistent, accurately spelled questions and responses to programmatically determine whether the screening was positive. However, even the existing depression-related Electronic Clinical Data Systems (ECDS) measures don’t get down to this level of text-based matching, as the depression screenings have LOINC or SNOMED codes and tallied scores that determine positive or negative results. Those giving feedback should consider how to source this data and consistently ensure its accuracy in their HEDIS engine to be able to produce the necessary results for this measure. This digital measure will need to have some method of intaking and calculating these screening results, but this level of detail is not yet available to understand NCQA’s expectations on how this data would be structured.

Emergency Department Visits for Hypoglycemia in Older Adults with Diabetes (EDH)

Within the measure specification for this proposed new measure, pay close attention to the definition of Rate 2 for Members Receiving Basal Insulin. The Event/Diagnosis criteria for this rate lacks specific details as to how the basal insulin dispensing events should be tabulated to determine whether a member meets the expected criteria. This brings several questions to mind, including:

  • Should the measurement logic from July 1 in the year prior through December 31 of the measurement year be broken into 180-day segments and validate that there is at least one dispensing event within each of those segments? 
  • Should the logic ensure that after the member’s first dispensing event of basal insulin that the next dispensing event is within 180 days from the prior dispensing event? 
  • Is daily supply taken into account within the calculations if a member fills a prescription early?

If there is a specific method for calculating this event criteria that comes to mind, consider sharing those suggestions with NCQA in your comment.

Ready to comment?

NCQA is looking for public comments on these new proposed HEDIS measures, updates to existing measures, proposed measure retirements, and new topics by 5:00 pm ET this Friday, March 11. Submit your comments via the NCQA public comment website.

Cotiviti’s Quality Intelligence measurement and reporting solution sets the standard for efficiency, integration, ease of use, and customer satisfaction. With our fully NCQA-certified quality measure logic, health plans are in good hands. Discover what Quality Intelligence can do for your plan.

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About the Author

Samantha is the HEDIS program manager supporting Cotiviti’s Quality Intelligence solution. She has over 10 years of experience working in HEDIS and is primarily responsible for bridging her knowledge of HEDIS requirements to inform product roadmap, operations, and client collaboration, guiding the organization through the annual HEDIS update cycle.

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