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NCQA publishes proposed changes to HEDIS measures for MY 2023

NCQA publishes proposed changes to HEDIS measures for MY 2023

The National Committee for Quality Assurance (NCQA) has released proposed updates and changes to HEDIS ® measures for Measurement Year 2023 (MY 2023) for public feedback, with the public comment period ending Friday, March 11. Here, we take a look at the new additions, changes, retirements, and discussion points for MY 2023 to help health plans digest these proposed updates during NCQA’s public comment period.

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Proposed new HEDIS measures

Dental measures

As NCQA retires the Annual Dental Visit (ADV) measure, it is proposing to add two new HEDIS measures related to dental care: Oral Evaluation, Dental Services; and Topical Fluoride for Children. The organization notes that cavities are one of the most common chronic conditions in children in the U.S., and regular evaluations and topical fluoride applications are a preventative treatment for tooth decay. Both measures are adapted from existing Dental Quality Alliance (DQA) measures.

Measure Name

Summary of Proposed Details

Oral Evaluation, Dental Services (OED)


The percentage of members under 21 years of age who received a comprehensive or periodic oral evaluation with a dental provider during the MY.


Topical Fluoride for Children (TFC)

The percentage of members 1–20 years old who received at least two topical fluoride applications during the MY.


Social Need Screening and Intervention

As NCQA increases its focus on social determinants of health (SDoH), another new proposed HEDIS measure (SNS-E) would screen members for unmet food, housing, and transportation needs and determine whether an intervention was performed for identified needs. Screenings would include:

  • Food screening: The percentage of members who were screened for unmet food needs.
  • Food intervention: The percentage of members who received a corresponding intervention within 1 month of screening positive for unmet food needs.
  • Housing screening: The percentage of members who were screened for unmet housing needs.
  • Housing intervention: The percentage of members who received a corresponding intervention within 1 month of screening positive for unmet housing needs.
  • Transportation screening: The percentage of members who were screened for unmet transportation needs.
  • Transportation intervention: The percentage of members who received a corresponding intervention within 1 month of screening positive for unmet transportation needs.

This measure is part of a larger attempt by NCQA to improve health equity and increase accountability among health plans to evaluate and address social determinants of health for members. As NCQA notes, these needs have been identified as a priority by health plans, providers, and other health system entities, requiring a focus on measuring factors that go beyond typical clinical operations and outcomes. As there is no current national health plan measure to determine and address members’ social needs, NCQA states, the organization is prioritizing this measure to fill the existing gap.

Notably, the new proposed Social Needs measure would be reported using the using the HEDIS Electronic Clinical Data Systems (ECDS) reporting standard.

Emergency Department Visits for Hypoglycemia in Older Adults With Diabetes

NCQA is proposing a measure that would address emergency department visits for hypoglycemia in diabetes patients 65 years and older.

Measure Name

Summary of Proposed Details

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

For members 65 years and older with diabetes (types 1 and 2), the risk-adjusted ratio of observed-to-expected emergency department (ED) visits for hypoglycemia during the MY.

As adult diabetics age, they become more prone to the negative effects of treatments meant to lower glucose, NCQA notes. They are also likelier to experience severe hypoglycemia, or low blood sugar, which leads to fall-related events and an increased risk of both cardiovascular events and cognitive decline. With the increased likelihood of these potentially damaging consequences, preventing hypoglycemia becomes key to aiding patient safety and avoiding intensive glycemic control. This is an opportunity for health plans to distinguish older diabetic patients with a high risk of hypoglycemia and implement fitting opportunities for prevention.

Proposed changes to existing measures

Adult Immunization Status

NCQA is updating the current HEDIS measure for Adult Immunization Status (AIS-E). The AIS-E measure evaluates the percentage of adults who are current on standard vaccinations, with separate indicators for influenza; tetanus and diphtheria (Td) or tetanus, diphtheria, and acellular pertussis (Tdap); zoster; and pneumococcal vaccinations. The proposed update will assess pneumococcal vaccination status while making new allowances and distinctions for member age-related factors and underlying conditions.

Measure Name

Summary of Proposed Changes

Adult Immunization Status (AIS-E)

Pneumococcal numerator:

  • Measure vaccinations among adults aged 65 and older, regardless of any underlying conditions. This measure does not include adults under the age of 65 due to the feasibility of identifying underlying conditions.
  • Revising the numerator time frame to include the receipt of vaccines between the age of 18 years and the end of the measurement period, since members with specific conditions can be vaccinated at younger ages.
  • Include the receipt of PCV20, PCV15, PCV13 or PPSV23 for the numerator, as some adults are not recommended to be re-vaccinated with new vaccines.

All numerators:

  • Standardize age ranges across product lines for all numerators.

Deprescribing of Benzodiazepines in Older Adults

This measure was initially included in MY 2022 specifications but was delayed to instead be released in MY 2023 due to the proposed changes. NCQA initially proposed an intermediate taper of ≥20% for members discontinuing the usage of benzodiazepines, due to concerns about the effects of withdrawal. But NCQA has conducted testing that suggests certain members can reach 100% discontinuation without an intermediate taper and without adverse effects.

Measure Name

Summary of Proposed Changes

Deprescribing of

Benzodiazepines in Older Adults (DBO)

  • Include a direct reference code for palliative care.
  • Include the Rules for Allowable Adjustments of HEDIS section.
  • Include language to explain numerator compliance for members reaching 100% discontinuation.
  • Include step to “Calculating number of days covered” definition for prescriptions dispensed on different days without overlapping days supply.
  • Include note that the same assumptions from “Calculating number of days covered” definition apply to “DME daily dose” and “average starting DME” calculations.
  • Include instructions for rounding to “Ending DME” and “PDC” definitions.

Proposed measure retirements

Frequency of Selected Procedures

NCQA is looking to retire the Frequency of Selected Procedures (FSP) HEDIS measure, which recaps the usage of frequently performed procedures with high variation and highlighted potential for being over- and underutilized across clinical procedures. This measure was originally proposed in a prior public comment to be retired for MY 2022, but the retirement decision has been pushed to MY 2023. FSP includes procedures such as:

  • Tonsillectomy
  • Bariatric weight loss surgery
  • Hysterectomy
  • Cholecystectomy
  • Back surgery

NCQA’s reasons for retiring this measure include:

  • Low utility and actionability. Without adjusted performance scores, interpreting measure results is challenging and not appropriate for plan comparisons. And the lack of performance benchmarks makes it difficult for health plans to target performance improvement.
  • Its length and complexity creates a significant burden on resources for health plans, vendors, and auditors, due to an excess of data variables and stratification combinations.
  • Unreliable validity due to interpretation variance over the years, as many stratifications create small sample sizes for individual reporting categories. 

Select CAHPS® health plan measures (FVA, FVO, PNU)

NCQA is looking to make changes to AIS-E, including retiring three immunization measures reported with the CAHPS® Health Plan Survey method. Since AIS-E will be publicly reported in MY 2022, these proposed measure retirements are being suggested as part of an effort to streamline adult immunizations in HEDIS.

Measure Name

Summary of Proposed Measure Retirements within AIS-E

Adult Immunization Status (AIS-E)

  • Flu Vaccinations for Adults Ages 18–64 (FVA)
  • Flu Vaccinations for Adults Ages 65 and Older (FVO)
  • Pneumococcal Vaccination Status for Older Adults (PNU)

Cross-cutting updates

Expansion of race and ethnicity stratification in HEDIS

NCQA introduced the race and ethnicity stratification to five HEDIS measures in MY 2022 and is looking to add at least five more measures in MY 2023. Based on feedback from expert panels and external stakeholders, the NCQA team developed a list of candidate measures for MY 2023 across several domains and is looking for feedback on this list as well as any others that should be considered.



Behavioral Health

Follow-Up After Emergency Department Visits for

Substance Use Disorder (FUA)

Pharmacotherapy for Opioid Use Disorder (POD)

Depression Screening and Follow-Up for Adolescents and Adults (DSF-E)

Utilization of the PHQ-9 to Monitor Depression

Symptoms for Adolescents and Adults (DMS-E)

Prenatal Depression Screening and Follow-Up (PND-E)

Postpartum Depression Screening and Follow-Up


Prevention and Screening

Breast Cancer Screening (BCS-E)

Adult Immunization Status (AIS-E)

Immunizations for Adolescents (IMA, IMA-E)

Prenatal Immunization Status (PRS-E)


Well-Child Visits in the First 30 Months of Life (W30)

Access and Availability of Care

Initiation and Engagement of Substance Use Disorder Treatment (IET)


Asthma Medication Ratio (AMR)

Care Coordination

Follow-Up After Emergency Department Visit for People With Multiple High-Risk Chronic Conditions (FMC)

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, Friday, March 11. Submit your comments via the NCQA public comment website.

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Read the fact sheet

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

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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