What You Need to Know: Key Changes for HEDIS MY2020

There have been a lot of changes with HEDIS® for MY2020.  We’ve highlighted key changes in the Volume 2 specifications until the final changes become available on October 1.

The first change to note is that NCQA has instituted a new naming convention to reduce confusion about the measurement year vs. reporting year. Going forward, all HEDIS publication titles will refer to the HEDIS measurement year.  For example, HEDIS MY2020/MY2021 Technical Specifications were released 7/1/2020.

Then, there are several overlapping changes across measures:

  • Risk Adjustment tables were reformatted to delineate by product line to reduce complexity. A user manual with supporting documentation regarding use of the updated tables will be provided by NCQA.
  • Palliative Care Exclusion added to multiple measures
  • Telehealth guidance provided for 40 measures to support the increased use of telehealth this year, aligning with telehealth guidance from CMS.
  • Practitioner definitions (Appendix 3) for “mental health provider” and “PCP” were revised.
  • Data element definitions (Appendix 4) added a standard ECDS data element table.
  • ECDS measures are in narrative form only in Volume 2.  The Digital Measure Bundle contains the CQL logic which should be used to program and report these measures. Measure naming convention change so all ECDS measures are noted as “Measure Name-E”

Next are the General Guideline Updates:

GG9: HEDIS Audit Timeline updated to include key dates and deadlines for MY2020 and MY2021

GG18: If organizations can identify members who die during the MY, these members must be excluded

GG31: Clarified that codes alone do not meet criteria for proof of service for supplemental data

GG33:  Clarified the Date of Service for Laboratory tests (previously known as Measures That Require Results from the Most Recent Test or Measurement)

GG42: Provides additional guidance on synchronous and asynchronous telehealth and associated Value Sets.

GG52: Reporting tables have been updated with shading according to how the data are reported for all measures.  Shading was added in the Data Elements for Reporting tables to indicate how the data are reported by the organization, calculated by the IDSS or the data are not used or reported.

Finally, there are numerous retired, new, revised and updated/restructured measures per below.

Retired Measures:

  • Adult BMI Assessment (ABA)
  • Medication Management for People with Asthma (MMA)
  • Disease-Modifying Anti-Rheumatic Drug Therapy for Rheumatoid Arthritis (ART) (retired for MY2021 but reported for MY2020)
  • Medication Reconciliation Post-Discharge (MRP) (remains an indication for the Transitions of Care measure)
  • Osteoporosis Testing in Older Women (OTO) (Health Outcome Survey measure)
  • Children and Adolescents’ Access to Primary Care Practitioners (CAP)
  • Board Certification (BCR)

Retired Rates and Product Lines:

  • Medical Attention for Nephropathy indicator for Comprehensive Diabetes Care (CDC): Commercial and Medicaid
  • Hemoglobin A1c <7 for Comprehensive Diabetes Care (CDC)

New Measures:

  • Cardiac Rehabilitation (CRE)
  • Kidney Health Evaluation for Patients with Diabetes (KED)
  • Osteoporosis Screening in Older Women (OSW)

Updated/Restructured Measures:

  • Well-Child Visits in the First 30 Months of Life (W30) is a revision the W15 measure with an extended measurement period and stratification.  Removed hybrid specification.
  • Child and Adolescent Well-Care Visits (WCV) has combined the W34 and AWC measures and added age stratifications.  Removed hybrid specification.
  • Emergency Department Utilization (EDU) was revised to remove visits that convert to Observation stays and removed high frequency utilizers from the risk-adjusted performance rates.  Added new outlier rate to report high frequency utilizers.
  • Depression Screening and Follow-Up for Adolescents and Adults (DSF), Prenatal Depression Screening and Follow-Up (PND), and Postpartum Depression Screening and Follow-Up (PDS) had the “positive screen” threshold raised, DSF modified the age stratification and PDS revised the screening time period.

Revised Measures:

  • Controlling High Blood Pressure (CBP)
  • Follow-Up After Hospitalization for Mental Illness (FUH)
  • Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC)
  • Care for Older Adults (COA)
  • Adult Immunization Status (AIS)
  • Unhealthy Alcohol Use Screening and Follow-Up (ASF)
  • Comprehensive Diabetes Care (CDC)
  • Use of High-Risk Medications in Older Adults (DAE)
  • Transitions of Care (TRC)

If you have any questions about how the changes may impact your business, please contact Centauri's Quality team at  info@centaurihs.com and we will be happy to assist you in any way that we can.


Melanie Richey
Vice President, Clinical Solutions
Centauri Health Solutions, Inc.