NCQA releases proposed HEDIS MY 2026 updates

Each year, NCQA publishes a list of measure updates, additions, and deletions for future HEDIS? measurement years. With big changes slated for the future as NCQA aims to fully transition to digital-only reporting by 2030, the public comment period allows plans the opportunity to weigh in on the relevance and feasibility of the proposed changes and ask questions of relevant stakeholders.

Read our summary of NCQA’s latest proposed changes for Measurement Year (MY) 2026, which Cotiviti will discuss during our Quality Decoded webinar this Thursday 3/6, as NCQA seeks feedback from health plans.

Proposed new measures and measure retirements for MY 2026

NCQA has proposed three new HEDIS measures:

Follow-Up After Acute Care Visits for Asthma (AAF-E)

This measure would assess the percentage of acute visits for asthma in members from 5–64 years old who had a corresponding outpatient follow-up visit within 30 days. It aims to improve asthma control and reduce acute exacerbations, which often indicate poorly managed asthma. NCQA proposes retiring the Asthma Medication Ratio (AMR) measure, which assesses the percentage of members from 5–64 years old with a ratio of controller medications to total asthma medications greater than or equal to 0.50, replacing it with this new asthma measure.

Tobacco Use Screening and Cessation Intervention (TSC-E)

This measure would focus on members 12 years and older, assessing the rate of members screened for tobacco use and the provision of cessation interventions for tobacco users. Given the significant health risks associated with tobacco use, this measure aims to enhance screening and intervention efforts. This measure is proposed to replace the Medical Assistance with Smoking and Tobacco Use Cessation (MSC) measure captured via Consumer Assessment of Healthcare Providers and Systems (CAHPS?) survey responses.

Disability Description of Membership (DDM)

This measure would track the collection of disability status information for members 15 years and older, aiming to improve the completeness and standardization of data on disabilities. More comprehensive documentation on disability data would assist in identifying care disparities, allowing for the development of more targeted measures to address care gaps in persons with disabilities.

Changes to existing HEDIS measures for MY 2026

NCQA proposes revisions to six existing HEDIS measures:

Social Need Screening and Intervention (SNS-E)

The proposed changes include adding HCPCS G codes to identify screenings and interventions, adding ICD-10 Z codes to identify members with social needs, as well as removing assessments from the allowable interventions.

Adult Immunization Status (AIS-E)

A new indicator for COVID-19 immunization status would be added for adults 19 years and older, following a similar timeframe for compliance as the existing Influenza indicator.

Lead Screening in Children (LSC-E)

NCQA had initially proposed that the LSC measure would transition to administrative-only reporting in MY 2026 on its blog. With the public comment period, it now proposes to transition this measure to using only the Electronic Clinical Data Systems (ECDS) reporting method, following several other measures that have transitioned to ECDS-only amid NCQA’s aim to fully digitize quality measurement by 2030.

Follow-Up After High-Intensity Care for Substance Use Disorder (FUI)

Proposed numerator changes include allowing the substance use diagnosis to be in any diagnosis position, adding peer support services, and removing pharmacotherapy events.

Statin Therapy for Patients with Cardiovascular Disease (SPC) and Statin Therapy for Patients with Diabetes (SPD)

Both measures would transition from administrative reporting to the ECDS reporting method, though this transition is specifically not up for public comment. For both measures, NCQA proposes updates to identifying members with ASCVD and removing the exclusion of members enrolled in an I-SNP or living in a long-term institution. For SPC, NCQA would remove the sex-specific age criteria including all members from 21–39 years old, as well as expanding to include members 76–85 years old.

Cross-cutting race and ethnicity stratification changes

NCQA seeks comments on aligning HEDIS race and ethnicity stratification with updated federal standards introduced in March 2024. This includes updates to reporting categories and terminology, combining race and ethnicity into a single reporting unit, and adding a category for Middle Eastern or North African members.

Changes not for public comment

Included with the public comment materials are a list of changes to expect for MY 2025 and MY 2026 that are not up for public comment. These changes include:

• Expanding the Breast Cancer Screening (BCS-E) measure to add 40-49 year old members for MY 2025
• Delaying the publication of the MY 2025 RAND table needed for the systematic sampling algorithm to October 2025, just prior to drawing production MY 2025 samples
• Removing SNOMED codes from value sets that identify lab tests, imaging studies, and vaccinations for MY 2026
• Updating the format of the HEDIS Volume 2 specifications for MY 2026 to align with FHIR standards
• Introducing a new ECDS version of the Blood Pressure Control for Patients With Diabetes (BPD) measure for optional reporting in MY 2026, though notably the new measure specification was not included in the public comment materials

Health plans have until Thursday, March 13 to submit comments on the proposed changes via NCQA’s portal.

Join us for the second installment of our 2025 Quality Decoded webinar series on Thursday, March 6 at 1 pm ET as we break down what you need to know about the latest public comment period for MY 2026.

Listen in as Cotiviti experts:

• Analyze the annual request for public comment on proposed HEDIS measure changes
• Recommend feedback to provide to NCQA on the proposed measure updates??
• Share observations on how proposals in the public comment may impact HEDIS reporting in the future

Register now

Don’t miss this opportunity to gain strategic insight into HEDIS measure changes and prepare for industry challenges with expert best practices. If you can’t attend the live webinar, be sure to register so we can email you the on-demand recording.

Stay informed with our Quality Decoded series providing information about key topics, measure changes, and announcements from NCQA and CMS throughout the year. Check out our future webinars tackling Star Ratings, HEDIS technical specifications, and more.

HEDIS? is a registered trademark of the National Committee for Quality Assurance. CAHPS? is a registered trademark of the?Agency for Healthcare Research and Quality?(AHRQ).

About the author

Samantha is the manager of program management supporting Cotiviti’s Quality Intelligence solution. She has over 12 years of experience working in HEDIS. Her team of HEDIS and state and custom program managers are responsible for ensuring adherence to NCQA and state Medicaid specifications. She 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.