12/29/2023 0 Comments Ncqa logic for identifiying ed visits![]() Simplified identifying members for whom first-line antipsychotic medications may be clinically appropriate only requires applicable diagnoses on two different dates of service in the MYĮxpansion of inclusivity and diversity initiativesĪs NCQA seeks to advance gender-inclusive measurement for transgender health plan members, it is expanding the criteria for the Breast Cancer Screening (BCS-E) and Cervical Cancer Screening (CCS, CCS-E) measures.Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics (APP) required exclusions:.Simplified to fracture diagnosis 60 days prior to episode date.Osteoporosis Management In Women Who Had a Fracture (OMW) negative diagnosis history:.Pharmacy data: Added a requirement to also have a diagnosis of diabetes in the MY or PY, removing the Diabetes Exclusions Value Set exclusion as well. ![]() Claim/encounter data: Simplified to only require two diagnoses of diabetes on different dates of service during the MY or prior year (PY).Diabetes measure event/diagnosis criteria:.Now a required exclusion along with I-SNP, LTI, and frailty.Simplified to two diagnoses on different dates of service or dispensed dementia medication.Notably, NCQA also confirmed that for MY 2025, ICD-9 diagnosis and procedure codes will be removed from value sets.įinally, for several measures, logic that previously required diagnoses in conjunction with visit setting codes has been simplified to require only diagnosis codes: All value sets containing only one code have been removed and replaced with direct reference codes.Conditions using multiple value sets have been combined into single, larger value sets.The Observation Value Set has been retired from all measures using it.Several value sets have been consolidated or removed: Restricting use of lab claims and CPT Category II codes with modifiers is now defined in measures directly for individual applicable value sets.The Hospice and Deceased General Guidelines have moved to each applicable measure’s ”Required exclusions” specification.In addition, several General Guidelines have now been removed and repurposed elsewhere: Use of Spirometry Testing in the Assessment and Diagnosis of COPD (SPR).Non-Recommended Cervical Cancer Screening in Adolescent Females (NCS).Inpatient Utilization-General Hospital/Acute Care (IPU).Meanwhile, no new measures will be added for MY 2024 and four measures are being retired altogether: Notably, Eye Exam for Patients With Diabetes (EED) will remain a hybrid measure for MY 2024. Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM).Follow-Up Care for Children Prescribed ADHD Medication (ADD). ![]() Cross-cutting consolidation and simplificationĪs NCQA continues its focus on electronic clinical data acquisition, several measures are being moved from administrative/hybrid reporting to the electronic clinical data systems (ECDS)-only standard, including: Here, we break down these changes for health plans across three key themes. With the August publication of the HEDIS Measurement Year 2024 Volume 2: Technical Specifications for Health Plans, the National Committee for Quality Assurance (NCQA) has now confirmed several proposed updates for the Measurement Year (MY) 2024 season following a public comment period earlier this year.
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