HEDIS® MY 2026 Public Comments: Highlights for Quality Teams

NCQA recently shared proposed new measures and measure changes for MY 2026 for public comments. The following is a summary of the proposed measure changes and things to keep in mind as you submit your comments.

Proposed new measures for HEDIS MY 2026 Public Comment

The first new measure is Tobacco Use Screening and Cessation Intervention.

If approved, this measure replaces Medical Assistance with Smoking and Tobacco Use Cessation (MSC). I find it interesting that this measure is not anchored on an inpatient visit, which lends itself to alternative interventions for tobacco assessment (i.e., in-home, care management). The measure looks for LOINC values to identify a tobacco assessment through the standard question set:

• Have you used tobacco in the last 30 days?
• Have you used smokeless tobacco product in the last 30 days?

The definition of tobacco use has expanded to vaping, chew, moist tobacco use, and e-cigarettes.

After identification of a tobacco user, the measure assesses those who received tobacco cessation intervention including cessation counseling or dispensing of pharmacotherapy medications.

The second proposed measure is Follow-Up After Acute Care Visits for Asthma.

If approved, this measure would replace Asthma Medication Ratio (AMR). AMR restricts the eligible population by only including individuals with persistent asthma. Additionally, the latest medical guidance points to the use of a combined inhaler (Maintenance and Reliever Therapy [MART]) that includes a controller and reliever medications.

The new measure looks at the percentage of acute visits, inclusive of urgent care, emergency department visits, observation stays, and inpatient visits for individuals with asthma that then had an outpatient follow-up within 30 days.

The goal of the measure is to have members leverage their primary care physicians to manage their asthma after an asthma exacerbation.

NCQA is requesting guidance on a 15- or 30-day follow-up window; both will be difficult to take action on when relying on urgent care or emergency visit claims to arrive, then a short window to get in following up with the member or provider.

The final new proposed measure is Disability Description of Membership, which looks at the estimated 1 in 4 members living with disabilities. This measure is based on self-reported data and does not need to be substantiated with a clinical diagnosis.

Self-reported disabilities include:

• Hearing
• Seeing
• Concentrating
• Walking
• Dressing/Bathing
• Completing Errands
• Communicating
• Other Disability

The measure is based on member self-reported disability questionnaire or accommodations. It will be a hard measure to audit as the data are member-reported and to program as there are no valid value sets outside of the measure description.

Preparing for MY26 starts now

As NCQA finalizes new measures and changes to existing measures, it’s important for health plans to keep one eye on the implications of future requirements while remaining focused on the current HEDIS season.

Stay updated with NCQA and follow along as Inovalon continues to share helpful insights and resources to help you master your HEDIS reporting.

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