HEDIS^® 2020 Medicare Advantage star measure changes

In July, the National Committee for Quality Assurance released proposed HEDIS^® specification changes** for the 2020 measurement year. NCQA will receive comments regarding the proposed changes and release final specifications at the end of October.

We’re providing advance communication of important specification changes at this time. 

Key updates:

Controlling high blood pressure (CBP)

New definition: Hypertensive patients ages 18 to 85 whose blood pressure is adequately controlled (<140/90) during the measurement year. The last blood pressure reading of the year determines compliance.

Important changes:

• Patients are now identified for the measure by two outpatient visits with a diagnosis of hypertension between Jan. 1 of the prior year and June 30 of the measure year.
• Blood pressure readings:
• Blood pressures taken by a patient from any digital device are acceptable as long as it’s documented in the patient’s legal record by the provider managing the patient’s blood pressure.
• Blood pressure readings taken by the patient using a non-digital device, such as a manual blood pressure cuff and a stethoscope, are not allowed for HEDIS reporting.
• Patient self-reported blood pressure readings may be obtained during telehealth, telephone, e-visits and virtual check-ins.

Submit claims with blood pressure CPT II code results even if the blood pressure isn’t compliant. Including CPT II result codes on the claim alleviates the need for a medical record request.

Palliative care exclusion
Patients receiving palliative care are now excluded from the following measures:

• Breast cancer screening (BCS)
• Colorectal cancer screening (COL)
• Controlling high blood pressure (CBP)
• Comprehensive diabetes care (CDC)
• Statin therapy for patients with cardiovascular disease (SPC)
• Osteoporosis management in women who had a fracture (OMW)

Advanced illness exclusion

The following measures now allow advanced illness to be captured via telephone and e-visits:

• Breast cancer screening (BCS)
• Disease-modifying anti-rheumatic drug therapy for rheumatoid arthritis (ART)
• Colorectal cancer screening (COL)
• Controlling high blood pressure (CBP)
• Comprehensive diabetes care (CDC)
• Statin therapy for patients with cardiovascular disease (SPC)
• Osteoporosis management in women who had a fracture (OMW)

Telephone and e-visit claims with advanced illness diagnoses will exclude patients from the measure if all exclusion requirements are met:

• 66 and older (67 and older for OMW)
• Two advanced illness claims in the measurement year or the prior measurement year and a frailty code in the measurement year

Frailty codes are required for the advanced illness exclusion but cannot be obtained through telephone or e-visit claim.

**HEDIS^® is a registered trademark of the National Committee for Quality Assurance.