Medicaid and CHIP Risk-Based Managed Care in 20 States. Experiences Over the Past Decade and Lessons for the Future.. Appendix D: Trends in NCQA HEDIS Requirements, 2001-2010


Timeliness of Prenatal Care


Revised to ensure that measures share the same denominator as Frequency of Ongoing Prenatal Care. Measure was clarified to include visits to physician assistants and nurse practitioners.


Added a practitioner requirement to the Postpartum Care numerator for the Hybrid Specification

Well-Child Visits

No changes

Childhood Immunizations


Deleted "documented history of illness" and "seropositive test result" as numerator evidence for DTaP, IPV, HiB, and pneumococcal conjugate. These were infrequent, and likely to affect plans equally. They were deleted due to small impact and measure and burden for reporting. Four acellular pertussis vaccines for the DTaP atigen were required.


Revised the required number of doses for the HiB vaccine, per ACIP recommendations to defer to the third HiB booster during vaccine shortage.


Increased HiB dose requirement from 2 to 3.

Breast Cancer Screening


Hybrid methodology was retired for this method.


Changed age range from 50–69 to 40–69. Plans reported three rates: Total; 40–49; 50–69.


Measure changed to one age band of 40–69.

Cervical Cancer Screening


The lower age limit was raised to 21 years of age from 18 years of age.

Comprehensive Diabetes Care (HbA1c)


Removed glycohemoglobin from the HbA1c screening and control indicators. Added new LOINC codes.


Added an administrative method to the measure.

Source: Personal communication with Alan Hoffman, NCQA, 2011.



This study was conducted by the Urban Institute under contract number HHSP23320095654WC, task order number HHSP23337015T, with the HHS’s Office of Assistant Secretary for Planning and Evaluation. The authors take full responsibility for the accuracy of material presented herein. The views expressed are those of the authors and should not be attributed to ASPE or HHS.

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