2023 Quality Assurance Reporting Requirements (QARR)

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Method Measure Domain Flag Alpha Name Product Lines Specs Patient-Level Detail
Commercial Qualified Health Plans Medicaid
PPO/ EPO HMO/POS EP PPO/ EPO HMO/POS HMO/ PHSP HIV HARP
A Adherence to Antipsychotic Medications for Individuals with Schizophrenia Effectiveness of Care   SAA ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2023 ●
A Annual Monitoring for Persons on Long-Term Opioid Therapy Effectiveness of Care   AMO NR NR NR ✓ ✓ NR NR NR QRS ●
A Antidepressant Medication Management Effectiveness of Care   AMM ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ HEDIS 2023 ●
A Appropriate Testing for Pharyngitis Effectiveness of Care   CWP ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2023 ●
A Appropriate Treatment for Upper Respiratory Infection Effectiveness of Care   URI ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ HEDIS 2023 ●
A Asthma Medication Ratio Effectiveness of Care 5 AMR ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ HEDIS 2023 ●
A Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis Effectiveness of Care   AAB ✓ ✓ ✓ ✓ ✓ ✓ NR ✓ HEDIS 2023 ●
A/H Blood Pressure Control for Patients With Diabetes Effectiveness of Care   BPD ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2023 ●
A Breast Cancer Screening (non electronic version only) Effectiveness of Care   BCS                    
A Cardiac Rehabilitation Effectiveness of Care   CRE ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2023 ●
A Cardiovascular Monitoring for People With Cardiovascular Disease and Schizophrenia Effectiveness of Care   SMC NR NR NR NR NR ✓ ✓ ✓ HEDIS 2023 ●
A/H Cervical Cancer Screening Effectiveness of Care   CCS ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ HEDIS 2023 ●
A/H Childhood Immunization Status Effectiveness of Care 1 CIS ✓ ✓ NR ✓ ✓ ✓ ✓ NR HEDIS 2023 ●
A Chlamydia Screening in Women Effectiveness of Care 2 CHL ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ HEDIS 2023 ●
A/H Colorectal Cancer Screening Effectiveness of Care 2, 5 COL ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ HEDIS 2023 ●
A/H Controlling High Blood Pressure Effectiveness of Care 5 CBP ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ HEDIS 2023 ●
A COVID-19 Immunization Status Effectiveness of Care   CVS ✓ ✓ ✓ NR NR ✓ ✓ ✓ NYS QARR 2023 ●
A Diabetes Monitoring for People With Diabetes and Schizophrenia Effectiveness of Care   SMD NR NR NR NR NR ✓ ✓ ✓ HEDIS 2023 ●
A Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications Effectiveness of Care   SSD NR NR NR NR NR ✓ ✓ ✓ HEDIS 2023 ●
A Developmental Screening in the First Three Years of Life Effectiveness of Care   DEV-N ✓ ✓ NR NR NR ✓ NR NR OHSU (See NYS QARR 2023) ●
A/H Eye Exam for Patients With Diabetes Effectiveness of Care   EED ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ HEDIS 2023 ●
S Flu Vaccinations for Adults Ages 18 - 64 Effectiveness of Care   FVA ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ CAHPS 5.1H/CMS Core Set  
A Follow-Up After High-Intensity Care for Substance Use Disorder Effectiveness of Care 3 FUI ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2023 ●
A Follow-Up After Emergency Department Visit for Mental Illness Effectiveness of Care 3 FUM ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2023 ●
A Follow-Up After Emergency Department Visit for Substance Use Effectiveness of Care 3,5 FUA ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2023 ●
A Follow-Up After Hospitalization for Mental Illness Effectiveness of Care 3, 1 FUH ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ HEDIS 2023 ●
A Follow-Up Care for Children Prescribed ADHD Medication Effectiveness of Care 3 ADD ✓ ✓ NR NR NR ✓ ✓ NR HEDIS 2023 ●
A/H Hemoglobin A1c Control for Patients With Diabetes Effectiveness of Care 1, 5 HBD ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ HEDIS 2023 ●
A/H Immunizations for Adolescents Effectiveness of Care 1, 5 IMA ✓ ✓ NR ✓ ✓ ✓ ✓ NR HEDIS 2023 ●
A International Normalized Ratio Monitoring for Individuals on Warfarin Effectiveness of Care   INR NR NR NR ✓ ✓ NR NR NR PQA ●
A Kidney Health Evaluation for Patients With Diabetes Effectiveness of Care   KED ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ HEDIS 2023 ●
A/H Lead Screening in Children Effectiveness of Care 6 LSC ✓ ✓ NR NR NR ✓ ✓ NR HEDIS 2023 ●
S Medical Assistance With Smoking and Tobacco Use Cessation Effectiveness of Care 4 MSC ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ CAHPS 5.1H  
A Metabolic Monitoring for Children and Adolescents on Antipsychotics Effectiveness of Care   APM ✓ ✓ NR NR NR ✓ ✓ NR HEDIS 2023 ●
A Non-Recommended Cervical Cancer Screening in Adolescent Females Effectiveness of Care   NCS ✓ ✓ NR NR NR ✓ NR NR HEDIS 2023 ●
A Oral Evaluation, Dental Services Effectiveness of Care   OED NR NR NR NR NR ✓ ✓ NR HEDIS 2023 ●
A Persistence of Beta-Blocker Treatment After a Heart Attack Effectiveness of Care   PBH ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2023 ●
A Pharmacotherapy for Opioid Use Disorder Effectiveness of Care 5 POD ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2023 ●
A Pharmacotherapy Management of COPD Exacerbation Effectiveness of Care   PCE ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2023 ●
A Proportion of Days Covered Effectiveness of Care   PDC NR NR NR ✓ ✓ NR NR NR PQA ●
A Risk of Continued Opioid Use Effectiveness of Care   COU ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2023  
A Statin Therapy for Patients With Cardiovascular Disease Effectiveness of Care   SPC ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2023 ●
A Statin Therapy for Patients With Diabetes Effectiveness of Care   SPD ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2023 ●
A Topical Fluoride for Children Effectiveness of Care   TFC NR NR NR NR NR ✓ ✓ NR HEDIS 2023 ●
A Use of Imaging Studies for Low Back Pain Effectiveness of Care   LBP ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ HEDIS 2023 ●
A Use of Opioids at High Dosage Effectiveness of Care   HDO ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2023 ●
A Use of Opioids from Multiple Providers Effectiveness of Care   UOP ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2023 ●
A Use of Spirometry Testing in the Assessment and Diagnosis of COPD Effectiveness of Care   SPR ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2023 ●
A Viral Load Suppression Effectiveness of Care 7 VLS NR NR NR NR NR ✓ ✓ ✓ NYS QARR 2023  
A/H Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents Effectiveness of Care   WCC ✓ ✓ NR ✓ ✓ ✓ ✓ NR HEDIS 2023 ●
Access / Availability of Care
A Adults' Access to Preventive/Ambulatory Health Services Access / Availability of Care   AAP ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2023 ●
A Annual Dental Visit Access / Availability of Care   ADV                 HEDIS 2023  
A Antibiotic Utilization for Respiratory Conditions Access / Availability of Care   AXR ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2023 ●
A Initiation and Engagement of Substance Use Disorder Treatment Access / Availability of Care 5 IET ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ HEDIS 2023 ●
A Initiation of Pharmacotherapy upon New Episode of Opioid Dependence Access / Availability of Care   POD-N NR NR NR NR NR ✓ ✓ ✓ NYS QARR 2023 ●
A/H Prenatal and Postpartum Care Access / Availability of Care 5 PPC ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ HEDIS 2023 ●
A Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics Access / Availability of Care   APP ✓ ✓ NR NR NR ✓ ✓ NR HEDIS 2023 ●
A Use of Pharmacotherapy for Alcohol Use or Dependence Access / Availability of Care   POA NR NR NR NR NR ✓ ✓ ✓ NYS QARR 2023 l
Health Plan Descriptive Information
  Enrollment by Product Line Access / Availability of Care   ENP ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2023  
Use of Services
A Acute Hospital Utilization Use of Services   AHU ✓ ✓ ✓ NR NR NR NR NR HEDIS 2023  
A Ambulatory Care Use of Services   AMB NR NR NR NR NR ✓ ✓ ✓ HEDIS 2023  
A Child and Adolescent Well-Care Visits Use of Services 1, 5 WCV ✓ ✓ NR ✓ ✓ ✓ ✓ ✓ HEDIS 2023 ●
A Diagnosed Mental Health Disorders Use of Services   DMH ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2023  
A Diagnosed Substance Use Disorder Use of Services   DSU ✓ ✓ NR NR NR ✓ ✓ ✓ HEDIS 2023  
A Emergency Department Utilization Use of Services   EDU ✓ ✓ ✓ NR NR NR NR NR HEDIS 2023  
A Frequency of Selected Procedures Use of Services   FSP                    
A Inpatient Utilization–General Hospital/Acute Care Use of Services   IPU NR NR NR NR NR ✓ ✓ ✓ HEDIS 2023  
A Plan All-Cause Readmission Use of Services   PCR ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ HEDIS 2023  
A Well-Child Visits in the First 30 Months of Life Use of Services 1,5 W30 ✓ ✓ NR ✓ ✓ ✓ ✓ NR HEDIS 2023 ●
Measures Collected Using Electronic Clinical Data Systems
E Adult Immunization Status ECDS   AIS-E ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ HEDIS 2023 ●
E Breast Cancer Screening ECDS 5 BCS-E ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ HEDIS 2023 ●
E Cervical Cancer Screening ECDS   CCS-E ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ HEDIS 2023 ●
E Childhood Immunization Status ECDS 1 CIS-E ✓ ✓ NR ✓ ✓ ✓ ✓ NR HEDIS 2023 ●
E Colorectal Cancer Screening ECDS 5 COL-E ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ HEDIS 2023 ●
E Depression Remission or Response for Adolescents and Adults ECDS   DRR-E NR NR NR NR NR NR NR NR HEDIS 2023  
E Depression Screening and Follow-Up for Adolescents and Adults ECDS   DSF-E ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2023 ●
E Follow-Up Care for Children Prescribed ADHD Medication ECDS   ADD-E ✓ ✓ NR NR NR ✓ ✓ NR HEDIS 2023 ●
E Immunizations for Adolescents ECDS 1 IMA-E ✓ ✓ NR ✓ ✓ ✓ ✓ NR HEDIS 2023 ●
E Prenatal Depression Screening and Follow-Up ECDS   PND-E ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2023 ●
E Postpartum Depression Screening and Follow-Up ECDS   PDS-E ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2023 ●
E Prenatal Immunization Status ECDS   PRS-E ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2023 ●
E Social Need Screening and Intervention ECDS   SNS-E ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2023 ●
E Unhealthy Alcohol Use Screening and Follow-Up ECDS   ASF-E NR NR NR NR NR NR NR NR HEDIS 2023  
E Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults ECDS   DMS-E NR NR NR NR NR NR NR NR HEDIS 2023  
Experience of Care
C CAHPS Health Plan Survey 5.1H Adult Version Experience of Care 4 CPA ✓ ✓ ✓ NR NR NR NR NR HEDIS 2023  
C CAHPS Health Plan Survey 5.1H Child Version Experience of Care 4 CPC NR NR NR NR NR NR NR NR HEDIS 2023  
C QHP Enrollee Experience Survey Experience of Care     NR NR NR ✓ ✓ NR NR NR QRS De-identified member file
NYS QARR 2023-Specific Prenatal Care Measures
A Risk-Adjusted Low Birth Weight NYS QARR 2023-Specific Prenatal Care Measures 7     These prenatal care measures will be calculated by the Office of Quality and Patient Safety using the birth data submitted by plans and the Department's Vital Statistics Birth File. NYS QARR 2023  
A Prenatal Care in the First Trimester NYS QARR 2023-Specific Prenatal Care Measures 7     NYS QARR 2023  
A Risk-Adjusted Primary C-Section NYS QARR 2023-Specific Prenatal Care Measures 7     NYS QARR 2023  
NYS QARR 2023-Specific Behavioral Health Measures
A Potentially Preventable Mental Health Related Readmission Rate 30 Days NYS QARR 2023-Specific Behavioral Health Measures 7 PPR-MH   This measure will be calculated by New York State using 3M Software and health plan submitted encounters. NYS QARR 2023  
A Utilization of Recovery-Oriented Services for Mental Health NYS QARR 2023-Specific Behavioral Health Measures 7 URO   This measure will be calculated and reported by New York State. No plan reporting is required. NYS QARR 2023  

Product Lines Flag Reporting Guidelines
EPO - Exclusive Provider Organization 1 = QHP ✓ - Reporting Required MY2023
PPO - Preferred Provider Organization 2 = Enhanced for Medicaid, separate file not required. ● - The PLD file requires reporting if a ✓ is in the product line
HMO - Health Maintenance Organization 3 = Enhanced for Medicaid, separate file required. NR - Not Required
POS - Point of Service 4 = DOH conducts Medicaid/HARP/HIVSNP CAHPS for both adult and child populations. Orange - New Measure
PHSP - Prepaid Health Services Plan 5 = Race and Ethnicity Stratification required for NCQA; the Patient Level Detail file should reflect the race and identified for the member and the method (direct or indirect). Gray - Not required for MY2023 reporting/Removed
HIVSNP - HIV Special Needs Plan Blue - Name Change/Specification Update
HARP - Health and Recovery Plan 6 = Commercial plans follow Medicaid specifications. Method
EP - Essential Plan 7 = DOH calculated; no plan reporting required. A - admin, H - hybrid, S - survey, E - electronic