2024 Quality Assurance Reporting Requirements (QARR)
- Table also available in Portable Document Format (PDF)
| 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 2024 | ● | |
| 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 2024 | ● | |
| A | Appropriate Testing for Pharyngitis | Effectiveness of Care | CWP | ✓ | ✓ | ✓ | NR | NR | ✓ | ✓ | ✓ | HEDIS 2024 | ● | |
| A | Appropriate Treatment for Upper Respiratory Infection | Effectiveness of Care | URI | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | HEDIS 2024 | ● | |
| A | Asthma Medication Ratio | Effectiveness of Care | 5 | AMR | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | HEDIS 2024 | ● |
| A | Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis | Effectiveness of Care | AAB | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | NR | ✓ | HEDIS 2024 | ● | |
| A/H | Blood Pressure Control for Patients With Diabetes | Effectiveness of Care | BPD | ✓ | ✓ | ✓ | NR | NR | ✓ | ✓ | ✓ | HEDIS 2024 | ● | |
| A | Cardiac Rehabilitation | Effectiveness of Care | CRE | ✓ | ✓ | ✓ | NR | NR | ✓ | ✓ | ✓ | HEDIS 2024 | ● | |
| A | Cardiovascular Monitoring for People With Cardiovascular Disease and Schizophrenia | Effectiveness of Care | SMC | NR | NR | NR | NR | NR | ✓ | ✓ | ✓ | HEDIS 2024 | ● | |
| A/H | Cervical Cancer Screening | Effectiveness of Care | CCS | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | HEDIS 2024 | ● | |
| A/H | Childhood Immunization Status | Effectiveness of Care | 1 | CIS | ✓ | ✓ | NR | ✓ | ✓ | ✓ | ✓ | NR | HEDIS 2024 | ● |
| A | Chlamydia Screening in Women | Effectiveness of Care | 2 | CHL | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | HEDIS 2024 | ● |
| ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | |||||||
| A/H | Controlling High Blood Pressure | Effectiveness of Care | 5 | CBP | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | HEDIS 2024 | ● |
| A | COVID-19 Immunization Status | Effectiveness of Care | CVS | ✓ | ✓ | ✓ | NR | NR | ✓ | ✓ | ✓ | NYS QARR 2024 | ● | |
| A | Diabetes Monitoring for People With Diabetes and Schizophrenia | Effectiveness of Care | SMD | NR | NR | NR | NR | NR | ✓ | ✓ | ✓ | HEDIS 2024 | ● | |
| 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 2024 | ● | |
| A | Developmental Screening in the First Three Years of Life | Effectiveness of Care | DEV-N | ✓ | ✓ | NR | NR | NR | ✓ | NR | NR | OHSU (See NYS QARR 2024) | ● | |
| A/H | Eye Exam for Patients With Diabetes | Effectiveness of Care | EED | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | HEDIS 2024 | ● | |
| A | Follow-Up After Emergency Department Visit for Mental Illness | Effectiveness of Care | 3 | FUM | ✓ | ✓ | ✓ | NR | NR | ✓ | ✓ | ✓ | HEDIS 2024 | ● |
| A | Follow-Up After Emergency Department Visit for Substance Use | Effectiveness of Care | 3,5 | FUA | ✓ | ✓ | ✓ | NR | NR | ✓ | ✓ | ✓ | HEDIS 2024 | ● |
| A | Follow-Up After High-Intensity Care for Substance Use Disorder | Effectiveness of Care | 3 | FUI | ✓ | ✓ | ✓ | NR | NR | ✓ | ✓ | ✓ | HEDIS 2024 | ● |
| A | Follow-Up After Hospitalization for Mental Illness | Effectiveness of Care | 3, 1 | FUH | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | HEDIS 2024 | ● |
| NR | NR | NR | NR | NR | NR | NR | NR | |||||||
| A/H | Glycemic Status Assessment for Patients With Diabetes |
Effectiveness of Care | 1, 5 | GSD |
✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | HEDIS 2024 | ● |
| A/H | Immunizations for Adolescents | Effectiveness of Care | 1, 5 | IMA | ✓ | ✓ | NR | ✓ | ✓ | ✓ | ✓ | NR | HEDIS 2024 | ● |
| A | International Normalized Ratio Monitoring for Individuals on Warfarin | Effectiveness of Care | INR | NR | NR | NR | ✓ | ✓ | NR | NR | NR | QRS/PQA | ● | |
| A | Kidney Health Evaluation for Patients With Diabetes | Effectiveness of Care | KED | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | HEDIS 2024 | ● | |
| A/H | Lead Screening in Children | Effectiveness of Care | 6 | LSC | ✓ | ✓ | NR | NR | NR | ✓ | ✓ | NR | HEDIS 2024 | ● |
| S | Medical Assistance With Smoking and Tobacco Use Cessation | Effectiveness of Care | 4 | MSC | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | CAHPS 5.1H | |
| NR | NR | NR | NR | NR | ||||||||||
| NR | NR | NR | NR | NR | ||||||||||
| A | Oral Evaluation, Dental Services | Effectiveness of Care | OED | NR | NR | NR | NR | NR | ✓ | ✓ | NR | HEDIS 2024 | ● | |
| A | Persistence of Beta-Blocker Treatment After a Heart Attack | Effectiveness of Care | PBH | ✓ | ✓ | ✓ | NR | NR | ✓ | ✓ | ✓ | HEDIS 2024 | ● | |
| A | Pharmacotherapy for Opioid Use Disorder | Effectiveness of Care | 5 | POD | ✓ | ✓ | ✓ | NR | NR | ✓ | ✓ | ✓ | HEDIS 2024 | ● |
| A | Pharmacotherapy Management of COPD Exacerbation | Effectiveness of Care | PCE | ✓ | ✓ | ✓ | NR | NR | ✓ | ✓ | ✓ | HEDIS 2024 | ● | |
| 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 2024 | ||
| A | Statin Therapy for Patients With Cardiovascular Disease | Effectiveness of Care | SPC | ✓ | ✓ | ✓ | NR | NR | ✓ | ✓ | ✓ | HEDIS 2024 | ● | |
| A | Statin Therapy for Patients With Diabetes | Effectiveness of Care | SPD | ✓ | ✓ | ✓ | NR | NR | ✓ | ✓ | ✓ | HEDIS 2024 | ● | |
| A | Topical Fluoride for Children | Effectiveness of Care | TFC | NR | NR | NR | NR | NR | ✓ | ✓ | NR | HEDIS 2024 | ● | |
| A | Use of Imaging Studies for Low Back Pain | Effectiveness of Care | LBP | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | HEDIS 2024 | ● | |
| A | Use of Opioids at High Dosage | Effectiveness of Care | HDO | ✓ | ✓ | ✓ | NR | NR | ✓ | ✓ | ✓ | HEDIS 2024 | ● | |
| A | Use of Opioids from Multiple Providers | Effectiveness of Care | UOP | ✓ | ✓ | ✓ | NR | NR | ✓ | ✓ | ✓ | HEDIS 2024 | ● | |
| NR | NR | NR | NR | NR | NR | NR | NR | |||||||
| A | Viral Load Suppression | Effectiveness of Care | 7 | VLS | NR | NR | NR | NR | NR | ✓ | ✓ | ✓ | NYS QARR 2024 | |
| A/H | Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents | Effectiveness of Care | WCC | ✓ | ✓ | NR | ✓ | ✓ | ✓ | ✓ | NR | HEDIS 2024 | ● | |
| Access / Availability of Care | ||||||||||||||
| A | Adults' Access to Preventive/Ambulatory Health Services | Access / Availability of Care | AAP | ✓ | ✓ | ✓ | NR | NR | ✓ | ✓ | ✓ | HEDIS 2024 | ● | |
| A | Antibiotic Utilization for Respiratory Conditions | Access / Availability of Care | AXR | ✓ | ✓ | ✓ | NR | NR | ✓ | ✓ | ✓ | HEDIS 2024 | ● | |
| A | Initiation and Engagement of Substance Use Disorder Treatment | Access / Availability of Care | 5 | IET | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | HEDIS 2024 | ● |
| A/H | Prenatal and Postpartum Care | Access / Availability of Care | 5 | PPC | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | HEDIS 2024 | ● |
| A | Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics | Access / Availability of Care | APP | ✓ | ✓ | NR | NR | NR | ✓ | ✓ | NR | HEDIS 2024 | ● | |
| Health Plan Descriptive Information | ||||||||||||||
| Enrollment by Product Line | Access / Availability of Care | ENP | ✓ | ✓ | ✓ | NR | NR | ✓ | ✓ | ✓ | HEDIS 2024 | |||
| Use of Services | ||||||||||||||
| A | Acute Hospital Utilization | Use of Services | AHU | ✓ | ✓ | ✓ | NR | NR | NR | NR | NR | HEDIS 2024 | ||
| NR | NR | NR | NR | NR | NR | NR | NR | |||||||
| A | Child and Adolescent Well-Care Visits | Use of Services | 1, 5 | WCV | ✓ | ✓ | NR | ✓ | ✓ | ✓ | ✓ | ✓ | HEDIS 2024 | ● |
| A | Diagnosed Mental Health Disorders | Use of Services | DMH | ✓ | ✓ | ✓ | NR | NR | ✓ | ✓ | ✓ | HEDIS 2024 | ||
| A | Diagnosed Substance Use Disorder | Use of Services | DSU | ✓ | ✓ | NR | NR | NR | ✓ | ✓ | ✓ | HEDIS 2024 | ||
| A | Emergency Department Utilization | Use of Services | EDU | ✓ | ✓ | ✓ | NR | NR | NR | NR | NR | HEDIS 2024 | ||
| NR | NR | NR | NR | NR | NR | NR | NR | |||||||
| A | Plan All-Cause Readmission | Use of Services | PCR | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | HEDIS 2024 | ||
| A | Well-Child Visits in the First 30 Months of Life | Use of Services | 1,5 | W30 | ✓ | ✓ | NR | ✓ | ✓ | ✓ | ✓ | NR | HEDIS 2024 | ● |
| Measures Collected Using Electronic Clinical Data Systems | ||||||||||||||
| E | Adult Immunization Status | ECDS | AIS-E | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | HEDIS 2024 | ● | |
| E | Breast Cancer Screening | ECDS | 5 | BCS-E | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | HEDIS 2024 | ● |
| E | Cervical Cancer Screening | ECDS | CCS-E | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | HEDIS 2024 | ● | |
| E | Childhood Immunization Status | ECDS | 1 | CIS-E | ✓ | ✓ | NR | ✓ | ✓ | ✓ | ✓ | NR | HEDIS 2024 | ● |
| E | Colorectal Cancer Screening | ECDS | 5 | COL-E | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | HEDIS 2024 | ● |
| E | Depression Remission or Response for Adolescents and Adults | ECDS | DRR-E | ✓ | ✓ | ✓ | NR | NR | ✓ | ✓ | ✓ | HEDIS 2024 | ||
| E | Depression Screening and Follow-Up for Adolescents and Adults | ECDS | DSF-E | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | HEDIS 2024 | ● | |
| E | Follow-Up Care for Children Prescribed ADHD Medication | ECDS | ADD-E | ✓ | ✓ | NR | NR | NR | ✓ | ✓ | NR | HEDIS 2024 | ● | |
| E | Immunizations for Adolescents | ECDS | 1 | IMA-E | ✓ | ✓ | NR | ✓ | ✓ | ✓ | ✓ | NR | HEDIS 2024 | ● |
| E | Metabolic Monitoring for Children and Adolescents on Antipsychotics | ECDS | APM-E | ✓ | ✓ | NR | NR | NR | ✓ | ✓ | NR | HEDIS 2024 | ● | |
| E | Prenatal Depression Screening and Follow-Up | ECDS | PND-E | ✓ | ✓ | ✓ | NR | NR | ✓ | ✓ | ✓ | HEDIS 2024 | ● | |
| E | Postpartum Depression Screening and Follow-Up | ECDS | PDS-E | ✓ | ✓ | ✓ | NR | NR | ✓ | ✓ | ✓ | HEDIS 2024 | ● | |
| E | Prenatal Immunization Status | ECDS | PRS-E | ✓ | ✓ | ✓ | NR | NR | ✓ | ✓ | ✓ | HEDIS 2024 | ● | |
| E | Social Need Screening and Intervention | ECDS | SNS-E | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | HEDIS 2024 | ● | |
| E | Unhealthy Alcohol Use Screening and Follow-Up | ECDS | ASF-E | NR | NR | NR | NR | NR | NR | NR | NR | HEDIS 2024 | ||
| 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 2024 | ||
| Experience of Care | ||||||||||||||
| C | CAHPS Health Plan Survey 5.1H Adult Version | Experience of Care | 4 | CPA | ✓ | ✓ | ✓ | NR | NR | NR | NR | NR | HEDIS 2024 | |
| C | CAHPS Health Plan Survey 5.1H Child Version | Experience of Care | 4 | CPC | NR | NR | NR | NR | NR | NR | NR | NR | HEDIS 2024 | |
| C | QHP Enrollee Experience Survey | Experience of Care | NR | NR | NR | ✓ | ✓ | NR | NR | NR | QRS | De-identified member file | ||
| NYS QARR 2024-Specific Prenatal Care Measures | ||||||||||||||
| A | Risk-Adjusted Low Birth Weight | NYS QARR 2024-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 2024 | |||||||||
| A | Prenatal Care in the First Trimester | NYS QARR 2024-Specific Prenatal Care Measures | 7 | NYS QARR 2024 | ||||||||||
| A | Risk-Adjusted Primary C-Section | NYS QARR 2024-Specific Prenatal Care Measures | 7 | NYS QARR 2024 | ||||||||||
| A | Vaginal Birth After C-section | NYS QARR 2024-Specific Prenatal Care Measures | 7 | NYS QARR 2024 | ||||||||||
| NYS QARR 2024-Specific Behavioral Health Measures | ||||||||||||||
| A | Continued Engagement in Substance Use Disorder Treatment | NYS QARR 2024-Specific Behavioral Health Measures | CET | ✓ | ✓ | ✓ | NR | NR | ✓ | ✓ | ✓ | NYS QARR 2024 | ● | |
| A | Initiation of Pharmacotherapy upon New Episode of Opioid Dependence | NYS QARR 2024-Specific Behavioral Health Measures | POD-N | NR | NR | NR | NR | NR | 4 | 4 | 4 | NYS QARR 2024 | ● | |
| A | Use of Pharmacotherapy for Alcohol Use or Dependence | NYS QARR 2024-Specific Behavioral Health Measures | POA | NR | NR | NR | NR | NR | 4 | 4 | 4 | NYS QARR 2024 | ● | |
| A | Potentially Preventable Mental Health Related Readmission Rate 30 Days | NYS QARR 2024-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 2024 | ||||||||
| A | Utilization of Recovery-Oriented Services for Mental Health | NYS QARR 2024-Specific Behavioral Health Measures | 7 | URO | This measure will be calculated and reported by New York State. No plan reporting is required. | NYS QARR 2024 | ||||||||
| Product Lines | Flag | Reporting Guidelines |
|---|---|---|
| EPO - Exclusive Provider Organization | 1 = QHP | ✓ - Reporting Required MY2024 |
| 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 MY2024 reporting/ |
| 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 |
