2025 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 2025 ●
A Annual Monitoring for Persons on Long-Term Opioid Therapy Effectiveness of Care   AMO NR NR NR ✓ ✓ NR NR NR QRS/PQA ●
A Antidepressant Medication Management Effectiveness of Care   AMM ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ HEDIS 2025  
A Appropriate Testing for Pharyngitis Effectiveness of Care   CWP ✓ ✓ ✓ NR NR ✓ NR ✓ HEDIS 2025 ●
A Appropriate Treatment for Upper Respiratory Infection Effectiveness of Care   URI ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ HEDIS 2025 ●
A Asthma Medication Ratio Effectiveness of Care 5 AMR ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ HEDIS 2025 ●
A Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis Effectiveness of Care   AAB ✓ ✓ ✓ ✓ ✓ ✓ NR ✓ HEDIS 2025 ●
A/H Blood Pressure Control for Patients With Diabetes Effectiveness of Care   BPD ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2025 ●
A Cardiac Rehabilitation Effectiveness of Care   CRE ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2025 ●
A Cardiovascular Monitoring for People With Cardiovascular Disease and Schizophrenia Effectiveness of Care   SMC NR NR NR NR NR ✓ ✓ ✓ HEDIS 2025 ●
A/H Cervical Cancer Screening +Only the CCS-E measure will be reported. Effectiveness of Care 5 CCS ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ HEDIS 2025  
A/H Childhood Immunization Status +Only the CIS-E measure will be reported. Effectiveness of Care 1, 5 CIS ✓ ✓ NR ✓ ✓ ✓ ✓ NR HEDIS 2025  
A Chlamydia Screening Effectiveness of Care 2 CHL ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ HEDIS 2025 ●
A/H Controlling High Blood Pressure Effectiveness of Care 5 CBP ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ HEDIS 2025 ●
A COVID-19 Immunization Status Effectiveness of Care   CVS ✓ ✓ ✓ NR NR ✓ ✓ ✓ NYS QARR 2025 ●
A Diabetes Monitoring for People With Diabetes and Schizophrenia Effectiveness of Care   SMD NR NR NR NR NR ✓ ✓ ✓ HEDIS 2025 ●
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 2025 ●
A Developmental Screening in the First Three Years of Life Effectiveness of Care   DEV-N ✓ ✓ NR NR NR ✓ NR NR OHSU (NYS QARR 2025) ●
A/H Eye Exam for Patients With Diabetes (Removed the Hybrid Data Collection Method) Effectiveness of Care 5 EED ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ HEDIS 2025 ●
A Follow-Up After Emergency Department Visit for Mental Illness Effectiveness of Care 3, 5 FUM ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2025 ●
A Follow-Up After Emergency Department Visit for Substance Use Effectiveness of Care 3, 5 FUA ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2025 ●
A Follow-Up After High-Intensity Care for Substance Use Disorder Effectiveness of Care 3 FUI ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2025 ●
A Follow-Up After Hospitalization for Mental Illness Effectiveness of Care 1, 3, 5 FUH ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ HEDIS 2025 ●
A/H Glycemic Status Assessment for Patients With Diabetes Effectiveness of Care 1, 5 GSD ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ HEDIS 2025 ●
A/H Immunizations for Adolescents +Only the IMA-E measure will be reported. Effectiveness of Care 1, 5 IMA ✓ ✓ NR ✓ ✓ ✓ ✓ NR HEDIS 2025  
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 5 KED ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ HEDIS 2025 ●
A/H Lead Screening in Children Effectiveness of Care 6 LSC ✓ ✓ NR NR NR ✓ ✓ NR HEDIS 2025 ●
S Medical Assistance With Smoking and Tobacco Use Cessation Effectiveness of Care ✓ MSC ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ CAHPS 5.1H  
A Oral Evaluation, Dental Services Effectiveness of Care   OED NR NR NR ✓ ✓ ✓ ✓ NR HEDIS 2025 ●
A Persistence of Beta-Blocker Treatment After a Heart Attack Effectiveness of Care   PBH ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2025 ●
A Pharmacotherapy for Opioid Use Disorder Effectiveness of Care 5 POD ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2025 ●
A Pharmacotherapy Management of COPD Exacerbation Effectiveness of Care   PCE ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2025 ●
A Proportion of Days Covered Effectiveness of Care   PDC NR NR NR ✓ ✓ NR NR NR QRS/PQA ●
A Risk of Continued Opioid Use Effectiveness of Care   COU ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2025  
A Statin Therapy for Patients With Cardiovascular Disease Effectiveness of Care   SPC ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2025 ●
A Statin Therapy for Patients With Diabetes Effectiveness of Care   SPD ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2025 ●
A Topical Fluoride for Children Effectiveness of Care   TFC NR NR NR NR NR ✓ ✓ NR HEDIS 2025 ●
A Use of Imaging Studies for Low Back Pain Effectiveness of Care   LBP ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ HEDIS 2025 ●
A Use of Opioids at High Dosage Effectiveness of Care   HDO ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2025 ●
A Use of Opioids from Multiple Providers Effectiveness of Care   UOP ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2025 ●
A Viral Load Suppression Effectiveness of Care 7 VLS NR NR NR NR NR ✓ ✓ ✓ NYS QARR 2025  
A/H Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents Effectiveness of Care   WCC ✓ ✓ NR ✓ ✓ ✓ ✓ NR HEDIS 2025 ●
Access / Availability of Care
A Adults' Access to Preventive/Ambulatory Health Services Access/Availability of Care   AAP ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2025 ●
A Antibiotic Utilization for Respiratory Conditions Access / Availability of Care   AXR ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2025 ●
A Initiation and Engagement of Substance Use Disorder Treatment Access / Availability of Care 5 IET ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ HEDIS 2025 ●
A/H Prenatal and Postpartum Care Access / Availability of Care 5 PPC ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ HEDIS 2025 ●
A Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics Access / Availability of Care   APP ✓ ✓ NR NR NR ✓ ✓ NR HEDIS 2025 ●
Health Plan Descriptive Information
  Enrollment by Product Line Access / Availability of Care   ENP ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2025  
Utilization and Risk Adjusted Utilization
A Acute Hospital Utilization Utilization & Risk Adjusted Utilization   AHU ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2025  
A Child and Adolescent Well-Care Visits Utilization & Risk Adjusted Utilization 1, 5 WCV ✓ ✓ NR ✓ ✓ ✓ ✓ ✓ HEDIS 2025 ●
A Diagnosed Mental Health Disorders Utilization & Risk Adjusted Utilization   DMH ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2025  
A Diagnosed Substance Use Disorder Utilization & Risk Adjusted Utilization   DSU ✓ ✓ NR NR NR ✓ ✓ ✓ HEDIS 2025  
A Emergency Department Utilization Utilization & Risk Adjusted Utilization   EDU ✓ ✓ ✓ NR NR NR NR NR HEDIS 2025  
A Plan All-Cause Readmission Utilization & Risk Adjusted Utilization   PCR ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ HEDIS 2025  
A Well-Child Visits in the First 30 Months of Life Utilization & Risk Adjusted Utilization 1, 5 W30 ✓ ✓ NR ✓ ✓ ✓ ✓ NR HEDIS 2025 ●
Measures Collected Using Electronic Clinical Data Systems
E Adult Immunization Status ECDS 5 AIS-E ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ HEDIS 2025 ●
E Blood Pressure Control for Patients With Hypertension ECDS   BPC-E ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2025 ●
E Breast Cancer Screening ECDS 5 BCS-E ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ HEDIS 2025 ●
E Cervical Cancer Screening ECDS 5 CCS-E ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ HEDIS 2025 ●
E Childhood Immunization Status ECDS 1, 5 CIS-E ✓ ✓ NR ✓ ✓ ✓ ✓ NR HEDIS 2025 ●
E Colorectal Cancer Screening ECDS 5 COL-E ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ HEDIS 2025 ●
E Depression Remission or Response for Adolescents and Adults ECDS   DRR-E ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2025 ●
E Depression Screening and Follow-Up for Adolescents and Adults ECDS   DSF-E ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ HEDIS 2025 ●
E Documented Assessment After Mammogram ECDS   DBM-E ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2025 ●
E Follow-Up After Abnormal Mammogram Assessment ECDS   FMA-E ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2025 ●
E Follow-Up Care for Children Prescribed ADHD Medication ECDS   ADD-E ✓ ✓ NR NR NR ✓ ✓ NR HEDIS 2025 ●
E Immunizations for Adolescents ECDS 1 IMA-E ✓ ✓ NR ✓ ✓ ✓ ✓ NR HEDIS 2025 ●
E Metabolic Monitoring for Children and Adolescents on Antipsychotics ECDS   APM-E ✓ ✓ NR NR NR ✓ ✓ NR HEDIS 2025 ●
E Prenatal Depression Screening and Follow-Up ECDS 5 PND-E ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2025 ●
E Postpartum Depression Screening and Follow-Up ECDS 5 PDS-E ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2025 ●
E Prenatal Immunization Status ECDS 5 PRS-E ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2025 ●
E Social Need Screening and Intervention ECDS   SNS-E ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ HEDIS 2025 ●
E Unhealthy Alcohol Use Screening and Follow-Up ECDS   ASF-E ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2025  
E Utilization of the PHQ-9 to Monitor
Depression Symptoms for Adolescents and Adults		 ECDS   DMS-E ✓ ✓ ✓ NR NR ✓ ✓ ✓ HEDIS 2025  
Experience of Care
C CAHPS Health Plan Survey 5.1H Adult Version Experience of Care ✓ CPA ✓ ✓ ✓ NR NR NR NR NR HEDIS 2025  
C CAHPS Health Plan Survey 5.1H Child Version Experience of Care ✓ CPC NR NR NR NR NR NR NR NR HEDIS 2025  
C QHP Enrollee Experience Survey Experience of Care     NR NR NR ✓ ✓ NR NR NR QRS De-identified member file
NYS QARR 2025-Specific Prenatal Care Measures
A Risk-Adjusted Low Birth Weight NYS QARR 2025-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 2025  
A Prenatal Care in the First Trimester NYS QARR 2025-Specific Prenatal Care Measures 7   NYS QARR 2025  
A Risk-Adjusted Primary C-Section NYS QARR 2025-Specific Prenatal Care Measures 7   NYS QARR 2025  
A Vaginal Birth After C-section NYS QARR 2025-Specific Prenatal Care Measures 7   NYS QARR 2025  
NYS QARR 2025-Specific Behavioral Health Measures
A Continued Engagement in Substance Use Disorder Treatment NYS QARR 2025-Specific Behavioral Health Measures   CET ✓ ✓ ✓ NR NR ✓ ✓ ✓ NYS QARR 2024 ●
A Initiation of Pharmacotherapy upon New Episode of Opioid Dependence NYS QARR 2025-Specific Behavioral Health Measures   POD-N NR NR NR NR NR ✓ ✓ ✓ NYS QARR 2025 ●
A Use of Pharmacotherapy for Alcohol Use or Dependence NYS QARR 2025-Specific Behavioral Health Measures   POA NR NR NR NR NR ✓ ✓ ✓ NYS QARR 2025 ●
A Potentially Preventable Mental Health Related Readmission Rate 30 Days NYS QARR 2025-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 2025  
A Utilization of Recovery-Oriented Services for Mental Health NYS QARR 2025-Specific Behavioral Health Measures 7 URO This measure will be calculated and reported by New York State. No plan reporting is required. NYS QARR 2025  

Key

Product Lines Flag Reporting Guidelines
EPO - Exclusive Provider Organization 1 = QHP only report numerators required by CMS. ✓ - Reporting Required MY2025
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/Reporting Requirement
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). Removed the data source reporting requirement. Gray – Not required for MY2025 reporting/Removed or Retired
HIVSNP - Special Needs Plans (HIV/AIDS) Blue – NYS Measure 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