People Living With HIV/AIDS
Value Based Payment Quality Measure Set
Measurement Year 2024
- Measure Set is also available in Portable Document Format (PDF)
February 2024 NYS Medicaid Value-Based Payment
INTRODUCTION
The Measurement Year (MY) 2024 People Living with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) Quality Measure Set was created in collaboration with the People Living with HIV/AIDS Quality of Care Clinical Advisory Committee (QAC), the Primary Care (Physical Health), and the Behavioral Health/Health and Recovery Plan (HARP) Clinical Advisory Groups (CAGs), as well as the New York State Department of Health (NYS DOH) CAG Strategy team. The goal of this measure set is to align with measures put forth in the NYS Quality Assurance Reporting Requirements (QARR), the Healthcare Effectiveness Data and Information Set® (HEDIS)1 Technical Specifications for Health Plans, the CMS Core measure set, and the Merit-based Incentive Payment System (MIPS), where applicable. The measure set is designed to encourage providers to meet high standards of patient-centered clinical care and coordination across multiple care settings.
MEASURE SELECTION AND FEASIBILITY
Upon receiving recommendations from the QAC & CAGs, the release of guidelines from national measure stewards, such as the National Committee for Quality Assurance (NCQA)/HEDIS and CMS, and in accordance with the NYS Value Based Payment (VBP) Roadmap;2 the State defined a final list of measures to be included in the HIV/AIDs Measure Set for MY2024. For MY2024 there are a total of thirty-one Category 1 and 2 People Living with HIV/AIDS Quality Measures.
VBP ARRANGEMENT REQUIREMENTS FOR MY2024 - HEALTH EQUITY
In MY2023, NCQA added race and ethnicity stratification for five HEDIS measures to help promote transparency into health plan performance. By doing so, NCQA hopes to better identify where disparities exist, so they can be addressed. They also hope to identify and learn from top performers in areas where disparities don't exist. To align with this initiative, NYS required payers and providers to incorporate race and ethnicity measure stratification in Value-Based Payment (VBP) arrangements starting in July 2023. For MY2024 HEDIS® is adding eight additional measures.
Stratification Specifications:
- Payers are required to include at least one of the following measures in all level 1 or higher VBP contracts and stratify results by race and ethnicity categories as outlined in the HEDIS MY2024 specifications.3 The table below depicts available quality measures by arrangement type.
| NQCA Measure Name | Measure Inclusion by Arrangement Type | |||||
|---|---|---|---|---|---|---|
| TCGP | HARP/BH | Maternity | HIV/AIDs | Children's | ||
| Adult Immunization Status (AIS-E)* | ✓ | |||||
| Asthma Medication Ratio (AMR)* | ✓ | ✓ | ✓ | ✓ | ||
| Breast Cancer Screening (BCS-E)* | ✓ | ✓ | ✓ | |||
| Cervical Cancer Screening (CCS; CCS-E)* | ✓ | ✓ | ✓ | |||
| Child and Adolescent Well-Care Visits (WCV) | ✓ | ✓ | ||||
| Childhood Immunization Status (CIS; CIS-E)* | ✓ | ✓ | ||||
| Colorectal Cancer Screening (COL; COL-E) | ✓ | ✓ | ✓ | |||
| Controlling High Blood Pressure (CBP) | ✓ | ✓ | ✓ | |||
| Eye Exam for Patients with Diabetes (EED)* | ✓ | ✓ | ✓ | |||
| Follow-Up After Emergency Department Visit for Mental Illness (FUM)* | ✓ | ✓ | ✓ | |||
| Follow-Up After Emergency Department Visit for Substance Use (FUA) | ✓ | ✓ | ||||
| Follow-Up After Hospitalization for Mental Illness (FUH)* | ✓ | ✓ | ||||
| Glycemic Status Assessment for Patients with Diabetes (GSD) (Formerly Hemoglobin A1c - HBD) | ✓ | ✓ | ✓ | |||
| Immunizations for Adolescents - Combo 2 (IMA, IMA-E) | ✓ | ✓ | ||||
| Initiation and Engagement of Substance Use Disorder Treatment (IET) | ✓ | ✓ | ✓ | |||
| Kidney Health Evaluation for Patients with Diabetes (KED)* | ✓ | ✓ | ✓ | |||
| Pharmacotherapy for Opioid Use Disorder (POD) | ✓ | ✓ | ||||
| Postpartum Depression Screening and Follow- Up (PDS-E)* | ✓ | |||||
| Prenatal and Postpartum Care (PPC) | ✓ | ✓ | ||||
| Prenatal Depression Screening and Follow-Up (PND-E)* | ✓ | |||||
| Prenatal Immunization Status (PRS-E)* | ✓ | ✓ | ||||
| Well-Child Visits in the First 30 Months of Life (W30) | ✓ | ✓ | ||||
*Added for MY2024
Stratification Requirements:
- Stratification of selected measures is to be classified as pay-for-reporting (P4R).
- Payers are required to include the following details in the Provider Contract Statement and Certification form (DOH-4255) and Contract language:
- Indicate what measure(s) will be included for race and ethnicity stratification.
- Indicate how the stratified measure results for applicable measures will be shared with the VBP contractor.
- Plans are required to include the race and ethnicity data submitted to NYS using the following method:
- Race and ethnicity fields have been added to the annual VBP member attribution submission file specifications. This will allow the State to stratify measure performance by race and ethnicity categories for applicable performance measures at the VBP contract and VBP Contractor levels.
All new contracts submitted on or after July 1, 2022, must meet this requirement to be approved by NYS DOH. As of April 1, 2023, all other existing contracts were to be updated/amended at the end of the contract's current measurement period and before the contract's next measurement period began.
MEASURE CLASSIFICATION
Each measure has been designated by the State as Category 1, 2, or 3 with associated recommendations for implementation and testing for future use in VBP Arrangements. The measures below are classified by category based on an assessment of reliability, validity, and feasibility, and according to suggested method of use (either Pay for Reporting (P4R) or Pay for Performance (P4P)).
Category 1
Category 1 quality measures as identified by the CAGs and accepted and deemed reportable by the State are to be reported by VBP Contractors to the MCOs. These measures are also intended to be used to determine the amount of shared savings for which VBP contractors are eligible.4 At least one Category 1 P4P measure must be included in a VBP contract.
The State classifies each Category 1 measure as either P4P or P4R:
- P4P measures are intended to be used in the determination of shared savings amounts for which VBP Contractors are eligible. Measures can be included in both the determination of the target budget and in the calculation of shared savings for VBP Contractors.
- P4R measures are intended to be used by the MCOs to incentivize VBP Contractors for reporting data to monitor quality of care delivered to members under the VBP contract. Incentives for reporting will be based on timeliness, accuracy, and completeness of data. Measures can be reclassified from P4R to P4P through annual CAG and State review or as determined by the MCO and VBP Contractor.
Not all Category 1 measures will be reportable for the measurement year, as reporting on some of these measures will be phased in over the next few years. Please refer to the 2024 Value Based Payment Reporting Requirements Technical Specifications Manual (MY2024) for details as to which measures must be reported for the measurement year. This manual will be updated annually each fall, in line with the release of the final VBP measure set for the subsequent year.
Categories 2 and 3
Category 2 measures have been accepted by the State based on the agreement of clinical importance, validity, and reliability but flagged as presenting concerns regarding implementation feasibility. The State has discussed measure testing approaches, data collection, and reporting requirements with VBP CAGs.
Measures designated as Category 3 were identified as unfeasible at this time or as presenting additional concerns, including accuracy or reliability when applied to the attributed member population for an arrangement; therefore, Category 3 measures are not included in the measure set.
MY 2024 HIV/AIDS QUALITY MEASURE SET
The measures provided on the following pages are recommendations for MY2024. Note that measure classification is a State recommendation and implementation is to be determined between the MCO and VBP Contractor.
Measure sets and classifications are considered dynamic and will be reviewed annually. Updates will include measure additions, deletions, recategorizations, and/or reclassifications from P4R to P4P or vice versa, based on experience with measure implementation in the prior year. Please see Appendix A for a full list of these changes.
Category 1
The table below displays the Category 1 HIV/AIDS Quality Measure Set, arranged alphabetically and includes the measure title, measure steward, and State-recommended classification for measure use. The measure set is redlined to highlight changes made between MY2023 and MY2024; please refer to the key at the end of this table for an explanation of redlined formatting.
| HIV/AIDS Measure | Measure Steward | Classification |
|---|---|---|
Medicaid Services (CMS) |
||
| Antidepressant Medication Management - Effective Acute Phase Treatment & Effective Continuation Phase Treatment (AMM)* | National Committee for Quality Assurance (NCQA) |
P4P |
| Asthma Medication Ratio (AMR) | NCQA | P4P |
| Breast Cancer Screening (BSC-E)^ | NCQA | P4P |
| Cervical Cancer Screening (CCS; CCS-E)^ | NCQA | P4P |
| Colorectal Cancer Screening (COL; COL-E)^ | NCQA | P4P |
| Controlling High Blood Pressure (CBP) | NCQA | P4P |
| COVID-19 Immunization Measure (CVS)^ | NYS | P4P |
| Depression Remission or Response for Adolescents and Adults (DRR-E) | NCQA | P4P |
| Depression Screening and Follow-Up for Adolescents and Adults (DSF-E) | NCQA | P4R |
| Diabetes Screening for People with Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications (SSD) | NCQA | P4P |
| Eye Exam for Patients With Diabetes (EED)^ | NCQA | P4P |
Glycemic Status Assessment for Patients with Diabetes (GSD)^ |
NCQA | P4P |
| HIV Viral Load Suppression (HVL-AD) | Health Resources and Services Adm (HRSA) |
P4P |
| Initiation and Engagement of Substance Use Disorder Treatment (IET) | NCQA | P4P |
| Initiation of Pharmacotherapy upon New Episode of Opioid Dependence | NYS | P4P |
| Kidney Health Evaluation for Patients with Diabetes (KED)^ | NCQA | P4P |
| Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan^ | CMS | P4R |
| Preventive Care and Screening: Influenza Immunization | NCQA | P4R |
| Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention^ | NCQA | P4R |
| Sexually Transmitted Infections: Screening for Chlamydia, Gonorrhea, and Syphilis | NYS | P4R |
| Social Need Screening and Intervention (SNS-E)^ | NCQA | P4R |
| Statin Therapy for Patients with Cardiovascular Disease (SPC)^ | NCQA | P4R |
| Use of Pharmacotherapy for Alcohol Abuse or Dependence | NYS | P4R |
*To Be Retired MY2025-MY2026
Retired/Removed for MY2024
^Measure Revised for MY2024
Category 2
The table below displays the Category 2 People Living with HIV/AIDS Quality Measure Set and includes the measure title, measure steward, and the NQF number (where applicable). All Category 2 measures are classified as P4R in MY2024. Category 2 measures were reviewed in detail this year and streamlined to include only those with an active measure steward and/or potential for movement to Category 1 in subsequent years. The measure set is redlined to highlight changes made between MY2023 and MY2024; please refer to the key at the end of this table for an explanation of redlined formatting.
| Measure | Measure Steward |
|---|---|
| Asthma Action Plan | American Academy of Allergy, Asthma & Immunology (AAAAI) |
| Asthma: Assessment of Asthma Control – Ambulatory Care Setting | AAAAI |
| Continuing Engagement in Treatment (CET) Alcohol and Other Drug Dependence | NYS |
| Continuity of Pharmacotherapy for Opioid Use Disorder (OUD)* | University of Southern California (USC) |
| Hepatitis C Screening | HRSA |
| Housing Status | HRSA |
| Prescription of HIV Antiretroviral Therapy | HRSA |
| Substance Abuse Screening | HRSA |
Retired/Removed for MY2024
*New Measure MY2024
Appendix A
The table below identifies the changes to the Category 1 and Category 2 measures for the MY2024 HIV/AIDS Quality Measure Set.
Category 1 Measure Changes from 2023 to 2024
| Measure Name | Change | Rationale for Change |
|---|---|---|
| Adherence to Mood Stabilizers for Individuals with Bipolar I Disorder | Measure removed | Steward no longer supports measure. |
| Antidepressant Medication Management – Effective Acute Phase Treatment & Effective Continuation Phase Treatment (AMM) | Proposed Retirement | To be retired by NCQA in MY2025 |
| Breast Cancer Screening (BCS-E) | Measure reporting specifications revised by NCQA for HEDIS MY2024 | Implemented gender- inclusive language |
| Cervical Cancer Screening (CCS; CCS-E) | Measure reporting specifications revised by NCQA for HEDIS MY2024 | Implemented gender- inclusive language |
| Cervical Cancer Screening (CCS; CCS-E) | HEDIS Stratified Measure | Added to NCQA list of Race and Ethnicity measures – New for MY2024 |
| Colorectal Cancer Screening ( |
Measure reporting specifications revised by NCQA for HEDIS MY2024 | ECDS Reporting only |
| COVID-19 Immunization Measure (CVS) | Measure reporting specifications revised by NYS for MY2024 | Refer to Quality Assurance Reporting Requirements (QARR) Technical Specifications for MY2024. |
| Eye Exam for Patients with Diabetes (EED) | Measure reporting specifications revised by NCQA for HEDIS MY2024 | Revised diabetes denominator |
| Eye Exam for Patients with Diabetes (EED) | HEDIS Stratified Measure | Added to NCQA list of Race and Ethnicity measures – New for MY2024 |
| Hemoglobin A1c Control for Patients with Diabetes (HBD) | Name and specifications revised for MY2024, now: Glycemic Status Assessment for Patients with Diabetes (GSD) | Revised diabetes denominator; Inclusion of Glucose Management Indicator (GMI) |
| Kidney Health Evaluation for Patients with Diabetes (KED) | HEDIS Stratified Measure | Added to NCQA list of Race and Ethnicity measures – New for MY2024 |
| Potentially Avoidable Complication (PAC) in Patients with HIV/AIDS | Measure removed from HIV/AIDs MY2024 CAT 1 measure set | Steward no longer supports measure. |
| Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention | Measure reporting specifications revised by CMS for MY2024 | Revised age group of the initial population. |
| Social Need Screening and Intervention (SNS-E) | Classification change | Second year measure; changed to P4P. |
| Statin Therapy for Patients with Cardiovascular Disease (SPC)^ | Classification change | Second year measure; changed to P4P. |
| Use of Spirometry Testing in the Assessment and Diagnosis of COPD (SPR) | Measure removed | HEDIS/NCQA retired measure for MY2024 |
Category 2 Measure Changes from 2023 to 2024
| Measure Name | Change | Rationale for Change |
|---|---|---|
| Asthma: Spirometry Evaluation | Measure removed from HIV/AIDs MY2024 CAT 2 measure set | Steward no longer supports measure. |
| Continuity of Care from Inpatient Detox to Lower Level of Care | Measure removed from HIV/AIDs MY2024 CAT 2 measure set | NYS no longer collects measure |
| Continuity of Pharmacotherapy for Opioid Use Disorder (OUD) | New measure to HIV/AIDs MY2024 CAT 2 measure set | Replaced Pharmacotherapy for Opioid Use Disorder (POD) measure |
| Diabetes Screening | Measure removed from HIV/AIDs MY2024 CAT 2 measure set | NYS no longer collects measure |
| Home Management Plan of Care (HMPC) Document Given to Patient/Caregiver (asthma) | Measure removed from HIV/AIDs MY2024 CAT 2 measure set | Steward no longer supports measure. |
| Linkage to HIV Medical Care | Measure removed from HIV/AIDs MY2024 CAT 2 measure set | NYS no longer collects measure |
| Medical Case Management: Care Plan | Measure removed from HIV/AIDs MY2024 CAT 2 measure set | NYS no longer collects measure |
| Pharmacotherapy for Opioid Use Disorder (POD) | Measure removed from HIV/AIDs MY2024 CAT 2 measure set | Replaced by Continuity of Pharmacotherapy for Opioid Use Disorder (OUD) |
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1. HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA). 1
2. New York State Department of Health, Medicaid Redesign Team, A Path Toward Value-Based Payment: Annual Update, September 2019. (Link) 2
3. HEDIS® Measurement Year 2023 Volume 2 Technical Specification for Heath Plans, General Guidelines section, page 28. 3
4. New York State Department of Health, Medicaid Redesign Team, Value Based Payment: Update, May 2022. (Link) 4
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