2026 VBP Behavioral Health/HARP Quality Measure Set
Value Based Payment Quality Measure Set
Measurement Year 2026
- Measure Set is also available in Portable Document Format (PDF)
January 2026 NYS Medicaid Value Based Payment
INTRODUCTION
The Measurement Year (MY) 2026 Behavioral Health/Health and Recovery Plan (HARP) Quality Measure Set was created in collaboration with the Behavioral Health/HARP Clinical Advisory Group (CAG), the Primary Care (Physical Health) CAG, the New York State Department of Health (the Department) CAG Strategy team, as well as subject matter experts from both the NYS Office of Mental Health (OMH) and NYS Office of Addiction Services and Supports (OASAS). 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 Centers for Medicare & Medicaid (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 CAGs, other NYS agencies, the release of guidelines from national measure stewards such as National Committee for Quality Assurance (NCQA)/HEDIS® and in accordance with the NYS Value Based Payment (VBP) Roadmap,2 the Department defined a final list of measures to be included in the Behavioral Health/HARP Measure Set.
HEALTH EQUITY VBP ARRANGEMENT REQUIREMENTS
In MY2022, NCQA added race and ethnicity stratification (RES) to several HEDIS measures to help promote transparency in health plan performance. For complete details, refer to the NCQA's Health Equity webpage: Data, Measurement and Equity. To align with this initiative, in July 2022, NYS required payers and providers to incorporate race and ethnicity measure stratification in VBP. Please refer to the following section for VBP contracting stratification specifications.
Stratification Specifications:
Payers are required to include at least one of the NCQA RES measures in all level 1 or higher VBP contracts and stratify results by race and ethnicity categories as outlined in the NCQA Race and Ethnicity Stratification Resource Guide, Stratified Measure list.3
Stratification Requirements:
- Arrangement appropriate measure(s) from the MY2026 Behavioral Health/HARP Quality Measure Set list should be selected for stratification of race and ethnicity provided the two groups approve on the contracting elements around other performance of the measure.
- Payers are required to include the following details in the Provider Contract Statement and Certification form (DOH-4255)4 and Contract language:
- Indicate what measure(s) are 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 when submitting to NYS. Race and ethnicity data will be collected via the Quality Assurance Reporting Requirements (QARR) Patient Level Detail (PLD) file. This will allow the Department to stratify measure performance by race and ethnicity categories for applicable performance measures at the VBP contract and VBP Contractor levels.
All new contracts must meet this requirement to be approved by the Department. 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 Department 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 measures are intended to be used to determine the amount of shared savings for which VBP contractors are eligible.5 At least one Category 1 P4P measure must be included in a VBP contract. The Department classified 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. In other words, these are the measures on which payments in VBP contracts may be based. Measure performance can be considered 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 to report data to monitor the quality of care delivered to members under a VBP contract. Incentives for reporting should be based on timeliness, accuracy, and completeness of data.
Categories 2 and 3
Category 2 measures have been accepted by the Department based on the agreement of clinical importance, validity, and reliability but flagged as presenting concerns regarding implementation feasibility. Measures designated as Category 3 were identified as unfeasible at the time or as presenting accuracy or reliability concerns, therefore Category 3 measures are not included in the measure set.
MY2026 HARP QUALITY MEASURE SET
The measures and Department-determined classifications provided on the following pages are recommendations for MY2026. Note that measure classification is a Department 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 Measures
The table below displays the Category 1 MY2026 Behavioral Health/HARP Quality Measure Set, arranged alphabetically and includes the measure title, measure steward, and the Department P4P or P4R classification.
| Behavioral Health/HARP Measures | Measure Steward | Classification |
|---|---|---|
| Adherence to Antipsychotic Medications for Individuals with Schizophrenia (SAA) | CMS | P4P |
| Adult Immunization Status - Electronic (Influenza)(AIS-E) | NCQA | P4P |
| Breast Cancer Screening (BCS-E) | NCQA | P4P |
| Cervical Cancer Screening (CCS-E) | NCQA | P4P |
| Chlamydia Screening (CHL) | NCQA | P4P |
| Colorectal Cancer Screening (COL-E) | NCQA | P4P |
| Continuing Engagement in Treatment Alcohol and Other Drug Dependence (CET) | NYS | P4R |
| Controlling High Blood Pressure (CBP) | NCQA | P4P |
| COVID-19 Immunization Measure (CVS) | NYS | P4P |
| 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 |
| Follow-Up After Emergency Department Visit for Mental Illness (FUM) | NCQA | P4P |
| Follow-Up After Emergency Department Visit for Substance Use (FUA) | NCQA | P4P |
| Follow-Up After High-Intensity Care for Substance Use Disorder (FUI) | NCQA | P4P |
| Follow-Up After Hospitalization for Mental Illness (FUH) | NCQA | P4P |
| Glycemic Status Assessment for Patients with Diabetes (GSD) | NCQA | P4P |
| Initiation of Pharmacotherapy upon New Episode of Opioid Dependence (POD-N) | NYS | P4P |
| Kidney Health Evaluation for Patients with Diabetes (KED) | NCQA | P4P |
| Pharmacotherapy for Opioid Use Disorder (POD) | NCQA | P4P |
| Potentially Preventable Mental Health-Related Readmission Rate 30 Days (PPR-MH) | NYS | P4P |
| Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan | CMS | P4R |
| Social Need Screening and Intervention (SNS-E) | NCQA | P4P |
| Statin Therapy for Patients with Cardiovascular Disease (SPC-E) | NCQA | P4R |
| Tobacco Use Screening and Cessation Intervention (TSC-E) | NCQA | P4R |
| Use of Pharmacotherapy for Alcohol Abuse or Dependence (POA) | NYS | P4R |
Category 2 Measures
The table below displays the Category 2 MY2026 Behavioral Health/HARP Quality Measure Set and includes the measure title and measure steward. All Category 2 measures are classified as P4R in MY2026.
| BEHAVIORAL HEALTH/HARP Measures | Measure Steward |
|---|---|
| Asthma Action Plan | AAAAI |
| Asthma: Assessment of Asthma Control - Ambulatory Care Setting | AAAAI |
| Percentage of HARP Enrolled Members Who Received Personalized Recovery Oriented Services (PROS) or Home and Community-Based Services (HCBS) | NYS |
Appendix A
The tables below identify the changes to the Category 1 and Categroy 2 measures for the MY2026 Behavioral Health/HARP Quality Measure Set.
Category 1 Measure Changes from 2025 to 2026
| Measure Name | Change | Rationale for Change |
|---|---|---|
| Adult Immunization Status - (AIS-E) | Measure Revised for MY2026 | Added COVID indicator |
| Asthma Medication Ratio (AMR) | Removed | Measure retired from HEDIS for MY2026 |
| Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention (MCS) | Removed | Measure retired from HEDIS for MY2026 |
| Statin Therapy for Patients with Cardiovascular Disease (SPC) | Removed | Measure retired from HEDIS for MY2026 |
| Statin Therapy for Patients with Cardiovascular Disease (SPC-E) | Added | First year measure, replaces SPC |
| Tobacco Use Screening and Cessation Intervention (TSC-E) | Added | First year measure, replaces MCS |
Category 2 Measure Changes from 2025 to 2026
| Measure Name | Change | Rationale for Change |
|---|---|---|
| Use of Opioid Dependence Pharmacotherapy | Removed | Duplicate measure, Category 1 - Pharmacotherapy for Opioid Use Disorder (POD) |
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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, Value Based Payment: Update, May 2022. (Link) 2
3. NCQA Race and Ethnicity Stratification Resource Guide, Measurement Year 2026, Page 5 (Link) 3
4. DOH 4255 has been updated, Section C 2e, to include a Quality Measure Race and Ethnicity Stratification section (Link) 4
5. New York State Department of Health, Medicaid Redesign Team, Value Based Payment: Update, May 2022. (Link) 5
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