People Living With HIV/AIDS
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 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 (the Department) 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 CAGs, the QACs, 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) Roadmap2 the State defined a final list of measures to be included in the HIV/AIDS Measure Set for MY2026.
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 arrangements. 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 People Living with HIV/AIDS 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 a 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 the 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. 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.
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.
MY 2026 HIV/AIDS QUALITY MEASURE SET
The measures 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.
The measures 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, steward changes, 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 Department-recommended classification for measure use. The measure set is redlined to highlight changes made between MY2024 and MY2026; please refer to the key at the end of this table for an explanation of redlined formatting.
| HIV/AIDS Measure | Measure Steward | Classification |
|---|---|---|
| Breast Cancer Screening (BCS-E) | NCQA | P4P |
| Cervical Cancer Screening (CCS-E) | NCQA | P4P |
| Colorectal Cancer Screening (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 Medical Visit Frequency | HRSA | P4R |
| HIV Viral Load Suppression (VLS) | NYS | P4P |
| Initiation and Engagement of Substance Use Disorder Treatment (IET) | 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 |
| Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan | CMS | P4R |
| Preventive Care and Screening: Influenza Immunization | NCQA | P4R |
| Sexually Transmitted Infections: Screening for Chlamydia, Gonorrhea, and Syphilis | NYS | 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 People Living with HIV/AIDS Quality Measure Set and includes the measure title and measure steward. All Category 2 measures are classified as P4R in MY2026.
| 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 |
Appendix A
The tables below identify the changes to the Category 1 and Category 2 measures for the MY2026 HIV/AIDS Quality Measure Set.
Category 1 Measure Changes from 2025 to 2026
| Measure Name | Change | Rationale for Change |
|---|---|---|
| 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 |
|---|---|---|
| No Changes for MY2026 | ||
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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, 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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