Maternity Care

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 Maternity Care Quality Measure Set was created in collaboration with the Maternity Care, the Primary Care (Physical Health), and the Children's Health Clinical Advisory Groups (CAGs), the New York State Department of Health (the Department) CAG Strategy team, as well as subject matter experts from the the Department Division of Family Health. 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 Services (CMS) Core measure set, the Merit-based Incentive Payment System (MIPS), where applicable, and the Department's Vital Statistics maternity care program. The Maternity measure set was designed to encourage providers to meet high standards of patient-centered clinical care and coordination across multiple care settings throughout the maternity care episode.

MEASURE SELECTION AND FEASIBILITY

Upon receiving recommendations from CAGs, the release of guidelines from national measure stewards, such as National Committee for Quality Assurance (NCQA)/HEDIS© and CMS, 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 Maternity Care 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 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:

  1. Arrangement appropriate measure(s) from the MY2026 Maternity Quality Measure Set should be selected for stratification of race and ethnicity provided the two groups approve on the contracting elements around other performance of the measure.
  2. Payers are required to include the following details in the Provider Contract Statement and Certification form (DOH-4255)4 and Contract language:
    1. Indicate what measure(s) are included for race and ethnicity stratification.
    2. Indicate how the stratified measure results for applicable measures will be shared with the VBP contractor.
  3. 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 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. 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.

MY 2026 MATERNITY 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. 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 Maternity Care Quality Measure Set, arranged alphabetically and includes the measure title, the measure steward, and the Department-recommended P4P or P4R classification.

Maternity Care Measures Measure Steward Classification
Cesarean Birth (eCQM~) (PC-02) The Joint Commission P4R
Contraceptive Care - Postpartum United States Office of Population Affairs P4R
COVID-19 Immunization Measure (CVS) NYS P4P
Depression Screening and Follow-Up for Adolescents and Adults (DSF-E) NCQA P4R
Exclusive Breast Milk Feeding (PC-05) The Joint Commission P4R
Hepatitis C Virus (HCV) for all Patients - one time screening American Gastroenterological Association P4R
Incidence of Episiotomy American Medical Association Physician Consortium for Performance Improvement P4R
Initiation and Engagement of Substance Use Disorder Treatment (IET) NCQA P4P
Live Births Weighing Less Than 2,500 Grams (LBW-CH) Centers for Disease Control and Prevention P4R
Postpartum Depression Screening and Follow-up (PDS-E) NCQA P4P
Prenatal and Postpartum Care (PPC) NCQA P4P
Prenatal Depression Screening and Follow-Up (PND-E) NCQA P4R
Prenatal Immunization Status (PRS-E) NCQA P4P
Social Need Screening and Intervention (SNS-E) NCQA P4P
Tobacco Use Screening and Cessation Intervention (TSC-E) NCQA P4R

Category 2 Measures

The table below displays the Category 2 MY2026 Maternity Care Quality Measure Set and includes the measure title and measure steward. All Category 2 measures are classified as P4R in MY2026.

Measure Measure Steward
Hepatitis B Vaccine Coverage Among All Live Newborn Infants Prior to Hospital or Birthing Facility Discharge Centers for Disease Control and Prevention
Postpartum Blood Pressure Monitoring Texas Maternity Bundle

Appendix A

The tables below identify the changes to the Category 1 measures for the MY2026 Maternity Care Quality Measure Set.

Category 1 Measure Changes from 2025 to 2026

Measure Name Change Rationale for Change
Postpartum Depression Screening and Follow-up (PDS-E) Classification Change P4R to P4P
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention (MCS) Removed Measure retired from HEDIS for MY2026
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 2026

__________________________________________________________

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 2023. (Link) 2
3. HEDIS® Measurement Year 2026 Volume 2 Technical Specification for Heath Plans, General Guidelines section 31. 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 2023. (Link) 5

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