NCQA Alters Telehealth Standards in Wake of COVID-19

In Covid-19, HEDIS & Quality Management by Marketing

The complications in care delivery brought about by COVID-19 has prompted NCQA to adopt significant changes to more than three dozen of its widely used HEDIS® measures governing telehealth. In a previous post, we discussed how with the right data tools Quality and Care Management teams can prioritize members with chronic diseases who would benefit from treatment and outreach provided through telemedicine.

The changes, which adhere to telehealth recommendations from CMS and other federal and state regulators, apply to healthcare quality measurements beginning in the current measurement year.

COVID-19 has accelerated the use of telehealth visits, and NCQA’s adjustments acknowledge the burden the virus has placed on healthcare providers. Here are the 40 changes NCQA has adopted:

Prevention and Screening

  • Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents
  • Breast Cancer Screening
  • Colorectal Cancer Screening
  • Care for Older Adults


  • Use of Spirometry Testing in the Assessment and Diagnosis of COPD
  • Asthma Medication Ratio

Cardiovascular Conditions

  • Controlling High Blood Pressure
  • Persistence of Beta-Blocker Treatment After a Heart Attack
  • Statin Therapy for Patients with Cardiovascular Disease
  • NEW MEASURE: Cardiac Rehabilitation


  • Comprehensive Diabetes Care
  • NEW MEASURE: Kidney Health Evaluation for Patients with Diabetes
  • Statin Therapy for Patients with Diabetes

Musculoskeletal Conditions

  • Disease-Modifying Anti-Rheumatic Drug Therapy for Rheumatoid Arthritis- Scheduled for Retirement
  • Osteoporosis Management in Women Who Had a Fracture
  • NEW MEASURE: Osteoporosis Screening in Older Women

Behavioral Health

  • Antidepressant Medication Management
  • Follow-up Care for Children Prescribed ADHD Medication
  • Follow-up After Hospitalization for Mental Illness
  • Follow-up After Emergency Department Visit for Mental Illness
  • Diabetes Screening for People with Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medication
  • Cardiovascular Monitoring for People with Cardiovascular Disease and Schizophrenia
  • Diabetes Monitoring for People with Diabetes and Schizophrenia
  • Adherence to Antipsychotic Medications for Individuals with Schizophrenia

Care Coordination

  • Transitions of Care
  • Follow-up After Emergency Department Visit for People with Multiple High-Risk Chronic Conditions

Access/Availability of Care

  • Prenatal and Postpartum Care
  • Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics


  • Well-Child Visits in the First 30 Months of Life
  • Child and Adolescent Well Care Visits
  • Mental Health Utilization

Risk-Adjusted Utilization

  • Plan All-Cause Readmissions
  • Hospitalization Following Discharge from a Skilled Nursing Facility
  • Acute Hospital Utilization
  • Emergency Department Utilization
  • Hospitalization for Potentially Preventable Complications

Measures Reported Using Electronic Clinical Data Systems

  • Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults
  • Depression Screening and Follow-up for Adolescents and Adults
  • Postpartum Depression Screening and Follow-up
  • Prenatal Depression Screening and Follow-up
  • Breast Cancer Screening
  • Colorectal Cancer Screening
  • Follow-up Care for Children Prescribed ADHD Medication

Updates to these 40 measures are included in HEDIS Volume 2 Technical Specifications, published July 1. Telehealth revisions are outlined in each measure specification’s “Summary of Changes” section.

NCQA will deliver Its final report and air a webinar at 2 p.m. Eastern Time on September 15 detailing the rationale behind the changes, such as patient safety, fraud, waste and abuse prevention, costs, and quality, as well as overarching telehealth issues.

Vital Data Technology’s Affinitē Quality™ streamlines the collection and reporting of telehealth data and supports NCQA’s increasing acceptance of telehealth to control healthcare costs and improve outcomes.
Contact Vital Data Technology for guidance on how comprehensive data collection and analysis can inform your telehealth education outreach to providers and members.

Keep Learning

Kelly Cieciorka MPA, HSA
Director of Quality

Kelly is the Director of Quality and Product Owner of Affinitē Quality™. She is responsible for guiding the quality product’s development and partnering with customers for successful implementation and optimization of the solution. Affinitē Quality is Vital Data Technology’s year-round HEDIS® and plan-defined quality management and submission module fully certified by NCQA for 2020 HEDIS measures.

She graduated from the University of San Francisco with a master’s degree in public administration. She has an undergraduate degree in pre-med and biology from the University of California, Santa Barbara.

Share on