SUMMARY TABLE OF MEASURES, PRODUCT LINES AND CHANGES

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1 Summary Table of Measures, Product Lines and Changes 1 SUMMARY TABLE OF MEASURES, PRODUCT LINES AND CHANGES General Guidelines for Data Collection and Reporting Guidelines for Calculations and Sampling Guidelines for Effectiveness of Care Added Employer/Union Only Direct Contract PFFS plans to General Guideline 7. Clarified the reporting guidelines in General Guideline 8. Added a description of the revised medical record review validation process in General Guideline 9. Updated the measures eligible for rotation in General Guideline 14. Updated submission dates and plan-lock date in General Guideline 35. Clarified General Guideline 39. Clarified that organization may refresh data for administrative-only measures, but must apply the refresh to all applicable measures in General Guideline 40. Revised the Note in step 2 in the Systematic Sampling Methodology. Updated step 5 in the Systematic Sampling Methodology for HEDIS 2013 reporting. Clarified the calculations in step 7 of Example 1. Clarified in Which services count? that reversed claims should be included when reporting measures. Adult BMI Assessment Deleted obsolete HCPCS code G0344 from Table ABA-A. Weight Assessment and Counseling for Nutrition and Physical Activity for Children/ Adolescents No changes to this measure. Childhood Immunization Status Revised dosing requirement for hepatitis A. Added ICD-9-CM Diagnosis code to Table CIS-B. Added a footnote to Table CIS-B that (without a fifth digit) is valid only if the date of service is prior to October 1, Immunizations for Adolescents Added ICD-9-CM Diagnosis code to Table IMA-B. Added a footnote to Table IMA-B that (without a fifth digit) is valid only if the date of service is prior to October 1, Deleted Table HPV-B; refer to Table IMA-B for codes to identify exclusions. Human Papillomavirus Vaccine for Female Adolescents Lead Screening in Children No changes to this measure.

2 Summary Table of Measures, Product Lines and Changes 2 Breast Cancer Screening Added CPT modifier codes RT and LT to Table BCS-B and revised the optional exclusion for bilateral mastectomy to include instances where a mastectomy is performed on the right side and the left side of the body on the same date of service. Cervical Cancer Screening No changes to this measure. Colorectal Cancer Screening No changes to this measure. Chlamydia Screening in Women Added HCPCS code G0450 to Table CHL-B. Added ICD-9-CM Diagnosis codes , to Table CHL-B. Added LOINC code to Table CHL-B. Glaucoma Screening in Older Adults Deleted obsolete CPT code from Table GSO-A. Care for Older Adults No changes to this measure. Appropriate Testing for Children With Pharyngitis Appropriate Treatment for Children With Upper Respiratory Infection Avoidance of Antibiotic Treatment in Adults With Acute Bronchitis Use of Spirometry Testing in the Assessment and Diagnosis of COPD Pharmacotherapy of COPD Exacerbation Added LOINC code to Table CWP-D. Clarified that claims/encounters with only a diagnosis for URI should be identified in step 2 of the Event/diagnosis criteria. No changes to this measure. Added ICD-9-CM Diagnosis code to Table SPR-A. Deleted UB Revenue codes 080x, 082x-085x, 088x from Table SPR-C. Deleted Table PCE-A; refer to Table SPR-A for codes to identify COPD.

3 Summary Table of Measures, Product Lines and Changes 3 Use of Appropriate Medications for People With Asthma Medication Management for People With Asthma Clarified the definition of Oral medication dispensing event. Revised the definitions of Inhaler dispensing event and Injection dispensing event to indicate that multiple dispensing events on the same date of service are counted as separate dispensing events. Clarified that the four outpatient visits in step 1 of the Event/diagnosis criteria must be on different dates of service. Deleted ICD-9-CM Diagnosis code from Emphysema in the Description column of Table ASM-E (the code is already included under COPD in the table). Renamed Table ASM-D and revised all references to preferred asthma therapy, to asthma controller medications. Clarified the definition of Oral medication dispensing event. Revised the definitions of Inhaler dispensing event and Injection dispensing event to indicate that each dispensing event is assessed separately. Clarified in the Definitions section how organizations should calculate the number of days covered for multiple prescriptions in the numerator. Clarified that the four outpatient visits in step 1 of the Event/diagnosis criteria must be on different dates of service. Clarified that each data element is reported for each rate in Table MMA-1/2. Asthma Medication Ratio First-year measure. Cholesterol Management for Patients With Cardiovascular Conditions Controlling High Blood Pressure Persistence of Beta-Blocker Treatment After a Heart Attack Added instructions to use only facility claims (not professional claims) to identify AMI and CABG for the event/diagnosis. Clarified that codes from Table CMC-D should be used to identify the most recent LDL-C test for the LDL-C control indicator. Clarified that the Friedewald equation may not be used if a direct or calculated result is present in the medical record for the most recent LDL-C test. No changes to this measure. Added instructions to use only facility claims (not professional claims) to identify AMI for the event/ diagnosis.

4 Summary Table of Measures, Product Lines and Changes 4 Comprehensive Diabetes Care Disease-Modifying Anti- Rheumatic Drug Therapy for Rheumatoid Arthritis Osteoporosis Management in Women Who Had a Fracture Use of Imaging Studies for Low Back Pain Added sitagliptin-simvastatin to the description of Antidiabeteic combinations in Table CDC-A. Deleted CPT codes 92002, 92004, 92012, from Table CDC-C. Added ICD-9-CM Diagnosis code 425 to Table CDC-P and clarified in the hybrid specification that cardiomyopathy is considered chronic heart failure (a required exclusion for HbA1c control [<7.0%] for a selected population). Added thoracic aortic aneurysm to the required exclusions for HbA1c control (<7.0%) for a selected population and added corresponding codes to Table CDC-P. Added instructions to use only facility claims to identify CABG for the required exclusion for the HbA1c control (<7.0%) for a selected population (do not use professional claims). Clarified that codes from Table CDC-D should be used to identify the most recent HbA1c test for the HbA1c control indicators. Clarified that a negative dilated eye exam in the year prior to the measurement year meets criteria for the Eye Exam indicator. Deleted ICD-9-CM Procedure codes (which identify procedures that occur in an inpatient setting) from Table CDC-G: Codes to Identify Eye Exams. The intent of the measure is to identify eye visits performed in an outpatient setting, which are identified by CPT and HCPCS. Clarified that codes from Table CDC-H should be used to identify the most recent LDL-C test for the LDL-C control indicator. Deleted obsolete CPT code from Table CDC-K. Deleted obsolete HCPCS codes G0392, G0393 from Table CDC-K. Deleted Aliskiren-hydrochlorothiazide-amlodipine from the Antihypertensive combinations description in Table CDC-L. Clarified that an incomplete reading is not compliant for the BP control indicators. Clarified that the Friedewald equation may not be used if a direct or calculated result is present in the medical record for the most recent LDL-C test. Replaced nonacute inpatient encounters with nonacute inpatient discharges to identify the event/ diagnosis and deleted codes that identify nonacute inpatient encounters. The organization should use its own methodology to identify nonacute inpatient discharges. No changes to this measure. Added J code J0897 to description of Other agents in Table OMW-C. Added Table OMW-D: Codes to Identify Visit Type. In step 1 of Event/diagnosis criteria, a fracture code must be in conjunction with a visit code from Table OMW-D.

5 Summary Table of Measures, Product Lines and Changes 5 Antidepressant Medication Management Follow-Up Care for Children Prescribed ADHD Medication Follow-Up After Hospitalization for Mental Illness Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications Diabetes Monitoring for People With Diabetes and Schizophrenia Cardiovascular Monitoring for People With Cardiovascular Disease and Schizophrenia Adherence to Antipsychotic Medications for Individuals With Schizophrenia Deleted Negative Diagnosis History. Deleted the Mental Health benefit. Revised Continuous enrollment criteria. Deleted codes and from Table AMM-A. Deleted Table AMM-C: Additional Codes to Identify Depression. Previous Table AMM-D is now Table AMM-C. Revised dates in intake period and age criteria to account for leap year. Added clonidine and guanfacine to the description of Alpha-2 receptor agonist in Table ADD-A. Added atomoxetine to description of Miscellaneous ADHD medications in Table ADD-A. Deleted Table ADD-B; use Tables IAD-A and IAD-B to exclude members who had an acute inpatient claim/ encounter with a principal diagnosis or DRG for substance abuse during the 30 days after the IPSD. Added instructions to use only facility claims (not professional claims) to identify discharges with a principal mental health diagnosis. First-year measure. First-year measure. First-year measure. First-year measure.

6 Summary Table of Measures, Product Lines and Changes 6 Annual Monitoring for Patients on Persistent Medications Medication Reconciliation Post- Discharge Potentially Harmful Drug-Disease Interactions in the Elderly Use of High-Risk Medications in the Elderly Clarified that organizations sum the days supply for all medications to determine treatment days in the Event/diagnosis criteria. Clarified in the Readmission or direct transfer section that the organization must have a method for identifying the status of a member through the end of the measurement year. Added ICD-9-CM Diagnosis codes to Table DDE-B. Added ICD-9-CM Diagnosis code to Table DDE-E. Deleted ICD-9-CM Diagnosis code from Table DDE-E. Deleted obsolete CPT codes 90921, from Table DDE-H. Deleted obsolete HCPCS codes G0317-G0319, G0323, G0327 from Table DDE-H. Added a note in the Description section to indicate NCQA will not publicly report this measure for HEDIS Revised age range to 66 years and older. Updated the medication list. Added days supply and average daily dose criteria for select medications. Added a Definitions section. Clarified numerator criteria to accommodate days supply and dosing criteria. Added Tables DAE-B and DAE-C. Fall Risk Management This measure is collected using survey methodology. Detailed specifications and summary of changes are contained in HEDIS 2013, Volume 6: Specifications for the Medicare Health Outcomes Survey. Management of Urinary Incontinence in Older Adults Osteoporosis Testing in Older Women This measure is collected using survey methodology. Detailed specifications and summary of changes are contained in HEDIS 2013, Volume 6: Specifications for the Medicare Health Outcomes Survey. This measure is collected using survey methodology. Detailed specifications and summary of changes are contained in HEDIS 2013, Volume 6: Specifications for the Medicare Health Outcomes Survey. Physical Activity in Older Adults This measure is collected using survey methodology. Detailed specifications and summary of changes are contained in HEDIS 2013, Volume 6: Specifications for the Medicare Health Outcomes Survey.

7 Summary Table of Measures, Product Lines and Changes 7 Aspirin Use and Discussion This measure is collected using survey methodology. Detailed specifications and Flu Shots for Adults Ages This measure is collected using survey methodology. Detailed specifications and Flu Shots for Older Adults This measure is collected using survey methodology. Detailed specifications and Medical Assistance With Smoking and Tobacco Use Cessation Pneumococcal Vaccination Status for Older Adults Access/Availability of Care Adults Access to Preventive/ Ambulatory Health Services This measure is collected using survey methodology. Detailed specifications and This measure is collected using survey methodology. Detailed specifications and Added HCPCS codes S0620, S0621 to Table AAP-A. No changes to this measure. Children s and Adolescents Access to Primary Care Practitioners Annual Dental Visit Deleted ICD-9-CM Procedure codes (which identify procedures that occur in an inpatient setting) from Table ADV-A. The intent of the measure is to identify dental visits performed in an outpatient setting, which are identified by CPT and HCPCS/CDT codes. Initiation and Engagement of Alcohol and Other Drug Dependence Treatment Added HCPCS code G0443 to Table IET-B. Prenatal and Postpartum Care Clarified in the Note section that the organization must define a method to determine which EDD to use and use one date consistently if multiple dates are documented. Call Answer Timeliness No changes to this measure.

8 Summary Table of Measures, Product Lines and Changes 8 Experience of Care CAHPS Health Plan Survey 5.0H, Adult Version CAHPS Health Plan Survey 5.0H, Child Version This measure is collected using survey methodology. Detailed specifications and This measure is collected using survey methodology. Detailed specifications and Children With Chronic Conditions This measure is collected using survey methodology. Detailed specifications and summary of changes for the measure are contained in HEDIS 2013, Volume 3: Specifications for Utilization and Relative Resource Use Frequency of Ongoing Prenatal Care Revised example in step 2 of the numerator to account for leap year. Well-Child Visits in the First 15 Months of Life Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life Revised example in continuous enrollment to account for leap year. Deleted obsolete CPT code from Table W15-A. No changes to this measure. Adolescent Well-Care Visits No changes to this measure. Frequency of Selected Procedures Removed the term closed from the laparoscopic cholecystectomy procedure, throughout the measure. Added CPT code to Table FSP-A. Ambulatory Care No changes to this measure. Deleted obsolete MS-DRG code 009 from tables IPU-A and IPU-B. Inpatient Utilization General Hospital/ Acute Care Identification of Alcohol and Other Drug Services Added CPT codes to Table IAD-C and Table IAD-D. Added HCPCS codes G0442, G0443 to Table IAD-D. Mental Health Utilization Added CPT codes to Table MPT-C and Table MPT-D. Antibiotic Utilization No changes to this measure.

9 Summary Table of Measures, Product Lines and Changes 9 Utilization and Relative Resource Use Plan All-Cause Readmissions Clarified the variance calculation in step 8 of the Risk Adjustment Weighting section. Added the variance calculation to Sample Table: PCR Risk Adjustment Weighting. Clarified how to calculate the average adjusted probability in step 1 in the Reporting: Risk Adjustment section. Revised the rounding requirements in steps 2 and 4 in the Reporting: Risk Adjustment section. Added a Note section and a note that Risk Assessment Protocols may not be used. Added the observed-to-expected ratio and lower and upper confidence interval calculations to the reporting tables. Guidelines for Relative Resource Use Measures Relative Resource Use for People With Diabetes Relative Resource Use for People With Cardiovascular Conditions Clarified that one prescription is 30 days or less, in step 4 of the Steps for Calculating Service Categories Calculating Service Frequency and in step 5 of Calculating Total Standard Cost and Frequency: Pharmacy Services. Clarified inpatient stays that should be counted in the frequency counts. Clarified that the final risk score should be rounded to 4 decimal places in step 8 of the HCC-RRU Risk Adjustment section. Added CPT code to Table RRU-A. Deleted CPT codes 92002, 92004, 92012, from Table RRU-E. Deleted UB Revenue codes 080x, 082x-085x, 088x from Table RRU-E. Clarified in step 2 of Calculating Total Standard Cost: Surgery and Procedure that organizations should only use the applicable modifiers contained in the SPTs. Clarified in step 2 of Calculating Total Standard Cost: Diagnostic Laboratory Services and Calculating Total Standard Cost: Diagnostic Imaging Services that the modifier example for Surgery and Procedure applies to these sections. Updated the Data Elements for Reporting section. Added Table RDI-C-1/2/3 in Data Element for Reporting to identify the calculated values provided to organizations. Added instructions to use only facility claims (not professional claims) to identify AMI and CABG for the Event/diagnosis. Added Table RCA-C-1/2/3 in Data Element for Reporting to identify the calculated values provided to organizations.

10 Summary Table of Measures, Product Lines and Changes 10 Utilization and Relative Resource Use Relative Resource Use for People With Hypertension Relative Resource Use for People With COPD Relative Resource Use for People With Asthma Health Plan Descriptive Information Revised the coding table reference for members who had an admission to a nonacute inpatient setting in the third bullet under Exclusions (optional). Added Table RHY-C-1/2/3 in Data Element for Reporting to identify the calculated values provided to organizations. Added Table RCO-C-1/2/3 in Data Element for Reporting to identify the calculated values provided to organizations. Clarified the Oral medication dispensing event definition. Revised the Inhaler dispensing event and Injection dispensing event definitions to indicate that each dispensing event is assessed separately. Clarified that the four outpatient visits in step 1 of the event/diagnosis criteria must be on different dates of service. Added Table RAS-C-1/2 in Data Element for Reporting to identify the calculated values provided to organizations. Board Certification Clarified the physicians/practitioners that Organizations must exclude from this measure. Revised specification to indicate that pediatricians and OB/GYN physicians should be reported for the Medicare product line. Enrollment by Product Line No changes to this measure. Enrollment by State No changes to this measure. Language Diversity of Membership Clarified how data not collected using a direct method should be reported in Table LDM-B-1/2/3. Race/Ethnicity Diversity of Membership Weeks of Pregnancy at Time of Enrollment Clarified that the total unduplicated count of members is the denominator for calculating all percentages in Table RDM-C-1/2/3. No changes to this measure. Total Membership No changes to this measure.