What changed in HEDIS for MY 2026
HEDIS (the Healthcare Effectiveness Data and Information Set) is NCQA's set of standardized quality measures, used by more than 90% of U.S. health plans, and it feeds the Medicare Star Ratings. For Measurement Year 2026 (MY 2026), NCQA added 7 measures, retired 2 measures, transitioned 4 measures into Electronic Clinical Data Systems (ECDS) reporting, and updated the measure format. It also made smaller changes across multiple existing measures. The combined effect points the program toward digital quality measurement.
What's new for MY 2026, measure by measure
The full list, with acronyms, to check against your own reporting plan.
| Change | Measure | Acronym |
|---|---|---|
| Added | Acute Hospitalizations Following Outpatient Orthopedic Surgery | HFO |
| Added | Acute Hospitalizations Following Outpatient General Surgery | HFG |
| Added | Acute Hospitalizations Following Outpatient Colonoscopy | HFC |
| Added | Acute Hospitalizations Following Outpatient Urologic Surgery | HFU |
| Added | Disability Description of Membership | DDM |
| Added | Follow-Up After Acute and Urgent Care Visits for Asthma | AAF-E |
| Added | Tobacco Use Screening and Cessation Intervention | TSC-E |
| Retired | Asthma Medication Ratio | AMR |
| Retired | Medical Assistance With Smoking and Tobacco Use Cessation | MSC |
| Moved to ECDS | Lead Screening in Children | LSC |
| Moved to ECDS | Statin Therapy for Patients With Cardiovascular Disease | SPC |
| Moved to ECDS | Statin Therapy for Patients With Diabetes | SPD |
| Moved to ECDS | Blood Pressure Control for Patients With Diabetes (voluntary reporting) | BPD-E |
Two of the additions are really replacements, and reading them that way saves confusion. AMR retires and AAF-E arrives in the same cycle, so asthma moves from a medication-ratio measure to a follow-up measure. MSC retires and TSC-E arrives, so tobacco moves from a CAHPS-survey-based measure to an ECDS screening and intervention measure. If your asthma or tobacco reporting was built on the old pair, it needs a rebuild, not an edit.
The four HF measures share a shape: they look at whether patients end up admitted after a procedure that was meant to be ambulatory, split by orthopedic, general, colonoscopy and urologic. DDM captures how a plan's enrollment is composed with respect to disability status. NCQA also made smaller specification edits across the rest of the measure set, so expect changed denominators, value sets, or logic somewhere in the measures you already report.
The March 31, 2026 technical update, required for MY 2026 reporting
NCQA released a MY 2026 technical update on March 31, 2026. It is not optional. Two changes in it will hit real numerators.
- CCS-E (Cervical Cancer Screening) now accepts self-collected samples. NCQA expanded the High Risk HPV Lab Test Value Set to include self-collected vaginal samples, following the guideline change. Plans that run self-collection programs can now get credit for them.
- SNS-E (Social Need Screening and Intervention) drops HCPCS G0136. The code comes out of the screening numerators and the ICD-10 Z codes come out of the intervention denominators, because the CY 2026 Medicare Physician Fee Schedule final rule repurposed G0136 from SDOH assessment to physical activity and nutrition assessment. If your SNS-E capture logic still keys on G0136, it is capturing the wrong thing.
What moved to ECDS and why it matters
Four measures transitioned into ECDS reporting for MY 2026. ECDS is NCQA's reporting standard built on structured electronic clinical data rather than manual chart abstraction, and the move is the operational core of the year's changes. As measures shift to ECDS, the way a plan earns credit shifts with them. The ECDS transition is the structural story behind most of MY 2026.
The Lead Screening in Children (LSC) measure is the clearest example. LSC transitions to ECDS-only reporting, which ends the traditional hybrid annual chart-retrieval process for it. Under the new approach, medical-record compliance must come through prospective supplemental data rather than a retrospective chase of charts after the measurement year closes. A plan that waits until spring to pull records for LSC no longer has a path to capture those numerators.
The FHIR-aligned format
The MY 2026 technical specifications use a new format aligned with the FHIR data standard, similar to the format already used for existing ECDS-reported measures. NCQA is bringing the rest of the measure set onto the same structure it built for ECDS.
For teams, the practical effect is that more measures are specified the way digital measures are specified: against structured clinical data elements, with value sets and logic that map to electronic records and standardized exchange. The format change does not alter what a measure asks for, but it changes how the data has to be assembled to report it.
The terminology changed too
The FHIR-aligned MY 2026 specifications renamed three terms every HEDIS analyst uses. "Eligible population" is now "initial population." "Required exclusions" are now "denominator exclusions." "Measurement year" is now "measurement period." The definitions did not change, but every internal spec document, data dictionary, and query comment that uses the old words is now out of step with the source.
The SSoR reporting change
NCQA no longer requires HEDIS ECDS data to be submitted by each source system of record (SSoR) used to produce the result. In prior years a plan had to attribute ECDS data back to the specific system it came from. That requirement is gone for MY 2026.
NCQA framed the change as simplifying reporting and supporting the move to digital quality measurement. In practice it lowers the bookkeeping burden on plans that pull clinical data from multiple feeds, since they no longer have to tag every result with its originating system before they submit.
The race and ethnicity stratification update
NCQA added "Middle Eastern or North African" as a minimum race and ethnicity reporting category for MY 2026. Measures that stratify results by race and ethnicity now recognize this group as a standard reporting category.
The update sits inside NCQA's longer effort to surface disparities in care through stratified measure results. Plans that collect and report race and ethnicity data will need their intake and reporting systems to capture the new category.
What this means for quality teams
The MY 2026 changes reward execution on structured and supplemental data, not the hybrid chart chase that has carried quality reporting for years. As measures move to ECDS and the format aligns with FHIR, the work shifts from retrieving charts after the year ends to getting clinical data into reportable form during the year.
The LSC change makes the point concrete. Once a measure is ECDS-only, a retrospective abstraction effort produces nothing; the numerator has to be captured prospectively through supplemental data feeds that run throughout the measurement year. Teams that already operate that way gain ground. Teams that still plan their year around a spring chart-retrieval sprint have to rebuild the workflow.
That rebuild is not only about timing. It is about plumbing. Prospective supplemental data means standing connections to the systems where clinical results live, logic that recognizes a numerator the moment the data lands, and a process that acts on it rather than filing it for review. The plans that adapt fastest will be the ones that treat quality as continuous data work rather than an annual reporting event.
What comes after MY 2026: the hybrid retirement schedule
NCQA is retiring the hybrid reporting method by MY 2029 and running fully digital HEDIS by MY 2030. It published the original timeline in November 2024 and then revised it in its MY 2027 Notification of Changes memo in February 2026. The endpoint did not move. Several of the measures did, and three of them moved in a direction that helps plans.
| Measure | Original plan (Nov 2024) | Where it stands after the Feb 2026 update |
|---|---|---|
| Glycemic Status Assessment for Patients With Diabetes (GSD) | ECDS by MY 2029 | Unchanged. ECDS version introduced alongside the hybrid version in MY 2027, optional for two years, ECDS-only by MY 2029. |
| Weight Assessment and Counseling for Children/Adolescents (WCC) | Administrative-only in MY 2027 | Not moving to administrative-only. NCQA is prioritizing retirement in MY 2029 and developing a replacement measure. |
| Prenatal and Postpartum Care (PPC) | Administrative-only in MY 2028 | Not moving to administrative-only. NCQA is building an ECDS and risk-based replacement for MY 2028, with the hybrid version retiring at the same time. |
| Transitions of Care (TRC) | ECDS in MY 2029 | New ECDS version delayed to MY 2028, optional until the hybrid method is removed in MY 2029. |
| Care for Older Adults (COA) | ECDS in MY 2029 | New ECDS version delayed to MY 2028, optional until the hybrid method is removed in MY 2029. |
Sources: NCQA hybrid retirement timeline (November 2024) and NCQA Notification of Changes for HEDIS, MY 2027 cycle (February 2026).
TRC and COA are the two to watch if you run a Medicare book. Both feed Star Ratings work, and both now have an extra year before their ECDS versions arrive. Use it to get discharge and post-discharge data flowing as structured supplemental data. Teams that read the delay as slack will be doing the same build in MY 2028 with less time to do it.
Two other items from the same memo. The HEDIS LTSS MY 2027 measure template moves to a FHIR-aligned format, the same direction the health-plan Volume 2 took for MY 2026, with no change to measure intent, data collection or calculation. And NCQA gave advance notice that for MY 2028 it will remove the exclusion of denied claims from 21 measures, on the reasoning that excluding denied claims may artificially improve measure performance and does not reflect the care delivered. The affected list includes PCR, EDU, AHU, the four new HF measures, and the heart failure and opioid measures. Nobody is writing about this one yet, and it will move rates on measures that are currently comfortable.
The HEDIS change that shows up in the Star Ratings
NCQA reevaluated Statin Therapy for Patients With Cardiovascular Disease (SPC) for MY 2026 and expanded the eligible population as part of the ECDS transition. CMS treated that as a substantive change, and it is why the Star Ratings version of the measure moves to the display page beginning with the 2028 Star Ratings under the Contract Year 2027 final rule. It is a clean example of how an NCQA specification decision propagates into a plan's Star Ratings two years later. We cover the rest of that rule in 2027 Medicare Star Ratings changes.
A note on HEDIS MY 2027
NCQA announced that HEDIS MY 2027 Volume 2 and the MY 2027 LTSS specifications would publish on August 3, 2026. Its public comment cycle closed March 13, 2026 and floated six new measures, including continuous glucose monitoring utilization, follow-up after a positive non-invasive colorectal screening test, and prenatal syphilis screening. Those are proposals, and NCQA has not yet posted its "What's New, What's Changed, What's Retired" summary for MY 2027, which is where the final adds, retirements and counts land. We are not going to publish proposed measures as if they were final. When that summary posts we will write up MY 2027 and link it here.
How Pelica helps
Most quality platforms hand a team a gap list and a dashboard. Pelica is the execution layer that works the list. The Quality & Stars copilot runs on one live member record and closes the gaps directly, capturing supplemental data, chasing the records that count, and following up until the work is resolved. That is the operating model the MY 2026 changes reward.
At HealthCare Partners, the largest IPA in the country, Pelica closes roughly 90% of BCS and KED gaps in-year and 70%+ of TRC gaps within 30 days, with 100% team adoption across more than 175,000 patients managed live. Those are the prospective, in-year results the shift to ECDS and supplemental data demands.
Sources
- NCQA: HEDIS MY 2026, what's new, what's changed, what's retired
- NCQA: HEDIS Measures
- NCQA: HEDIS Electronic Clinical Data Systems (ECDS) Reporting
- NCQA: Notification of Changes for HEDIS, MY 2027 cycle (updated hybrid retirement timeline, LTSS FHIR alignment, MY 2028 denied-claims removal)
- NCQA: proposed timeline for retiring and replacing HEDIS hybrid measures, November 2024
- NCQA: HEDIS MY 2027 publications (release status)
- CMS: Contract Year 2027 Medicare Advantage and Part D Final Rule fact sheet (SPC respecification treated as substantive; move to the 2028 display page)