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
The 7 new measures cover areas NCQA had not measured before. They address acute hospitalizations following outpatient surgeries, health plan disability membership, follow-up after acute and urgent care visits for asthma, and tobacco use screening and cessation.
- Acute hospitalizations following outpatient surgeries looks at whether patients end up admitted to the hospital after a procedure that was meant to be ambulatory, a signal of safety and care quality around outpatient surgery.
- Health plan disability membership captures how a plan's enrollment is composed with respect to disability status, giving NCQA a denominator for understanding the population a plan serves.
- Follow-up after acute and urgent care visits for asthma tracks whether patients seen for asthma in acute or urgent settings receive timely follow-up care afterward.
- Tobacco use screening and cessation measures whether plans are identifying tobacco use and supporting patients who want to quit.
NCQA frames these additions as filling gaps in how plans track safety, access, and the composition of their populations. Alongside the new measures, the 2 retirements and the smaller specification edits across the rest of the measure set mean most quality teams will see at least some change in the denominators, value sets, or logic they report on this year. None of it is a wholesale reset, but enough moved that last year's reporting plan cannot be run unchanged.
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 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.
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.