Healthcare Effectiveness Data and Information Set (HEDIS) – 2023 Diabetes Care Measures
| Date: | October 17, 2023 |
| To: | Health Plan of San Joaquin (HPSJ) Primary Care Providers (PCPs), Federally Qualified Health Centers (FQHCs), Rural Health Clinics, and Facilities |
| Type: | Regulatory |
| Subject: | Healthcare Effectiveness Data and Information Set (HEDIS) – 2023 Diabetes Care Measures |
| Business: | Medi-Cal Managed Care |
The following is regarding an update to Health Effectiveness Data and Information Set (HEDIS) Diabetes Care measures for measurement year 2023.
Patients 18–75 years of age with diabetes (types 1 and 2) should receive all the following testing and monitoring annually:
Hemoglobin A1c Control (<8%) for Patients with Diabetes (HBD) – Testing for Hemoglobin A1c (HbA1c) at least annually with a controlled A1c of <8.0%:
- Medical record must include a note indicating the date when the HbA1c test was performed and result.
Note: Missing test results are considered poor control.
Blood Pressure Control for Patents with Diabetes (BPD) – Blood pressure (BP) reading with adequate control of <140/90mm Hg at least annually.
Eye Exam for Patients with Diabetes (EED) – A retinal eye exam in the calendar year, or a negative retinal eye exam in the previous calendar year. Results of the retinal exam must be present in medical record documentation to ensure compliance.
Kidney Health Evaluation for Patients with Diabetes (KED) – An Estimated Glomerular Filtration Rate (eGFR) Lab test and a Quantitative Urine Albumin Lab test (uACR) during the measurement year. Testing must be performed four or fewer days apart.
Statin Therapy for Patients with Diabetes (SPD) – Patients 40-75 years of age with a diagnosis of diabetes who do not currently have clinical atherosclerotic cardiovascular artery disease (ASCVD) who receive at least one statin therapy medication and remain on therapy for at least 80% of the measurement year.
Please refer to the link provided for the most up to date covered medication:
https://medi-calrx.dhcs.ca.gov/cms/medicalrx/static-assets/documents/provider/forms-and-information/cdl/Medi-Cal_Rx_Contract_Drugs_List_FINAL.pdf
Recommended Best Practices for Overall Diabetic Patient Care:
- Follow up with patients to monitor changes and schedule follow up testing.
- Document date of all lab results including any point of care testing.
- Educate patients about the difference between refractive and retinal eye exams.
- Document in the medical record the date and time of call and the reading for patient-reported BP from digital cuffs. Digital cuffs are required for telemedicine visit compliance.
- Create a treatment plan and recheck process for elevated and abnormal BP and ensure all BP’s taken during visit are recorded.
- Review treatment plan for out-of-control readings and schedule follow up care as necessary.
- Code claims to the highest specificity and include all applicable CPT II reporting codes.
- Review patient medication profile to confirm current statin therapy and to determine statin history.
- Educate patients on the importance of staying on medication and proper dose, frequency route and timing.
If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan of San Joaquin and our services is always available on our website https://www.hpsj.com/.