Pediatric HEDIS Measures
Click the links below to review guidance on the medical record documentation required to be submitted to close HEDIS care gaps for Children and Adolescents.
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Age 13 years Documentation required for Gap Closure Immunization record, documentation from NJIIS, or progress notes with dates, documented name of vaccine and/or illness for: - HPV: At least two vaccines between 9th and 13th birthday (for 2-dose series, there must be at least 146 days between both)
- MCV: One vaccine between 11th and 13th birthday
- Tdap: One vaccine between 10th and 13th birthday
Combo 1: MCV and Tdap;
Combo 2: HPV, MCV and Tdap
Product(s) Impacted - Medicaid
- Commercial
Applicable HEDIS Program Primary Care Provider -
Age On or before 2nd birthday Documentation required for Gap Closure Lab report, progress note, or NJIIS form indicating lead test, date, and result before the member's second birthday Product(s) Impacted Medicaid Applicable HEDIS Program Primary Care Provider -
Age 9-26 months Documentation required for Gap Closure EPSDT (State Contract): 2 lead tests are required as follows: - Between nine (9) months and eighteen (18) months of age – target age twelve (12) months
- Between eighteen (18) months and twenty-six (26) months of age – target age twenty-four (24) months
Product(s) Impacted Medicaid Applicable HEDIS Program Primary Care Provider -
Age 3-17 years Documentation required for Gap Closure Documentation of height, weight and either of the following: - BMI percentile documented as a value (e.g. 85th percentile)
- BMI percentile plotted on an age-growth BMI chart
- Ranges and thresholds do not meet criteria for the BMI percentile (e.g. 25%-50%, >95%, etc.).
- Member reported biometric values (height, weight, BMI percentile) are acceptable when associated with a telehealth visit.
- BMI value does not count as BMI percentile
Product(s) Impacted Medicaid
CommercialApplicable HEDIS Program Primary Care Provider -
Age 3-17 years Documentation required for Gap Closure Documentation must note the date and at least ONE of the following in the measurement year: - Discussion of current nutrition behaviors (e.g., eating habits, dieting behaviors)
- Checklist indicating nutrition was addressed
- Counseling or referral for nutrition education
- Member received educational materials on nutrition during a face-to-face visit
- Anticipatory guidance for nutrition
- Weight or obesity counseling
Product(s) Impacted Medicaid
CommercialApplicable HEDIS Program Primary Care Provider -
Age 3-17 years Documentation required for Gap Closure Documentation must note the date and at least ONE of the following in the measurement year: - Discussion of current physical activity behaviors (e.g., exercise routine, participation in sports activities, exam for sports participation)
- Checklist indicating physical activity was addressed
- Counseling or referral for physical activity
- Member received educational materials on physical activity during a face-to-face visit
- Anticipatory guidance for physical activity
- Weight or obesity counseling
Product(s) Impacted Medicaid
CommercialApplicable HEDIS Program Primary Care Provider -
Age On or before 2nd birthday Documentation required for Gap Closure Immunization record or documentation from NJIIS with dates, documented name of vaccine and/or illness for all of the following ON OR BEFORE the child’s second birthday: - DTaP (4)
- IPV (3)
- Hepatitis B (3)
- HiB (3)
- Pneumococcal conjugate (4)
- MMR (1)
- VZV (1)
- Hepatitis A (1)
- Influenza (2)
One of the two vaccinations can be an LAIV vaccination administered on the child’s second birthday. - Rotavirus (at least 2); any of the below meet compliance:
- At least 2 doses of two-dose vaccine
- At least 3 doses of three-dose vaccine
- At least 1 dose of the two-dose vaccine and at least 2 doses of the three-dose vaccine
- A note stating the “member is up to date” with all immunizations, but does not list them, is not considered compliant.
- For Rotavirus, if documentation does not specify whether the two- or three-dose schedule was used, it will be assumed that three doses were administered.
Product(s) Impacted Medicaid
CommercialApplicable HEDIS Program Primary Care Provider