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COVID-19

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.

  • Age 13 years
    Documentation required for Gap Closure Immunization record, progress note or a certificate of immunization (ie NJIIS form) 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 or 3-dose series on different dates of service)
    • MCV: One vaccine between 11th and 13th birthday
    • Tdap: One vaccine between 10th and 13th birthday
    Notes:
    Combo 1: MCV and Tdap;
    Combo 2: HPV, MCV and Tdap
    Product(s) Impacted
    • Medicaid
    • Commercial
    Applicable HEDIS Program Primary Care Provider
  • Age 9-26 months
    Documentation required for Gap Closure Lab report, progress note, or NJIIS form indicating the date AND result of the lead test

    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
    AND
    • 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 in the measurement year:
    • BMI percentile documented as a value (e.g. 85th percentile)
    • BMI percentile plotted on an age-growth BMI chart
    Notes:
    • 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


    WCC Tip: Measure indicators can take place during a visit other than a well-child visit as long as the services are not specific to the assessment or treatment of an acute or chronic condition.
    Product(s) Impacted Medicaid
    Commercial
    Applicable 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
    Note: WIC referrals may be used for compliance.

    WCC Tip: Measure indicators can take place during a visit other than a well-child visit as long as the services are not specific to the assessment or treatment of an acute or chronic condition.
    Product(s) Impacted Medicaid
    Commercial
    Applicable 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


    WCC Tip: Measure indicators can take place during a visit other than a well-child visit as long as the services are not specific to the assessment or treatment of an acute or chronic condition.
    Product(s) Impacted Medicaid
    Commercial
    Applicable HEDIS Program Primary Care Provider
  • Age On or before 2nd birthday
    Documentation required for Gap Closure Immunization record, progress note or a certificate of immunization (ie NJIIS form) with dates, documented name of vaccine and/or illness ON OR BEFORE the child's second birthday:
    1. DTaP (4 doses on different dates between 42 days old and 2 years old)
    2. IPV (3 doses on different dates between 42 days old and 2 years old)
    3. Hepatitis B (3 doses on different dates by 2 years old)
    4. HiB (3 doses on different dates between 42 days old and 2 years old)
    5. Pneumococcal conjugate (4 doses on different dates between 42 days old and 2 years old)
    6. MMR (1 dose between first and second birthdays)
    7. VZV (1 dose between first and second birthdays)
    8. Hepatitis A (1 dose between first and second birthdays)
    9. Influenza (2 doses on different dates by 2 years old)
    10. Rotavirus (at least 2 doses on different dates by 2 years old); 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
    Notes:
    • 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.
    Combinations Accepted Combo-10 (DTap, IPV, HepB, HIB. PCV, MMR, VZV, HepA, Rotavirus and Influenza)

    Combo-7 (DTap, IPV, HepB, HIB. PCV, MMR, VZV, HepA, Rotavirus)
    Product(s) Impacted Medicaid
    Commercial
    Applicable HEDIS Program Primary Care Provider