Claims-Based Measures
What type of provider must provide the oral health evaluation for adults with Diabetes?
Dentist, no hygienists
How many patients are in the sample size that we receive from OHA for hybrid measures such as Postpartum Care?
411
What are the upstream measures in the 2025 measure set?
What are the data sources used to calculate both immunization measures?
ALERT and Claims
What is the new reading type that is included in the Diabetes measure in 2025?
Glucose Management Indicators (GMI) from Continuous Glucose Monitoring (CGM)
What age can patients receive their first dose of the HPV vaccine for the adolescent immunization measure?
9 years old
What is the window of time that a woman must receive a postpartum care visit to count for the measure?
Between 7 and 84 days
What are the three SDOH domains that members must be screened for?
Housing, food, and transportation
What are the allowable enrollment gaps for the well-child visit measure?
No more than 1 gap in enrollment of up to 45 days in the measurement year
What is the timeframe that a referral is required after a positive social need is identified through SDOH screening?
15 calendar days
What are the SUD diagnosis cohorts in the IET measure?
What are the two ways a member would be included in the numerator of the HbA1c measure?
HbA1c or GMI above 9 and no HbA1c was performed in the measurement year or is missing
What ages are foster children required to receive a mental health assessment in the DHS measure?
3-17 years old
How are members interpreter needs identified for the Meaningful Language Access denominator?
The HCI interpreter needs flag included in the OHA 834 enrollment files
What are the challenge pool measures?
What vaccines are included in the childhood immunization measure?
DTaP, IPV (Polio), MMR, HiB, Hepatitis B, VZV (Varicella), and PCV (Pneumococcal)
What are the most common screening tools that count for the screening portion of the depression screening and follow-up measure?
PHQ-2 & PHQ-9
Who is included in the child-level social emotional denominator?
All children aged 1-5.99 by 12/31/25
What is the sample size and reporting threshold for the SDOH measure component 2 in 2025?
1,067 members with a 90% reporting threshold
What timeframe is considered a new SUD diagnosis? i.e. What is the negative SUD diagnosis history time period?
194 days (~6.5) months
When a patient is newly diagnosed with SUD, what is the timeframe that they need to initiate and engage in treatment in?
Initiation in 14 days and engagement within 34 days of the initiation date
How do we determine whether a member is included in the denominator for the EHR-based measures?
Qualifying encounter during the measurement year as identified through EHR data
What are the refusal reasons that allow a service to be excluded from the language access measure in 2025?
Which measures allow patient denial exclusions/exceptions?
How does UHA obtain data from clinics for the EHR-based measures?
Clinical data feeds through direct feeds from clinic EHRs, Reliance HIE, and other third parties such as eCW