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DSS to align prenatal‑visit measure with HEDIS; new baseline and parallel reporting planned for 2026
Summary
DSS and its actuarial partner will change the prenatal‑visit measure specification to require both provider type and procedure code (aligning with HEDIS), set a new baseline for the updated measure in 2026, and run old and new specs in parallel through July so providers can compare results.
Mercer and DSS staff told providers that the prenatal‑visit quality measure will be updated for calendar year 2026 to use more restrictive logic that aligns with HEDIS: instead of an OR test, the new specification requires both the billing/performing provider to be an OBGYN or PCP and the procedure code to be in the defined value set.
"This will not have any impact on performance year one nor the reconciliation for performance year one," a Mercer presenter said, adding that DSS will run the old and new specifications in parallel through July while establishing a new baseline for the updated measure. Quarterly dashboards issued to practices will therefore include both the legacy specification and the new specification (with the new baseline) so practices can inspect differences before the new spec is used operationally.
DSS staff encouraged practices to request one‑on‑one walkthroughs of their dashboards; CHN will coordinate those follow‑ups. Presenters emphasized that data under the existing specification will continue to inform PY1 reconciliation and that the new measure will start from a fresh baseline rather than compare directly to prior‑spec performance.
Providers asked for assurance that slide decks and recordings would be shared; DSS confirmed meeting materials and the recording will be posted on the DSS website and that teams are available to answer individual questions.
