HEDIS MY 2027 Changes: What Health Plans Need to Know — and Where At-Home Testing Fits In

NCQA just released its Measurement Year 2027 updates, and for health plans running HEDIS-driven quality programs, this isn't a minor technical refresh. Six new measures are being added, three existing measures are changing, and ten are up for retirement — all while NCQA keeps pushing plans toward electronic and remote data sources over manual chart chases. For Medicare Advantage plans working to protect Star Ratings, the timing matters: MY 2027 specifications are locked in now, and how a plan collects clinical evidence over the next measurement year will shape how it performs.

At-home testing already plays a role in HEDIS gap closure — most plans use it for cervical cancer, colorectal cancer, and kidney health screening today. The MY 2027 changes make that role more central, not less. Here's what's new, and where a program like Ash fits.

What's Actually Changing in MY 2027

NCQA's update splits into three buckets.

New measures include Follow-Up After Positive Colorectal Cancer Non-Invasive Screening (COF-E), which tracks whether members who screen positive on a non-invasive test actually get to a diagnostic colonoscopy. Also new: Prenatal Syphilis Screening (PSY-E), three person-centered outcome measures for Special Needs Plans, and Continuous Glucose Monitoring for Diabetes (CGD-E).

Updated measures include Pharmacotherapy Management of COPD Exacerbation (shifting to a person-based denominator and aligning with 2025 GOLD guidelines), Adult Immunization Status (new pneumococcal age stratification at 50+), and Emergency Department Utilization (adding a Medicaid product line for ages 18–64).

Proposed retirements cover ten measures, including several tied to schizophrenia monitoring, diagnosed behavioral health disorders, opioid dosage and continued use, and dental care. Public comment on these ran August 3–17, 2026, with a decision expected after NCQA's Committee on Performance Measurement reviews feedback in September; any approved retirements would take effect in the March 2027 Technical Update.

Separately, NCQA also released MY 2027 Volume 2 specifications for Long-Term Services and Supports (LTSS), moving those measures onto a FHIR-based data structure and updating terminology — "eligible population" is now "initial population," for example. It's a smaller update for most commercial and MA plans, but it's part of the same broader pattern: NCQA is rebuilding its specifications around structured, electronic data rather than narrative chart language.

The Bigger Theme: NCQA Keeps Betting on Electronic Data

The most consequential thread running through all of this isn't any single measure — it's NCQA's continued expansion of Electronic Clinical Data Systems (ECDS) reporting. ECDS gives plans a standardized way to report HEDIS measures using electronic sources: EHRs and personal health records, health information exchanges and clinical registries, case management systems, and administrative and claims data. For MY 2027, NCQA is extending voluntary ECDS reporting to additional measures and reorganizing how ECDS-eligible measures are grouped into clinically specific domains rather than a standalone "electronic data" bucket.

That shift matters because it signals where NCQA wants measurement to go: away from provider chart abstraction and toward data that's already structured, timestamped, and lab- or system-verified. It's also a reminder that not every data source qualifies automatically. NCQA's HEDIS FAQ is explicit that member-reported, self-administered point-of-care results don't count as valid evidence — proof of service still has to come from a clinical or laboratory source. That distinction is exactly why the type of at-home testing program a plan uses matters.

Where At-Home Testing Fits — and Where It Doesn't

At-home testing isn't a new idea for HEDIS, but COF-E puts a spotlight on the part of the screening pathway plans have historically struggled with most: what happens after a positive result.

Ash's collection kits for Colorectal Cancer Screening (FIT) and Cervical Cancer Screening (HPV) are processed by CLIA-certified, CAP-accredited lab partners, with every test carrying a clinician order and clinician review of results — not a member self-reading a device at home. That distinction is what makes lab-processed self-collection a valid proof-of-service source under HEDIS today, and it's the mechanism plans already rely on to close COL and CCS gaps at scale.

COF-E raises the bar on what "closing the gap" means for colorectal screening: a completed FIT test isn't the finish line if the result is positive. Here, results delivery and clinical follow-up matter as much as the kit itself. When a member's result comes back positive, Ash's clinical oversight model — clinician review, results delivery to the member, and faxing of results to the member's PCP — puts the information in front of the provider who can order the follow-up colonoscopy. That's a meaningful piece of the COF-E puzzle: getting positive results into provider hands fast, so the follow-up visit isn't the part that falls through the cracks.

Accurate follow-up tracking runs both directions, too. In Ash's national case study on colorectal cancer screening outreach, member engagement conversations surfaced people who had already completed a colonoscopy recently but had never had it reported back to their plan — correcting the record instead of sending a kit to someone who was already compliant. That kind of detail, caught through outreach rather than a claims feed, is exactly the sort of gap-closure accuracy NCQA's follow-up-oriented measures are pushing plans toward.

On the Diabetes management side, Ash's HbA1c (GSD) and Kidney Health Evaluation (KED) programs remain squarely in the current measure set, and they're worth watching as NCQA experiments with device-based measurement like CGD-E. It's an early signal that NCQA is comfortable expanding what counts as valid clinical evidence beyond the traditional office visit — a trend that favors testing models built on structured, lab-verified data from the start.

What This Means for Your Program Now

MY 2027 doesn't change the fundamentals of gap closure — it raises the stakes on speed and follow-through. Plans that pair self-collection with real engagement (not just kit fulfillment) close more gaps: members who receive multi-channel outreach complete testing 2.4x more often than with single-channel methods. Pair that engagement with a clinical model that gets positive results to providers quickly, and plans are better positioned for both the measures they're reporting today and the follow-up-oriented measures NCQA is clearly building toward.

If your plan is reassessing its screening and diagnostic strategy ahead of MY 2027, contact Ash to talk through how at-home testing and results routing fit into your HEDIS and Star Ratings strategy.

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