Newsletter Article

Participation Agreements Issued for New HEDIS, EQR Audits and PIP Support 

CalMHSA’s team of epidemiologists, data experts, and quality improvement and assurance professionals is gearing up for a new round of Healthcare Effectiveness Data and Information Set (HEDIS) reporting requirements for measurement year (MY) 2025/reporting year 2026 — as well as calendar year 2026 External Quality Review (EQR) audits and Performance Improvement Project (PIP) support. Activities begin soon, so counties that haven’t yet executed contracts are encouraged to do so.   

DHCS now requires any entity calculating HEDIS measures to be NCQA-certified, a designation that must be earned annually; CalMHSA recently earned full certification for MY 2025. Also new this year is a requirement for counties to gather data from local Managed Care Plans to augment their Plan Data Feed data. For more information, mark your calendar for our upcoming HEDIS Data Acquisition webinar on Nov. 18 at noon. 

CalMHSA’s MY 2025 participation agreement includes a simple version (annual calculation) and enhanced version (quarterly calculations), with both options including access to detailed member-level files. 

CalMHSA continues to support county plans using SmartCare in preparing for and completing the FY 2025-26 EQR audits. CalMHSA support includes assistance with completing the Information Systems Capability Assessment Tool, subject matter expert participation in the virtual audit sessions, and help with post-audit document re-submission.  

To help counties meet their FY 2025-26 EQR PIP requirements, CalMHSA provides regular PIP coaching and consultation around using QI tools, strategies to support PIP progress, assistance drafting PIP submissions and resubmissions as needed, and data support, including: calculating MY 2025 PIP baseline performance indicator rates; providing consultation around measures to monitor intervention effectiveness; and assistance with interpreting and applying HEDIS measure descriptive analysis reports to PIPs. HEDIS-based PIP support is available only to counties also participating in CalMHSA’s HEDIS Performance Measurement program for MY 2025. 

For more information on any of these important initiatives, contact [email protected]. 

October 22, 2025