Administrative bulletin: 2026-08-003 Quality information

Professional and facility Providers

Childhood immunization status – Combination #10 (CIS-E)

KEY POINT: Following the Centers for Disease Control (CDC) recommended timelines and best practices for vaccines can prevent common diseases that may seriously harm or prove fatal to infants.

Measure importance:

This measure assesses the percentage of children who became two years old during the measurement year and who received at least the following vaccinations on or before two years of age:

• Four (4) diphtheria-tetanus-acellular pertussis (DTaP).
• Three (3) Inactivated Polio Vaccine (IPV).
• One (1) Measles, Mumps, and Rubella (MMR).
• Three (3) Haemophilus Influenza Type B (Hib).
• Three (3) Hepatitis B (HepB).
• One (1) Chicken Pox (VZV).
• Four (4) doses of Pneumococcal Conjugate (PCV)
• One (1) Hepatitis A (HepA).
• Two or three doses of Rotavirus (RV).
• Two (2) Influenza (flu) vaccines.

This measure aligns with recommendations from the CDC’s Advisory Committee on Immunization Practices (ACIP). HEDIS® measures are designed to assess population-level performance and are not a substitute for clinical judgment. Please refer to the Comprehensive Performance Measures Guide in the Theon™ Care Collaborator toolkit for more information on the Childhood Immunization Status – E measure. Theon Care (capbluecross.com)

Best practices:

• Use Theon™ Action Reports to manage your population’s health by identifying care gaps and prioritizing outreach.
• Your Population Health Consultant or Provider Engagement Consultant can show you how to:
• Perform outreach when members are missing the service.
• Provide data to Capital if the service was provided but not captured.
• Identify practice patterns that can be addressed through education. CDC Vaccine Information Statements (VISs) explain both the benefits and risks of a vaccine. As a health care provider, you can give the VIS for any vaccine. Deciding to Vaccinate Your Child: Common Concerns | CDC.
• Use the EMR system alerts to flag due or overdue vaccines.
• Schedule well-child visits in alignment with recommended immunization timelines.
• Place guidelines to schedule visits within the CDC guideline timeframe in the office waiting area.
• Review each child’s date of birth and ensure all vaccines are administered before the second birthday.

Exclusions:

• Parent refusal is not a valid exclusion.
• Members who died during the measurement year.
• In hospice or using hospice services anytime during the measurement year.
• Children who had a contraindication to a vaccine on or before their second birthday. Either of the following meets the criteria:
1. Contraindications to childhood vaccines and
2. Organ and bone marrow transplants.

Resources:

Getting shots: Help your child have a better vaccine visit (capbluecross.com)

Preventive Care (capbluecross.com)

Catch-up Immunization Schedule for Children, Birth-18 Years | CDC

HEDIS^® flu vaccine measure

KEY POINT: Helpful information is provided about the flu, including tips for addressing the flu vaccine HEDIS^® measure.

Measure importance:

The Flu is a contagious disease that spreads around the United States every year, usually between October and May. Anyone can get the flu, but it is more dangerous for some people. Infants and young children, people 65 years and older, pregnant people, and people with certain health conditions or a weakened immune system are at greatest risk of flu complications. In an average year, thousands of people in the United States die from the flu, and many more are hospitalized. The flu vaccine prevents millions of illnesses and flu-related doctor visits each year.

Prevention remains the most effective strategy to reduce influenza-related morbidity and mortality according to the CDC National Center for Health Statistics:

• Children (6 months–17 years): 43.7% influenza rate, CDC (2024)
• Adults (65 years and older): 67.1% influenza rate, CDC (2024)

The Centers for Disease Control (CDC) Vaccine Information Statements (VISs) explain both the benefits and risks of a vaccine. As a health care provider, you can provide the VIS at any vaccine visit. Providers may reference CDC resources addressing common vaccine concerns: Common Concerns for Deciding to Vaccinate Your Child: Common Concerns | CDC helps with common questions about vaccines for children.

The Influenza (Flu) vaccine is an integral part of protection from influenza for children, adults, and pregnant women.

Measure description:

The HEDIS^® Childhood Immunization Status – Combination #10 measure requires children who became two years old during the measurement year to receive two influenza vaccines on or before two years of age to meet compliance. This measure follows the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices (ACIP) guidelines for immunizations. The Advisory Committee on Immunization Practices (ACIP) recommends influenza vaccines for pregnant women to help protect them from serious illness and death, as well as to protect their infants after birth. The ACIP recommends influenza vaccines for all adults 19 years of age and older and for those 18–64 with certain underlying conditions.

Best practices:

• Routinely assess patients’ vaccination history and offer needed vaccines to adults.
• Implement reminder-recall systems.
• Use standing-order programs and analyze practice- or provider-specific vaccination rates.
• In addition, providing easy access and convenience for vaccination (such as walk-in visits, extended hours, or offering vaccines at retail clinics) within and outside of the health care setting is important for increasing adult vaccine uptake.
• Leveraging health information technology to share immunization data among patients, providers, pharmacies, retail clinics, and public health agencies and registries is also a key strategy for tracking patients’ immunization history and keeping them up to date on vaccines.
• Please refer to the Comprehensive Performance Measures Guide in the Theon Care Collaborator toolkit for more information on the Childhood Immunization Status measure. Theon Care (capbluecross.com)

Resources:

CDC National Center for Health Statistics

CDC Vaccine Information Statements (VIS)

Deciding to Vaccinate Your Child: Common Concerns | CDC

Theon Care (capbluecross.com)

Immunization for adolescents – Combination #2 (IMA – E)

KEY POINT: Following the Centers for Disease Control (CDC) recommended timelines and best practices for vaccines can prevent common diseases that may seriously harm or prove fatal to adolescents.

Measure description:

Evaluates the percentage of adolescents 13 years of age during the measurement year who received the following three vaccinations on or before their 13th birthday: one dose of meningococcal vaccine, one tetanus, diphtheria toxoids, and acellular pertussis (Tdap) vaccine, and have completed the human papillomavirus (HPV) vaccine series.

• One (1) Meningococcal serogroup A, C, W, Y or A, C, W, Y. or B vaccine.
• One (1) Tetanus, diphtheria toxoids and acellular pertussis (Tdap).
• Human papillomavirus vaccine series (HPV).
• At least two HPV vaccines with dates of service at least 146 days apart on or between the member’s 9th and 13th birthdays.
• At least three HPV vaccines with different dates of service on or between the member’s 9th and 13th birthdays.

This measure aligns with recommendations from the CDC’s Advisory Committee on Immunization Practices (ACIP). HEDIS^® measures are designed to assess population-level performance and are not a substitute for clinical judgment. Please refer to the Comprehensive Performance Measures Guide in the Theon™ Care Collaborator toolkit for more information on the Immunization for Adolescent Combination #2 (IMA-E) measure. Theon Care (capbluecross.com)

Best practices:

• Use Theon™ Action Reports to manage your population’s health by identifying care gaps and prioritizing outreach.
• Your Population Health Consultant or Provider Engagement Consultant can show you how.
• Perform outreach when members are missing the service.
• Provide data to Capital if the service was provided but not captured.
• Identify practice patterns that can be addressed through education. CDC Vaccine Information Statements (VISs) explain both the benefits and risks of a vaccine. As a health care provider, you can give the VIS for any vaccine. Deciding to Vaccinate Your Child: Common Concerns | CDC.
• Utilize electronic medical record (EMR) alerts to flag due or overdue vaccines.
• Schedule well-child visits in alignment with recommended immunization timelines.
• Place guidelines to schedule visits within the CDC guideline timeframe in the office waiting area.
• Review member’s birth date and schedule appointments and vaccinations accordingly.
• Scheduling immunizations during annual well visits and sports physicals.
• Educating patients and caregivers about the importance of completing the HPV vaccine series.
• Consistent recommendations from providers are one of the most influential factors in improving adolescent vaccine uptake, particularly for the HPV vaccine.

Exclusions:

• Members who died during the measurement year.
• In hospice or using hospice services anytime during the measurement year.

Resources:

Getting shots: Help your child have a better vaccine visit (capbluecross.com)

Preventive Care (capbluecross.com)

Catch-up Immunization Schedule for Children, Birth-18 Years | CDC