[Federal Register Volume 77, Number 2 (Wednesday, January 4, 2012)]
[Notices]
[Pages 286-291]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-33756]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Office of the Secretary
[CMS-2420-FN]
Medicaid Program: Initial Core Set of Health Care Quality
Measures for Medicaid-Eligible Adults
AGENCY: Office of the Secretary, HHS.
ACTION: Final notice.
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SUMMARY: This final notice announces the initial core set of health
care quality measures for Medicaid-eligible adults, as required by
section 2701 of the Affordable Care Act, for voluntary use by State
programs administered under title XIX of the Social Security Act,
health insurance issuers and managed care entities that enter into
contracts with Medicaid, and providers of items and services under
these programs.
FOR FURTHER INFORMATION CONTACT: Karen Llanos, Centers for Medicare &
Medicaid Services, (410) 786-9071.
SUPPLEMENTARY INFORMATION:
I. Background
Section 2701 of the Patient Protection and Affordable Care Act
(Affordable Care Act) (Pub. L. 111-148) added new section 1139B to the
Social Security Act (the Act). Section 1139B(a) of the Act directs the
Secretary of Health and Human Services (HHS) to identify and publish
for public comment a recommended initial core set of health care
quality measures for Medicaid-eligible adults, and section 1139B(b)(1)
of the Act requires that an initial core set be published by January 1,
2012. Additionally, the statute requires the initial core set
recommendation to consist of existing adult health care quality
measures in use under public and privately sponsored health care
coverage arrangements or that are part of reporting systems that
measure both the presence and duration of health insurance coverage
over time and that may be applicable to Medicaid-eligible adults.
Section 1139B of the Act also requires the Secretary to complete
the following actions:
--By January 1, 2012:
Establish a Medicaid Quality Measurement Program to fund
development, testing, and validation of emerging and innovative
evidence-based measures.
--By January 1, 2013:
Develop a standardized reporting format for the core set
of adult quality measures and procedures to encourage voluntary
reporting by the States.
--By January 1, 2014:
Annually publish recommended changes to the initial core
set that shall reflect the results of the testing, validation, and
consensus process for the development of adult health quality measures.
Include in the report to Congress mandated under section
1139A(a)(6) of the Act on the quality of health care of children in
Medicaid and the Children's Health Insurance Program (CHIP) similar
information for adult health quality with respect to measures
established under section 1139B of the Act. This report must be
published every 3 years thereafter in accordance with the statute.
--By September 30, 2014:
Collect, analyze, and make publicly available the
information reported by the States as required in section 1139B(d)(1)
of the Act.
Identification of the initial core set of measures for Medicaid-
eligible adults is an important first step in an overall strategy to
encourage and enhance quality improvement. States that chose to collect
the initial core set will be better positioned to measure their
performance and develop action plans to achieve the three part aims of
better care, healthier people, and affordable care as identified in
HHS' National Strategy for Quality Improvement in Health Care.
Additional information about the National Quality Strategy can be found
at: http://www.ahrq.gov/workingforquality/nqs/.
The initial core set of quality measures for voluntary annual
reporting by States has been determined based on recommendations from
the Agency for Healthcare Research and Quality's Subcommittee to the
National Advisory Council for Healthcare Research and Quality, as well
as public comments, before being finalized by the Secretary. These core
set measures will support HHS and its State partners in developing a
quality-driven, evidence-based, national system for measuring the
quality of health care provided to Medicaid-eligible adults.
Over the next year, CMS will phase in components of the Medicaid
Adult Quality Measures Program that will help to further identify
measurement gap areas and begin testing the collection of some of the
initial core measures. The Medicaid Adult Quality Measures Program will
focus on developing and refining measures, where needed, so that future
updates to the initial core set can meet a wider range of States'
health care quality measurement needs. By September 2012, CMS will
release technical specifications as a resource for States that seek to
voluntarily collect and report the initial core set of health care
quality measures for Medicaid-eligible adults. Additionally, as
required in statute, by January 1, 2013, CMS will issue guidance for
submitting the initial core set to CMS in a standardized format.
Lastly, much like activities conducted under section 1139A of the Act
for the initial core child health care quality measures, the Secretary
will launch a Technical Assistance and Analytic Support Program to help
States collect, report, and use the voluntary core set of adult
measures.
II. Method for Determining the Initial Set of Health Care Quality
Measures for Medicaid-Eligible Adults
The Affordable Care Act requires the development of a core set of
health quality measures for adults eligible for benefits under
Medicaid. The statute parallels the requirement under section 1139A of
the Act to identify and publish a recommended initial core set of
quality measures for children in Medicaid and the CHIP. HHS used a
similar process to identify the initial set of health care quality
measures for Medicaid-eligible adults.
The Centers for Medicare & Medicaid Services (CMS) partnered with
the Agency for Healthcare Research and Quality (AHRQ) to collaborate on
the identification of the initial core set of health care quality
measures for adults. Working through its National Advisory Council for
Healthcare Research and Quality, which provides advice and
recommendations to the Director of AHRQ and to the Secretary of HHS on
priorities for a national health services research agenda, AHRQ created
a Subcommittee in the fall of 2010 to evaluate candidate measures for
the initial core set. The Subcommittee consisted of State Medicaid
representatives, health care quality experts, and representatives of
health professional organizations and associations, and was charged
with considering the health care quality needs of adults (ages 18 and
older) enrolled in Medicaid in its
[[Page 287]]
recommendation for an initial core set of measures to HHS. The
Subcommittee reviewed and evaluated measures from nationally recognized
sources, including measures endorsed by the National Quality Forum
(NQF), measures submitted by Medicaid medical directors, measures
currently in use by CMS, and measures suggested by the Co-chairs and
members of the Subcommittee. Starting from approximately 1,000
measures, a total of 51 measures were recommended and posted for public
comment. A report detailing the initial convening of the Subcommittee
may be found on the AHRQ Web site: http://www.ahrq.gov/about/nacqm/.
The measures were posted for public comment through a Federal
Register (75 FR 82397) notice published on December 30, 2010, with
comments due by March 1, 2011. The public submitted 100 comments.
Public comments suggested concern about the large size of the proposed
set, with many requesting alignment to the extent possible with
existing Federal initiatives. An additional 43 measures were suggested
through public comment. See discussion in section III of this final
notice for a more detailed discussion.
To be responsive to the public comments, the Subcommittee sought to
identify measures that ensured comprehensive representation of
variables affecting Medicaid-eligible adults while considering ways to
decrease the number of measures in the set. AHRQ and CMS identified
five criteria against which to evaluate the proposed core measures:
importance; scientific evidence supporting the measure; scientific
soundness of the measure; current use in and alignment with existing
Federal programs; and feasibility for State reporting (a background
report detailing the selection criteria and Subcommittee process can be
found at: http://www.ahrq.gov). The criteria represented attributes
desired of State-level measures that would represent Medicaid-eligible
adults. In particular, those criteria regarding current use in and
alignment with existing Federal programs and feasibility for State
reporting were given particular emphasis, since those were attributes
identified repeatedly in the public comments. Documented use of or
alignment with existing Federal programs such as the National Quality
Strategy's six priorities, the Medicare and Medicaid Electronic Health
Record (EHR) Incentive Programs, and Physician Quality Reporting was
taken into consideration as the Subcommittee reviewed each measure.
As in the initial meeting, the Subcommittee broke into workgroups
focusing on four dimensions of health care related to adults in
Medicaid: Adult Health, Maternal/Reproductive Health, Complex Health
Care Needs, and Mental Health and Substance Use. Workgroups were
assigned two sets of measures that related to their specific areas:
originally recommended measures and measures proposed in public
comment. To assess how each measure fared against the five criteria,
the Subcommittee reviewed background information (including numerator,
denominator, exclusions, prevalence, clinical guidelines, past
performance rates, etc.) on each measure from the measure owners,
developers, or stewards.
A. Adult Health
The workgroup prioritized 10 of the original measures to be
included in the final set, dropping five measures that were duplicative
of other measures. The workgroup brought forward one measure that was
suggested in public comment, Adult Body Mass Index (BMI) Assessment,
replacing a similar BMI measure that had been originally recommended
for the core set, Preventive Care and Screening: BMI Screening and
Follow-Up. The workgroup did not recommend including the remaining 16
newly suggested measures received from the public comment period.
B. Maternal/Reproductive Health
After evaluating the measures against the criteria, the Maternal/
Reproductive Health workgroup recommended keeping each of the five
measures originally posed for the core set, noting that these measures
addressed areas of high importance to women and reproductive health,
were feasible to report and aligned well with current programs
(including the initial core set of children's health care quality
measures \1\). The workgroup noted that, while future measures should
tie screenings to outcomes and assess additional issues outside of
pregnancy that affect women (for example, access to care, incontinence
due to multiple pregnancies), the measures being recommended for the
core set were an important first step of using performance measures for
quality improvement. Of the measures newly suggested through public
comment, the workgroup recommended bringing one measure forward to a
Subcommittee vote: Chlamydia Screening in Women. The workgroup rated
this measure high on each criterion and noted its alignment with the
initial core set of children's health care quality measures (the
initial core set of children's measures specified only the lower age
group of this measure; adding the higher age range means the measure
now would be reported in full).
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\1\ Initial Core Set of Children's Health Care Quality Measures
https://www.cms.gov/MedicaidCHIPQualPrac/Downloads/CHIPRACoreSetTechManual.pdf.
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C. Complex Health Care Needs
The Complex Health Care Needs workgroup recommended nine of the 18
measures originally posed for inclusion in the draft core set. Although
the topic areas represented in the measures suggested through public
comment were important to Medicaid, many of the measures scored low on
multiple criteria (for example, scientific soundness and feasibility
for State reporting) and thus were deemed not ready for wide-scale
implementation. Further, although several of the proposed measures
assessed the very important topic of care coordination for patients who
are hospitalized or transferred across multiple facilities, the
workgroup noted that many of these measures were challenged by complex
requirements for data collection and excluded target populations (for
example, dually eligible beneficiaries and individuals with long-term
care services and supports needs). Many of the measures, for example,
required medical record review across time or at more than one site
(for example, Change in Basic Mobility as Measured by the AM-PAC and
Medication Reconciliation Post-Discharge). The workgroup concluded that
the remaining measures suggested in public comment, though relevant to
people with complex health care needs, addressed very narrow clinical
conditions, excluded key populations, were difficult to collect at the
State level, or were duplicative of other, more highly-rated measures.
D. Mental Health and Substance Use
After discussing how well the 13 measures originally proposed fared
against the selection criteria, the Mental Health and Substance Use
workgroup recommended nine measures for inclusion in the draft core set
and decided against bringing forward any of the additional measures
suggested in public comment. In general, the workgroup prioritized
measures that were broadly applicable to the Medicaid population or to
primary care settings. For example, the workgroup included measures
that assessed conditions that may be prevalent in a low-income
population, including depression, schizophrenia, and substance use, in
[[Page 288]]
addition to measures that assessed utilization of general mental health
services. The workgroup did not recommend including any of the five
measures suggested in public comment, as they concluded that these
measures addressed similar content areas as other higher-rated measures
or were rated very low in feasibility for State collection and
reporting.
E. Summary
A total of 35 measures received a majority vote from the full
Subcommittee. The measures voted upon by the Subcommittee included
recommendations from each workgroup that were based on the original 51
measures as well as new measures identified through public comment that
were brought forth by each workgroup. The Adult Health work group
recommended eleven measures for inclusion in the initial core set. The
Maternal/Reproductive Health work group recommended six measures. The
Complex Health Care Needs work group recommended nine measures and the
Mental Health and Substance Use recommended nine measures.
The Subcommittee discussed how these measures represented
conditions and populations relevant to Medicaid, and examined each
measure's data source and use in existing programs. In the final round
of voting, 24 \2\ measures ultimately received a majority vote by
Subcommittee members. In order to ensure priority populations were
fully represented and that the goals of planned initiatives could be
monitored, we then added two measures originally proposed for the draft
core set (PC-01 Elective Delivery and Timely Transmission of Transition
Record). The Subcommittee deferred the decision to CMS and AHRQ on
which of the two HIV-related measures under consideration (HIV/AIDS
Screening: Members at High Risk of HIV/AIDS and HIV/AIDS: Medical
Visits) would be included in the core set. Upon discussion with
colleagues from the Centers for Disease Control and Prevention and the
Health Resources and Services Administration, the decision was made to
include the measure originally proposed for the core set, HIV/AIDS:
Medical Visit. A total of 26 are included in the initial core set.
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\2\ The CAHPS Health Plan Survey v 4.0--Adult Questionnaire and
the CAHPS Health Plan Survey v 4.0H--NCQA Supplemental Items for
CAHPS are counted as one measure.
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III. Analysis of and Responses to Public Comments on the Notice of
Comment Period
In response to the publication of the December 30, 2010 notice with
comment period, we received 100 timely public comments. The following
are a summary of the public comments that we received related to that
notice, and our responses to the comments:
Comment: About a third of the comments specifically noted that the
draft core set published in the Federal Register on December 30, 2010,
was too large or raised the burden of reporting by States as a concern.
Commenters also suggested reducing the measures to two measures per
category or considering a phase-in approach.
Response: To address these concerns, the size of the core set was
reduced by almost half (from 51 measures in the draft core set to 26
measures in the initial core set). Although the numbers of measures was
reduced, we believe that this initial core set still reflects the
health care needs of Medicaid-eligible adults. In addition to reducing
the size of the initial core set, to support States in collecting and
reporting these measures, CMS will provide technical assistance as well
as additional guidance and tools to increase the feasibility of
voluntary reporting.
Comment: Numerous comments suggested avoiding measures for
inclusion in the initial core set that require medical record review.
Response: To the degree possible, measures that require medical
record review were excluded in large-scale from the initial core set.
However, in order to address aspects of health care quality important
to the adult Medicaid population and to align with existing measurement
programs (for example, the Medicare & Medicaid EHR Incentive Programs)
a few measures that require medical record review (for example,
controlling high blood pressure) were included in the initial core set.
Comment: Many comments suggested aligning measures with existing
reporting programs, such as the Medicare and Medicaid EHR Incentive
Programs and the Inpatient Hospital Quality Reporting program, as a way
to decrease burden.
Response: We agree with these comments. To the degree possible, the
initial core set aligns with existing Federal reporting programs.
Seventeen measures from the initial core set are used in other CMS
programs (refer to table at the end of Notice). Alignment was a key
criterion employed in the review, based in part, on the strength of
related public comments. At the same time, the areas addressed by the
measures in the initial core set, however, must reflect the
requirements of the statute to provide an overall assessment of the
quality of care received by adults in Medicaid. As such, the types of
quality measures included in other reporting programs may not fully
represent the health care measurement needs of Medicaid-eligible
adults.
Comment: Several commenters suggested using only measures endorsed
by the National Quality Forum or National Committee for Quality
Assurance Health Employer Data and Information Set (HEDIS[supreg])
measures. Many comments also emphasized the importance of ensuring the
initial core set measures met thresholds for evidence, validity,
reliability and feasibility.
Response: A key priority used in selecting the initial core set
measures was whether or not the measure was relevant to the Medicaid
population. While NQF endorsement signifies that measures have been
deemed as meeting certain criteria for scientific soundness, validity
and reliability, requiring NQF endorsement would have eliminated
inclusion of measures in the initial core set that are relevant for
assessing important aspects of care for the Medicaid population.
Similarly, selecting only HEDIS measures, which were originally
developed for health plan use, would have limited the initial core
set's ability to address the range of care settings and conditions
relevant to the Medicaid population.
Comment: Public comments questioned the appropriateness of some
proposed measures.
Response: These comments are appreciated and helped us narrow the
list. Each measure included in the initial core set has been compared
against five criteria--importance, scientific evidence, scientific
soundness, alignment with existing programs and feasibility for State
reporting. Public comments related to specific measures were also
reviewed and considered. To aid in assessing each measure for inclusion
in the initial core set, specific information was collected for each
measure, including:
Measure description, numerator, denominator and
exclusions.
Data sources (for example, claims, medical records,
electronic health records).
Description of health importance, prevalence, financial
importance and opportunity for improvement, including what is known
about gaps in care and health care disparities.
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Brief description of the scientific literature, including
what is known about effectiveness of the intervention being addressed,
and what is known about management and follow-up.
Published clinical guidelines relevant to the measure.
Validity and reliability of results, including a
description of the study sample and methods used.
Performance rates (most recent and two years prior).
Comment: Two comments requested clarification on whether the
initial core measures would be applied to Medicaid fee-for-service,
Medicaid managed care or both types of health care delivery systems.
Other commenters requested clarification on the target Medicaid
population, particularly since NCQA measures included in the draft
measures list had varying age ranges.
Response: The initial core set will be used by States to assess the
quality of health care provided in their Medicaid programs for adults
(ages 18 years and older) and across all health care delivery systems
(for example, fee-for-service, managed care, primary care case
management). We understand that some of the measures are currently
specified only for a particular delivery system (for example, managed
care). However, additional guidance will be provided to States so that
these measures can be used across delivery systems and Medicaid funded
programs targeting adults, including long-term services and supports.
Comment: Multiple comments suggested including measures related to
patient safety and rehabilitation services. Specifically, commenters
noted the need for measures that address a range of disabilities
present among Medicaid beneficiaries and those receiving home and
community-based services. The need for outcome measures for management
of chronic conditions and care coordination measures was also noted.
Response: The measurement topic areas identified in these public
comments are ones that CMS recognizes as important to assessing the
health care quality of all adults enrolled in Medicaid, and we agree on
the importance of measurement for chronic conditions and care
coordination as well as for those receiving home and community-based
services. However, the Subcommittee did not identify any existing
measures in these areas that met the criteria for scientific soundness.
As such, these topics will be considered measurement gap areas and will
be prioritized for new measure development as part of the Medicaid
Adult Quality Measures Program required under this statute.
Comment: In addition to public comments received about each of the
proposed measures, 43 measures were suggested by the public.
Response: We appreciate these suggestions. Forty-two of the 43
measures had been previously considered by the Subcommittee and CMS for
inclusion in the draft core measures set. The one measure that had not
been considered was a newly developed measure that had not appeared in
the original inventory of candidate measures (Healthy Term Newborn).
The Subcommittee reviewed all 43 of these measures again and evaluated
them based on the established selection criteria. The Healthy Term
Newborn measure did not rate highly when compared against the selection
criteria and the Subcommittee felt the measure would be more effective
if paired with a process of care measure.
For additional information on consideration of the public comments
and the finalization of the initial core set of health care quality
measures for Medicaid-eligible adults, a background report can be found
at: http://www.ahrq.gov/.
IV. Collection of Information Requirements
This final notice announces the initial core set of health care
quality measures for Medicaid-eligible adults for voluntary use by
State Medicaid programs. As required in statute, by January 1, 2013,
CMS will issue guidance for submitting the initial core set to CMS in a
standardized format. States choosing to collect the initial core set of
measures will use that reporting template to submit data to CMS.
Voluntary reporting will not begin until December 2013.
The guidance, core measures, and template are subject to the
Paperwork Reduction Act and will be submitted to the Office of
Management and Budget (OMB) for their review and approval at a later
time. No persons are required to respond to a collection of information
(whether voluntary or mandatory) unless it displays a valid OMB control
number issued by OMB.
V. Executive Order 12866
In accordance with the provisions of Executive Order 12866, this
notice was reviewed by the Office of Management and Budget.
Authority: Sections XIX and XXI of the Social Security Act (42
U.S.C. 13206 through 9a).
Dated: November 16, 2011.
Marilyn B. Tavenner,
Acting Administrator, Centers for Medicare & Medicaid Services.
Approved: December 21, 2011.
Kathleen Sebelius,
Secretary, Health and Human Services.
Initial Core Set of Health Care Quality Measures for Medicaid-Eligible
Adults
This table of the initial core set of health care quality measures
for Medicaid-eligible adults includes National Quality Forum (NQF)
identifying numbers for measures that have been endorsed, provides the
measure stewards and indicates those measures which are used in various
Federal and public sector programs including: Initial Core Set of
Children's Health Care Quality Measures; the Medicare & Medicaid EHR
Incentive Programs for eligible health care professionals and hospitals
that adopt certified Electronic Health Record technology under the
Final Rule published in the July 28, 2010 Federal Register (75 FR
44314); the Medicare Physician Quality Reporting System (PQRS); Health
Employer Data and Information Set (HEDIS); National Committee for
Quality Assurance Accreditation; The Joint Commission's ORYX [supreg]
Performance Measurement Initiative and other national programs.
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Programs in which
Measure the measure is
NQF No. [dagger] Steward[Dagger] Measure name currently
used[yen]
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Prevention & Health Promotion.. 0039............... NCQA............... Flu Shots for HEDIS[supreg],
Adults Ages 50-64 NCQA
(Collected as Accreditation.
part of HEDIS
CAHPS
Supplemental
Survey).
N/A................ NCQA............... Adult BMI HEDIS[supreg],
Assessment. Health Homes
Core.
0031............... NCQA............... Breast Cancer MU1,
Screening. HEDIS[supreg],
NCQA
Accreditation,
PQRS GPRO,
Shared Savings
Program.
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0032............... NCQA............... Cervical Cancer MU1,
Screening. HEDIS[supreg],
NCQA
Accreditation.
0027............... NCQA............... Medical Assistance MU1,
With Smoking and HEDIS[supreg],
Tobacco Use Medicare, NCQA
Cessation Accreditation.
(Collected as
part of HEDIS
CAHPS
Supplemental
Survey).
0418............... CMS................ Screening for PQRS, CMS QIP,
Clinical Health Homes
Depression and Core, Shared
Follow-Up Plan. Savings Program.
N/A................ NCQA............... Plan All-Cause HEDIS[supreg].
Readmission.
0272............... AHRQ............... PQI 01: Diabetes, .................
Short-Term
Complications
Admission Rate.
0275............... AHRQ............... PQI 05: Chronic Shared Savings
Obstructive Program.
Pulmonary Disease
(COPD) Admission
Rate.
0277............... AHRQ............... PQI 08: Congestive Shared Savings
Heart Failure Program.
Admission Rate.
0283............... AHRQ............... PQI 15: Adult .................
Asthma Admission
Rate.
0033............... NCQA............... Chlamydia MU1,
Screening in HEDIS[supreg],
Women Ages 21-24 NCQA
(same as CHIPRA Accreditation,
core measure, CHIPRA Core.
however, the
State would
report on the
adult age group).
Management of Acute Conditions. 0576............... NCQA............... Follow-Up After HEDIS[supreg],
Hospitalization NCQA
for Mental Accreditation,
Illness. CHIPRA Core,
Health Home
Core.
0469............... HCA, TJC........... PC-01: Elective HIP QDRP, TJC's
Delivery. ORYX Performance
Measurement
Program.
0476............... Prov/CWISH/NPIC/QAS/ PC-03 Antenatal TJC's ORYX
TJC. Steroids. Performance
Measurement
Program.
Management of Chronic 0403............... NCQA............... Annual HIV/AIDS .................
Conditions. Medical Visit.
0018............... NCQA............... Controlling High MU1,
Blood Pressure. HEDIS[supreg],
NCQA
Accreditation,
PQRS GPRO,
Shared Savings
Program.
0063............... NCQA............... Comprehensive MU1,
Diabetes Care: HEDIS[supreg],
LDL-C Screening. NCQA
Accreditation,
PQRS.
0057............... NCQA............... Comprehensive MU1,
Diabetes Care: HEDIS[supreg],
Hemoglobin A1c NCQA
Testing. Accreditation,
PQRS.
0105............... NCQA............... Antidepressant MU1,
Medication HEDIS[supreg],
Management. NCQA
Accreditation.
N/A................ CMS-QMHAG.......... Adherence to VHA.
Antipsychotics
for Individuals
with
Schizophrenia.
0021............... NCQA............... Annual Monitoring HEDIS[supreg],
for Patients on NCQA
Persistent Accreditation.
Medications.
Family Experiences of Care..... 0006 & 0007........ AHRQ & NCQA........ CAHPS Health Plan HEDIS[supreg],
Survey v 4.0-- NCQA
Adult Accreditation,
Questionnaire Shared Savings
with CAHPS Health Program
Plan Survey v (NQF000
4.0H--NCQA 6).
Supplemental.
Care Coordination.............. 648................ AMA-PCPI........... Care Transition-- Health Homes
Transition Record Core.
Transmitted to
Health Care
Professional.
Availability................... 0004............... NCQA............... Initiation and MU1,
Engagement of HEDIS[supreg],
Alcohol and Other Health Homes
Drug Dependence Core.
Treatment.
1391............... NCQA............... Prenatal and HEDIS[supreg].
Postpartum Care:
Postpartum Care
Rate (second
component to
CHIPRA core
measure
``Timeliness of
Prenatal Care,''
State would now
report 2/2
components
instead of 1).
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[dagger] NQF ID National Quality Forum identification numbers are used for measures that are NQF-endorsed;
otherwise, NA is used.
[Dagger] Measure Steward:
AHRQ--Agency for Healthcare Research and Quality.
CMS--Centers for Medicare & Medicaid Services.
CMS-QMHAG--Centers for Medicare & Medicaid Services, Quality Measurement and Health Assessment Group.
HCA, TJC--Hospital Corporation of America-Women's and Children's Clinical Services, The Joint Commission.
NCQA--National Committee for Quality Assurance.
Prov/CWISH/NPIC/QAS/TJC--Providence St. Vincent Medical Center/Council of Women's and Infant's Specialty
Hospitals/National Perinatal Information Center/Quality Analytic Services/The Joint Commission.
TJC--The Joint Commission.
[yen] Programs in which Measures are Currently in Use:
CHIPRA Core--Children's Health Insurance Program Reauthorization Act--Initial Core Set.
CMS QIP--CMS Quality Incentive Program.
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HIP QDRP--Hospital Inpatient Quality Data Reporting Program.
Health Homes Core--CMS Health Homes Core Measures.
MU1--Meaningful Use Stage 1 of the Medicare & Medicaid Electronic Health Record Incentive Programs.
PQRS--Physician Quality Reporting Program Group Practice Reporting Option.
Shared Savings Program--Medicare Shared Savings Program.
VHA--Veterans Health Administration.
[FR Doc. 2011-33756 Filed 12-30-11; 4:15 pm]
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