Medicaid and CHIP Programs; Initial Core Set of Children's Healthcare Quality Measures for Voluntary Use by Medicaid and CHIP Programs, 68846-68849 [E9-30802]
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Federal Register / Vol. 74, No. 248 / Tuesday, December 29, 2009 / Notices
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FOR FURTHER INFORMATION CONTACT:
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This guidance is being issued as a
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Dated: December 23, 2009.
David Horowitz,
Assistant Commissioner for Policy.
[FR Doc. E9–30750 Filed 12–28–09; 8:45 am]
BILLING CODE 4160–01–S
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Office of the Secretary
[CMS–2474–NC]
Medicaid and CHIP Programs; Initial
Core Set of Children’s Healthcare
Quality Measures for Voluntary Use by
Medicaid and CHIP Programs
Office of the Secretary, HHS.
Notice with comment period.
AGENCY:
ACTION:
SUMMARY: This notice identifies and
solicits public comments on the initial,
recommended core set of children’s
health care quality measures for
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voluntary use by State programs
administered under titles XIX and XXI
of the Social Security Act, health
insurance issuers and managed care
entities that enter into contracts with
Medicaid and Children’s Health
Insurance Programs, and providers of
items and services under these
programs, in accordance with the
Children’s Health Insurance Program
Reauthorization Act of 2009 (Pub. L.
111–3). This notice also discusses steps
already underway to facilitate the
programs’ voluntary use of the
children’s health care quality measures.
In addition, this notice solicits
comments on how the steps might be
enhanced, and recommendations for
additional steps to facilitate use of the
measures.
DATES: To be assured consideration,
comments must be received at one of
the addresses provided below, no later
than 5 p.m. on March 1, 2010.
ADDRESSES: Because of staff and
resource limitations, we cannot accept
comments by facsimile (FAX)
transmission.
You may submit comments in one of
two ways (please choose only one of the
ways listed):
1. Electronic Mail. CHIPRAquality
measures@ahrq.hhs.gov.
2. Regular Mail. Agency for
Healthcare Research and Quality,
Attention: Office of Extramural
Research, Education, and Priority
Populations—Public Comment, CHIPRA
Core Measures, 540 Gaither Rd.,
Rockville, MD 20850.
Please note that all submissions may
be posted without change to https://
www.AHRQ.gov, including any personal
information provided.
FOR FURTHER INFORMATION CONTACT:
CHIPRAqualitymeasures@
AHRQ.hhs.gov.
SUPPLEMENTARY INFORMATION:
I. Background
On February 4, 2009, the Congress
enacted the Children’s Health Insurance
Program Reauthorization Act (CHIPRA)
of 2009 (Pub. L. 111–3). Section 401(a)
of the legislation amended the Social
Security Act (the Act), to establish
section 1139A (42 U.S.C. 1320b-9a).
This section requires the Secretary to
identify and publish for general
comment an initial, recommended core
set of child health quality measures for
use by State programs administered
under titles XIX and XXI of the Act,
health insurance issuers and managed
care entities that enter into contracts
with such programs, and providers of
items and services under such
programs. The statute requires that the
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Federal Register / Vol. 74, No. 248 / Tuesday, December 29, 2009 / Notices
Secretary identify and publish these
measures by January 1, 2010. The
Secretary delegated this task to the
Centers for Medicare & Medicaid
Services (CMS). A ‘‘Memorandum of
Understanding’’ was signed with the
Agency for Healthcare Research and
Quality (AHRQ), by which CMS and
AHRQ would collaborate to make
recommendations for the initial core set
of children’s health care quality
measures to be posted for public
comment. The initial core set is
intended to be used voluntarily by
Medicaid and the Children’s Health
Insurance Program (CHIP).
The initial core set of children’s
health care quality measures for
voluntary use by Medicaid and CHIP
programs was developed in consultation
with organizations representing the
stakeholder categories set out at section
1139A(b)(3) of the Act (including States;
health care providers specializing in
pediatric health and dentistry; health
care providers that furnish primary
health care to children and families who
live in urban and rural medically
underserved communities or who are
members of distinct population subgroups at heightened risk for poor
health outcomes; national organizations
representing children and families;
individuals and organizations with
health care quality measurement
expertise; and other organizations
involved in the advancement of
evidence-based measures of health
care).
Measures for consideration for the
initial core set were compiled from
‘‘existing quality of care measures for
children that are 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’’ as
required by section 1139A(a)(2) of the
Act.
The statute requires that the initial
core set of child health quality measures
include the following:
1. The duration of children’s health
insurance coverage over a 12-month
time period.
2. The availability and effectiveness of
a full range of preventive services,
treatments, and services for acute
conditions, including services to
promote healthy birth, prevent and treat
premature birth, and detect the presence
or risk of physical or mental conditions
that could adversely affect growth and
development; and treatments to correct
or ameliorate the effects of physical and
mental conditions, including chronic
conditions in infants, young children,
school-age children, and adolescents.
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19:02 Dec 28, 2009
Jkt 220001
3. The availability of care in a range
of ambulatory and inpatient health care
settings in which such care is furnished.
4. The types of measures that, taken
together, can be used to estimate the
overall national quality of health care
for children, including children with
special needs, and to perform
comparative analyses of pediatric health
care quality and racial, ethnic, and
socioeconomic disparities in child
health and health care for children.
To help facilitate an evidenceinformed and transparent process for
making recommendations, AHRQ’s
National Advisory Council on
Healthcare Research and Quality created
a Subcommittee on Children’s
Healthcare Quality Measures for
Medicaid and CHIP programs (the
‘‘Subcommittee’’). The Subcommittee
held public meetings, and considered
public comments and measure
nominations throughout their
deliberations. Subcommittee members
were provided with standard
definitions, criteria, and objective
information to facilitate scoring of
measures for validity, feasibility, and
importance over several iterations of
measure consideration. The
Subcommittee’s recommendations were
reported to the Chair of AHRQ’s
National Advisory Council on
Healthcare Research and Quality and
subsequently considered further by
Medicaid and CHIP officials, as well as
staff in the Office of the Secretary of the
Department of Health and Human
Services (HHS) prior to this public
posting. Extensive details regarding the
process, the measures recommended,
and other considerations regarding the
initial core set can be found at https://
www.ahrq.gov/chip/corebackgrnd.htm.
We are now soliciting additional
comments from the public to help
determine which measures should
remain in the core set, which measures
may need further development to
enhance their validity and feasibility,
and the nature of technical assistance
and other resources required before
State Medicaid and CHIP programs and
health care providers can be expected to
implement and report on these
measures. In submitting comments, it is
important to consider the kinds of
activities already under way at HHS to
facilitate making the measures more
feasible and valid for use by the States
for reporting across all Medicaid and
CHIP programs (for example, managed
care, fee-for-service and enrollees).
HHS will be making improvements
and enhancements to the core set of
measures as a result of the following:
• Public comment on the initial,
recommended core measure set.
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68847
• Products developed by a pediatric
quality measures program of grants and
contracts to begin in 2010 (section
1139A(b) of the Act).
• Products stimulated by CMS’s
CHIPRA Quality Demonstration Grants,
including evaluation and
experimentation with the measures and
development of an electronic health
record format for children’s health care
(section 1139A(d) of the Act).
• Other advancements and
improvements to children’s health care
quality measures (such as annual
quality reporting as required under
section 1139A(a)(4) of the Act).
Section 1139A(b)(5) of the Act directs
that an improved, evidence-based core
measure set is to be available by January
1, 2013, to be feasible for use by a broad
range of providers, payers, and
programs, both public and private (42
U.S.C. 1320b-9a).
To further these efforts, AHRQ and
CMS are currently working to continue
or implement the following initiatives:
1. Establishing methodologies to
create measure specifications that are
applicable to all Medicaid and CHIP
enrollees, and suitable for identifying
disparities in quality by race, ethnicity,
socioeconomic status, and special
health care needs status, as required by
CHIPRA.
2. Providing technical assistance to
States to facilitate implementation of the
initial, recommended core measure set.
3. Using a public process for the
pediatric quality measures grants and
contracts program to build on priorities
identified during the 2009 identification
of the initial, recommended core set.
Priority topics already identified
include quality measures for: mental
health and substance abuse services for
children, other specialty services,
inpatient care, duration of enrollment
and coverage, medical home and other
integrated health care delivery
mechanisms, and availability of
services.
4. Considering ways to align State
reporting requirements across CHIPRA
provisions, with Early and Periodic
Screening, Diagnostic and Treatment
Services (EPSDT) via CMS 416
reporting, and with annual reporting
requirements for CHIP.
5. Coordinating quality measurement
efforts with payment reform strategies,
health information technology and
electronic health record initiatives, and
6. Working with States to identify the
best formats for sharing Medicaid and
CHIP quality measurement data,
including when and how state reports
should be made publicly available.
7. Continuing to work with States and
national stakeholders to develop
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68848
Federal Register / Vol. 74, No. 248 / Tuesday, December 29, 2009 / Notices
national intervention strategies for
improving health care quality and
outcomes for children (for example,
Medicaid Transformation Grants and
the CHIPRA Quality Demonstration
Grants).
8. Continuing development and
implementation of the Federal-State
National Quality Framework in
alignment with CHIPRA initiatives for
improving the quality of care for
children.
9. Due to the concurrent CHIPRA and
American Recovery and Reinvestment
Act (ARRA) HIT implementation
activities, CMS will align the two
programs and strive to create
efficiencies for States and pediatric
providers, where applicable, by
prioritizing consistency in measure
selection for pediatric providers.
II. Categories of the Initial,
Recommended Core Set of Children’s
Healthcare Quality Measures
The basic categories of the initial,
recommended core set of children’s
health care quality measures are set
forth below. For full specifications of
each measure and summaries of the
rationales behind each recommended
measure, see the background paper for
this Federal Register notice at https://
www.ahrq.gov/chip/corebackgrnd.htm.
Measures that have received National
Quality Forum (NQF) endorsement are
indicated with the relevant number.
MEASURES RECOMMENDED FOR INITIAL CORE SET OF CHILDREN’S HEALTHCARE QUALITY FOR VOLUNTARY REPORTING BY
MEDICAID AND CHIP PROGRAMS, MEASURE LABELS BY LEGISLATIVE CATEGORY
Measure number
Legislative measure topic/Subtopic/Current measure label
PREVENTION AND HEALTH PROMOTION
Prenatal/Perinatal
1 ......................................................
2 ......................................................
3 ......................................................
4 ......................................................
Frequency of ongoing prenatal care.
Timeliness of prenatal care—the percentage of deliveries that received a prenatal care visit as a member
of the organization in the first trimester or within 42 days of enrollment in the organization.
Percent of live births weighing less than 2,500 grams.
Cesarean Rate for low-risk first birth women [NQF #0471].
Immunizations
5 ......................................................
6 ......................................................
Childhood immunization status [NQF #0038].
Immunizations for adolescents.
Screening
7 ......................................................
8 ......................................................
9 ......................................................
BMI documentation 2–18 year olds [NQF #0024].
Screening using standardized screening tools for potential delays in social and emotional development—
Assuring Better Child Health and Development (ABCD) initiative measures.
Chlamydia screening for women [NQF #0033].
Well-child Care Visits (WCV)
10 ....................................................
11 ....................................................
12 ....................................................
WCVs in the first 15 months of life.
WCVs in the third, fourth, fifth and sixth years of life.
WCV for 12–21 yrs of age—with PCP or OB–GYN.
Dental
13 ....................................................
Total eligibles receiving preventive dental services (EPSDT measure Line 12B).
MANAGEMENT OF ACUTE CONDITIONS
Upper Respiratory—Appropriate Use of Antibiotics
14 ....................................................
15 ....................................................
Appropriate testing for children with pharyngitis [NQF #0002].
Otitis Media with Effusion—avoidance of inappropriate use of systemic antimicrobials—ages 2–12.
Dental
16 ....................................................
Total EPSDT eligibles who received dental treatment services (EPSDT CMS Form 416, Line 12C).
Emergency Department
17 ....................................................
Emergency Department (ED) Utilization—Average number of ED visits per member per reporting period.
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Inpatient Safety
18 ....................................................
Pediatric catheter-associated blood stream infection rates (PICU and NICU) [NQF #0139].
MANAGEMENT OF CHRONIC CONDITIONS
Asthma
19 ....................................................
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19:02 Dec 28, 2009
Annual number of asthma patients (≥ 1 year old) with ≥ 1 asthma related ER visit (S/AL Medicaid Program).
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Federal Register / Vol. 74, No. 248 / Tuesday, December 29, 2009 / Notices
68849
MEASURES RECOMMENDED FOR INITIAL CORE SET OF CHILDREN’S HEALTHCARE QUALITY FOR VOLUNTARY REPORTING BY
MEDICAID AND CHIP PROGRAMS, MEASURE LABELS BY LEGISLATIVE CATEGORY—Continued
Measure number
Legislative measure topic/Subtopic/Current measure label
ADHD
20 ....................................................
Follow-up care for children prescribed attention-deficit/hyperactivity disorder (ADHD) medication (Continuation and Maintenance Phase) [NQF #108].
Mental Health
21 ....................................................
Follow up after hospitalization for mental illness.
Diabetes
22 ....................................................
Annual hemoglobin A1C testing (all children and adolescents diagnosed with diabetes).
23 ....................................................
CAHPS®
FAMILY EXPERIENCES OF CARE
Health Plan Survey 4.0, Child Version including Medicaid and Children with Chronic Conditions
supplemental items.
AVAILABILITY
24 ....................................................
Children and adolescents’ access to primary care practitioners (PCP), by age and total.
Comments on the measures
themselves are encouraged to:
• Specify which of the measures are
being addressed with each comment.
• Explain views and reasoning
clearly.
In addition, comments are invited on
the AHRQ and CMS plans to enhance
the initial, recommended core measure
set so that they can be collected most
efficiently and accurately across all
Medicaid and CHIP programs,
providers, and enrollees.
We strongly encourage comments to
be as succinct as possible (250 words or
less recommended, with additional
supporting data allowed).
III. Collection of Information
Requirements
This document does not impose
information collection and
recordkeeping requirements.
Consequently, it need not be reviewed
by the Office of Management and
Budget under the authority of the
Paperwork Reduction Act of 1995 (44
U.S.C. 35).
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IV. Regulatory Impact Analysis
As this notice does not meet the
significance criteria of Executive Order
12866, it was not reviewed by the Office
of Management and Budget.
Authority: Section XIX and XXI of the
Social Security Act (42 U.S.C. 13206 through
9a)
(Catalog of Federal Domestic Assistance
Program No. 93.778, Medical Assistance
Program)
VerDate Nov<24>2008
19:02 Dec 28, 2009
Jkt 220001
Dated: December 22, 2009.
Kathleen Sebelius,
Secretary.
[FR Doc. E9–30802 Filed 12–28–09; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
National Institutes of Health
Eunice Kennedy Shriver National
Institute of Child Health & Human
Development; Notice of Closed
Meeting
Pursuant to section 10(d) of the
Federal Advisory Committee Act, as
amended (5 U.S.C. App.), notice is
hereby given of the following meeting.
The meeting will be closed to the
public in accordance with the
provisions set forth in sections
552b(c)(4) and 552b(c)(6), Title 5 U.S.C.,
as amended. The grant applications
and/or contract proposals and the
discussions could disclose confidential
trade secrets or commercial property
such as patentable material, and
personal information concerning
individuals associated with the grant
applications and/or contract proposals,
the disclosure of which would
constitute a clearly unwarranted
invasion of personal privacy.
Name of Committee: National Institute of
Child Health and Human Development
Special Emphasis Panel; Novel Technologies
in Newborn Screening.
Date: January 14, 2010.
Time: 2 a.m. to 3:30 p.m.
Agenda: To review and evaluate concept
review.
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Place: National Institutes of Health, 6100
Executive Boulevard, Room 5B01, Rockville,
MD 20852. (Telephone Conference Call)
Contact Person: Sathasiva B. Kandasamy,
PhD, Scientific Review Officer, Division of
Scientific Review, Eunice Kennedy Shriver
National Institute of Child Health and
Human Development, 6100 Executive
Boulevard, Room 5B01, Bethesda, MD
20892–9304, (301) 435–6680,
skandasa@mail.nih.gov.
(Catalogue of Federal Domestic Assistance
Program Nos. 93.864, Population Research;
93.865, Research for Mothers and Children;
93.929, Center for Medical Rehabilitation
Research; 93.209, Contraception and
Infertility Loan Repayment Program, National
Institutes of Health, HHS)
Dated: December 18, 2009.
Jennifer Spaeth,
Director, Office of Federal Advisory
Committee Policy.
[FR Doc. E9–30680 Filed 12–28–09; 8:45 am]
BILLING CODE 4140–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Administration for Children and
Families
Proposed Adoption of ANA Program
Policies and Procedures
AGENCY: Administration for Native
Americans (ANA), HHS.
ACTION: Notice of Public Comment on
the Proposed Adoption of ANA Program
Policies and Procedures.
SUMMARY: Pursuant to Section 814 of the
Native American Programs Act of 1974
(NAPA), as amended, the
Administration for Native Americans is
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]]>Agencies
[Federal Register Volume 74, Number 248 (Tuesday, December 29, 2009)]
[Notices]
[Pages 68846-68849]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E9-30802]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Office of the Secretary
[CMS-2474-NC]
Medicaid and CHIP Programs; Initial Core Set of Children's
Healthcare Quality Measures for Voluntary Use by Medicaid and CHIP
Programs
AGENCY: Office of the Secretary, HHS.
ACTION: Notice with comment period.
-----------------------------------------------------------------------
SUMMARY: This notice identifies and solicits public comments on the
initial, recommended core set of children's health care quality
measures for voluntary use by State programs administered under titles
XIX and XXI of the Social Security Act, health insurance issuers and
managed care entities that enter into contracts with Medicaid and
Children's Health Insurance Programs, and providers of items and
services under these programs, in accordance with the Children's Health
Insurance Program Reauthorization Act of 2009 (Pub. L. 111-3). This
notice also discusses steps already underway to facilitate the
programs' voluntary use of the children's health care quality measures.
In addition, this notice solicits comments on how the steps might be
enhanced, and recommendations for additional steps to facilitate use of
the measures.
DATES: To be assured consideration, comments must be received at one of
the addresses provided below, no later than 5 p.m. on March 1, 2010.
ADDRESSES: Because of staff and resource limitations, we cannot accept
comments by facsimile (FAX) transmission.
You may submit comments in one of two ways (please choose only one
of the ways listed):
1. Electronic Mail. CHIPRAqualitymeasures@ahrq.hhs.gov.
2. Regular Mail. Agency for Healthcare Research and Quality,
Attention: Office of Extramural Research, Education, and Priority
Populations--Public Comment, CHIPRA Core Measures, 540 Gaither Rd.,
Rockville, MD 20850.
Please note that all submissions may be posted without change to
https://www.AHRQ.gov, including any personal information provided.
FOR FURTHER INFORMATION CONTACT: CHIPRAqualitymeasures@AHRQ.hhs.gov.
SUPPLEMENTARY INFORMATION:
I. Background
On February 4, 2009, the Congress enacted the Children's Health
Insurance Program Reauthorization Act (CHIPRA) of 2009 (Pub. L. 111-3).
Section 401(a) of the legislation amended the Social Security Act (the
Act), to establish section 1139A (42 U.S.C. 1320b-9a). This section
requires the Secretary to identify and publish for general comment an
initial, recommended core set of child health quality measures for use
by State programs administered under titles XIX and XXI of the Act,
health insurance issuers and managed care entities that enter into
contracts with such programs, and providers of items and services under
such programs. The statute requires that the
[[Page 68847]]
Secretary identify and publish these measures by January 1, 2010. The
Secretary delegated this task to the Centers for Medicare & Medicaid
Services (CMS). A ``Memorandum of Understanding'' was signed with the
Agency for Healthcare Research and Quality (AHRQ), by which CMS and
AHRQ would collaborate to make recommendations for the initial core set
of children's health care quality measures to be posted for public
comment. The initial core set is intended to be used voluntarily by
Medicaid and the Children's Health Insurance Program (CHIP).
The initial core set of children's health care quality measures for
voluntary use by Medicaid and CHIP programs was developed in
consultation with organizations representing the stakeholder categories
set out at section 1139A(b)(3) of the Act (including States; health
care providers specializing in pediatric health and dentistry; health
care providers that furnish primary health care to children and
families who live in urban and rural medically underserved communities
or who are members of distinct population sub-groups at heightened risk
for poor health outcomes; national organizations representing children
and families; individuals and organizations with health care quality
measurement expertise; and other organizations involved in the
advancement of evidence-based measures of health care).
Measures for consideration for the initial core set were compiled
from ``existing quality of care measures for children that are 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'' as required by
section 1139A(a)(2) of the Act.
The statute requires that the initial core set of child health
quality measures include the following:
1. The duration of children's health insurance coverage over a 12-
month time period.
2. The availability and effectiveness of a full range of preventive
services, treatments, and services for acute conditions, including
services to promote healthy birth, prevent and treat premature birth,
and detect the presence or risk of physical or mental conditions that
could adversely affect growth and development; and treatments to
correct or ameliorate the effects of physical and mental conditions,
including chronic conditions in infants, young children, school-age
children, and adolescents.
3. The availability of care in a range of ambulatory and inpatient
health care settings in which such care is furnished.
4. The types of measures that, taken together, can be used to
estimate the overall national quality of health care for children,
including children with special needs, and to perform comparative
analyses of pediatric health care quality and racial, ethnic, and
socioeconomic disparities in child health and health care for children.
To help facilitate an evidence-informed and transparent process for
making recommendations, AHRQ's National Advisory Council on Healthcare
Research and Quality created a Subcommittee on Children's Healthcare
Quality Measures for Medicaid and CHIP programs (the ``Subcommittee'').
The Subcommittee held public meetings, and considered public comments
and measure nominations throughout their deliberations. Subcommittee
members were provided with standard definitions, criteria, and
objective information to facilitate scoring of measures for validity,
feasibility, and importance over several iterations of measure
consideration. The Subcommittee's recommendations were reported to the
Chair of AHRQ's National Advisory Council on Healthcare Research and
Quality and subsequently considered further by Medicaid and CHIP
officials, as well as staff in the Office of the Secretary of the
Department of Health and Human Services (HHS) prior to this public
posting. Extensive details regarding the process, the measures
recommended, and other considerations regarding the initial core set
can be found at https://www.ahrq.gov/chip/corebackgrnd.htm. We are now
soliciting additional comments from the public to help determine which
measures should remain in the core set, which measures may need further
development to enhance their validity and feasibility, and the nature
of technical assistance and other resources required before State
Medicaid and CHIP programs and health care providers can be expected to
implement and report on these measures. In submitting comments, it is
important to consider the kinds of activities already under way at HHS
to facilitate making the measures more feasible and valid for use by
the States for reporting across all Medicaid and CHIP programs (for
example, managed care, fee-for-service and enrollees).
HHS will be making improvements and enhancements to the core set of
measures as a result of the following:
Public comment on the initial, recommended core measure
set.
Products developed by a pediatric quality measures program
of grants and contracts to begin in 2010 (section 1139A(b) of the Act).
Products stimulated by CMS's CHIPRA Quality Demonstration
Grants, including evaluation and experimentation with the measures and
development of an electronic health record format for children's health
care (section 1139A(d) of the Act).
Other advancements and improvements to children's health
care quality measures (such as annual quality reporting as required
under section 1139A(a)(4) of the Act).
Section 1139A(b)(5) of the Act directs that an improved, evidence-
based core measure set is to be available by January 1, 2013, to be
feasible for use by a broad range of providers, payers, and programs,
both public and private (42 U.S.C. 1320b-9a).
To further these efforts, AHRQ and CMS are currently working to
continue or implement the following initiatives:
1. Establishing methodologies to create measure specifications that
are applicable to all Medicaid and CHIP enrollees, and suitable for
identifying disparities in quality by race, ethnicity, socioeconomic
status, and special health care needs status, as required by CHIPRA.
2. Providing technical assistance to States to facilitate
implementation of the initial, recommended core measure set.
3. Using a public process for the pediatric quality measures grants
and contracts program to build on priorities identified during the 2009
identification of the initial, recommended core set. Priority topics
already identified include quality measures for: mental health and
substance abuse services for children, other specialty services,
inpatient care, duration of enrollment and coverage, medical home and
other integrated health care delivery mechanisms, and availability of
services.
4. Considering ways to align State reporting requirements across
CHIPRA provisions, with Early and Periodic Screening, Diagnostic and
Treatment Services (EPSDT) via CMS 416 reporting, and with annual
reporting requirements for CHIP.
5. Coordinating quality measurement efforts with payment reform
strategies, health information technology and electronic health record
initiatives, and
6. Working with States to identify the best formats for sharing
Medicaid and CHIP quality measurement data, including when and how
state reports should be made publicly available.
7. Continuing to work with States and national stakeholders to
develop
[[Page 68848]]
national intervention strategies for improving health care quality and
outcomes for children (for example, Medicaid Transformation Grants and
the CHIPRA Quality Demonstration Grants).
8. Continuing development and implementation of the Federal-State
National Quality Framework in alignment with CHIPRA initiatives for
improving the quality of care for children.
9. Due to the concurrent CHIPRA and American Recovery and
Reinvestment Act (ARRA) HIT implementation activities, CMS will align
the two programs and strive to create efficiencies for States and
pediatric providers, where applicable, by prioritizing consistency in
measure selection for pediatric providers.
II. Categories of the Initial, Recommended Core Set of Children's
Healthcare Quality Measures
The basic categories of the initial, recommended core set of
children's health care quality measures are set forth below. For full
specifications of each measure and summaries of the rationales behind
each recommended measure, see the background paper for this Federal
Register notice at https://www.ahrq.gov/chip/corebackgrnd.htm. Measures
that have received National Quality Forum (NQF) endorsement are
indicated with the relevant number.
Measures Recommended for Initial Core Set of Children's Healthcare
Quality for Voluntary Reporting by Medicaid and CHIP Programs, Measure
Labels by Legislative Category
------------------------------------------------------------------------
Legislative measure topic/Subtopic/
Measure number Current measure label
------------------------------------------------------------------------
PREVENTION AND HEALTH PROMOTION
Prenatal/Perinatal
------------------------------------------------------------------------
1................................. Frequency of ongoing prenatal care.
2................................. Timeliness of prenatal care--the
percentage of deliveries that
received a prenatal care visit as a
member of the organization in the
first trimester or within 42 days
of enrollment in the organization.
3................................. Percent of live births weighing less
than 2,500 grams.
4................................. Cesarean Rate for low-risk first
birth women [NQF 0471].
------------------------------------------------------------------------
Immunizations
------------------------------------------------------------------------
5................................. Childhood immunization status [NQF
0038].
6................................. Immunizations for adolescents.
------------------------------------------------------------------------
Screening
------------------------------------------------------------------------
7................................. BMI documentation 2-18 year olds
[NQF 0024].
8................................. Screening using standardized
screening tools for potential
delays in social and emotional
development--Assuring Better Child
Health and Development (ABCD)
initiative measures.
9................................. Chlamydia screening for women [NQF
0033].
------------------------------------------------------------------------
Well-child Care Visits (WCV)
------------------------------------------------------------------------
10................................ WCVs in the first 15 months of life.
11................................ WCVs in the third, fourth, fifth and
sixth years of life.
12................................ WCV for 12-21 yrs of age--with PCP
or OB-GYN.
------------------------------------------------------------------------
Dental
------------------------------------------------------------------------
13................................ Total eligibles receiving preventive
dental services (EPSDT measure Line
12B).
------------------------------------------------------------------------
MANAGEMENT OF ACUTE CONDITIONS
Upper Respiratory--Appropriate Use of Antibiotics
------------------------------------------------------------------------
14................................ Appropriate testing for children
with pharyngitis [NQF 0002].
15................................ Otitis Media with Effusion--
avoidance of inappropriate use of
systemic antimicrobials--ages 2-12.
------------------------------------------------------------------------
Dental
------------------------------------------------------------------------
16................................ Total EPSDT eligibles who received
dental treatment services (EPSDT
CMS Form 416, Line 12C).
------------------------------------------------------------------------
Emergency Department
------------------------------------------------------------------------
17................................ Emergency Department (ED)
Utilization--Average number of ED
visits per member per reporting
period.
------------------------------------------------------------------------
Inpatient Safety
------------------------------------------------------------------------
18................................ Pediatric catheter-associated blood
stream infection rates (PICU and
NICU) [NQF 0139].
------------------------------------------------------------------------
MANAGEMENT OF CHRONIC CONDITIONS
Asthma
------------------------------------------------------------------------
19................................ Annual number of asthma patients (>=
1 year old) with >= 1 asthma
related ER visit (S/AL Medicaid
Program).
------------------------------------------------------------------------
[[Page 68849]]
ADHD
------------------------------------------------------------------------
20................................ Follow-up care for children
prescribed attention-deficit/
hyperactivity disorder (ADHD)
medication (Continuation and
Maintenance Phase) [NQF 108].
------------------------------------------------------------------------
Mental Health
------------------------------------------------------------------------
21................................ Follow up after hospitalization for
mental illness.
------------------------------------------------------------------------
Diabetes
------------------------------------------------------------------------
22................................ Annual hemoglobin A1C testing (all
children and adolescents diagnosed
with diabetes).
------------------------------------------------------------------------
FAMILY EXPERIENCES OF CARE
------------------------------------------------------------------------
23................................ CAHPS[supreg] Health Plan Survey
4.0, Child Version including
Medicaid and Children with Chronic
Conditions supplemental items.
------------------------------------------------------------------------
AVAILABILITY
------------------------------------------------------------------------
24................................ Children and adolescents' access to
primary care practitioners (PCP),
by age and total.
------------------------------------------------------------------------
Comments on the measures themselves are encouraged to:
Specify which of the measures are being addressed with
each comment.
Explain views and reasoning clearly.
In addition, comments are invited on the AHRQ and CMS plans to
enhance the initial, recommended core measure set so that they can be
collected most efficiently and accurately across all Medicaid and CHIP
programs, providers, and enrollees.
We strongly encourage comments to be as succinct as possible (250
words or less recommended, with additional supporting data allowed).
III. Collection of Information Requirements
This document does not impose information collection and
recordkeeping requirements. Consequently, it need not be reviewed by
the Office of Management and Budget under the authority of the
Paperwork Reduction Act of 1995 (44 U.S.C. 35).
IV. Regulatory Impact Analysis
As this notice does not meet the significance criteria of Executive
Order 12866, it was not reviewed by the Office of Management and
Budget.
Authority: Section XIX and XXI of the Social Security Act (42
U.S.C. 13206 through 9a)
(Catalog of Federal Domestic Assistance Program No. 93.778, Medical
Assistance Program)
Dated: December 22, 2009.
Kathleen Sebelius,
Secretary.
[FR Doc. E9-30802 Filed 12-28-09; 8:45 am]
BILLING CODE 4120-01-P
