Medicaid Program: Initial Core Set of Health Quality Measures for Medicaid-Eligible Adults, 82397-82399 [2010-32978]
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Federal Register / Vol. 75, No. 250 / Thursday, December 30, 2010 / Notices
I. Background
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Jean H. Ellen,
Chief Docket Clerk.
[FR Doc. 2010–33038 Filed 12–28–10; 11:15 am]
BILLING CODE 6735–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Office of the Secretary
[CMS–2420–NC]
Medicaid Program: Initial Core Set of
Health Quality Measures for MedicaidEligible Adults
Office of the Secretary, HHS.
Notice with comment period.
AGENCY:
ACTION:
This notice identifies an
initial core set of health quality
measures recommended for Medicaideligible 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 (the Act), health
insurance issuers and managed care
entities that enter into contracts with
Medicaid, and providers of items and
services under these programs. This
notice also solicits comments on these
initial measures, on facilitating the use
of these measures by States and on
identifying priority areas for measure
enhancement and development.
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, 2011.
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.
medicaidadultmeasures@ahrq.hhs.gov.
2. Regular Mail. Agency for
Healthcare Research and Quality,
Attention: Nancy Wilson, Immediate
Office of the Director, Room 3028, 540
Gaither Road, Rockville, MD 20850.
FOR FURTHER INFORMATION CONTACT:
Nancy Wilson, M.D., M.P.H.,
Coordinator of the Advisory Council
Subcommittee, at the Agency for
Healthcare Research and Quality, 540
Gaither Road, Rockville, MD 20850,
(301) 427–1310. For press-related
information, please contact Karen
Migdail at (301) 427–1855.
SUPPLEMENTARY INFORMATION:
jlentini on DSKJ8SOYB1PROD with NOTICES
SUMMARY:
VerDate Mar<15>2010
16:35 Dec 29, 2010
Jkt 223001
On March 23, 2010, President Obama
signed into law the Patient Protection
and Affordable Care Act (Affordable
Care Act) (Pub. L. 111–148). Section
2701 of the Affordable Care Act added
new section 1139B to the Social
Security Act (the Act); section 1139B(a)
of the Act now mandates that the
Secretary of Health and Human Services
(HHS) identify and publish for public
comment a recommended initial core
set of health quality measures for
Medicaid eligible adults. Section
1139B(b) of the Act, as added by section
2701 of the Affordable Care Act,
requires that a recommended initial core
set be published for public comment by
January 1, 2011, and that an initial core
set be published by January 1, 2012.
In addition, the Affordable Care Act
mandates that HHS should complete the
following actions
—By January 1, 2012:
• Establish a Medicaid Quality
Measurement Program to fund
development, testing, and validation of
emerging and innovative evidencebased measures.
—By January 1, 2013:
• Develop a standardized reporting
format on the core set 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.
—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.
Additionally, the statute requires the
initial core set recommendation to
consist of existing adult health quality
measures that are in use under public
and privately sponsored health care
coverage arrangements or 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.
II. Method for Determining Proposed
Initial Core Set of Adult Health Quality
Measures
The Affordable Care Act parallels the
requirement under title IV of the
Children’s Health Insurance Program
Reauthorization Act (Pub. L. 111–3) to
identify and publish a recommended
initial core set of quality measures for
children in Medicaid and the Children’s
PO 00000
Frm 00026
Fmt 4703
Sfmt 4703
82397
Health Insurance Program. A similar
process was used to identify the
proposed initial core set of adult health
quality measures. To facilitate an
evidence-based and transparent process
for making recommendations, the
National Advisory Council of the
Agency for Healthcare Research and
Quality (AHRQ) created a subcommittee
(the Subcommittee) for identifying
quality measures for Medicaid-eligible
adults. The Subcommittee consisted of
State Medicaid representatives, health
care quality experts, and representatives
of health professional organizations and
associations. The Subcommittee held a
public meeting October 18th and 19th
and considered public comments. The
Subcommittee’s advice was reported to
the Chair of AHRQ’s National Advisory
Council and considered further by the
Centers for Medicare & Medicaid
Services (CMS) and staff in the Office of
the Secretary of HHS prior to this public
posting.
The initial core set was developed by
reviewing measures from nationally
recognized sources, including measures
currently 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 of AHRQ’s National
Advisory Council.
In prioritizing measures, the
Subcommittee considered the needs of
adults (ages 18 and older) enrolled in
Medicaid. To help guide the discussion
of priority health needs within the adult
populations covered by Medicaid, the
Subcommittee was divided into four
workgroups—Maternal/Reproductive
Health, Overall Adult Health, Complex
Health Care Needs, and Mental Health
and Substance Use. The workgroups
considered potential measurement
opportunities across the Institute of
Medicine’s (IOM) eight domains of
quality: Safe, timely, effective, efficient,
access, patient and family centeredness,
care coordination, and infrastructure
capabilities for health care. The
Subcommittee also considered how
health care equity and value (also from
the IOM) could be reflected in the initial
measurement set. Ultimately, the
Subcommittee used the following three
criteria in voting on the recommended
measures for the core set:
• The scientific acceptability of
measure properties.
• Feasibility of use by Medicaid.
• Importance to Medicaid programs.
The Subcommittee also considered
whether the measures were currently
used in other Medicaid quality
E:\FR\FM\30DEN1.SGM
30DEN1
82398
Federal Register / Vol. 75, No. 250 / Thursday, December 30, 2010 / Notices
measurement efforts (for example, three
maternity care measures included in the
initial core set of children’s quality
measures, and measures designated for
inclusion in the Medicare and Medicaid
Electronic Health Record Incentive
Payment Programs). The Subcommittee
identified many measures that were
cross-cutting and relevant to the entire
adult Medicaid population. In the end,
the Subcommittee identified a set of 51
measures to recommend as the initial
core set of adult quality measures.
We are now soliciting public
comments on the recommended initial
core set of adult quality measures.
Specifically, we seek comment on
whether any measures should be added
or deleted from the initial core set, the
reporting burden, which measures may
need further development, and the types
of technical assistance and other
resources States may need to implement
these measures. We also are interested
in feedback on how many measures are
feasible and realistic for a State to
collect and use in its monitoring of
quality of care. We are trying to strike
a balance between the need for State
data to monitor and improve quality and
an interest in minimizing the reporting
burden on States and providers by
aligning with other quality reporting
and incentive initiatives.
HHS will be making improvements
and enhancements to the core set as a
result of public comments on the initial
recommended core measure set. To
further these efforts, AHRQ and CMS
are working to identify ways to align
State reporting requirements with other
HHS quality reporting initiatives and
requirements; coordinate quality
NQF
ID†
Number
measurement efforts with payment
reform strategies, health information
technology, and electronic health record
initiatives; and identify priority areas
for the development of new measures.
States will also receive technical
assistance to facilitate implementation
of the measures. The initial core set of
adult quality measures, as required by
the Affordable Care Act, will serve as
the groundwork for creating a
standardized approach to better
understand the quality of care adults in
Medicaid receive, improve how this
care is measured, and create
opportunities to impact health
outcomes.
III. The Draft Initial Core Set of Health
Quality Measures for Medicaid-Eligible
Adults
The list of measures in the
accompanying table of measures was
developed on the basis of advice from
the Subcommittee. For additional
information, see the background paper
at https://ahrq.hhs.gov/.
Respondents commenting on the
measurement set are encouraged to:
• Specify which of the measures are
being addressed.
• Explain the reasoning behind their
comment.
In addition, we invite comments on
ways to enhance the initial core set of
measures so they can be implemented
efficiently and accurately across all
Medicaid programs, providers, and
enrollees.
IV. Collection of Information
Requirements
This document does not impose
information collection and record-
Measure owner
keeping 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. Chapter 35).
V. Regulatory Impact Statement
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 17, 2010.
Donald M. Berwick,
Administrator, Centers for Medicare &
Medicaid Services.
Approved: December 20, 2010.
Kathleen Sebelius,
Secretary, Health and Human Services.
Measures Recommended for Initial
Core Set of Health Quality Measures for
Medicaid-Eligible Adults
This table of the recommended initial
core measure set includes National
Quality Forum (NQF) identifying
numbers for measures that have been
endorsed, provides the measure owners,
and indicates those measures that have
been designated for inclusion in the
Medicare & Medicaid Electronic Health
Record Incentive Payment 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).
Measure name
EHR ‡
Prevention & Health Promotion
jlentini on DSKJ8SOYB1PROD with NOTICES
1 ...........
0039 ....
NCQA ................................................
2 ...........
3 ...........
4 ...........
5 ...........
6 ...........
7 ...........
8 ...........
9 ...........
10 .........
11 .........
12 .........
13 .........
14 .........
15 .........
16 .........
17 .........
18 .........
19 .........
20 .........
0421 ....
0031 ....
0032 ....
NA .......
0027 ....
0418 ....
NA .......
0272 ....
0273 ....
0274 ....
0275 ....
0276 ....
0277 ....
0280 ....
0279 ....
0281 ....
0282 ....
0638 ....
0283 ....
CMS ...................................................
NCQA ................................................
NCQA ................................................
RAND .................................................
NCQA ................................................
CMS ...................................................
NCQA ................................................
AHRQ ................................................
AHRQ ................................................
AHRQ ................................................
AHRQ ................................................
AHRQ ................................................
AHRQ ................................................
AHRQ ................................................
AHRQ ................................................
AHRQ ................................................
AHRQ ................................................
AHRQ ................................................
AHRQ ................................................
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Flu Shots for Adults Ages 50–64 (Collected as part of HEDIS CAHPS
Supplemental Survey).
Adult Weight Screening and Follow up .........................................................
Breast Cancer Screening ..............................................................................
Cervical Cancer Screening ............................................................................
Alcohol Misuse: Screening, Brief Intervention, Referral for Treatment .........
Medical Assistance With Smoking and Tobacco Use Cessation .................
Screening for Clinical Depression and Followup Plan ..................................
Plan All-Cause Readmission.
PQI 01: Diabetes, short-term complications ..................................................
PQI 02: Perforated appendicitis.
PQI 03: Diabetes, long-term complications ...................................................
PQI 05: Chronic obstructive pulmonary disease ...........................................
PQI 07: Hypertension.
PQI 08: Congestive heart failure. ..................................................................
PQI 10: Dehydration ......................................................................................
PQI 11: Bacterial pneumonia ........................................................................
PQI 12: Urinary Tract Infection Admission Rate ...........................................
PQI 13: Angina without procedure.
PQI 14: Uncontrolled Diabetes Admission Rate ...........................................
PQI 15: Adult asthma.
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X
X
X
X
Federal Register / Vol. 75, No. 250 / Thursday, December 30, 2010 / Notices
Number
NQF
ID†
Measure owner
Measure name
21 .........
0285 ....
AHRQ ................................................
82399
PQI 16: Lower extremity amputations among patients with diabetes ...........
EHR ‡
Management of Acute Conditions
22
23
24
25
.........
.........
.........
.........
0052
0640
0576
0476
....
....
....
....
26 .........
27 .........
0469 ....
0648 ....
NCQA ................................................
TJC ....................................................
NCQA ................................................
Providence St. Vincent Medical Center.
Hospital Corporation of America .......
AMA–PCPI .........................................
28 .........
0647 ....
AMA–PCPI .........................................
Use of Imaging Studies for Low Back Pain ..................................................
HBIPS—2 Hours of physical restraint use.
Followup After Hospitalization for Mental Illness ..........................................
Appropriate Use of Antenatal Steroids.
X
Elective delivery prior to 39 completed weeks gestation ..............................
Timely Transmission of Transition Record (Inpatient Discharges to Home/
Self-Care or Any Other Site of Care).
Transition Record With Specified Elements Received by Discharged Patients (Inpatient Discharges to Home/Self-Care or Any Other Site of
Care).
Management of Chronic Conditions
29 .........
30 .........
31 .........
0071 ....
0018 ....
0074 ....
NCQA ................................................
NCQA ................................................
AMA–PCPI .........................................
32 .........
0075 ....
NCQA ................................................
33
34
35
36
37
38
.........
.........
.........
.........
.........
.........
0063 ....
0057 ....
0036 ....
0403 ....
0105 ....
NA .......
NCQA ................................................
NCQA ................................................
NCQA ................................................
NCQA ................................................
NCQA ................................................
RAND .................................................
39 .........
NA .......
RAND .................................................
40 .........
NA .......
RAND .................................................
41 .........
NA .......
RAND .................................................
42 .........
NA .......
RAND .................................................
43 .........
44 .........
0021 ....
0541 ....
NCQA ................................................
PQA ...................................................
Persistence of Beta-Blocker Treatment After a Heart Attack .......................
Controlling High Blood Pressure ...................................................................
Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL Cholesterol.
Comprehensive Ischemic Vascular Disease Care: Complete Lipid Profile
and LDL–C Control Rates.
Diabetes: Lipid profile.
Comprehensive Diabetes Care: Hemoglobin A1c testing .............................
Use of Appropriate Medications for People With Asthma .............................
HIV/AIDS: Medical visit.
Antidepressant Medication Management ......................................................
Bipolar I Disorder 2: Annual assessment of weight or BMI, glycemic control, and lipids.
Bipolar I Disorder C: Proportion of patients with bipolar I disorder treated
with mood stabilizer medications during the course of bipolar I disorder
treatment.
Schizophrenia 2: Annual assessment of weight/BMI, glycemic control,
lipids.
Schizophrenia B: Proportion of schizophrenia patients with long-term utilization of antipsychotic medications.
Schizophrenia C: Proportion of selected schizophrenia patients with
antipsychotic polypharmacy utilization.
Annual Monitoring for Patients on Persistent Medications ...........................
Proportion of Days Covered (PDC): 5 Rates by Therapeutic Category .......
X
X
X
X
X
Family Experiences of Care
45 .........
46 .........
0006 ....
0007 ....
AHRQ ................................................
NCQA ................................................
CAHPS Health Plan Survey v 4.0—Adult Questionnaire ..............................
CAHPS Health Plan Survey v 4.0H—NCQA Supplemental items for
CAHPS 4.0 Adult Questionnaire.
Availability
47 .........
48 .........
49 .........
NA .......
NA .......
0004 ....
NCQA ................................................
NCQA ................................................
NCQA ................................................
50 .........
51 .........
NA .......
NA .......
NCQA ................................................
NCQA ................................................
Ambulatory Care: Outpatient and Emergency Department Visits .................
Inpatient Utilization: General Hospital/Acute Care ........................................
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment.
Mental Health Utilization.
Prenatal and Postpartum Care: Postpartum Care Rate ...............................
† NQF
X
ID National Quality Forum identification numbers are used for measures that are NQF-endorsed; otherwise, NA is used.
Measures with an ‘‘X’’ are included in the Medicare and Medicaid Electronic Health Record Incentive Payment Program and may be collected through electronic health records. Specifications for these measures are available from the Centers for Medicare & Medicaid Services
Web site at: https://www.cms.gov/QualityMeasures/03_ElectronicSpecifications.asp#TopOfPage.
jlentini on DSKJ8SOYB1PROD with NOTICES
‡ EHR
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]]>Agencies
[Federal Register Volume 75, Number 250 (Thursday, December 30, 2010)]
[Notices]
[Pages 82397-82399]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2010-32978]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Office of the Secretary
[CMS-2420-NC]
Medicaid Program: Initial Core Set of Health Quality Measures for
Medicaid-Eligible Adults
AGENCY: Office of the Secretary, HHS.
ACTION: Notice with comment period.
-----------------------------------------------------------------------
SUMMARY: This notice identifies an initial core set of health quality
measures recommended 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 (the
Act), health insurance issuers and managed care entities that enter
into contracts with Medicaid, and providers of items and services under
these programs. This notice also solicits comments on these initial
measures, on facilitating the use of these measures by States and on
identifying priority areas for measure enhancement and development.
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, 2011.
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. medicaidadultmeasures@ahrq.hhs.gov.
2. Regular Mail. Agency for Healthcare Research and Quality,
Attention: Nancy Wilson, Immediate Office of the Director, Room 3028,
540 Gaither Road, Rockville, MD 20850.
FOR FURTHER INFORMATION CONTACT: Nancy Wilson, M.D., M.P.H.,
Coordinator of the Advisory Council Subcommittee, at the Agency for
Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850,
(301) 427-1310. For press-related information, please contact Karen
Migdail at (301) 427-1855.
SUPPLEMENTARY INFORMATION:
I. Background
On March 23, 2010, President Obama signed into law the Patient
Protection and Affordable Care Act (Affordable Care Act) (Pub. L. 111-
148). Section 2701 of the Affordable Care Act added new section 1139B
to the Social Security Act (the Act); section 1139B(a) of the Act now
mandates that the Secretary of Health and Human Services (HHS) identify
and publish for public comment a recommended initial core set of health
quality measures for Medicaid eligible adults. Section 1139B(b) of the
Act, as added by section 2701 of the Affordable Care Act, requires that
a recommended initial core set be published for public comment by
January 1, 2011, and that an initial core set be published by January
1, 2012.
In addition, the Affordable Care Act mandates that HHS should
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 on the core set
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.
--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.
Additionally, the statute requires the initial core set
recommendation to consist of existing adult health quality measures
that are in use under public and privately sponsored health care
coverage arrangements or 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.
II. Method for Determining Proposed Initial Core Set of Adult Health
Quality Measures
The Affordable Care Act parallels the requirement under title IV of
the Children's Health Insurance Program Reauthorization Act (Pub. L.
111-3) to identify and publish a recommended initial core set of
quality measures for children in Medicaid and the Children's Health
Insurance Program. A similar process was used to identify the proposed
initial core set of adult health quality measures. To facilitate an
evidence-based and transparent process for making recommendations, the
National Advisory Council of the Agency for Healthcare Research and
Quality (AHRQ) created a subcommittee (the Subcommittee) for
identifying quality measures for Medicaid-eligible adults. The
Subcommittee consisted of State Medicaid representatives, health care
quality experts, and representatives of health professional
organizations and associations. The Subcommittee held a public meeting
October 18th and 19th and considered public comments. The
Subcommittee's advice was reported to the Chair of AHRQ's National
Advisory Council and considered further by the Centers for Medicare &
Medicaid Services (CMS) and staff in the Office of the Secretary of HHS
prior to this public posting.
The initial core set was developed by reviewing measures from
nationally recognized sources, including measures currently 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 of AHRQ's
National Advisory Council.
In prioritizing measures, the Subcommittee considered the needs of
adults (ages 18 and older) enrolled in Medicaid. To help guide the
discussion of priority health needs within the adult populations
covered by Medicaid, the Subcommittee was divided into four
workgroups--Maternal/Reproductive Health, Overall Adult Health, Complex
Health Care Needs, and Mental Health and Substance Use. The workgroups
considered potential measurement opportunities across the Institute of
Medicine's (IOM) eight domains of quality: Safe, timely, effective,
efficient, access, patient and family centeredness, care coordination,
and infrastructure capabilities for health care. The Subcommittee also
considered how health care equity and value (also from the IOM) could
be reflected in the initial measurement set. Ultimately, the
Subcommittee used the following three criteria in voting on the
recommended measures for the core set:
The scientific acceptability of measure properties.
Feasibility of use by Medicaid.
Importance to Medicaid programs.
The Subcommittee also considered whether the measures were currently
used in other Medicaid quality
[[Page 82398]]
measurement efforts (for example, three maternity care measures
included in the initial core set of children's quality measures, and
measures designated for inclusion in the Medicare and Medicaid
Electronic Health Record Incentive Payment Programs). The Subcommittee
identified many measures that were cross-cutting and relevant to the
entire adult Medicaid population. In the end, the Subcommittee
identified a set of 51 measures to recommend as the initial core set of
adult quality measures.
We are now soliciting public comments on the recommended initial
core set of adult quality measures. Specifically, we seek comment on
whether any measures should be added or deleted from the initial core
set, the reporting burden, which measures may need further development,
and the types of technical assistance and other resources States may
need to implement these measures. We also are interested in feedback on
how many measures are feasible and realistic for a State to collect and
use in its monitoring of quality of care. We are trying to strike a
balance between the need for State data to monitor and improve quality
and an interest in minimizing the reporting burden on States and
providers by aligning with other quality reporting and incentive
initiatives.
HHS will be making improvements and enhancements to the core set as
a result of public comments on the initial recommended core measure
set. To further these efforts, AHRQ and CMS are working to identify
ways to align State reporting requirements with other HHS quality
reporting initiatives and requirements; coordinate quality measurement
efforts with payment reform strategies, health information technology,
and electronic health record initiatives; and identify priority areas
for the development of new measures. States will also receive technical
assistance to facilitate implementation of the measures. The initial
core set of adult quality measures, as required by the Affordable Care
Act, will serve as the groundwork for creating a standardized approach
to better understand the quality of care adults in Medicaid receive,
improve how this care is measured, and create opportunities to impact
health outcomes.
III. The Draft Initial Core Set of Health Quality Measures for
Medicaid-Eligible Adults
The list of measures in the accompanying table of measures was
developed on the basis of advice from the Subcommittee. For additional
information, see the background paper at https://ahrq.hhs.gov/.
Respondents commenting on the measurement set are encouraged to:
Specify which of the measures are being addressed.
Explain the reasoning behind their comment.
In addition, we invite comments on ways to enhance the initial core
set of measures so they can be implemented efficiently and accurately
across all Medicaid programs, providers, and enrollees.
IV. Collection of Information Requirements
This document does not impose information collection and record-
keeping 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. Chapter 35).
V. Regulatory Impact Statement
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 17, 2010.
Donald M. Berwick,
Administrator, Centers for Medicare & Medicaid Services.
Approved: December 20, 2010.
Kathleen Sebelius,
Secretary, Health and Human Services.
Measures Recommended for Initial Core Set of Health Quality Measures
for Medicaid-Eligible Adults
This table of the recommended initial core measure set includes
National Quality Forum (NQF) identifying numbers for measures that have
been endorsed, provides the measure owners, and indicates those
measures that have been designated for inclusion in the Medicare &
Medicaid Electronic Health Record Incentive Payment 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).
------------------------------------------------------------------------
NQF EHR
Number ID[dagger] Measure owner Measure name [Dagger]
------------------------------------------------------------------------
Prevention & Health Promotion
------------------------------------------------------------------------
1.......... 0039...... NCQA........... Flu Shots for Adults ........
Ages 50-64
(Collected as part
of HEDIS CAHPS
Supplemental
Survey).
2.......... 0421...... CMS............ Adult Weight X
Screening and
Follow up.
3.......... 0031...... NCQA........... Breast Cancer X
Screening.
4.......... 0032...... NCQA........... Cervical Cancer X
Screening.
5.......... NA........ RAND........... Alcohol Misuse: ........
Screening, Brief
Intervention,
Referral for
Treatment.
6.......... 0027...... NCQA........... Medical Assistance X
With Smoking and
Tobacco Use
Cessation.
7.......... 0418...... CMS............ Screening for ........
Clinical Depression
and Followup Plan.
8.......... NA........ NCQA........... Plan All-Cause ........
Readmission.
9.......... 0272...... AHRQ........... PQI 01: Diabetes, ........
short-term
complications.
10......... 0273...... AHRQ........... PQI 02: Perforated ........
appendicitis.
11......... 0274...... AHRQ........... PQI 03: Diabetes, ........
long-term
complications.
12......... 0275...... AHRQ........... PQI 05: Chronic ........
obstructive
pulmonary disease.
13......... 0276...... AHRQ........... PQI 07: ........
Hypertension.
14......... 0277...... AHRQ........... PQI 08: Congestive ........
heart failure..
15......... 0280...... AHRQ........... PQI 10: Dehydration. ........
16......... 0279...... AHRQ........... PQI 11: Bacterial ........
pneumonia.
17......... 0281...... AHRQ........... PQI 12: Urinary ........
Tract Infection
Admission Rate.
18......... 0282...... AHRQ........... PQI 13: Angina ........
without procedure.
19......... 0638...... AHRQ........... PQI 14: Uncontrolled ........
Diabetes Admission
Rate.
20......... 0283...... AHRQ........... PQI 15: Adult ........
asthma.
[[Page 82399]]
21......... 0285...... AHRQ........... PQI 16: Lower ........
extremity
amputations among
patients with
diabetes.
------------------------------------------------------------------------
Management of Acute Conditions
------------------------------------------------------------------------
22......... 0052...... NCQA........... Use of Imaging X
Studies for Low
Back Pain.
23......... 0640...... TJC............ HBIPS--2 Hours of ........
physical restraint
use.
24......... 0576...... NCQA........... Followup After ........
Hospitalization for
Mental Illness.
25......... 0476...... Providence St. Appropriate Use of ........
Vincent Antenatal Steroids.
Medical Center.
26......... 0469...... Hospital Elective delivery ........
Corporation of prior to 39
America. completed weeks
gestation.
27......... 0648...... AMA-PCPI....... Timely Transmission ........
of Transition
Record (Inpatient
Discharges to Home/
Self-Care or Any
Other Site of Care).
28......... 0647...... AMA-PCPI....... Transition Record ........
With Specified
Elements Received
by Discharged
Patients (Inpatient
Discharges to Home/
Self-Care or Any
Other Site of Care).
------------------------------------------------------------------------
Management of Chronic Conditions
------------------------------------------------------------------------
29......... 0071...... NCQA........... Persistence of Beta- ........
Blocker Treatment
After a Heart
Attack.
30......... 0018...... NCQA........... Controlling High X
Blood Pressure.
31......... 0074...... AMA-PCPI....... Coronary Artery X
Disease (CAD): Drug
Therapy for
Lowering LDL
Cholesterol.
32......... 0075...... NCQA........... Comprehensive X
Ischemic Vascular
Disease Care:
Complete Lipid
Profile and LDL-C
Control Rates.
33......... 0063...... NCQA........... Diabetes: Lipid ........
profile.
34......... 0057...... NCQA........... Comprehensive ........
Diabetes Care:
Hemoglobin A1c
testing.
35......... 0036...... NCQA........... Use of Appropriate X
Medications for
People With Asthma.
36......... 0403...... NCQA........... HIV/AIDS: Medical ........
visit.
37......... 0105...... NCQA........... Antidepressant X
Medication
Management.
38......... NA........ RAND........... Bipolar I Disorder ........
2: Annual
assessment of
weight or BMI,
glycemic control,
and lipids.
39......... NA........ RAND........... Bipolar I Disorder ........
C: Proportion of
patients with
bipolar I disorder
treated with mood
stabilizer
medications during
the course of
bipolar I disorder
treatment.
40......... NA........ RAND........... Schizophrenia 2: ........
Annual assessment
of weight/BMI,
glycemic control,
lipids.
41......... NA........ RAND........... Schizophrenia B: ........
Proportion of
schizophrenia
patients with long-
term utilization of
antipsychotic
medications.
42......... NA........ RAND........... Schizophrenia C: ........
Proportion of
selected
schizophrenia
patients with
antipsychotic
polypharmacy
utilization.
43......... 0021...... NCQA........... Annual Monitoring ........
for Patients on
Persistent
Medications.
44......... 0541...... PQA............ Proportion of Days ........
Covered (PDC): 5
Rates by
Therapeutic
Category.
------------------------------------------------------------------------
Family Experiences of Care
------------------------------------------------------------------------
45......... 0006...... AHRQ........... CAHPS Health Plan ........
Survey v 4.0--Adult
Questionnaire.
46......... 0007...... NCQA........... CAHPS Health Plan ........
Survey v 4.0H--NCQA
Supplemental items
for CAHPS 4.0 Adult
Questionnaire.
------------------------------------------------------------------------
Availability
------------------------------------------------------------------------
47......... NA........ NCQA........... Ambulatory Care: ........
Outpatient and
Emergency
Department Visits.
48......... NA........ NCQA........... Inpatient ........
Utilization:
General Hospital/
Acute Care.
49......... 0004...... NCQA........... Initiation and X
Engagement of
Alcohol and Other
Drug Dependence
Treatment.
50......... NA........ NCQA........... Mental Health ........
Utilization.
51......... NA........ NCQA........... Prenatal and ........
Postpartum Care:
Postpartum Care
Rate.
------------------------------------------------------------------------
[dagger] NQF ID National Quality Forum identification numbers are used
for measures that are NQF-endorsed; otherwise, NA is used.
[Dagger] EHR Measures with an ``X'' are included in the Medicare and
Medicaid Electronic Health Record Incentive Payment Program and may be
collected through electronic health records. Specifications for these
measures are available from the Centers for Medicare & Medicaid
Services Web site at: https://www.cms.gov/QualityMeasures/03_ElectronicSpecifications.asp#TopOfPage.
[FR Doc. 2010-32978 Filed 12-29-10; 8:45 am]
BILLING CODE 4120-01-P
