Welcome to the Health Homes Quality Measure - …...Choose State Plan Amendment (SPA)* CONVERTED...

11/25/2015 Annual Report Admin Screen

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Welcome to the Health Homes Quality MeasureCMS10434 OMB 09381188

Federal Fiscal Year *

2013

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The Health Homes provision, authorized by section 2703 of the Affordable Care Act (section 1945 of the Social Security Act), provides an opportunity to build a personcentered care delivery model that focuses on improving outcomes and disease management for beneficiaries with chronic conditions. The Health Homes core set of quality measures will be used to evaluate care across all state Health Homes programs. Specifically, section 2703 requires Health Homes providers to report health care quality measures in order to receive payment. The recommended Health Homes core set will require reporting at the Health Homes provider level which the state will collect and aggregate at the Health Homes program level.

Choose State Plan Amendment (SPA)*

CONVERTED Oregon Health Home Services in process

Provide responses to the Administrative Questions and Cost Data here.

Core Measures

Measure Status

Adult Body Mass Index (BMI) Assessment (ABA) Not Started

Screening for Clinical Depression and FollowUp Plan (CDF) Not Started

Plan AllCause Readmission Rate (PCR) Not Started

FollowUp After Hospitalization for Mental Illness (FUH) Not Started

Controlling High Blood Pressure (CBP) Not Started

Care Transition Timely Transmission of Transtition Record (CTR) Not Started

Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (IET) Not Started

Prevention Quality Indicator (PQI) 92: Chronic Condition Composite Not Started

Manage Health Home State Specific Goals and Measures Not Started

19 of 9

Utilization Measures

Measure Status

Ambulatory Care Emergency Department Visits (AMB) Not Started

Inpatient Utilization (IU) Not Started

Nursing Facility Utilization (NFU) Not Started

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PRA Disclosure Statement According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 09381188. The time required to complete this information collection is estimated to average 40 hours per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C42605, Baltimore, Maryland 212441850.

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Adult Body Mass Index (BMI) Assessment (ABA)Health Homes Quality Measure OR 2013

Request Technical Assistance Clear View All Responses

Are you reporting on this measure? *YesNo


Please explain why you are not reporting on the measureSelect all that apply (must select at least one)

Service not covered

Population not covered Portion of population not covered *Entire population not coveredPartial population not covered

Data not available Explain why data not availableSelect all that apply (must select at least one)

Budget Constraints

Staff Constraints

Data Inconsistencies/Accuracy

*Please explain

Data not submitted by Providers to State

Data source not easily accessible

Reason Select all that apply

Requires medical record review

Requires data linkage, which does not currentlyexist

* Other

Information not collected


Not collected by provider (hospital/health plan)

* Other

Other

*Please explain

Small sample size (less than 30) Enter specific sample size *

Continuous enrollment requirement not met due to start date of SPA

Other Explain other reason why data not reported *

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Saved Documents

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Would you like to validate the core measure data at this time?

Yes No(Note: While the measure does not need to be validated at this time in order to proceed, each measure must be validated for the measure to be marked as ‘complete’ andbefore the report can be submitted to CMS).

Note: If validation fails, errors will appear in red above.







Please explain why you are not reporting on the measureSelect all that apply (must select at least one)

Service not covered

Population not covered Portion of population not covered *Entire population not coveredPartial population not covered

*Explain thepartial population

not covered

Data not available Explain why data not availableSelect all that apply (must select at least one)

Budget Constraints

Staff Constraints

Data Inconsistencies/Accuracy

*Please explain

Data not submitted by Providers to State

Data source not easily accessible


Requires medical record review

Requires data linkage, which does not currentlyexist

* Other

Information not collected


Not collected by provider (hospital/health plan)

* Other

Other

*Please explain

Small sample size (less than 30) Enter specific sample size *





Continuous enrollment requirement not met due to start date of SPA

Other Explain other reason why data not reported *

Report Documents

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Saved Documents



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Measurement Specification

+/

NCQA: National Committee for Quality AssuranceOther

Specify version of HEDIS used *

2011

HEDIS: Healthcare Effectiveness Data and Information Set

Data Source

+/

Administrative Data From where is the Administrative Data coming?Must select one or more

Medicaid Management Information System (MMIS)

Other

*Specify

Character count: 0/2000

Hybrid (Administrative and Medical Records Data) From where is the Administrative Data coming?Must select one or more


Other

*Specify


From where is the Medical Records coming?Must select only one

Electronic Health Record (EHR) DataPaperBoth (EHR and Paper)

Other Specify *


Date Range




+/

Please define the date range for the reporting period based on the “From” time period as the month and year that corresponds to the beginning period in which utilization took place and please report the “To” time period as the month and year that corresponds to the end period in which utilization took place. Do not report the year in which data were collected from the measure, or the version of HEDIS® used to calculate the measure, both of which may be different from the period corresponding to the utilization of services.

Start Date

January

Month

2000

Year

End Date

February

Month

2014

Year

Definition of Population Included in the Measure

+/

Definition of Denominator

Select all that apply

Denominator includes Medicaid population

Denominator includes Medicare and Medicaid DuallyEligible population

Other Specify *

Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure?

YesNo

Definition of Numerator

Health Home enrollees for whom BMI was documented (Table ABA.B) during the measurement year or the year prior to the measurement year.

*States that report using a oneyear lookback period should include only BMI during the measurement year.

Deviations from Measure Specifications

+/

Did your calculation of the measure deviate from the measure specification in any way? *YesNo

Please select and explain the deviation(s)

Age Range: 1864

Numerator Explain *

Denominator Explain *

Explain *



Other Explain *

Age Range: 6574

Numerator Explain *


Other Explain *

Age Range: Total

Numerator Explain *


Other Explain *

Performance Measure

+/

The percentage of Medicaid enrollees ages 18 to 74 who had an outpatient visit and whose body mass index (BMI) was documented during the measurement year or the year prior to the measurement year.

Age Range: 1864

Please explain why data was not entered for this numerator/denominator/rate set*




Age Range: 6574



The option "Denominator includes Medicare and Medicaid DuallyEligible population" was selected in the "Definition of Population included in theMeasure" section; however, no data were reported for the population age 65 and older. Are data available for population age 65 and over? *

YesNo

Age Range: Total



Additional Notes/Comments on Measure


Optional Measure Stratification

+/

If this measure is also reported by additional classifications/subcategories, e.g. racial, ethnic, gender, language, disability status, or geography, complete the following as applicable.

Check all that apply

Race (NonHispanic)

White

Classification/Subcategory Numerator Denominator Rate

Age Range: 1864 0 0 0 ClearRow


0 0 0 ClearRow

+ Additional/Alternative Classification/Subcategory

Black or African American






0 0 0 ClearRow


American Indian or Alaska Native




0 0 0 ClearRow


Asian




0 0 0 ClearRow


Native Hawaiian or Other Pacific Islander




0 0 0 ClearRow


Please define the otherrace *

jhlhhjDelete OtherRace




0 0 0 ClearRow


+ Additional Race(s)



Ethnicity

Hispanic or Latino




0 0 0 ClearRow


Not Hispanic or Latino




0 0 0 ClearRow


Please define the otherethnicity *

hjkhjDelete OtherEthnicity




0 0 0 ClearRow


+ Additional Ethnicity(ies)

Sex

Male




0 0 0 ClearRow


Female






0 0 0 ClearRow


Disability Status

SSI




0 0 0 ClearRow


NonSSI




0 0 0 ClearRow


Please define the otherdisabilitystatus *

ghjghjDelete OtherDisabilityStatus




0 0 0 ClearRow


+ Additional Disability Status(es)

Primary Spoken Language

English






0 0 0 ClearRow


Spanish




0 0 0 ClearRow


Please define the otherlanguage *

uuyhiDelete OtherLanguage




0 0 0 ClearRow


+ Additional Primary Spoken Language(s)

Geography

Urban




0 0 0 ClearRow


Rural



Age Range: 6574 Clear



0 0 0 Row

0 0 0 ClearRow


Please define the othergeographicalregion *

dfhydfhdDelete OtherGeographicalRegion




0 0 0 ClearRow


+ Additional Geographical Region(s)

Final Comments (Optional)

+/

Please enter any summary comments

Report Documents

+/

Saved Documents



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+/



2011


Data Source

+/



Other

*Specify




Other

*Specify




Other Specify *


Date Range




+/


Start Date

January

Month

2000

Year

End Date

February

Month

2014

Year


+/





Other Specify *


YesNo





+/



Age Range: 1864

Numerator Explain *


Explain *



Other Explain *

Age Range: 6574

Numerator Explain *


Other Explain *

Age Range: Total

Numerator Explain *


Other Explain *

Performance Measure

+/


Age Range: 1864

Numerator Denominator Rate

0 0 0

Age Range: 6574




0 0 0

Age Range: Total


0 0 0




+/



Race (NonHispanic)

White




0 0 0 ClearRow






0 0 0 ClearRow






Clear



0 0 0 Row


Asian




0 0 0 ClearRow






0 0 0 ClearRow







0 0 0 ClearRow



Ethnicity

Hispanic or Latino




0 0 0 ClearRow








0 0 0 ClearRow







0 0 0 ClearRow



Sex

Male




0 0 0 ClearRow


Female




0 0 0 ClearRow


Disability Status



SSI




0 0 0 ClearRow


NonSSI




0 0 0 ClearRow







0 0 0 ClearRow




English




0 0 0 ClearRow


Spanish






0 0 0 ClearRow







0 0 0 ClearRow



Geography

Urban




0 0 0 ClearRow


Rural




0 0 0 ClearRow










0 0 0 ClearRow




+/


Report Documents

+/

Saved Documents



No items available













+/



2011


Data Source

+/



Other

*Specify




Other

*Specify




Other Specify *


Date Range




+/


Start Date

January

Month

2000

Year

End Date

February

Month

2014

Year


+/





Other Specify *


YesNo





+/


Performance Measure

+/


Age Range: 1864


0 0 0

Age Range: 6574


0 0 0



Age Range: Total


0 0 0




+/



Race (NonHispanic)

White




0 0 0 ClearRow






0 0 0 ClearRow






0 0 0 ClearRow




Asian




0 0 0 ClearRow






0 0 0 ClearRow







0 0 0 ClearRow



Ethnicity

Hispanic or Latino




0 0 0 ClearRow








0 0 0 ClearRow







0 0 0 ClearRow



Sex

Male




0 0 0 ClearRow


Female




0 0 0 ClearRow


Disability Status

SSI


Age Range: 18640 0 0 Clear



Row


0 0 0 ClearRow


NonSSI




0 0 0 ClearRow







0 0 0 ClearRow




English




0 0 0 ClearRow


Spanish



0 0 0 Clear



Age Range: 6574 Row

0 0 0 ClearRow







0 0 0 ClearRow



Geography

Urban




0 0 0 ClearRow


Rural




0 0 0 ClearRow










0 0 0 ClearRow




+/


Report Documents

+/

Saved Documents



No items available













+/



2011


Data Source

+/



Other

*Specify




Other

*Specify




Other Specify *


Date Range




+/


Start Date

January

Month

2000

Year

End Date

February

Month

2014

Year


+/





Other Specify *


YesNo

Explain which populations are excluded and why *

What is the sample size? *

What is the measureeligible population? *





+/


Performance Measure

+/


Age Range: 1864




0 0 0

Age Range: 6574


0 0 0

Age Range: Total


0 0 0




+/



Race (NonHispanic)

White




0 0 0 ClearRow






0 0 0 ClearRow








0 0 0 ClearRow


Asian




0 0 0 ClearRow






0 0 0 ClearRow







0 0 0 ClearRow



Ethnicity

Hispanic or Latino



0 0 0 Clear



Age Range: 6574 Row

0 0 0 ClearRow






0 0 0 ClearRow







0 0 0 ClearRow



Sex

Male




0 0 0 ClearRow


Female




Clear



0 0 0 Row


Disability Status

SSI




0 0 0 ClearRow


NonSSI




0 0 0 ClearRow







0 0 0 ClearRow




English




0 0 0 Clear



Row


Spanish




0 0 0 ClearRow







0 0 0 ClearRow



Geography

Urban




0 0 0 ClearRow


Rural




0 0 0 ClearRow










0 0 0 ClearRow




+/


Report Documents

+/

Saved Documents



No items available













+/


Explain *

Data Source

+/



Other

*Specify




Other

*Specify




Other Specify *


Date Range




Date Range

+/


Start Date

January

Month

2000

Year

End Date

February

Month

2014

Year


+/





Other Specify *


YesNo

Explain which populations are excluded and why *

What is the sample size? *

What is the measureeligible population? *





+/


Other Performance Measure

+/

Please describe the other methodology used *



Please describe the rate (e.g.,1864) Numerator Denominator Rate

No items available

+ Additional/Other Rate(s)



+/



Race (NonHispanic)

White




0 0 0 ClearRow






0 0 0 ClearRow






0 0 0 ClearRow




Asian




0 0 0 ClearRow






0 0 0 ClearRow







0 0 0 ClearRow



Ethnicity

Hispanic or Latino




0 0 0 ClearRow








0 0 0 ClearRow







0 0 0 ClearRow



Sex

Male




0 0 0 ClearRow


Female




0 0 0 ClearRow


Disability Status

SSI


Age Range: 1864 Clear



0 0 0 Row


0 0 0 ClearRow


NonSSI




0 0 0 ClearRow







0 0 0 ClearRow




English




0 0 0 ClearRow


Spanish



Clear



Age Range: 6574 0 0 0 Row

0 0 0 ClearRow







0 0 0 ClearRow



Geography

Urban




0 0 0 ClearRow


Rural




0 0 0 ClearRow










0 0 0 ClearRow




+/


Report Documents

+/

Saved Documents



No items available







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Ambulatory Care Emergency Department Visits (AMB)Health Homes Quality Measure OR 2013





+/



Select Year


Data Source

+/

Administrative Data Only From where is the Administrative Data coming?Must select one or more


Other

*Specify


Other

Date Range

+/


Start Date

Select Month

Month

Select Year

Year

End Date

Select Month

Month

Select Year

Year


+/





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Other Specify *


YesNo


The total number of emergency department visits for Health Home enrollees that Medicaid (or Medicare for Dual Eligible beneficiaries) paid for, or expects to pay for, during the measurement year.

Each visit that does not result in an inpatient stay is counted once, regardless of the intensity of duration of the visit. Emergency department visits that result in an inpatient stay are not included.


+/



Age Range: 017

Numerator Explain *


Other Explain *

Age Range: 1864

Numerator Explain *


Other Explain *



Age Range: 65 and older

Numerator Explain *


Other Explain *

Age Range: Total

Numerator Explain *


Other Explain *

Performance Measure

+/

The rate of emergency department (ED) visits per 1,000 enrollee months among Health Home enrollees.

Age Range: 017

ED Visits Enrollee Months Visits per 1,000 Enrollee Months

0 0 0

Age Range: 1864




0 0 0



0 0 0

Age Range: Total


0 0 0




+/



Race (NonHispanic)

White




Age Range: 65 and older 0 0 0 ClearRow
















Asian













Ethnicity

Hispanic or Latino











Sex



Male





Female





Disability Status

SSI





NonSSI







English





Spanish








Geography

Urban





Rural







+/


Report Documents

+/

Saved Documents



No items available




Cancel Save Go to Admin Screen Go to Next Measure




Warning: Any field containing more than 4000 characters will be truncated when saved.



Ambulatory Care Emergency Department Visits (AMB)Health Homes Quality Measure OR 2013





+/


Explain *

Data Source

+/

Administrative Data Only From where is the Administrative Data coming?Must select one or more


Other

*Specify


Other

Date Range

+/


Start Date

Select Month

Month

Select Year

Year

End Date

Select Month

Month

Select Year

Year


+/



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Other Specify *


YesNo


The total number of emergency department visits for Health Home enrollees that Medicaid (or Medicare for Dual Eligible beneficiaries) paid for, or expects to pay for, during the measurement year.

Each visit that does not result in an inpatient stay is counted once, regardless of the intensity of duration of the visit. Emergency department visits that result in an inpatient stay are not included.


+/



Age Range: 017

Numerator Explain *


Other Explain *

Age Range: 1864

Numerator Explain *




Other Explain *


Numerator Explain *


Other Explain *

Age Range: Total

Numerator Explain *


Other Explain *

Other Performance Measure

+/

Please describe the other methodology used *

Please describe the rate (e.g.,1864) Numerator Denominator Rate

0 0 0 ClearRow



+ Additional/Other Rate(s)



+/



Race (NonHispanic)

White


















Asian


Age Range: 017 0 Clear



0 0 Row











Ethnicity

Hispanic or Latino











Sex

Male






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Welcome to the Health Homes Quality Measure - …...Choose State Plan Amendment (SPA)* CONVERTED...

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