Medicaid Program:

Federal Register: December 30, 2010 (Volume 75, Number 250)

Notices

Page 82397-82399

From the Federal Register Online via GPO Access [wais.access.gpo.gov]

DOCID:fr30de10-73

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:

  1. 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.

  2. 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.

  3. 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 http://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.

  4. 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).

  5. 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: http://www.cms.gov/QualityMeasures/03_

    ElectronicSpecifications.asp#TopOfPage.

    FR Doc. 2010-32978 Filed 12-29-10; 8:45 am

    BILLING CODE 4120-01-P

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