CMS-10398 (#48) Quality Measurement Data Reporting Templates

Generic Clearance for Medicaid and CHIP State Plan, Waiver, and Program Submissions (CMS-10398)

Demonstration223Templates(508) OMB and CMS #.xlsx

GenIC #48 - Section 223 Demonstration Programs to Improve Community Mental Health Services

OMB: 0938-1148

Document [xlsx]
Download: xlsx | pdf

Overview

Cover Page
Instructions
BHC-Lead CCBHC-Required Measure
Case Load Characteristics
I-EVAL
BMI-SF
WCC-BH
TSC
ASC
SRA-BH-C
SRA-A
CDF-BH
DEP-REM-12
Other BHC-Lead Measures
ROUT
TX-EVAL
SUIC
DOC
CBP-BH
State-Lead CCBHC Measures
HOU
PEC
YFEC
FUM
FUA
PCR-BH
SSD
SAA-BH
FUH-BH-A
FUH-BH-C
ADD-BH
AMM-BH
IET-BH
Other State-Lead Measures
SU-A
SMI-PC
APM
SMC
AMS-BD
Roll-up Report
BHC Measurement Periods
State Measurement Periods


Sheet 1: Cover Page

Data Reporting Templates for Behavioral Health Clinic Quality Measures
End of Worksheet

Sheet 2: Instructions

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Quality Measures Data Reporting Instructions
These templates are to be used to report the set of Behavioral Health Clinic (BHCs) quality measures. For the Section 223 Demonstration Program for Certified Community Behavioral Health Clinics (CCBHCs), states are required to report all measures to Substance Abuse and Mental Health Services Administration (SAMHSA), including those performance measures that are reported by the clinics to the states as part of the CCBHC Demonstration Program. Users are referred to the Technical Specifications and Resource Manual for additional detailed instructions regarding each measure as well as general instructions for the set as a whole.
These measures are specified at the clinic level. Some of the measures are drawn from established specified measures and others are not; those derived from existing measures have been respecified to the clinic level unless they were already specified at the provider level.
Organization:
The templates are divided into 4 parts: 1) BHC-Lead Measures Required for the CCBHC Demonstration; 2) BHC-Lead Measures Not Required for the CCBHC Demonstration; 3) State-Lead Measures Required for the CCBHC Demonstration; and 4) State-Lead Measures Not Required for the CCBHC Demonstration, followed by a roll-up sheet and sheet related to CCBHC measurement periods.
Data Issues:
Although states may not be accustomed to reporting data or measures with small denominators, for the CCBHC Demonstration Program, all required measures must be reported. Those with denominators less than 30 will not be used for Quality Bonus Payment or be publically reported, but will be considered in the evaluation and should be treated by the CCBHCs and states as information to be used in internal quality improvement.
Data used for reporting should be final.
Optional Measure Stratification:
This reporting template includes only the stratification required by the measure specification. If states wish to designate other stratification categories in addition to those specified, the reporter (clinic or state) may add additional stratification groups provided they encompass the specified stratification and are reported separately from the rates required by the specifications. States should keep in mind that, if they require reporting of additional stratification categories, the numbers may not be sufficiently large to be meaningful. For reporting of any other stratification categories, provide the results in Section F Additional Notes.
Case Load Characteristics Instructions:
A table is provided for reporting numbers and percentages of the population of BHC consumers who fall into different categories. This information is being requested for the Section 223 evaluation. States may elect to require additional information. The spreadsheet is formatted to automatically calculate the percentages once numbers are entered.
A CCBHC consumer is anyone who has an enumerated visit at the clinic during the demonstration year.
Ethnicity and race are reported separately. For each consumer, both ethnicity and race should be reported.
Section-by-Section Instructions for Measure Templates:
A. Measurement Year: Insert the Measurement Year. For CCBHCs, the measurement year will be the demonstration year (DY1 or DY2) with DY1 running from the date when the demonstration services begin. For other purposes, the measurement year typically will be the calendar year (e.g., MY2017).
B. Data Source: With the exception of the PEC, Y/FEC, and HOU measures, there are three potential data sources: (1) administrative (claims data/encounter records); (2) medical records (typically electronic health records (EHR), registries, and/or paper records); and (3) hybrid (a combination of (1) and (2)). Each measure is specified for one of these data sources and the corresponding reporting template indicates which it is. The template for a measure will ask if you used the specified data source. If the answer is yes, further information about that data source is requested. If the answer is "Other," information about the non-specified data source is required.
C. Date Range (mm/dd/yyyy): Define the date range for the reporting period based on the “Start” time period as the month, day, and year that corresponds to the beginning period in which utilization took place and report the “End” time period as the month, day, and year that corresponds to the end period in which utilization took place (for the denominator and numerator separately). If a measure reports utilization of services during the measurement year and prior year(s) (the “look-back period”), the full measurement period for utilization should be reported in the Date Range. Do not report the year in which data were collected, or the version of HEDIS® used to calculate the measure, if it is a HEDIS-derived measure. If reporting on a CCBHC, please see Appendix A of the technical specifications and the final two worksheets (Measurement Periods) for help in calculating appropriate measurement periods.
D. Performance Measure: The measure is described. A table is then provided for the reporter to insert the numerator and denominator. The rate for each stratification and the total are automatically calculated. All numbers provided are rounded to the second decimal place (e.g., denominator = 550.37894= 550.38; 550.37443 = 550.37).
E. Adherence to Measure Specifications: This section, first, provides a space to identify the population included in the denominator. It then addresses adherence to the specifications. Reporters are expected to follow the specifications. If, for any reason, there is a deviation from those specifications, this section provides a place to so indicate. Examples of deviations include: coding issues (numerator); different age groups (denominator), definition of continuous enrollment (denominator); start/end dates; data sources. If a deviation is indicated, the reporter first must indicate if the denominator represents the total measure eligible population as defined by the technical specifications for this measure. If not, a description of excluded populations must be provided, as well as the size of the denominator used and the size of the actual eligible population as specified. Additionally, the reporter is asked to provide the actual numerator, denominator, and any other changes for each stratification specified for the measure (e.g., by age, payer status).
F. Additional Notes: Space is provided for the reporter to provide any additional information they feel is important. Please use this space to provide further explanations of any aspects of your state's reporting for the measure. Examples of such information may include context about why a data field cannot be reported; a change in the state's methodology, population, or program that would affect trendability of the measure; sampling approach used for hybrid measures; indication of external quality review or state validation if applicable.
Roll-up Report Instructions:
A table is provided to summarize the results of each measure. The contents are automatically inserted from the measure worksheets.
End of Worksheet

Sheet 3: BHC-Lead CCBHC-Required Measure

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BHC-Lead Measures Required for the CCBHC Demonstration Program
State Name:
BHC Name:
BHC Identifier:
End of Worksheet

Sheet 4: Case Load Characteristics

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Case Load Characteristics
Characteristic Number Percent
Age
0-11 years

12-17 years

18-64 years

65+ years

Gender
Women

Men

Other

Unknown

Ethnicity
Not Hispanic or Latino

Hispanic or Latino

Unknown

Race
White

Black or African American

American Indian or Alaskan Native

Asian

Native Hawaiian or Pacific Islander

More than one Race

Unknown

Insurance Status
Medicaid

CHIP

Medicare

Medicare and Medicaid Dually-Eligible

VHA/TRICARE

Commercially insured

Uninsured

Other

Veteran or Military Status
Active Duty Military

Prior Military Service/Veteran

Neither

Total Clinic Population

End of Worksheet

Sheet 5: I-EVAL

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Time to Initial Evaluation (I-EVAL)
A SAMHSA-Developed Metric
A. Measurement Year:
Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017.

B. Data Source:
Select the data source type (Medical Records or Other):
If medical records data, select source (EHR, Paper Records, Both):
If other data source selected, specify source:
No Data
C. Date Range:
Denominator Start Date (mm/dd/yyyy)
No Data
Denominator End Date (mm/dd/yyyy)
No Data
Numerator Start Date (mm/dd/yyyy)
No Data
Numerator End Date (mm/dd/yyyy)
No Data
D. Performance Measure:
Metric 1. The percentage of new consumers with initial evaluation provided within 10 business days of first contact
Metric 2. The mean number of days until initial evaluation for new consumers
These metrics are stratified to report by age (12–17 years, 18 years and older) and are stratified to report by Medicaid, Medicare & Medicaid, other, and total population.
Metric #1: Percentage of New Clients with Initial Evaluation within 10 Business Days
Measure Numerator Denominator Rate
Age 12-17 years 0 0
Medicaid


Medicare & Medicaid


Other


Age 18+ years 0 0
Medicaid


Medicare & Medicaid


Other


Total (all Age Groups) 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
Metric #2: Mean Number of Days until Initial Evaluation
Measure Numerator Denominator Rate
Age 12-17 years 0 0
Medicaid


Medicare & Medicaid


Other


Age 18+ years 0 0
Medicaid


Medicare & Medicaid


Other


Total (all Age Groups) 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
E. Adherence to Measure Specifications:
Population included in the denominator (indicate yes or no for each of the options below):
Medicaid population
No Data
Title XIX-eligible CHIP population
No Data
Title XXI-eligible CHIP population
No Data
Other CHIP enrollees


Medicare population
No Data
Medicare and Medicaid Dually-Eligible population
No Data
VHA/TRICARE population
No Data
Commercially insured population
No Data
Uninsured population
No Data
Other
If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded:
Did your calculation of the measure deviate from the measure specification in any way?
If Yes, the measure differs: Explain how the calculation differed and why.
Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure?
If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell:
Specify the size of the population included in the denominator:
Specify the size of the measure-eligible population:
Provide the following information for each rate/stratification:
For Metric #1: Percentage of New Clients with Initial Eval within 10 Business Days
Age Range: 12-17 years
Did the numerator differ for the 12-17 years age range?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the 12-17 years age range?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the 12-17 years age range?
If other, explain the deviation in the next cell:
Age Range: 18+ years
Did the numerator differ for the 18+ years age range?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the 18+ years age range?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the 18+ years age range?
If other, explain the deviation in the next cell:
Medicaid Population:
Did the numerator differ for the Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicaid population?
If other, explain the deviation in the next cell:
Medicare & Medicaid Population:
Did the numerator differ for the Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Neither Medicaid nor Medicare & Medicaid Population:
Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Total Eligible Population:
Did the numerator differ for the Total Eligible population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Total Eligible population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Total Eligible population?
If other, explain the deviation in the next cell:
For Metric #2: Mean Number of Days until Initial Evaluation:
Age Range: 12-17 years
Did the numerator differ for the 12-17 years age range?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the 12-17 years age range?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the 12-17 years age range?
If other, explain the deviation in the next cell:
Age Range: 18+ years
Did the numerator differ for the 18+ years age range?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the 18+ years age range?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the 18+ years age range?
If other, explain the deviation in the next cell:
Medicaid Population:
Did the numerator differ for the Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicaid population?
If other, explain the deviation in the next cell:
Medicare & Medicaid Population:
Did the numerator differ for the Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Neither Medicaid nor Medicare & Medicaid Population:
Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Total Eligible Population:
Did the numerator differ for the Total Eligible population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Total Eligible population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Total Eligible population?
If other, explain the deviation in the next cell:
F. Additional Notes:

End of Worksheet

Sheet 6: BMI-SF

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Preventive Care and Screening: Adult Body Mass Index (BMI) Screening and Follow-Up (BMI-SF)
Based on a measure stewarded by the Centers for Medicare & Medicaid Services (NQF #0421, PQRS #128)
A. Measurement Year:
Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017.

B. Data Source:
Select the data source type (Medical Records or Other):
If medical records data, select source (EHR, Paper Records, Both):
If other data source selected, specify source:
No Data
C. Date Range:
Denominator Start Date (mm/dd/yyyy)
No Data
Denominator End Date (mm/dd/yyyy)
No Data
Numerator Start Date (mm/dd/yyyy)
No Data
Numerator End Date (mm/dd/yyyy)
No Data
D. Performance Measure:
The percentage of consumers aged 18 years and older with a BMI documented during the current encounter or during the previous six months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous six months of the current encounter
Normal Parameters: Age 65 years and older BMI ≥ 23 and < 30 kg/m2, Age 18 - 64 years BMI ≥ 18.5 and < 25 kg/m2
The measure is stratified to report Medicaid, Medicare & Medicaid, other, and total population
Measure Numerator Denominator Rate
Medicaid


Medicare & Medicaid


Other


Total 0 0
E. Adherence to Measure Specifications:
Population included in the denominator (indicate yes or no for each of the options below):
Medicaid population
No Data
Title XIX-eligible CHIP population
No Data
Title XXI-eligible CHIP population
No Data
Other CHIP enrollees
No Data
Medicare population
No Data
Medicare and Medicaid Dually-Eligible population
No Data
VHA/TRICARE population
No Data
Commercially insured population
No Data
Uninsured population
No Data
Other
If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded:
Did your calculation of the measure deviate from the measure specification in any way?
If Yes, the measure differs: Explain how the calculation differed and why.
Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure?
If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell:
Specify the size of the population included in the denominator:
Specify the size of the measure-eligible population.
Medicaid Population:
Did the numerator differ for the Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicaid population?
If other, explain the deviation in the next cell:
Medicare & Medicaid Population:
Did the numerator differ for the Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Neither Medicaid nor Medicare & Medicaid Population:
Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Total Eligible Population:
Did the numerator differ for the Total Eligible population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Total Eligible population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Total Eligible population?
If other, explain the deviation in the next cell:
F. Additional Notes:

End of Worksheet

Sheet 7: WCC-BH

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Weight Assessment for Children/Adolescents: Body Mass Index Assessment for Children/Adolescents (WCC-BH)
Based on a measure stewarded by the National Committee for Quality Assurance (NQF #0024, HEDIS 2016, Medicaid Child and Adolescent Core Set)
A. Measurement Year:
Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017.

B. Data Source:
Select the data source type:
No Data
If administrative data only, select source (Medicaid Management Information System (MMIS) or Other):
If other administrative data, specify data source:
If hybrid data, select administrative data source (Medicaid Management Information System (MMIS) or Other):
If other for administrative hybrid data, specify data source:
If hybrid data, select medical records source (EHR, Paper Records, Both):
No Data
If hybrid data, what is the sample size?
No Data
If hybrid, what is the measure-eligible population?
No Data
If source other than administrative or hybrid selected, provide source:
No Data
C. Date Range:
Denominator Start Date (mm/dd/yyyy)
No Data
Denominator End Date (mm/dd/yyyy)
No Data
Numerator Start Date (mm/dd/yyyy)
No Data
Numerator End Date (mm/dd/yyyy)
No Data
D. Performance Measure:
Percentage of children ages 3 to 17 who had an outpatient visit with a primary care practitioner (PCP) or obstetrical/ gynecological (OB/GYN) practitioner and who had evidence of body mass index (BMI) percentile documentation during the measurement year. Because BMI norms for youth vary with age and gender, this measure evaluates whether BMI percentile is assessed rather than the absolute BMI value.
The measure is stratified to report by age (3-11, 12-17, and total (all age groups)), and by the Medicaid, Medicare & Medicaid, and other population.
Measure Numerator Denominator Rate
3-11 years
Medicaid


Medicare & Medicaid


Other


Total 0 0
12-17 years
Medicaid


Medicare & Medicaid


Other


Total 0 0
E. Adherence to Measure Specifications:
Population included in the denominator (indicate yes or no for each of the options below):
Medicaid population
No Data
Title XIX-eligible CHIP population
No Data
Title XXI-eligible CHIP population
No Data
Other CHIP enrollees
No Data
Medicare population
No Data
Medicare and Medicaid Dually-Eligible population
No Data
VHA/TRICARE population
No Data
Commercially insured population
No Data
Uninsured population
No Data
Other
If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded:
Did your calculation of the measure deviate from the measure specification in any way?
If Yes, the measure differs: Explain how the calculation differed and why.
Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure?
If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell:
Specify the size of the population included in the denominator:
Specify the size of the measure-eligible population:
Provide the following information for each rate/stratification:
Age Range: 3-11 years
Did the numerator differ for the 3-11 years age range?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the 3-11 years age range?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the 3-11 years age range?
If other, explain the deviation in the next cell:
Age Range: 12-17 years
Did the numerator differ for the 12-17 years age range?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the 12-17 years age range?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the 12-17 years age range?
If other, explain the deviation in the next cell:
Medicaid Population:
Did the numerator differ for the Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicaid population?
If other, explain the deviation in the next cell:
Medicare & Medicaid Population:
Did the numerator differ for the Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Neither Medicaid nor Medicare & Medicaid Population:
Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Total Eligible Population:
Did the numerator differ for the Total Eligible population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Total Eligible population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Total Eligible population?
If other, explain the deviation in the next cell:
F. Additional Notes:

End of Worksheet

Sheet 8: TSC

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Preventive Care & Screening: Tobacco Use: Screening & Cessation Intervention (TSC)
Based on a measure stewarded by the American Medical Association (AMA) and PCPI® Foundation (PCPI®) (NQF #0028, PQRS #226)
A. Measurement Year:
Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017.

B. Data Source:
Select the data source type (Medical Records or Other):
If medical records data, select source (EHR, Paper Records, Both):
If other data source selected, specify source:
No Data
C. Date Range:
Denominator Start Date (mm/dd/yyyy)
No Data
Denominator End Date (mm/dd/yyyy)
No Data
Numerator Start Date (mm/dd/yyyy)
No Data
Numerator End Date (mm/dd/yyyy)
No Data
D. Performance Measure:
Percentage of consumers aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received cessation counseling intervention if identified as a tobacco user
The measure is stratified to report Medicaid, Medicare & Medicaid, other, and total population.
Measure Numerator Denominator Rate
Medicaid


Medicare & Medicaid


Other


Total 0 0
E. Adherence to Measure Specifications:
Population included in the denominator (indicate yes or no for each of the options below):
Medicaid population
No Data
Title XIX-eligible CHIP population
No Data
Title XXI-eligible CHIP population
No Data
Other CHIP enrollees
No Data
Medicare population
No Data
Medicare and Medicaid Dually-Eligible population
No Data
VHA/TRICARE population
No Data
Commercially insured population
No Data
Uninsured population
No Data
Other
If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded:
Did your calculation of the measure deviate from the measure specification in any way?
If Yes, the measure differs: Explain how the calculation differed and why.
Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure?
If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell:
Specify the size of the population included in the denominator:
Specify the size of the measure-eligible population.
Provide the following information for each rate/stratification:
Medicaid Population:
Did the numerator differ for the Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicaid population?
If other, explain the deviation in the next cell:
Medicare & Medicaid Population:
Did the numerator differ for the Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Neither Medicaid nor Medicare & Medicaid Population:
Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Total Eligible Population:
Did the numerator differ for the Total Eligible population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Total Eligible population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Total Eligible population?
If other, explain the deviation in the next cell:
F. Additional Notes:

End of Worksheet

Sheet 9: ASC

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Preventive Care and Screening: Unhealthy Alcohol Use: Screening & Brief Counseling (ASC)
Based on a measure stewarded by the American Medical Association (AMA) and PCPI® Foundation (PCPI®) (NQF #2152, PQRS #431)
A. Measurement Year:
Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017.

B. Data Source:
Select the data source type (Medical Records or Other):
If medical records data, select source (EHR, Paper Records, Both):
If other data source selected, specify source:
No Data
C. Date Range:
Denominator Start Date (mm/dd/yyyy)
No Data
Denominator End Date (mm/dd/yyyy)
No Data
Numerator Start Date (mm/dd/yyyy)
No Data
Numerator End Date (mm/dd/yyyy)
No Data
D. Performance Measure:
Percentage of consumers aged 18 years and older who were screened at least once within the last 24 months for unhealthy alcohol use using a systematic screening method AND who received brief counseling if identified as an unhealthy alcohol user.
The measure is stratified to report Medicaid, Medicare & Medicaid, other, and total population.
Measure Numerator Denominator Rate
Medicaid


Medicare & Medicaid


Other


Total 0 0
E. Adherence to Measure Specifications:
Population included in the denominator (indicate yes or no for each of the options below):
Medicaid population
No Data
Title XIX-eligible CHIP population
No Data
Title XXI-eligible CHIP population
No Data
Other CHIP enrollees
No Data
Medicare population
No Data
Medicare and Medicaid Dually-Eligible population
No Data
VHA/TRICARE population
No Data
Commercially insured population
No Data
Uninsured population
No Data
Other
If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded:
Did your calculation of the measure deviate from the measure specification in any way?
If Yes, the measure differs: Explain how the calculation differed and why.
Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure?
If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell:
Specify the size of the population included in the denominator:
Specify the size of the measure-eligible population.
Provide the following information for each rate/stratification:
Medicaid Population:
Did the numerator differ for the Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicaid population?
If other, explain the deviation in the next cell:
Medicare & Medicaid Population:
Did the numerator differ for the Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Neither Medicaid nor Medicare & Medicaid Population:
Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Total Eligible Population:
Did the numerator differ for the Total Eligible population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Total Eligible population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Total Eligible population?
If other, explain the deviation in the next cell:
F. Additional Notes:

End of Worksheet

Sheet 10: SRA-BH-C

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Child and Adolescent Major Depressive Disorder: Suicide Risk Assessment (SRA-BH-C)
Based on a measure stewarded by the American Medical Association (AMA) and PCPI® Foundation (PCPI®) (NQF #1365, Medicaid Child and Adolescent Core Set)
A. Measurement Year:
Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017.

B. Data Source:
Select the data source type (Medical Records or Other):
If medical records data, select source (EHR, Paper Records, Both):
If other data source selected, specify source:
No Data
C. Date Range:
Denominator Start Date (mm/dd/yyyy)
No Data
Denominator End Date (mm/dd/yyyy)
No Data
Numerator Start Date (mm/dd/yyyy)
No Data
Numerator End Date (mm/dd/yyyy)
No Data
D. Performance Measure:
The percentage of consumer visits for those consumers aged 6 through 17 years with a diagnosis of Major Depressive Disorder (MDD) with an assessment for suicide risk
The measure is stratified to report Medicaid, Medicare & Medicaid, other, and total population.
Measure Numerator Denominator Rate
Medicaid


Medicare & Medicaid


Other


Total 0 0
E. Adherence to Measure Specifications:
Population included in the denominator (indicate yes or no for each of the options below):
Medicaid population
No Data
Title XIX-eligible CHIP population
No Data
Title XXI-eligible CHIP population
No Data
Other CHIP enrollees
No Data
Medicare population
No Data
Medicare and Medicaid Dually-Eligible population
No Data
VHA/TRICARE population
No Data
Commercially insured population
No Data
Uninsured population
No Data
Other
If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded:
Did your calculation of the measure deviate from the measure specification in any way?
If Yes, the measure differs: Explain how the calculation differed and why.
Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure?
If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell:
Specify the size of the population included in the denominator:
Specify the size of the measure-eligible population.
Provide the following information for each rate/stratification:
Medicaid Population:
Did the numerator differ for the Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicaid population?
If other, explain the deviation in the next cell:
Medicare & Medicaid Population:
Did the numerator differ for the Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Neither Medicaid nor Medicare & Medicaid Population:
Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Total Eligible Population:
Did the numerator differ for the Total Eligible population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Total Eligible population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Total Eligible population?
If other, explain the deviation in the next cell:
F. Additional Notes:

End of Worksheet

Sheet 11: SRA-A

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Adult Major Depressive Disorder (MDD): Suicide Risk Assessment (SRA-A)
Based on a measure stewarded by the American Medical Association (AMA) and PCPI® Foundation (PCPI®) (NQF #0104)
A. Measurement Year:
Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017.

B. Data Source:
Select the data source type (Medical Records or Other):
If medical records data, select source (EHR, Paper Records, Both):
If other data source selected, specify source:
No Data
C. Date Range:
Denominator Start Date (mm/dd/yyyy)
No Data
Denominator End Date (mm/dd/yyyy)
No Data
Numerator Start Date (mm/dd/yyyy)
No Data
Numerator End Date (mm/dd/yyyy)
No Data
D. Performance Measure:
Percentage of consumers aged 18 years and older with a diagnosis of major depressive disorder (MDD) with a suicide risk assessment completed during the visit in which a new diagnosis or recurrent episode was identified
The measure is stratified to report Medicaid, Medicare & Medicaid, other, and total population.
Measure Numerator Denominator Rate
Medicaid


Medicare & Medicaid


Other


Total 0 0
E. Adherence to Measure Specifications:
Population included in the denominator (indicate yes or no for each of the options below):
Medicaid population
No Data
Title XIX-eligible CHIP population
No Data
Title XXI-eligible CHIP population
No Data
Other CHIP enrollees
No Data
Medicare population
No Data
Medicare and Medicaid Dually-Eligible population
No Data
VHA/TRICARE population
No Data
Commercially insured population
No Data
Uninsured population
No Data
Other
If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded:
Did your calculation of the measure deviate from the measure specification in any way?
If Yes, the measure differs: Explain how the calculation differed and why.
Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure?
If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell:
Specify the size of the population included in the denominator:
Specify the size of the measure-eligible population.
Provide the following information for each rate/stratification:
Medicaid Population:
Did the numerator differ for the Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicaid population?
If other, explain the deviation in the next cell:
Medicare & Medicaid Population:
Did the numerator differ for the Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Neither Medicaid nor Medicare & Medicaid Population:
Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Total Eligible Population:
Did the numerator differ for the Total Eligible population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Total Eligible population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Total Eligible population?
If other, explain the deviation in the next cell:
F. Additional Notes:

End of Worksheet

Sheet 12: CDF-BH

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Screening for Clinical Depression and Follow-up Plan (CDF-BH)
Based on a measure stewarded by the Centers for Medicare & Medicaid Services (NQF #0418, Medicaid Adult Core Set)
A. Measurement Year:
Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017.

B. Data Source:
Select the data source type:
No Data
If hybrid data, select administrative data source (Medicaid Management Information System (MMIS) or Other):
If other hybrid data, specify data source:
If hybrid data, select medical records source (EHR, Paper Records, Both):
No Data
If hybrid data, what is the sample size?
No Data
If Hybrid, what is the measure-eligible population?
No Data
If source other than hybrid selected, provide source:
No Data
C. Date Range:
Denominator Start Date (mm/dd/yyyy)
No Data
Denominator End Date (mm/dd/yyyy)
No Data
Numerator Start Date (mm/dd/yyyy)
No Data
Numerator End Date (mm/dd/yyyy)
No Data
D. Performance Measure:
Percentage of consumers aged 12 years and older screened for clinical depression on the date of the encounter using an age-appropriate standardized depression screening tool, and if positive, a follow-up plan is documented on the date of the positive screen
The measure is stratified to report by age (12-17, 18-64, 65 and older), and by the Medicaid, Medicare & Medicaid, and other population.
Measure Numerator Denominator Rate
12-17 years 0 0
Medicaid


Medicare & Medicaid


Other


18-64 years 0 0
Medicaid


Medicare & Medicaid


Other


65+ years 0 0
Medicaid


Medicare & Medicaid


Other


E. Adherence to Measure Specifications:
Population included in the denominator (indicate yes or no for each of the options below):
Medicaid population
No Data
Title XIX-eligible CHIP population
No Data
Title XXI-eligible CHIP population
No Data
Other CHIP enrollees
No Data
Medicare population
No Data
Medicare and Medicaid Dually-Eligible population
No Data
VHA/TRICARE population
No Data
Commercially insured population
No Data
Uninsured population
No Data
Other
If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded:
Did your calculation of the measure deviate from the measure specification in any way?
If Yes, the measure differs: Explain how the calculation differed and why.
Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure?
If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell:
Specify the size of the population included in the denominator:
Specify the size of the measure-eligible population.
Provide the following information for each rate/stratification:
Age Range: 12-17 years
Did the numerator differ for the 12-17 years age range?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the 12-17 years age range?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the 12-17 years age range?
If other, explain the deviation in the next cell:
Age Range: 18-64 years
Did the numerator differ for the 18-64 years age range?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the 18-64 years age range?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the 18-64 years age range?
If other, explain the deviation in the next cell:
Age Range: 65+ years
Did the numerator differ for the 65+ years age range?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the 65+ years age range?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the 65+ years age range?
If other, explain the deviation in the next cell:
Medicaid Population:
Did the numerator differ for the Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicaid population?
If other, explain the deviation in the next cell:
Medicare & Medicaid Population:
Did the numerator differ for the Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Neither Medicaid nor Medicare & Medicaid Population:
Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population?
If other, explain the deviation in the next cell:
F. Additional Notes:

End of Worksheet

Sheet 13: DEP-REM-12

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Depression Remission at Twelve Months (DEP-REM-12)
Based on a measure stewarded by Minnesota Community Measurement (NQF #0710)
A. Measurement Year:
Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017.

B. Data Source:
Select the data source type (Medical Records or Other):
If medical records data, select source (EHR, Paper Records, Both):
If other data source selected, specify source:
No Data
C. Date Range:
Denominator Start Date (mm/dd/yyyy)
No Data
Denominator End Date (mm/dd/yyyy)
No Data
Numerator Start Date (mm/dd/yyyy)
No Data
Numerator End Date (mm/dd/yyyy)
No Data
D. Performance Measure:
Adult consumers 18 years of age or older with Major Depression or Dysthymia who reached remission 12 months (± 30 days) after an index visit. This measure applies to consumers with both newly diagnosed and existing Depression whose current PHQ-9 score indicates a need for treatment.
The measure is stratified to report Medicaid, Medicare & Medicaid, other, and total population.
Measure Numerator Denominator Rate
Medicaid


Medicare & Medicaid


Other


Total 0 0
E. Adherence to Measure Specifications:
Population included in the denominator (indicate yes or no for each of the options below):
Medicaid population
No Data
Title XIX-eligible CHIP population
No Data
Title XXI-eligible CHIP population
No Data
Other CHIP enrollees
No Data
Medicare population
No Data
Medicare and Medicaid Dually-Eligible population
No Data
VHA/TRICARE population
No Data
Commercially insured population
No Data
Uninsured population
No Data
Other
If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded:
Did your calculation of the measure deviate from the measure specification in any way?
If Yes, the measure differs: Explain how the calculation differed and why.
Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure?
If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell:
Specify the size of the population included in the denominator:
Specify the size of the measure-eligible population.
Provide the following information for each rate/stratification:
Medicaid Population:
Did the numerator differ for the Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicaid population?
If other, explain the deviation in the next cell:
Medicare & Medicaid Population:
Did the numerator differ for the Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Neither Medicaid nor Medicare & Medicaid Population:
Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Total Eligible Population:
Did the numerator differ for the Total Eligible population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Total Eligible population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Total Eligible population?
If other, explain the deviation in the next cell:
F. Additional Notes:

End of Worksheet

Sheet 14: Other BHC-Lead Measures

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Other BHC-Lead Measures Not Required for the CCBHC Demonstration Program
State Name:
BHC Name:
BHC Identifier:
End of Worksheet

Sheet 15: ROUT

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Routine Care Needs (ROUT)
A SAMHSA-Developed Metric
A. Measurement Year:
Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017.

B. Data Source:
Select the data source type (Medical Records or Other):
If medical records data, select source (EHR, Paper Records, Both):
If other data source selected, specify source:
No Data
C. Date Range:
Denominator Start Date (mm/dd/yyyy)
No Data
Denominator End Date (mm/dd/yyyy)
No Data
Numerator Start Date (mm/dd/yyyy)
No Data
Numerator End Date (mm/dd/yyyy)
No Data
D. Performance Measure:
Percentage of new consumers requesting services who were determined to need routine care
The measure is stratified to report Medicaid, Medicare & Medicaid, other, and total population.
Measure Numerator Denominator Rate
Medicaid


Medicare & Medicaid


Other


Total 0 0
E. Adherence to Measure Specifications:
Population included in the denominator (indicate yes or no for each of the options below):
Medicaid population
No Data
Title XIX-eligible CHIP population
No Data
Title XXI-eligible CHIP population
No Data
Other CHIP enrollees
No Data
Medicare population
No Data
Medicare and Medicaid Dually-Eligible population
No Data
VHA/TRICARE population
No Data
Commercially insured population
No Data
Uninsured population
No Data
Other
If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded:
Did your calculation of the measure deviate from the measure specification in any way?
If Yes, the measure differs: Explain how the calculation differed and why.
Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure?
If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell:
Specify the size of the population included in the denominator:
Specify the size of the measure-eligible population.
Provide the following information for each rate/stratification:
Medicaid Population:
Did the numerator differ for the Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicaid population?
If other, explain the deviation in the next cell:
Medicare & Medicaid Population:
Did the numerator differ for the Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Neither Medicaid nor Medicare & Medicaid Population:
Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Total Eligible Population:
Did the numerator differ for the Total Eligible population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Total Eligible population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Total Eligible population?
If other, explain the deviation in the next cell:
F. Additional Notes:

End of Worksheet

Sheet 16: TX-EVAL

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Time to Comprehensive Person- and Family-Centered Diagnostic and Treatment Planning Evaluation (TX-EVAL)
A SAMHSA-Developed Metric
A. Measurement Year:
Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017.

B. Data Source:
Select the data source type (Medical Records or Other):
If medical records data, select source (EHR, Paper Records, Both):
If other data source selected, specify source:
No Data
C. Date Range:
Denominator Start Date (mm/dd/yyyy)
No Data
Denominator End Date (mm/dd/yyyy)
No Data
Numerator Start Date (mm/dd/yyyy)
No Data
Numerator End Date (mm/dd/yyyy)
No Data
D. Performance Measure:
Mean number of days after first contact until comprehensive person-centered and family-centered diagnostic and treatment planning evaluation is performed for new consumers
These metrics are stratified to report by age (12–17 years, 18 years and older) and are stratified to report by Medicaid, Medicare & Medicaid, other, and total population.
Measure Numerator Denominator Mean
Age 12-17 years 0 0
Medicaid


Medicare & Medicaid


Other


Age 18+ years 0 0
Medicaid


Medicare & Medicaid


Other


Total (all Age Groups) 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
E. Adherence to Measure Specifications:
Population included in the denominator (indicate yes or no for each of the options below):
Medicaid population
No Data
Title XIX-eligible CHIP population
No Data
Title XXI-eligible CHIP population
No Data
Other CHIP enrollees
No Data
Medicare population
No Data
Medicare and Medicaid Dually-Eligible population
No Data
VHA/TRICARE population
No Data
Commercially insured population
No Data
Uninsured population
No Data
Other
If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded:
Did your calculation of the measure deviate from the measure specification in any way?
If Yes, the measure differs: Explain how the calculation differed and why.
Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure?
If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell:
Specify the size of the population included in the denominator:
Specify the size of the measure-eligible population.
Provide the following information for each rate/stratification:
Age Range: 12-17 years
Did the numerator differ for the 12-17 years age range?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the 12-17 years age range?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the 12-17 years age range?
If other, explain the deviation in the next cell:
Age Range: 18+ years
Did the numerator differ for the 18+ years age range?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the 18+ years age range?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the 18+ years age range?
If other, explain the deviation in the next cell:
Medicaid Population:
Did the numerator differ for the Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicaid population?
If other, explain the deviation in the next cell:
Medicare & Medicaid Population:
Did the numerator differ for the Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Neither Medicaid nor Medicare & Medicaid Population:
Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Total Eligible Population:
Did the numerator differ for the Total Eligible population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Total Eligible population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Total Eligible population?
If other, explain the deviation in the next cell:
F. Additional Notes:

End of Worksheet

Sheet 17: SUIC

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Deaths by Suicide (SUIC)
A SAMHSA-Developed Metric
A. Measurement Year:
Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017.

B. Data Source:
Select the data source type (Medical Records or Other):
If medical records data, select source (EHR, Paper Records, Both):
If other data source selected, specify source:
No Data
C. Date Range:
Denominator Start Date (mm/dd/yyyy)
No Data
Denominator End Date (mm/dd/yyyy)
No Data
Numerator Start Date (mm/dd/yyyy)
No Data
Numerator End Date (mm/dd/yyyy)
No Data
D. Performance Measure:
The percentage of consumers aged 12 years and older who died by suicide during the measurement year
These metrics are stratified to report by age (12-17 years, 18-64 years, 65 years and older, and total (all age groups) and are stratified to report by Medicaid, Medicare & Medicaid, other, and total population.
Measure Numerator Denominator Rate
Age 12-17 years 0 0
Medicaid


Medicare & Medicaid


Other


Age 18-64 years 0 0
Medicaid


Medicare & Medicaid


Other


Age 65+ years 0 0
Medicaid


Medicare & Medicaid


Other


Total (all Age Groups) 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
E. Adherence to Measure Specifications:
Population included in the denominator (indicate yes or no for each of the options below):
Medicaid population
No Data
Title XIX-eligible CHIP population
No Data
Title XXI-eligible CHIP population
No Data
Other CHIP enrollees
No Data
Medicare population
No Data
Medicare and Medicaid Dually-Eligible population
No Data
VHA/TRICARE population
No Data
Commercially insured population
No Data
Uninsured population
No Data
Other
If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded:
Did your calculation of the measure deviate from the measure specification in any way?
If Yes, the measure differs: Explain how the calculation differed and why.
Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure?
If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell:
Specify the size of the population included in the denominator:
Specify the size of the measure-eligible population.
Provide the following information for each rate/stratification:
Age Range: 12-17 years
Did the numerator differ for the 12-17 years age range?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the 12-17 years age range?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the 12-17 years age range?
If other, explain the deviation in the next cell:
Age Range: 18-64 years
Did the numerator differ for the 18-64 years age range?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the 18-64 years age range?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the 18-64 years age range?
If other, explain the deviation in the next cell:
Age Range: 65+ years
Did the numerator differ for the 65+ years age range?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the 65+ years age range?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the 65+ years age range?
If other, explain the deviation in the next cell:
Medicaid Population:
Did the numerator differ for the Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicaid population?
If other, explain the deviation in the next cell:
Medicare & Medicaid Population:
Did the numerator differ for the Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Neither Medicaid nor Medicare & Medicaid Population:
Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Total Eligible Population:
Did the numerator differ for the Total Eligible population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Total Eligible population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Total Eligible population?
If other, explain the deviation in the next cell:
F. Additional Notes:

End of Worksheet

Sheet 18: DOC

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Documentation of Current Medications in the Medical Record (DOC)
Based on a measure stewarded by the Centers for Medicare & Medicaid Services (NQF #0419, PQRS #130)
A. Measurement Year:
Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017.

B. Data Source:
Select the data source type (Medical Records or Other):
If medical records data, select source (EHR, Paper Records, Both):
If other data source selected, specify source:
No Data
C. Date Range:
Denominator Start Date (mm/dd/yyyy)
No Data
Denominator End Date (mm/dd/yyyy)
No Data
Numerator Start Date (mm/dd/yyyy)
No Data
Numerator End Date (mm/dd/yyyy)
No Data
D. Performance Measure:
The percentage of visits for consumers aged 18 years and older for which the eligible professional attests to documenting a list of current medications using all immediate resources available on the date of the encounter. This list must include ALL known prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications’ name, dosage, frequency, and route of administration.
The measure is stratified to report Medicaid, Medicare & Medicaid, other, and total population.
Measure Numerator Denominator Rate
Medicaid


Medicare & Medicaid


Other


Total 0 0
E. Adherence to Measure Specifications:
Population included in the denominator (indicate yes or no for each of the options below):
Medicaid population
No Data
Title XIX-eligible CHIP population
No Data
Title XXI-eligible CHIP population
No Data
Other CHIP enrollees
No Data
Medicare population
No Data
Medicare and Medicaid Dually-Eligible population
No Data
VHA/TRICARE population
No Data
Commercially insured population
No Data
Uninsured population
No Data
Other
If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded:
Did your calculation of the measure deviate from the measure specification in any way?
If Yes, the measure differs: Explain how the calculation differed and why.
Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure?
If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell:
Specify the size of the population included in the denominator:
Specify the size of the measure-eligible population.
Provide the following information for each rate/stratification:
Medicaid Population:
Did the numerator differ for the Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicaid population?
If other, explain the deviation in the next cell:
Medicare & Medicaid Population:
Did the numerator differ for the Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Neither Medicaid nor Medicare & Medicaid Population:
Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Total Eligible Population:
Did the numerator differ for the Total Eligible population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Total Eligible population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Total Eligible population?
If other, explain the deviation in the next cell:
F. Additional Notes:

End of Worksheet

Sheet 19: CBP-BH

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Controlling High Blood Pressure (CBP-BH)
Based on a measure stewarded by the National Committee for Quality Assurance (NQF #0018, HEDIS 2016, Medicaid Adult Core Set)
A. Measurement Year:
Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017.

B. Data Source:
Select the data source type:
No Data
If hybrid data, select administrative data source (Medicaid Management Information System (MMIS) or Other):
If other administrative hybrid data, specify data source:
If hybrid data, select medical records source (EHR, Paper Records, Both):
No Data
If hybrid data, what is the sample size?
No Data
If Hybrid, what is the measure-eligible population?
No Data
If source other than hybrid selected, provide source:
No Data
C. Date Range:
Denominator Start Date (mm/dd/yyyy)
No Data
Denominator End Date (mm/dd/yyyy)
No Data
Numerator Start Date (mm/dd/yyyy)
No Data
Numerator End Date (mm/dd/yyyy)
No Data
D. Performance Measure:
Percentage of consumers ages 18 to 85 who had a diagnosis of hypertension (HTN) and whose blood pressure (BP) was adequately controlled during the measurement year based on the following criteria:
• Consumers ages 18 to 59 whose BP was <140/90 mm Hg
• Consumers ages 60 to 85 with a diagnosis of diabetes whose BP was <140/90 mm Hg
• Consumers ages 60 to 85 without a diagnosis of diabetes whose BP was <150/90 mm Hg
Measure Numerator Denominator Rate
18-64 years 0 0
Medicaid


Medicare & Medicaid


Other


65-85 years 0 0
Medicaid


Medicare & Medicaid


Other


E. Adherence to Measure Specifications:
Population included in the denominator (indicate yes or no for each of the options below):
Medicaid population
No Data
Title XIX-eligible CHIP population
No Data
Title XXI-eligible CHIP population
No Data
Other CHIP enrollees
No Data
Medicare population
No Data
Medicare and Medicaid Dually-Eligible population
No Data
VHA/TRICARE population
No Data
Commercially insured population
No Data
Uninsured population
No Data
Other
If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded:
Did your calculation of the measure deviate from the measure specification in any way?
If Yes, the measure differs: Explain how the calculation differed and why.
Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure?
If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell:
Specify the size of the population included in the denominator:
Specify the size of the measure-eligible population.
Provide the following information for each rate/stratification:
Age Range: 18-64 years
Did the numerator differ for the 18-64 years age range?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the 18-64 years age range?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the 18-64 years age range?
If other, explain the deviation in the next cell:
Age Range: 65-85 years
Did the numerator differ for the 65+ years age range?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the 65+ years age range?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the 65+ years age range?
If other, explain the deviation in the next cell:
Medicaid Population:
Did the numerator differ for the Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicaid population?
If other, explain the deviation in the next cell:
Medicare & Medicaid Population:
Did the numerator differ for the Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Neither Medicaid nor Medicare & Medicaid Population:
Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population?
If other, explain the deviation in the next cell:
F. Additional Notes:

End of Worksheet

Sheet 20: State-Lead CCBHC Measures

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State-Lead Measures Required for the CCBHC Demonstration Program
State Name:
BHC Name:
BHC Identifier:
End of Worksheet

Sheet 21: HOU

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Housing Status (HOU)
A SAMHSA-Developed Metric
A. Measurement Year:
Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017.

B. Data Source:
Select the data source type (Uniform Reporting System (URS) or Other):
No Data
If other data source selected, specify source:
No Data
C. Date Range:
Measurement Year Part One Start Date (mm/dd/yyyy)
No Data
Measurement Year Part One End Date (mm/dd/yyyy)
No Data
Measurement Year Part Two Start Date (mm/dd/yyyy)
No Data
Measurement Year Part Two End Date (mm/dd/yyyy)
No Data
D. Performance Measure:
The percentage of consumers in 10 categories of living situation
Living situation Numerator Denominator Percentage
Private residence
0
Foster home
0
Residential care
0
Crisis residence
0
Residential treatment center
0
Institutional setting
0
Jail (correctional facility)
0
Homeless (shelter)
0
Other
0
Not available
0
Total 0 0
E. Adherence to Measure Specifications:
Population included in the denominator (indicate yes or no for each of the options below):
Medicaid population
No Data
Title XIX-eligible CHIP population
No Data
Title XXI-eligible CHIP population
No Data
Other CHIP enrollees
No Data
Medicare population
No Data
Medicare and Medicaid Dually-Eligible population
No Data
VHA/TRICARE population
No Data
Commercially insured population
No Data
Uninsured population
No Data
Other
If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded:
Did your calculation of the measure deviate from the measure specification in any way?
If Yes, the measure differs: Explain how the calculation differed and why.
Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure?
If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell:
Specify the size of the population included in the denominator:
Specify the size of the measure-eligible population.
F. Additional Notes:

End of Worksheet

Sheet 22: PEC

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Patient Experience of Care Survey (PEC )
A SAMHSA-Developed Metric
A. Measurement Year:
Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017.

B. Data Source:
Select the data source type (Mental Health Statistics Improvement Program (MHSIP) Adult Consumer Experience of Care Survey or Other):
No Data
If other data source selected, specify source:
No Data
C. Date Range:
Survey Start Date (mm/dd/yyyy)
No Data
Survey End Date (mm/dd/yyyy)
No Data
D. Performance Measure:
Annual completion and submission of Mental Health Statistics Improvement Program (MHSIP) Adult Consumer Experience of Care Survey, for the CCBHC Demonstration Program identifying results separately for CCBHCs and comparison clinics and oversampling those clinics.
For this BHC, complete a copy of Tables 11 and 11a of the URS reporting template that is current at the time of the survey (http://www.nri-inc.org/#!urs-forms--info/c1xvm) (Table 22A for the Mental Health Block Grant), including required information on sampling methodology and response rates. For CCBHCs, identify results separately for CCBHCs and comparison clinics.
E. Adherence to Measure Specifications:
Population included in the denominator (indicate yes or no for each of the options below):
Medicaid population
No Data
Title XIX-eligible CHIP population
No Data
Title XXI-eligible CHIP population
No Data
Other CHIP enrollees
No Data
Medicare population
No Data
Medicare and Medicaid Dually-Eligible population
No Data
VHA/TRICARE population
No Data
Commercially insured population
No Data
Uninsured population
No Data
Other
If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded:
Did your calculation of the measure deviate from the measure specification in any way?
If Yes, the measure differs, explain how the calculation differed and why:
If Yes, the measure differs, did you oversample this clinic?
If Yes, the measure differs, specify the size of the sample:
F. Additional Notes:

End of Worksheet

Sheet 23: YFEC

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Youth/Family Experience of Care Survey (Y/FEC )
A SAMHSA-Developed Metric
A. Measurement Year:
Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017.

B. Data Source:
Select the data source type (Youth/Family Services Survey for Families (YSS-F) Experience of Care Survey or Other):
No Data
If other data source selected, specify source:
No Data
C. Date Range:
Survey Start Date (mm/dd/yyyy)
No Data
Survey End Date (mm/dd/yyyy)
No Data
D. Performance Measure:
Annual completion and submission of Youth/Family Services Survey for Families (YSS-F) Experience of Care Survey, for the CCBHC Demonstration Program identifying results separately for CCBHCs and comparison clinics and oversampling those clinics.
For this BHC, complete a copy of Tables 11 and 11a of the URS reporting template that is current at the time of the survey (http://www.nri-inc.org/#!urs-forms--info/c1xvm (Table 22B for the Mental Health Block Grant)), including required information on sampling methodology and response rates. For CCBHCs, identify results separately for CCBHCs and comparison clinics.
E. Adherence to Measure Specifications:
Population included in the denominator (indicate yes or no for each of the options below):
Medicaid population
No Data
Title XIX-eligible CHIP population
No Data
Title XXI-eligible CHIP population
No Data
Other CHIP enrollees
No Data
Medicare population
No Data
Medicare and Medicaid Dually-Eligible population
No Data
VHA/TRICARE population
No Data
Commercially insured population
No Data
Uninsured population
No Data
Other
If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded:
Did your calculation of the measure deviate from the measure specification in any way?
If Yes, the measure differs, explain how the calculation differed and why:
If Yes, the measure differs, did you oversample this clinic?
If Yes, the measure differs, specify the size of the sample:
F. Additional Notes:

End of Worksheet

Sheet 24: FUM

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Follow-up After Emergency Department Visit for Mental Illness (FUM)
Based on a measure stewarded by the National Committee for Quality Assurance (Draft HEDIS 2017)
A. Measurement Year:
Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017.

B. Data Source:
Select the data source type:
No Data
If administrative data only, select source (Medicaid Management Information System (MMIS) or Other):
If other administrative data, specify data source:
If source other than administrative selected, provide source:
No Data
C. Date Range:
Denominator Start Date (mm/dd/yyyy)
No Data
Denominator End Date (mm/dd/yyyy)
No Data
Numerator Start Date (mm/dd/yyyy)
No Data
Numerator End Date (mm/dd/yyyy)
No Data
D. Performance Measure:
The percentage of emergency department (ED) visits for consumers 6 years of age and older with a primary diagnosis of mental illness, who had an outpatient visit, an intensive outpatient encounter or a partial hospitalization for mental illness. Two rates are reported:
1. The percentage of ED visits for which the consumer received follow-up within 30 days of the ED visit.
2. The percentage of ED visits for which the consumer received follow-up within 7 days of the ED visit.
The measure is stratified to report Medicaid, Medicare & Medicaid, other, and total population.
Measure Numerator Denominator Rate
ED MH Visits with 7 Day Follow-up
Medicaid


Medicare & Medicaid


Other


Total 0 0
ED MH Visits with 30 Day Follow-up
Medicaid


Medicare & Medicaid


Other


Total 0 0
E. Adherence to Measure Specifications:
Population included in the denominator (indicate yes or no for each of the options below):
Medicaid population
No Data
Title XIX-eligible CHIP population
No Data
Title XXI-eligible CHIP population
No Data
Other CHIP enrollees
No Data
Medicare population
No Data
Medicare and Medicaid Dually-Eligible population
No Data
VHA/TRICARE population
No Data
Commercially insured population
No Data
Uninsured population
No Data
Other
If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded:
Did your calculation of the measure deviate from the measure specification in any way?
If Yes, the measure differs: Explain how the calculation differed and why.
Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure?
If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell:
Specify the size of the population included in the denominator:
Specify the size of the measure-eligible population.
Provide the following information for each rate/stratification:
ED MH Visits with 7 Day Follow-up:
Medicaid Population:
Did the numerator differ for the Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicaid population?
If other, explain the deviation in the next cell:
Medicare & Medicaid Population:
Did the numerator differ for the Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Neither Medicaid nor Medicare & Medicaid Population:
Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Total Eligible Population:
Did the numerator differ for the Total Eligible population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Total Eligible population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Total Eligible population?
If other, explain the deviation in the next cell:
ED MH Visits with 30 Day Follow-up:
Medicaid Population:
Did the numerator differ for the Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicaid population?
If other, explain the deviation in the next cell:
Medicare & Medicaid Population:
Did the numerator differ for the Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Neither Medicaid nor Medicare & Medicaid Population:
Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Total Eligible Population:
Did the numerator differ for the Total Eligible population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Total Eligible population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Total Eligible population?
If other, explain the deviation in the next cell:
F. Additional Notes:

End of Worksheet

Sheet 25: FUA

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Follow-up After Emergency Department Visit for Alcohol and Other Drug Dependence (FUA)
Based on a measure stewarded by the National Committee for Quality Assurance (Draft HEDIS 2017)
A. Measurement Year:
Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017.

B. Data Source:
Select the data source type:
No Data
If administrative data only, select source (Medicaid Management Information System (MMIS) or Other):
If other administrative data, specify data source:
If source other than administrative selected, provide source:
No Data
C. Date Range:
Denominator Start Date (mm/dd/yyyy)
No Data
Denominator End Date (mm/dd/yyyy)
No Data
Numerator Start Date (mm/dd/yyyy)
No Data
Numerator End Date (mm/dd/yyyy)
No Data
D. Performance Measure:
The percentage of emergency department (ED) visits for consumers 13 years of age and older with a primary diagnosis of alcohol or other drug (AOD) dependence, who had an outpatient visit, an intensive outpatient encounter or a partial hospitalization for AOD. Two rates are reported:
1. The percentage of ED visits for which the consumer received follow-up within 30 days of the ED visit.
2. The percentage of ED visits for which the consumer received follow-up within 7 days of the ED visit.
The measure is stratified to report Medicaid, Medicare & Medicaid, other, and total population.
Measure Numerator Denominator Rate
ED AOD Visits with 7 Day Follow-up
Medicaid


Medicare & Medicaid


Other


Total 0 0
ED AOD Visits with 30 Day Follow-up
Medicaid


Medicare & Medicaid


Other


Total 0 0
E. Adherence to Measure Specifications:
Population included in the denominator (indicate yes or no for each of the options below):
Medicaid population
No Data
Title XIX-eligible CHIP population
No Data
Title XXI-eligible CHIP population
No Data
Other CHIP enrollees
No Data
Medicare population
No Data
Medicare and Medicaid Dually-Eligible population
No Data
VHA/TRICARE population
No Data
Commercially insured population
No Data
Uninsured population
No Data
Other
If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded:
Did your calculation of the measure deviate from the measure specification in any way?
If Yes, the measure differs: Explain how the calculation differed and why.
Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure?
If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell:
Specify the size of the population included in the denominator:
Specify the size of the measure-eligible population.
Provide the following information for each rate/stratification:
ED AOD Visits with 7 Day Follow-up:
Medicaid Population:
Did the numerator differ for the Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicaid population?
If other, explain the deviation in the next cell:
Medicare & Medicaid Population:
Did the numerator differ for the Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Neither Medicaid nor Medicare & Medicaid Population:
Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Total Eligible Population:
Did the numerator differ for the Total Eligible population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Total Eligible population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Total Eligible population?
If other, explain the deviation in the next cell:
ED AOD Visits with 30 Day Follow-up:
Medicaid Population:
Did the numerator differ for the Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicaid population?
If other, explain the deviation in the next cell:
Medicare & Medicaid Population:
Did the numerator differ for the Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Neither Medicaid nor Medicare & Medicaid Population:
Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Total Eligible Population:
Did the numerator differ for the Total Eligible population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Total Eligible population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Total Eligible population?
If other, explain the deviation in the next cell:
F. Additional Notes:

End of Worksheet

Sheet 26: PCR-BH

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Plan All-Cause Readmissions Rate (PCR-BH)
Based on a measure stewarded by the National Committee for Quality Assurance (NQF #1768, HEDIS 2016, Medicaid Adult Core Set)
A. Measurement Year:
Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017.

B. Data Source:
Select the data source type:
No Data
If administrative data only, select source (Medicaid Management Information System (MMIS) or Other):
If other administrative data, specify data source:
If source other than administrative selected, provide source:
No Data
C. Date Range:
Denominator Start Date (mm/dd/yyyy)
No Data
Denominator End Date (mm/dd/yyyy)
No Data
Numerator Start Date (mm/dd/yyyy)
No Data
Numerator End Date (mm/dd/yyyy)
No Data
D. Performance Measure:
For consumers age 18 and older, the number of acute inpatient stays during the measurement year that were followed by an unplanned acute readmission for any diagnosis within 30 days.
Data are reported in the following three categories:
Count of Index Hospital Stays (IHS)(denominator)
Count of 30-Day Readmissions (numerator)
Readmission Rate
The measure is stratified to report by age (18-64 years, 65 and older), and by the Medicaid, Medicare & Medicaid, and other population.
Measure Numerator Denominator Rate
18-64 years 0 0
Medicaid


Medicare & Medicaid


Other


65+ years 0 0
Medicaid


Medicare & Medicaid


Other


E. Adherence to Measure Specifications:
Population included in the denominator (indicate yes or no for each of the options below):
Medicaid population
No Data
Title XIX-eligible CHIP population
No Data
Title XXI-eligible CHIP population
No Data
Other CHIP enrollees
No Data
Medicare population
No Data
Medicare and Medicaid Dually-Eligible population
No Data
VHA/TRICARE population
No Data
Commercially insured population
No Data
Uninsured population
No Data
Other
If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded:
Did your calculation of the measure deviate from the measure specification in any way?
If Yes, the measure differs: Explain how the calculation differed and why.
Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure?
If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell:
Specify the size of the population included in the denominator:
Specify the size of the measure-eligible population.
Provide the following information for each rate/stratification:
Age Range: 18-64 years
Did the numerator differ for the 18-64 years age range?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the 18-64 years age range?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the 18-64 years age range?
If other, explain the deviation in the next cell:
Age Range: 65+ years
Did the numerator differ for the 65+ years age range?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the 65+ years age range?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the 65+ years age range?
If other, explain the deviation in the next cell:
Medicaid Population:
Did the numerator differ for the Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicaid population?
If other, explain the deviation in the next cell:
Medicare & Medicaid Population:
Did the numerator differ for the Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Neither Medicaid nor Medicare & Medicaid Population:
Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population?
If other, explain the deviation in the next cell:
F. Additional Notes:

End of Worksheet

Sheet 27: SSD

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Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications (SSD)
Based on a measure stewarded by the National Committee for Quality Assurance (NQF #1932, HEDIS 2016)
A. Measurement Year:
Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017.

B. Data Source:
Select the data source type:
No Data
If administrative data only, select source (Medicaid Management Information System (MMIS) or Other):
If other administrative data, specify data source:
If source other than administrative selected, provide source:
No Data
C. Date Range:
Denominator Start Date (mm/dd/yyyy)
No Data
Denominator End Date (mm/dd/yyyy)
No Data
Numerator Start Date (mm/dd/yyyy)
No Data
Numerator End Date (mm/dd/yyyy)
No Data
D. Performance Measure:
The percentage of consumers 18-64 years of age with Schizophrenia or Bipolar Disorder, who were dispensed an antipsychotic medication and had a diabetes screening test during the measurement year
The measure is stratified to report Medicaid, Medicare & Medicaid, other, and total population.
Measure Numerator Denominator Rate
Medicaid


Medicare & Medicaid


Other


Total 0 0
E. Adherence to Measure Specifications:
Population included in the denominator (indicate yes or no for each of the options below):
Medicaid population
No Data
Title XIX-eligible CHIP population
No Data
Title XXI-eligible CHIP population
No Data
Other CHIP enrollees
No Data
Medicare population
No Data
Medicare and Medicaid Dually-Eligible population
No Data
VHA/TRICARE population
No Data
Commercially insured population
No Data
Uninsured population
No Data
Other
If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded:
Did your calculation of the measure deviate from the measure specification in any way?
If Yes, the measure differs: Explain how the calculation differed and why.
Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure?
If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell:
Specify the size of the population included in the denominator:
Specify the size of the measure-eligible population.
Provide the following information for each rate/stratification:
Medicaid Population:
Did the numerator differ for the Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicaid population?
If other, explain the deviation in the next cell:
Medicare & Medicaid Population:
Did the numerator differ for the Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Neither Medicaid nor Medicare & Medicaid Population:
Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Total Eligible Population:
Did the numerator differ for the Total Eligible population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Total Eligible population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Total Eligible population?
If other, explain the deviation in the next cell:
F. Additional Notes:

End of Worksheet

Sheet 28: SAA-BH

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Adherence to Antipsychotic Medications for Individuals With Schizophrenia (SAA-BH)
Based on a measure stewarded by the Centers for Medicare and Medicaid Services (HEDIS 2016, Medicaid Adult Core Set)
A. Measurement Year:
Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017.

B. Data Source:
Select the data source type:
No Data
If administrative data only, select source (Medicaid Management Information System (MMIS) or Other):
If other administrative data, specify data source:
If source other than administrative selected, provide source:
No Data
C. Date Range:
Denominator Start Date (mm/dd/yyyy)
No Data
Denominator End Date (mm/dd/yyyy)
No Data
Numerator Start Date (mm/dd/yyyy)
No Data
Numerator End Date (mm/dd/yyyy)
No Data
D. Performance Measure:
The percentage of clients ages 19 to 64 during the measurement year with schizophrenia who were dispensed and remained on an antipsychotic medication for at least 80 percent of their treatment period.
The measure is stratified to report Medicaid, Medicare & Medicaid, neither, and total population.
Measure Numerator Denominator Rate
Medicaid


Medicare & Medicaid


Other


Total 0 0
E. Adherence to Measure Specifications:
Population included in the denominator (indicate yes or no for each of the options below):
Medicaid population
No Data
Title XIX-eligible CHIP population
No Data
Title XXI-eligible CHIP population
No Data
Other CHIP enrollees
No Data
Medicare population
No Data
Medicare and Medicaid Dually-Eligible population
No Data
VHA/TRICARE population
No Data
Commercially insured population
No Data
Uninsured population
No Data
Other
If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded:
Did your calculation of the measure deviate from the measure specification in any way?
If Yes, the measure differs: Explain how the calculation differed and why.
Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure?
If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell:
Specify the size of the population included in the denominator:
Specify the size of the measure-eligible population.
Provide the following information for each rate/stratification:
Medicaid Population:
Did the numerator differ for the Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicaid population?
If other, explain the deviation in the next cell:
Medicare & Medicaid Population:
Did the numerator differ for the Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Neither Medicaid nor Medicare & Medicaid Population:
Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Total Eligible Population:
Did the numerator differ for the Total Eligible population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Total Eligible population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Total Eligible population?
If other, explain the deviation in the next cell:
F. Additional Notes:

End of Worksheet

Sheet 29: FUH-BH-A

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Follow-up After Hospitalization for Mental Illness (FUH-BH-A)
Based on a measure stewarded by the National Committee for Quality Assurance (NQF #0576, HEDIS 2016, Medicaid Adult Core Set)
A. Measurement Year:
Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017.

B. Data Source:
Select the data source type:
No Data
If administrative data only, select source (Medicaid Management Information System (MMIS) or Other):
If other administrative data, specify data source:
If source other than administrative selected, provide source:
No Data
C. Date Range:
Denominator Start Date (mm/dd/yyyy)
No Data
Denominator End Date (mm/dd/yyyy)
No Data
30 Day Follow-up:
Numerator Start Date (mm/dd/yyyy)
No Data
Numerator End Date (mm/dd/yyyy)
No Data
7 Day Follow-up:
Numerator Start Date (mm/dd/yyyy)
No Data
Numerator End Date (mm/dd/yyyy)
No Data
D. Performance Measure:
The percentage of discharges for consumers age 21 and older who were hospitalized for treatment of selected mental illness diagnoses and who had an outpatient visit, an intensive outpatient encounter, or partial hospitalization with a mental health practitioner. Two rates are reported:
1. Percentage of discharges for which the consumer received follow-up within 30 days of discharge
2. Percentage of discharges for which the consumer received follow-up within 7 days of discharge
For each of those rates, the measure is stratified to report by age (21-64 years, 65 and older), and by the Medicaid, Medicare & Medicaid, and other population.
Measure Numerator Denominator Rate
30-Day Follow-up
21-64 years 0 0
Medicaid


Medicare & Medicaid


Other


65+ years 0 0
Medicaid


Medicare & Medicaid


Other


7-Day Follow-up
21-64 years 0 0
Medicaid


Medicare & Medicaid


Other


65+ years 0 0
Medicaid


Medicare & Medicaid


Other


E. Adherence to Measure Specifications:
Population included in the denominator (indicate yes or no for each of the options below):
Medicaid population
No Data
Title XIX-eligible CHIP population
No Data
Title XXI-eligible CHIP population
No Data
Other CHIP enrollees
No Data
Medicare population
No Data
Medicare and Medicaid Dually-Eligible population
No Data
VHA/TRICARE population
No Data
Commercially insured population
No Data
Uninsured population
No Data
Other
If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded:
Did your calculation of the measure deviate from the measure specification in any way?
If Yes, the measure differs: Explain how the calculation differed and why.
Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure?
If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell:
Specify the size of the population included in the denominator:
Specify the size of the measure-eligible population.
Provide the following information for each rate/stratification:
Follow-up Within 30 Days of Discharge:
Age Range: 21-64 years
Did the numerator differ for the 21-64 years age range?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the 21-64 years age range?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the 21-64 years age range?
If other, explain the deviation in the next cell:
Age Range: 65+ years
Did the numerator differ for the 65+ years age range?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the 65+ years age range?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the 65+ years age range?
If other, explain the deviation in the next cell:
Medicaid Population:
Did the numerator differ for the Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicaid population?
If other, explain the deviation in the next cell:
Medicare & Medicaid Population:
Did the numerator differ for the Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Neither Medicaid nor Medicare & Medicaid Population:
Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Follow-up Within 7 days of Discharge:
Age Range: 21-64 years
Did the numerator differ for the 21-64 years age range?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the 21-64 years age range?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the 21-64 years age range?
If other, explain the deviation in the next cell:
Age Range: 65+ years
Did the numerator differ for the 65+ years age range?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the 65+ years age range?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the 65+ years age range?
If other, explain the deviation in the next cell:
Medicaid Population:
Did the numerator differ for the Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicaid population?
If other, explain the deviation in the next cell:
Medicare & Medicaid Population:
Did the numerator differ for the Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Neither Medicaid nor Medicare & Medicaid Population:
Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population?
If other, explain the deviation in the next cell:
F. Additional Notes:

End of Worksheet

Sheet 30: FUH-BH-C

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Follow-Up After Hospitalization For Mental Illness (FUH-BH-C)
Based on a measure stewarded by the National Committee for Quality Assurance (NQF #0576, HEDIS 2016, Medicaid Child and Adolescent Core Set)
A. Measurement Year:
Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017.

B. Data Source:
Select the data source type:
No Data
If administrative data only, select source (Medicaid Management Information System (MMIS) or Other):
If other administrative data, specify data source:
If source other than administrative selected, provide source:
No Data
C. Date Range:
Denominator Start Date (mm/dd/yyyy)
No Data
Denominator End Date (mm/dd/yyyy)
No Data
30 Day Follow-up:
Numerator Start Date (mm/dd/yyyy)
No Data
Numerator End Date (mm/dd/yyyy)
No Data
7 Day Follow-up:
Numerator Start Date (mm/dd/yyyy)
No Data
Numerator End Date (mm/dd/yyyy)
No Data
D. Performance Measure:
Percentage of discharges for children and adolescents ages 6 to 20 who were hospitalized for treatment of selected mental illness diagnoses and who had an outpatient visit, an intensive outpatient encounter, or partial hospitalization with a mental health practitioner. Two rates are reported:
1. Percentage of discharges for which children received follow-up within 30 days of discharge
2. Percentage of discharges for which children received follow-up within 7 days of discharge
For each of those rates, the measure is stratified to report by the Medicaid, Medicare & Medicaid, other, and total population.
Measure Numerator Denominator Rate
30-Day Follow-up
Medicaid


Medicare & Medicaid


Other


Total 0 0
7-Day Follow-up
Medicaid


Medicare & Medicaid


Other


Total 0 0
E. Adherence to Measure Specifications:
Population included in the denominator (indicate yes or no for each of the options below):
Medicaid population
No Data
Title XIX-eligible CHIP population
No Data
Title XXI-eligible CHIP population
No Data
Other CHIP enrollees
No Data
Medicare population
No Data
Medicare and Medicaid Dually-Eligible population
No Data
VHA/TRICARE population
No Data
Commercially insured population
No Data
Uninsured population
No Data
Other
If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded:
Did your calculation of the measure deviate from the measure specification in any way?
If Yes, the measure differs: Explain how the calculation differed and why.
Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure?
If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell:
Specify the size of the population included in the denominator:
Specify the size of the measure-eligible population.
Provide the following information for each rate/stratification:
30-Day Follow-up
Medicaid Population:
Did the numerator differ for the Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicaid population?
If other, explain the deviation in the next cell:
Medicare & Medicaid Population:
Did the numerator differ for the Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Neither Medicaid nor Medicare & Medicaid Population:
Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population?
If other, explain the deviation in the next cell:
7-Day Follow-up
Medicaid Population:
Did the numerator differ for the Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicaid population?
If other, explain the deviation in the next cell:
Medicare & Medicaid Population:
Did the numerator differ for the Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Neither Medicaid nor Medicare & Medicaid Population:
Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population?
If other, explain the deviation in the next cell:
F. Additional Notes:

End of Worksheet

Sheet 31: ADD-BH

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Follow-up Care for Children Prescribed Attention-Deficit Hyperactivity Disorder (ADHD) Medication (ADD-BH)
Based on a measure stewarded by the National Committee for Quality Assurance (NQF #0108, Medicaid Child and Adolescent Core Set)
A. Measurement Year:
Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017.

B. Data Source:
Select the data source type:
No Data
If administrative data only, select source (Medicaid Management Information System (MMIS) or Other):
If other administrative data, specify data source:
If source other than administrative selected, provide source:
No Data
C. Date Range:
Index Prescription Start Date (IPSD):
Denominator Start Date (mm/dd/yyyy)
No Data
Denominator End Date (mm/dd/yyyy)
No Data
Negative Medication History Review:
Denominator Start Date (mm/dd/yyyy)
No Data
Denominator End Date (mm/dd/yyyy)
No Data
Initiation Phase:
Numerator Start Date (mm/dd/yyyy)
No Data
Numerator End Date (mm/dd/yyyy)
No Data
Continuation and Maintenance Phase:
Numerator Start Date (mm/dd/yyyy)
No Data
Numerator End Date (mm/dd/yyyy)
No Data
D. Performance Measure:
Percentage of children newly prescribed attention-deficit/hyperactivity disorder (ADHD) medication who had at least three follow-up care visits within a 10-month period, one of which was within 30 days of when the first ADHD medication was dispensed. Two rates are reported.
Initiation Phase: Percentage of children ages 6 to 12 as of the Index Prescription Start Date (IPSD) with an ambulatory prescription dispensed for ADHD medication who had one follow-up visit with practitioner with prescribing authority during the 30-day Initiation Phase.
Continuation and Maintenance (C&M) Phase: Percentage of children 6 to 12 years old as of the IPSD with an ambulatory prescription dispensed for ADHD medication who remained on the medication for at least 210 days and, in addition to the visit in the Initiation Phase, had at least two follow-up visits with a practitioner within 270 days (9 months) after the Initiation Phase ended.
For each of those rates, the measure is stratified to report by the Medicaid, Medicare & Medicaid, other, and total population.
Measure Numerator Denominator Rate
Initiation Phase
Medicaid


Medicare & Medicaid


Other


Total 0 0
Continuation & Maintenance Phase
Medicaid


Medicare & Medicaid


Other


Total 0 0
E. Adherence to Measure Specifications:
Population included in the denominator (indicate yes or no for each of the options below):
Medicaid population
No Data
Title XIX-eligible CHIP population
No Data
Title XXI-eligible CHIP population
No Data
Other CHIP enrollees
No Data
Medicare population
No Data
Medicare and Medicaid Dually-Eligible population
No Data
VHA/TRICARE population
No Data
Commercially insured population
No Data
Uninsured population
No Data
Other
If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded:
Did your calculation of the measure deviate from the measure specification in any way?
If Yes, the measure differs: Explain how the calculation differed and why.
Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure?
If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell:
Specify the size of the population included in the denominator:
Specify the size of the measure-eligible population.
Provide the following information for each rate/stratification:
Initiation Phase Treatment:
Medicaid Population:
Did the numerator differ for the Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicaid population?
If other, explain the deviation in the next cell:
Medicare & Medicaid Population:
Did the numerator differ for the Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Neither Medicaid nor Medicare & Medicaid Population:
Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Total Eligible Population:
Did the numerator differ for the Total Eligible population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Total Eligible population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Total Eligible population?
If other, explain the deviation in the next cell:
C&M Phase Treatment:
Medicaid Population:
Did the numerator differ for the Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicaid population?
If other, explain the deviation in the next cell:
Medicare & Medicaid Population:
Did the numerator differ for the Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Neither Medicaid nor Medicare & Medicaid Population:
Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Total Eligible Population:
Did the numerator differ for the Total Eligible population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Total Eligible population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Total Eligible population?
If other, explain the deviation in the next cell:
F. Additional Notes:

End of Worksheet

Sheet 32: AMM-BH

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Antidepressant Medication Management (AMM-BH)
Based on a measure stewarded by the National Committee for Quality Assurance (NQF #0105, HEDIS 2016, Medicaid Adult Core Set)
A. Measurement Year:
Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017.

B. Data Source:
Select the data source type:
No Data
If administrative data only, select source (Medicaid Management Information System (MMIS) or Other):
If other administrative data, specify data source:
If source other than administrative selected, provide source:
No Data
C. Date Range:
Index Prescription Start Date (IPSD):
Denominator Start Date (mm/dd/yyyy)
No Data
Denominator End Date (mm/dd/yyyy)
No Data
Negative Medication History Review:
Denominator Start Date (mm/dd/yyyy)
No Data
Denominator End Date (mm/dd/yyyy)
No Data
Acute Phase:
Numerator Start Date (mm/dd/yyyy)
No Data
Numerator End Date (mm/dd/yyyy)
No Data
Continuation Phase:
Numerator Start Date (mm/dd/yyyy)
No Data
Numerator End Date (mm/dd/yyyy)
No Data
D. Performance Measure:
The percentage of consumers age 18 and older who were treated with antidepressant medication, had a diagnosis of Major Depression and who remained on an antidepressant medication treatment. Two rates are reported:
1. Effective Acute Phase Treatment. Percentage of consumers who remained on an antidepressant medication for at least 84 days (12 weeks).
2. Effective Continuation Phase Treatment. Percentage of consumers who remained on an antidepressant medication for at least 180 days (6 months).
For each of those rates, the measure is stratified to report by age (18-64 years, 65 and older), and by the Medicaid, Medicare & Medicaid, and other population.
Measure Numerator Denominator Rate
Acute Phase
18-64 years 0 0
Medicaid


Medicare & Medicaid


Other


65+ years 0 0
Medicaid


Medicare & Medicaid


Other


Continuation & Maintenance Phase
18-64 years 0 0
Medicaid


Medicare & Medicaid


Other


65+ years 0 0
Medicaid


Medicare & Medicaid


Other


E. Adherence to Measure Specifications:
Population included in the denominator (indicate yes or no for each of the options below):
Medicaid population
No Data
Title XIX-eligible CHIP population
No Data
Title XXI-eligible CHIP population
No Data
Other CHIP enrollees
No Data
Medicare population
No Data
Medicare and Medicaid Dually-Eligible population
No Data
VHA/TRICARE population
No Data
Commercially insured population
No Data
Uninsured population
No Data
Other
If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded:
Did your calculation of the measure deviate from the measure specification in any way?
If Yes, the measure differs: Explain how the calculation differed and why.
Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure?
If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell:
Specify the size of the population included in the denominator:
Specify the size of the measure-eligible population.
Provide the following information for each rate/stratification:
Acute Phase Treatment:
Age Range: 18-64 years
Did the numerator differ for the 18-64 years age range?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the 18-64 years age range?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the 18-64 years age range?
If other, explain the deviation in the next cell:
Age Range: 65+ years
Did the numerator differ for the 65+ years age range?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the 65+ years age range?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the 65+ years age range?
If other, explain the deviation in the next cell:
Medicaid Population:
Did the numerator differ for the Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicaid population?
If other, explain the deviation in the next cell:
Medicare & Medicaid Population:
Did the numerator differ for the Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Neither Medicaid nor Medicare & Medicaid Population:
Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Continuation and Maintenance Phase Treatment:
Age Range: 18-64 years
Did the numerator differ for the 18-64 years age range?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the 18-64 years age range?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the 18-64 years age range?
If other, explain the deviation in the next cell:
Age Range: 65+ years
Did the numerator differ for the 65+ years age range?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the 65+ years age range?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the 65+ years age range?
If other, explain the deviation in the next cell:
Medicaid Population:
Did the numerator differ for the Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicaid population?
If other, explain the deviation in the next cell:
Medicare & Medicaid Population:
Did the numerator differ for the Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Neither Medicaid nor Medicare & Medicaid Population:
Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population?
If other, explain the deviation in the next cell:
F. Additional Notes:

End of Worksheet

Sheet 33: IET-BH

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Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (IET-BH)
Based on a measure stewarded by the National Committee for Quality Assurance (NQF #0004, HEDIS 2016)
A. Measurement Year:
Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017.

B. Data Source:
Select the data source type:
No Data
If administrative data only, select source (Medicaid Management Information System (MMIS) or Other):
If other administrative data, specify data source:
If source other than administrative selected, provide source:
No Data
C. Date Range:
Index Episode Start Date (IESD):
Denominator Start Date (mm/dd/yyyy)
No Data
Denominator End Date (mm/dd/yyyy)
No Data
Negative Diagnosis History Review:
Denominator Start Date (mm/dd/yyyy)
No Data
Denominator End Date (mm/dd/yyyy)
No Data
Initiation of AOD Treatment:
Numerator Start Date (mm/dd/yyyy)
No Data
Numerator End Date (mm/dd/yyyy)
No Data
Engagement of AOD Treatment:
Numerator Start Date (mm/dd/yyyy)
No Data
Numerator End Date (mm/dd/yyyy)
No Data
D. Performance Measure:
The percentage of consumers age 13 and older with a new episode of alcohol or other drug (AOD) dependence who received the following:
1. Initiated treatment through an inpatient AOD admission, outpatient visit, intensive outpatient encounter or partial hospitalization within 14 days of the diagnosis
2. Initiated treatment and who had two or more additional services with a diagnosis of AOD within 30 days of the initiation visit
For each of those rates, the measure is stratified to report by age (13-17, 18-64, 65 and older), and by the Medicaid, Medicare & Medicaid, and other population.
Measure Numerator Denominator Rate
Initiation of AOD Treatment
13-17 years 0 0
Medicaid


Medicare & Medicaid


Other


18-64 years 0 0
Medicaid


Medicare & Medicaid


Other


65+ years 0 0
Medicaid


Medicare & Medicaid


Other


Engagement of AOD Treatment
13-17 years 0 0
Medicaid


Medicare & Medicaid


Other


18-64 years 0 0
Medicaid


Medicare & Medicaid


Other


65+ years 0 0
Medicaid


Medicare & Medicaid


Other


E. Adherence to Measure Specifications:
Population included in the denominator (indicate yes or no for each of the options below):
Medicaid population
No Data
Title XIX-eligible CHIP population
No Data
Title XXI-eligible CHIP population
No Data
Other CHIP enrollees
No Data
Medicare population
No Data
Medicare and Medicaid Dually-Eligible population
No Data
VHA/TRICARE population
No Data
Commercially insured population
No Data
Uninsured population
No Data
Other
If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded:
Did your calculation of the measure deviate from the measure specification in any way?
If Yes, the measure differs: Explain how the calculation differed and why.
Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure?
If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell:
Specify the size of the population included in the denominator:
Specify the size of the measure-eligible population.
Provide the following information for each rate/stratification:
Initiation of AOD Treatment:
Age Range: 13-17 years
Did the numerator differ for the 13-17 years age range?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the 13-17 years age range?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the 13-17 years age range?
If other, explain the deviation in the next cell:
Age Range: 18-64 years
Did the numerator differ for the 18-64 years age range?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the 18-64 years age range?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the 18-64 years age range?
If other, explain the deviation in the next cell:
Age Range: 65+ years
Did the numerator differ for the 65+ years age range?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the 65+ years age range?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the 65+ years age range?
If other, explain the deviation in the next cell:
Medicaid Population:
Did the numerator differ for the Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicaid population?
If other, explain the deviation in the next cell:
Medicare & Medicaid Population:
Did the numerator differ for the Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Neither Medicaid nor Medicare & Medicaid Population:
Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Engagement of AOD Treatment:
Age Range: 13-17 years
Did the numerator differ for the 13-17 years age range?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the 13-17 years age range?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the 13-17 years age range?
If other, explain the deviation in the next cell:
Age Range: 18-64 years
Did the numerator differ for the 18-64 years age range?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the 18-64 years age range?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the 18-64 years age range?
If other, explain the deviation in the next cell:
Age Range: 65+ years
Did the numerator differ for the 65+ years age range?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the 65+ years age range?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the 65+ years age range?
If other, explain the deviation in the next cell:
Medicaid Population:
Did the numerator differ for the Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicaid population?
If other, explain the deviation in the next cell:
Medicare & Medicaid Population:
Did the numerator differ for the Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Neither Medicaid nor Medicare & Medicaid Population:
Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population?
If other, explain the deviation in the next cell:
F. Additional Notes:

End of Worksheet

Sheet 34: Other State-Lead Measures

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State-Lead Measures Not Required for the CCBHC Demonstration Program
State Name:
BHC Name:
BHC Identifier:
End of Worksheet

Sheet 35: SU-A

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Suicide Attempts (SU-A)
A SAMHSA-Developed Metric
A. Measurement Year:
Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017.

B. Data Source:
Select the data source type:
No Data
If administrative data only, select source (Medicaid Management Information System (MMIS) or Other):
If other administrative data, specify data source:
If source other than administrative selected, provide source:
No Data
C. Date Range:
Denominator Start Date (mm/dd/yyyy)
No Data
Denominator End Date (mm/dd/yyyy)
No Data
Numerator Start Date (mm/dd/yyyy)
No Data
Numerator End Date (mm/dd/yyyy)
No Data
D. Performance Measure:
The percentage of consumers aged 12 years and older who attempted suicide during the measurement year, where the suicide attempt resulted in injury requiring medical services
The measure is stratified to report by age (12–17 years, 18–64 years, 65 years and older, and total (all age groups)), and by the Medicaid, Medicare & Medicaid, other, and total population.
Measure Numerator Denominator Rate
12-17 years 0 0
Medicaid


Medicare & Medicaid


Other


18-64 years 0 0
Medicaid


Medicare & Medicaid


Other


65+ years 0 0
Medicaid


Medicare & Medicaid


Other


Total (all age groups) 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
E. Adherence to Measure Specifications:
Population included in the denominator (indicate yes or no for each of the options below):
Medicaid population
No Data
Title XIX-eligible CHIP population
No Data
Title XXI-eligible CHIP population
No Data
Other CHIP enrollees
No Data
Medicare population
No Data
Medicare and Medicaid Dually-Eligible population
No Data
VHA/TRICARE population
No Data
Commercially insured population
No Data
Uninsured population
No Data
Other
If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded:
Did your calculation of the measure deviate from the measure specification in any way?
If Yes, the measure differs: Explain how the calculation differed and why.
Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure?
If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell:
Specify the size of the population included in the denominator:
Specify the size of the measure-eligible population.
Provide the following information for each rate/stratification:
Age Range: 12-17 years
Did the numerator differ for the 12-17 years age range?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the 12-17 years age range?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the 12-17 years age range?
If other, explain the deviation in the next cell:
Age Range: 18-64 years
Did the numerator differ for the 18-64 years age range?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the 18-64 years age range?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the 18-64 years age range?
If other, explain the deviation in the next cell:
Age Range: 65+ years
Did the numerator differ for the 65+ years age range?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the 65+ years age range?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the 65+ years age range?
If other, explain the deviation in the next cell:
Medicaid Population:
Did the numerator differ for the Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicaid population?
If other, explain the deviation in the next cell:
Medicare & Medicaid Population:
Did the numerator differ for the Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Neither Medicaid nor Medicare & Medicaid Population:
Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Total Eligible Population:
Did the numerator differ for the Total Eligible population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Total Eligible population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Total Eligible population?
If other, explain the deviation in the next cell:
F. Additional Notes:

End of Worksheet

Sheet 36: SMI-PC

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Diabetes Care For People With Serious Mental Illness: Hemoglobin A1c (Hba1c) Poor Control (>9.0%) (SMI-PC)
Based on a measure stewarded by the National Committee for Quality Assurance (NQF #2607)
A. Measurement Year:
Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017.

B. Data Source:
Select the data source type:
No Data
If administrative data only, select source (Medicaid Management Information System (MMIS) or Other):
If other administrative data, specify data source:
If source other than administrative selected, provide source:
No Data
C. Date Range:
Denominator Start Date (mm/dd/yyyy)
No Data
Denominator End Date (mm/dd/yyyy)
No Data
Numerator Start Date (mm/dd/yyyy)
No Data
Numerator End Date (mm/dd/yyyy)
No Data
D. Performance Measure:
The percentage of consumers 18–75 years of age with a serious mental illness and diabetes (type 1 and type 2) whose most recent Hemoglobin A1c (HbA1c) level during the measurement year is >9.0%.
The measure is stratified to report Medicaid, Medicare & Medicaid, other, and total population.
Measure Numerator Denominator Rate
Medicaid


Medicare & Medicaid


Other


Total 0 0
E. Adherence to Measure Specifications:
Population included in the denominator (indicate yes or no for each of the options below):
Medicaid population
No Data
Title XIX-eligible CHIP population
No Data
Title XXI-eligible CHIP population
No Data
Other CHIP enrollees
No Data
Medicare population
No Data
Medicare and Medicaid Dually-Eligible population
No Data
VHA/TRICARE population
No Data
Commercially insured population
No Data
Uninsured population
No Data
Other
If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded:
Did your calculation of the measure deviate from the measure specification in any way?
If Yes, the measure differs: Explain how the calculation differed and why.
Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure?
If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell:
Specify the size of the population included in the denominator:
Specify the size of the measure-eligible population.
Provide the following information for each rate/stratification:
Medicaid Population:
Did the numerator differ for the Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicaid population?
If other, explain the deviation in the next cell:
Medicare & Medicaid Population:
Did the numerator differ for the Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Neither Medicaid nor Medicare & Medicaid Population:
Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Total Eligible Population:
Did the numerator differ for the Total Eligible population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Total Eligible population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Total Eligible population?
If other, explain the deviation in the next cell:
F. Additional Notes:

End of Worksheet

Sheet 37: APM

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Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM)
Based on a measure stewarded by the National Committee for Quality Assurance (HEDIS 2016)
A. Measurement Year:
Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017.

B. Data Source:
Select the data source type:
No Data
If administrative data only, select source (Medicaid Management Information System (MMIS) or Other):
If other administrative data, specify data source:
If source other than administrative selected, provide source:
No Data
C. Date Range:
Denominator Start Date (mm/dd/yyyy)
No Data
Denominator End Date (mm/dd/yyyy)
No Data
Numerator Start Date (mm/dd/yyyy)
No Data
Numerator End Date (mm/dd/yyyy)
No Data
D. Performance Measure:
The percentage of children and adolescents aged 1–17 years who had two or more antipsychotic prescriptions and had metabolic testing
The measure is stratified to report by age (1-5 years, 6-11, 12-17, and total), and by the Medicaid, Medicare & Medicaid, other, and total population.
Measure Numerator Denominator Rate
1-5 years 0 0
Medicaid


Medicare & Medicaid


Other


6-11 years 0 0
Medicaid


Medicare & Medicaid


Other


12-17 years 0 0
Medicaid


Medicare & Medicaid


Other


Total (all age groups) 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
E. Adherence to Measure Specifications:
Population included in the denominator (indicate yes or no for each of the options below):
Medicaid population
No Data
Title XIX-eligible CHIP population
No Data
Title XXI-eligible CHIP population
No Data
Other CHIP enrollees
No Data
Medicare population
No Data
Medicare and Medicaid Dually-Eligible population
No Data
VHA/TRICARE population
No Data
Commercially insured population
No Data
Uninsured population
No Data
Other
If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded:
Did your calculation of the measure deviate from the measure specification in any way?
If Yes, the measure differs: Explain how the calculation differed and why.
Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure?
If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell:
Specify the size of the population included in the denominator:
Specify the size of the measure-eligible population.
Provide the following information for each rate/stratification:
Age Range: 1-5 years
Did the numerator differ for the 1-5 years age range?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the 1-5 years age range?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the 1-5 years age range?
If other, explain the deviation in the next cell:
Age Range: 6-11 years
Did the numerator differ for the 6-11 years age range?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the 6-11 years age range?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the 6-11 years age range?
If other, explain the deviation in the next cell:
Age Range: 12-17 years
Did the numerator differ for the 12-17 years age range?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the 12-17 years age range?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the 12-17 years age range?
If other, explain the deviation in the next cell:
Medicaid Population:
Did the numerator differ for the Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicaid population?
If other, explain the deviation in the next cell:
Medicare & Medicaid Population:
Did the numerator differ for the Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Neither Medicaid nor Medicare & Medicaid Population:
Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Total Eligible Population:
Did the numerator differ for the Total Eligible population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Total Eligible population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Total Eligible population?
If other, explain the deviation in the next cell:
F. Additional Notes:

End of Worksheet

Sheet 38: SMC

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Cardiovascular Monitoring for People With Cardiovascular Disease and Schizophrenia (SMC)
Based on measure stewarded by the National Committee for Quality Assurance (NQF #1933, HEDIS 2016)
A. Measurement Year:
Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017.

B. Data Source:
Select the data source type:
No Data
If administrative data only, select source (Medicaid Management Information System (MMIS) or Other):
If other administrative data, specify data source:
If source other than administrative selected, provide source:
No Data
C. Date Range:
Denominator Start Date (mm/dd/yyyy)
No Data
Denominator End Date (mm/dd/yyyy)
No Data
Numerator Start Date (mm/dd/yyyy)
No Data
Numerator End Date (mm/dd/yyyy)
No Data
D. Performance Measure:
The percentage of consumers 18–64 years of age with Schizophrenia and cardiovascular disease, who had an LDL-C test during the measurement year
The measure is stratified to report Medicaid, Medicare & Medicaid, other, and total population.
Measure Numerator Denominator Rate
Medicaid


Medicare & Medicaid


Other


Total 0 0
E. Adherence to Measure Specifications:
Population included in the denominator (indicate yes or no for each of the options below):
Medicaid population
No Data
Title XIX-eligible CHIP population
No Data
Title XXI-eligible CHIP population
No Data
Other CHIP enrollees
No Data
Medicare population
No Data
Medicare and Medicaid Dually-Eligible population
No Data
VHA/TRICARE population
No Data
Commercially insured population
No Data
Uninsured population
No Data
Other
If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded:
Did your calculation of the measure deviate from the measure specification in any way?
If Yes, the measure differs: Explain how the calculation differed and why.
Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure?
If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell:
Specify the size of the population included in the denominator:
Specify the size of the measure-eligible population.
Provide the following information for each rate/stratification:
Medicaid Population:
Did the numerator differ for the Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicaid population?
If other, explain the deviation in the next cell:
Medicare & Medicaid Population:
Did the numerator differ for the Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Neither Medicaid nor Medicare & Medicaid Population:
Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Total Eligible Population:
Did the numerator differ for the Total Eligible population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Total Eligible population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Total Eligible population?
If other, explain the deviation in the next cell:
F. Additional Notes:

End of Worksheet

Sheet 39: AMS-BD

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Adherence to Mood Stabilizers for Individuals with Bipolar I Disorder (AMS-BD)
Based on a measure stewarded by the Centers for Medicare & Medicaid Services (NQF #1880)
A. Measurement Year:
Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017.

B. Data Source:
Select the data source type:
No Data
If administrative data only, select source (Medicaid Management Information System (MMIS) or Other):
If other administrative data, specify data source:
If source other than administrative selected, provide source:
No Data
C. Date Range:
Denominator Start Date (mm/dd/yyyy)
No Data
Denominator End Date (mm/dd/yyyy)
No Data
Numerator Start Date (mm/dd/yyyy)
No Data
Numerator End Date (mm/dd/yyyy)
No Data
D. Performance Measure:
The percentage of consumers at least 18 years of age as of the beginning of the measurement period with Bipolar I Disorder who had at least two prescription drug claims for mood stabilizer medications and had a Proportion of Days Covered (PDC) of at least 0.8 for mood stabilizer medications during the measurement period (12 consecutive months).
The measure is stratified to report Medicaid, Medicare & Medicaid, other, and total population.
Measure Numerator Denominator Rate
Medicaid


Medicare & Medicaid


Other


Total 0 0
E. Adherence to Measure Specifications:
Population included in the denominator (indicate yes or no for each of the options below):
Medicaid population
No Data
Title XIX-eligible CHIP population
No Data
Title XXI-eligible CHIP population
No Data
Other CHIP enrollees
No Data
Medicare population
No Data
Medicare and Medicaid Dually-Eligible population
No Data
VHA/TRICARE population
No Data
Commercially insured population
No Data
Uninsured population
No Data
Other
If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded:
Did your calculation of the measure deviate from the measure specification in any way?
If Yes, the measure differs: Explain how the calculation differed and why.
Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure?
If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell:
Specify the size of the population included in the denominator:
Specify the size of the measure-eligible population.
Provide the following information for each rate/stratification:
Medicaid Population:
Did the numerator differ for the Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicaid population?
If other, explain the deviation in the next cell:
Medicare & Medicaid Population:
Did the numerator differ for the Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Neither Medicaid nor Medicare & Medicaid Population:
Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population?
If other, explain the deviation in the next cell:
Total Eligible Population:
Did the numerator differ for the Total Eligible population?
If numerator differs, explain the deviation in the next cell:
Did the denominator differ for the Total Eligible population?
If denominator differs, explain the deviation in the next cell:
Did the calculation differ in some other way for the Total Eligible population?
If other, explain the deviation in the next cell:
F. Additional Notes:

End of Worksheet

Sheet 40: Roll-up Report

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Roll-up All Measures
BHC-Lead CCBHC-Required Measures
Time to Initial Evaluation (I-EVAL)
Metric #1:Percentage of New Clients with Initial Evaluation within 10 Business Days
Measure Numerator Denominator Percentage
Age 12-17 years 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
Age 18+ years 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
Total (all age groups) 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
Metric #2: Mean Number of Days until Initial Evaluation
Measure Numerator Denominator Mean
Age 12-17 years 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
Age 18+ years 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
Total (all age groups) 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
No Data - Continue to next measure roll-up
Preventive Care and Screening: Adult Body Mass Index (BMI) Screening and Follow-Up (BMI-SF)
Measure Numerator Denominator Rate
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
Total 0 0
No Data - Continue to next measure roll-up
Weight Assessment for Children/Adolescents:Body Mass Index Assessment for Children/Adolescents (WCC-BH)
Measure Numerator Denominator Rate
3-11 years
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
Total 0 0
12-17 years
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
Total 0 0
No Data - Continue to next measure roll-up
Preventive Care & Screening:Tobacco Use: Screening & Cessation Intervention (TSC)
CCBHC required measure
Measure Numerator Denominator Rate
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
Total 0 0
No Data - Continue to next measure roll-up
Preventive Care and Screening: Unhealthy Alcohol Use: Screening & Brief Counseling (ASC)
Measure Numerator Denominator Rate
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
Total 0 0
No Data - Continue to next measure roll-up
Child and Adolescent Major Depressive Disorder: Suicide Risk Assessment (SRA-BH-C)
Measure Numerator Denominator Rate
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
Total 0 0
No Data - Continue to next measure roll-up
Adult Major Depressive Disorder (MDD): Suicide Risk Assessment (SRA-A)
Measure Numerator Denominator Rate
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
Total 0 0
No Data - Continue to next measure roll-up
Screening for Clinical Depression and Follow-up Plan (CDF-BH)
Measure Numerator Denominator Rate
12-17 years 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
18-64 years 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
65+ years 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
No Data - Continue to next measure roll-up
Depression Remission at Twelve Months (DEP-REM-12)
Measure Numerator Denominator Rate
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
Total 0 0
No Data - Continue to next measure roll-up
Other BHC-Lead Measures
Routine Care Needs (ROUT)
Measure Numerator Denominator Rate
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
Total 0 0
No Data - Continue to next measure roll-up
Time to Comprehensive Person- and Family-Centered Diagnostic and Treatment Planning Evaluation (TX-EVAL)
Measure Numerator Denominator Mean
Age 12-17 years 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
Age 18+ years 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
Total (all age groups) 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
No Data - Continue to next measure roll-up
Deaths by Suicide (SUIC)
Measure Numerator Denominator Rate
12-17 years 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
18-64 years 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
65 years and older 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
Total (all age groups) 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
No Data - Continue to next measure roll-up
Documentation of Current Medications in the Medical Record (DOC)
Measure Numerator Denominator Rate
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
Total 0 0
No Data - Continue to next measure roll-up
Controlling High Blood Pressure (CBP-BH)
Measure Numerator Denominator Rate
18-64 years 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
65-85 years 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
No Data - Continue to next measure roll-up
State-Lead CCBHC-Required Measures
Housing Status (HOU)
Living Situation Numerator Denominator Percentage
Private residence 0 0
Foster home 0 0
Residential care 0 0
Crisis residence 0 0
Residential treatment center 0 0
Institutional setting 0 0
Jail (correctional facility) 0 0
Homeless (shelter) 0 0
Other 0 0
Not Available 0 0
Total 0 0
No Data - Continue to next measure roll-up
Patient Experience of Care Survey (PEC)
For this BHC, complete a copy of Tables 11 and 11a of the URS reporting template that is current at the time of the survey (http://www.nri-inc.org/#!urs-forms--info/c1xvm) (Table 22A for the Mental Health Block Grant), including required information on sampling methodology and response rates.For CCBHCs, identify results separately for CCBHCs and comparison clinics.
Youth/Family Experience of Care Survey (Y/FEC )
For this BHC, complete a copy of Tables 11 and 11a of the URS reporting template that is current at the time of the survey (http://www.nri-inc.org/#!urs-forms--info/c1xvm (Table 22B for the Mental Health Block Grant)), including required information on sampling methodology and response rates.For CCBHCs, identify results separately for CCBHCs and comparison clinics.
No Data - Continue to next measure roll-up
Follow-up After Emergency Department Visit for Mental Illness (FUM)
Measure Numerator Denominator Rate
ED MH Visits with 7 Day Follow-up
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
Total 0 0
ED MH Visits with 30 Day Follow-up
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
Total 0 0
No Data - Continue to next measure roll-up
Follow-up After Emergency Department Visit for Alcohol and Other Drug Dependence (FUA)
Measure Numerator Denominator Rate
ED AOD Visits with 7 Day Follow-up
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
Total 0 0
ED AOD Visits with 30 Day Follow-up
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
Total 0 0
No Data - Continue to next measure roll-up
Plan All-Cause Readmissions Rate (PCR-BH)
Measure Numerator Denominator Rate
18-64 years 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
65+ years 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
No Data - Continue to next measure roll-up
Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications (SSD)
Measure Numerator Denominator Rate
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
Total 0 0
No Data - Continue to next measure roll-up
Adherence to Antipsychotic Medications for Individuals With Schizophrenia (SAA-BH)
Measure Numerator Denominator Rate
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
Total 0 0
No Data - Continue to next measure roll-up
Follow-up After Hospitalization for Mental Illness (FUH-BH-A)
Measure Numerator Denominator Rate
30-Day Follow-up


21-64 years 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
65+ years 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
7-Day Follow-up


21-64 years 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
65+ years 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
No Data - Continue to next measure roll-up
Follow-Up After Hospitalization For Mental Illness (FUH-BH-C)
Measure Numerator Denominator Rate
30-Day Follow-up
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
Total 0 0
7-Day Follow-up


Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
Total 0 0
No Data - Continue to next measure roll-up
Follow-up Care for Children Prescribed Attention-Deficit Hyperactivity Disorder (ADHD) Medication (ADD-BH)
Measure Numerator Denominator Rate
Initiation Phase


Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
Total 0 0
Continuation & Maintenance Phase
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
Total 0 0
No Data - Continue to next measure roll-up
Antidepressant Medication Management (AMM-BH)
Measure Numerator Denominator Rate
Acute Phase


18-64 years 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
65+ years 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
Continuation and Maintenance Phase
18-64 years 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
65+ years 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
No Data - Continue to next measure roll-up
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (IET-BH)
Measure Numerator Denominator Rate
Initiation of AOD Treatment
13-17 years 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
18-64 years 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
65+ years 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
Engagement of AOD Treatment
13-17 years 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
18-64 years 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
65+ years 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
No Data - Continue to next measure roll-up
Other State-Lead Measures
Suicide Attempts (SU-A)
Measure Numerator Denominator Rate
12-17 years 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
18-64 years 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
65 years and older 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
Total (all age groups) 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
No Data - Continue to next measure roll-up
Diabetes Care For People With Serious Mental Illness: Hemoglobin A1c (Hba1c) Poor Control (>9.0%) (SMI-PC)
Measure Numerator Denominator Rate
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
Total 0 0
No Data - Continue to next measure roll-up
Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM)
Measure Numerator Denominator Rate
1-5 years 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
6-11 years 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
12-17 years 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
Total (all age groups) 0 0
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
No Data - Continue to next measure roll-up
Cardiovascular Monitoring for People With Cardiovascular Disease and Schizophrenia (SMC)
Measure Numerator Denominator Rate
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
Total 0 0
No Data - Continue to next measure roll-up
Adherence to Mood Stabilizers for Individuals with Bipolar I Disorder (AMS-BD)
Measure Numerator Denominator Rate
Medicaid 0 0
Medicare & Medicaid 0 0
Other 0 0
Total 0 0





Sheet 41: BHC Measurement Periods

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Table 1. BHC-Reported Measures Measurement Periods (MPs) for CCBHCs -- Demonstration Years (DY) 1 and 2
Factor and Time Period Routine Care Needs





(ROUT)
Time to Initial Evaluation





(I-EVAL)
Time to Comprehensive Person- and Family-Centered Diagnostic and Treatment Planning Evaluation



(TX-EVAL)
Deaths by Suicide





(SUIC)
Documentation of Current Medications in the Medical Record




(DOC)
Preventive Care and Screening: Adult Body Mass Index (BMI) Screening and Follow-Up



(BMI-SF)
Weight Assessment for Children/Adolescents: Body Mass Index Assessment for Children/Adolescents


(WCC-BH)
Controlling High Blood Pressure





(CBP-BH)
Preventive Care & Screening: Tobacco Use: Screening & Cessation Intervention



(TSC)
Preventive Care and Screening: Unhealthy Alcohol Use: Screening & Brief Counseling



(ASC)
Child and Adolescent Major Depressive Disorder: Suicide Risk Assessment



(SRA-BH-C)
Adult Major Depressive Disorder (MDD): Suicide Risk Assessment




(SRA-BH-A)
Screening for Clinical Depression and Follow-up Plan




(CDF-BH)
Depression Remission at Twelve Months




(DEP-REM-12)
Denominator MP - DY1 July 1, 2016 – Dec. 31, 2017 July 1, 2016 – Dec. 1, 2017 July 1, 2016 – Oct. 2, 2017 Jan. 1, 2017 – Dec. 31, 2017 Jan. 1, 2017 – Dec. 31, 2017 Jan. 1, 2017 – Dec. 31, 2017 Jan. 1, 2017 – Dec. 31, 2017 Jan. 1, 2017 – Dec. 31, 2017 Jan. 1, 2017 – Dec. 31, 2017 Jan. 1, 2017 – Dec. 31, 2017 Jan. 1, 2017 – Dec. 31, 2017 Jan. 1, 2017 – Dec. 31, 2017 Jan. 1, 2017 – Dec. 31, 2017 Jan. 1, 2017 – Dec. 31, 2017
Denominator MP - DY1 Aug. 1, 2016 – Jan. 31, 2018 Aug. 1, 2016 – Jan. 1, 2018 Aug. 1, 2016 – Nov. 2, 2017 Feb. 1, 2017 – Jan. 31, 2018 Feb. 1, 2017 – Jan. 31, 2018 Feb. 1, 2017 – Jan. 31, 2018 Feb. 1, 2017 – Jan. 31, 2018 Feb. 1, 2017 – Jan. 31, 2018 Feb. 1, 2017 – Jan. 31, 2018 Feb. 1, 2017 – Jan. 31, 2018 Feb. 1, 2017 – Jan. 31, 2018 Feb. 1, 2017 – Jan. 31, 2018 Feb. 1, 2017 – Jan. 31, 2018 Feb. 1, 2017 – Jan. 31, 2018
Denominator MP - DY1 Sept. 1, 2016 – Feb. 28, 2018 Sept. 1, 2016 – Jan. 29, 2018 Sept. 1, 2016 – Nov. 30, 2017 March 1, 2017 – Feb. 28, 2018 March 1, 2017 – Feb. 28, 2018 March 1, 2017 – Feb. 28, 2018 March 1, 2017 – Feb. 28, 2018 March 1, 2017 – Feb. 28, 2018 March 1, 2017 – Feb. 28, 2018 March 1, 2017 – Feb. 28, 2018 March 1, 2017 – Feb. 28, 2018 March 1, 2017 – Feb. 28, 2018 March 1, 2017 – Feb. 28, 2018 March 1, 2017 – Feb. 28, 2018
Denominator MP - DY1 Oct. 1, 2016 – March 31, 2018 Oct. 1, 2016 – March 1, 2018 Oct. 1, 2016 – Dec. 31, 2017 April 1, 2017 – March 31, 2018 April 1, 2017 – March 31, 2018 April 1, 2017 – March 31, 2018 April 1, 2017 – March 31, 2018 April 1, 2017 – March 31, 2018 April 1, 2017 – March 31, 2018 April 1, 2017 – March 31, 2018 April 1, 2017 – March 31, 2018 April 1, 2017 – March 31, 2018 April 1, 2017 – March 31, 2018 April 1, 2017 – March 31, 2018
Denominator MP - DY1 Nov. 1, 2016 – April 30, 2018 Nov. 1, 2016 – March 31, 2018 Nov. 1, 2016 – Jan. 30, 2018 May 1, 2017 – April 30, 2018 May 1, 2017 – April 30, 2018 May 1, 2017 – April 30, 2018 May 1, 2017 – April 30, 2018 May 1, 2017 – April 30, 2018 May 1, 2017 – April 30, 2018 May 1, 2017 – April 30, 2018 May 1, 2017 – April 30, 2018 May 1, 2017 – April 30, 2018 May 1, 2017 – April 30, 2018 May 1, 2017 – April 30, 2018
Denominator MP - DY1 Dec. 1, 2016 – May 31, 2018 Dec. 1, 2016 – May 1, 2018 Dec. 1, 2016 – March 2, 2018 June 1, 2017 – May 31, 2018 June 1, 2017 – May 31, 2018 June 1, 2017 – May 31, 2018 June 1, 2017 – May 31, 2018 June 1, 2017 – May 31, 2018 June 1, 2017 – May 31, 2018 June 1, 2017 – May 31, 2018 June 1, 2017 – May 31, 2018 June 1, 2017 – May 31, 2018 June 1, 2017 – May 31, 2018 June 1, 2017 – May 31, 2018
Denominator MP - DY1 Jan. 1, 2017 – June 30, 2018 Jan. 1, 2017 – May 31, 2018 Jan. 1, 2017 – April 1, 2018 July 1, 2017 – June 30, 2018 July 1, 2017 – June 30, 2018 July 1, 2017 – June 30, 2018 July 1, 2017 – June 30, 2018 July 1, 2017 – June 30, 2018 July 1, 2017 – June 30, 2018 July 1, 2017 – June 30, 2018 July 1, 2017 – June 30, 2018 July 1, 2017 – June 30, 2018 July 1, 2017 – June 30, 2018 July 1, 2017 – June 30, 2018
Denominator MP - DY2 July 1, 2017 – Dec. 31, 2018 July 1, 2017 – Dec. 1, 2018 July 1, 2017 – Oct. 2, 2018 Jan. 1, 2018 – Dec. 31, 2018 Jan. 1, 2018 – Dec. 31, 2018 Jan. 1, 2018 – Dec. 31, 2018 Jan. 1, 2018 – Dec. 31, 2018 Jan. 1, 2018 – Dec. 31, 2018 Jan. 1, 2018 – Dec. 31, 2018 Jan. 1, 2018 – Dec. 31, 2018 Jan. 1, 2018 – Dec. 31, 2018 Jan. 1, 2018 – Dec. 31, 2018 Jan. 1, 2018 – Dec. 31, 2018 Jan. 1, 2018 – Dec. 31, 2018
Denominator MP - DY2 Aug. 1, 2017 – Jan. 31, 2019 Aug. 1, 2017 – Jan. 1, 2019 Aug. 1, 2017 – Nov. 2, 2018 Feb. 1, 2018 – Jan. 31, 2019 Feb. 1, 2018 – Jan. 31, 2019 Feb. 1, 2018 – Jan. 31, 2019 Feb. 1, 2018 – Jan. 31, 2019 Feb. 1, 2018 – Jan. 31, 2019 Feb. 1, 2018 – Jan. 31, 2019 Feb. 1, 2018 – Jan. 31, 2019 Feb. 1, 2018 – Jan. 31, 2019 Feb. 1, 2018 – Jan. 31, 2019 Feb. 1, 2018 – Jan. 31, 2019 Feb. 1, 2018 – Jan. 31, 2019
Denominator MP - DY2 Sept. 1, 2017 – Feb. 28, 2019 Sept. 1, 2017 – Jan. 29, 2019 Sept. 1, 2017 – Nov. 30, 2018 March 1, 2018 – Feb. 28, 2019 March 1, 2018 – Feb. 28, 2019 March 1, 2018 – Feb. 28, 2019 March 1, 2018 – Feb. 28, 2019 March 1, 2018 – Feb. 28, 2019 March 1, 2018 – Feb. 28, 2019 March 1, 2018 – Feb. 28, 2019 March 1, 2018 – Feb. 28, 2019 March 1, 2018 – Feb. 28, 2019 March 1, 2018 – Feb. 28, 2019 March 1, 2018 – Feb. 28, 2019
Denominator MP - DY2 Oct. 1, 2017 – March 31, 2019 Oct. 1, 2017 – March 1, 2019 Oct. 1, 2017 – Dec. 31, 2018 April 1, 2018 – March 31, 2019 April 1, 2018 – March 31, 2019 April 1, 2018 – March 31, 2019 April 1, 2018 – March 31, 2019 April 1, 2018 – March 31, 2019 April 1, 2018 – March 31, 2019 April 1, 2018 – March 31, 2019 April 1, 2018 – March 31, 2019 April 1, 2018 – March 31, 2019 April 1, 2018 – March 31, 2019 April 1, 2018 – March 31, 2019
Denominator MP - DY2 Nov. 1, 2017 – April 30, 2019 Nov. 1, 2017 – March 31, 2019 Nov. 1, 2017 – Jan. 30, 2019 May 1, 2018 – April 30, 2019 May 1, 2018 – April 30, 2019 May 1, 2018 – April 30, 2019 May 1, 2018 – April 30, 2019 May 1, 2018 – April 30, 2019 May 1, 2018 – April 30, 2019 May 1, 2018 – April 30, 2019 May 1, 2018 – April 30, 2019 May 1, 2018 – April 30, 2019 May 1, 2018 – April 30, 2019 May 1, 2018 – April 30, 2019
Denominator MP - DY2 Dec. 1, 2017 – May 31, 2019 Dec. 1, 2017 – May 1, 2019 Dec. 1, 2017 – March 2, 2019 June 1, 2018 – May 31, 2019 June 1, 2018 – May 31, 2019 June 1, 2018 – May 31, 2019 June 1, 2018 – May 31, 2019 June 1, 2018 – May 31, 2019 June 1, 2018 – May 31, 2019 June 1, 2018 – May 31, 2019 June 1, 2018 – May 31, 2019 June 1, 2018 – May 31, 2019 June 1, 2018 – May 31, 2019 June 1, 2018 – May 31, 2019
Denominator MP - DY2 Jan. 1, 2018 – June 30, 2019 Jan. 1, 2018 – May 31, 2019 Jan. 1, 2018 – April 1, 2019 July 1, 2018 – June 30, 2019 July 1, 2018 – June 30, 2019 July 1, 2018 – June 30, 2019 July 1, 2018 – June 30, 2019 July 1, 2018 – June 30, 2019 July 1, 2018 – June 30, 2019 July 1, 2018 – June 30, 2019 July 1, 2018 – June 30, 2019 July 1, 2018 – June 30, 2019 July 1, 2018 – June 30, 2019 July 1, 2018 – June 30, 2019
Numerator MP - DY1 Jan. 1, 2017 – Dec. 31, 2017 Jan. 1, 2017 – Dec. 31, 2017 Jan. 1, 2017 – Dec. 31, 2017 Jan. 1, 2017 – Dec. 31, 2017 Jan. 1, 2017 – Dec. 31, 2017 July 1, 2016 – Dec. 31, 2017 Jan. 1, 2017 – Dec. 31, 2017 Jan. 1, 2017 – Dec. 31, 2017 Jan. 1, 2016 – Dec. 31, 2017 Jan. 1, 2016 – Dec. 31, 2017 Jan. 1, 2017 – Dec. 31, 2017 Jan. 1, 2017 – Dec. 31, 2017 Jan. 1, 2017 – Dec. 31, 2017 Jan. 1, 2017 – Jan. 30, 2018
Numerator MP - DY1 Feb. 1, 2017 – Jan. 31, 2018 Feb. 1, 2017 – Jan. 31, 2018 Feb. 1, 2017 – Jan. 31, 2018 Feb. 1, 2017 – Jan. 31, 2018 Feb. 1, 2017 – Jan. 31, 2018 Aug. 1, 2016 – Jan. 31, 2018 Feb. 1, 2017 – Jan. 31, 2018 Feb. 1, 2017 – Jan. 31, 2018 Feb. 1, 2016 – Jan. 31, 2018 Feb. 1, 2016 – Jan. 31, 2018 Feb. 1, 2017 – Jan. 31, 2018 Feb. 1, 2017 – Jan. 31, 2018 Feb. 1, 2017 – Jan. 31, 2018 Feb. 1, 2017 – March 2, 2018
Numerator MP - DY1 March 1, 2017 – Feb. 28, 2018 March 1, 2017 – Feb. 28, 2018 March 1, 2017 – Feb. 28, 2018 March 1, 2017 – Feb. 28, 2018 March 1, 2017 – Feb. 28, 2018 Sept. 1, 2016 – Feb. 28, 2018 March 1, 2017 – Feb. 28, 2018 March 1, 2017 – Feb. 28, 2018 March 1, 2016 – Feb. 28, 2018 March 1, 2016 – Feb. 28, 2018 March 1, 2017 – Feb. 28, 2018 March 1, 2017 – Feb. 28, 2018 March 1, 2017 – Feb. 28, 2018 March 1, 2017 – March 30, 2018
Numerator MP - DY1 April 1, 2017 – March 31, 2018 April 1, 2017 – March 31, 2018 April 1, 2017 – March 31, 2018 April 1, 2017 – March 31, 2018 April 1, 2017 – March 31, 2018 Oct. 1, 2016 – March 31, 2018 April 1, 2017 – March 31, 2018 April 1, 2017 – March 31, 2018 April 1, 2016 – March 31, 2018 April 1, 2016 – March 31, 2018 April 1, 2017 – March 31, 2018 April 1, 2017 – March 31, 2018 April 1, 2017 – March 31, 2018 April 1, 2017 – April 30, 2018
Numerator MP - DY1 May 1, 2017 – April 30, 2018 May 1, 2017 – April 30, 2018 May 1, 2017 – April 30, 2018 May 1, 2017 – April 30, 2018 May 1, 2017 – April 30, 2018 Nov. 1, 2016 – April 30, 2018 May 1, 2017 – April 30, 2018 May 1, 2017 – April 30, 2018 May 1, 2016 – April 30, 2018 May 1, 2016 – April 30, 2018 May 1, 2017 – April 30, 2018 May 1, 2017 – April 30, 2018 May 1, 2017 – April 30, 2018 May 1, 2017 – May 30, 2018
Numerator MP - DY1 June 1, 2017 – May 31, 2018 June 1, 2017 – May 31, 2018 June 1, 2017 – May 31, 2018 June 1, 2017 – May 31, 2018 June 1, 2017 – May 31, 2018 Dec. 1, 2016 – May 31, 2018 June 1, 2017 – May 31, 2018 June 1, 2017 – May 31, 2018 June 1, 2016 – May 31, 2018 June 1, 2016 – May 31, 2018 June 1, 2017 – May 31, 2018 June 1, 2017 – May 31, 2018 June 1, 2017 – May 31, 2018 June 1, 2017 – June 30, 2018
Numerator MP - DY1 July 1, 2017 – June 30, 2018 July 1, 2017 – June 30, 2018 July 1, 2017 – June 30, 2018 July 1, 2017 – June 30, 2018 July 1, 2017 – June 30, 2018 Jan. 1, 2017 – June 30, 2018 July 1, 2017 – June 30, 2018 July 1, 2017 – June 30, 2018 July 1, 2016 – June 30, 2018 July 1, 2016 – June 30, 2018 July 1, 2017 – June 30, 2018 July 1, 2017 – June 30, 2018 July 1, 2017 – June 30, 2018 July 1, 2017 – July 30, 2018
Numerator MP - DY2 Jan. 1, 2018 – Dec. 31, 2018 Jan. 1, 2018 – Dec. 31, 2018 Jan. 1, 2018 – Dec. 31, 2018 Jan. 1, 2018 – Dec. 31, 2018 Jan. 1, 2018 – Dec. 31, 2018 July 1, 2017 – Dec. 31, 2018 Jan. 1, 2018 – Dec. 31, 2018 Jan. 1, 2018 – Dec. 31, 2018 Jan. 1, 2017 – Dec. 31, 2018 Jan. 1, 2017 – Dec. 31, 2018 Jan. 1, 2018 – Dec. 31, 2018 Jan. 1, 2018 – Dec. 31, 2018 Jan. 1, 2018 – Dec. 31, 2018 Jan. 1, 2018 – Jan. 30, 2019
Numerator MP - DY2 Feb. 1, 2018 – Jan. 31, 2019 Feb. 1, 2018 – Jan. 31, 2019 Feb. 1, 2018 – Jan. 31, 2019 Feb. 1, 2018 – Jan. 31, 2019 Feb. 1, 2018 – Jan. 31, 2019 Aug. 1, 2017 – Jan. 31, 2019 Feb. 1, 2018 – Jan. 31, 2019 Feb. 1, 2018 – Jan. 31, 2019 Feb. 1, 2017 – Jan. 31, 2019 Feb. 1, 2017 – Jan. 31, 2019 Feb. 1, 2018 – Jan. 31, 2019 Feb. 1, 2018 – Jan. 31, 2019 Feb. 1, 2018 – Jan. 31, 2019 Feb. 1, 2018 – March 2, 2019
Numerator MP - DY2 March 1, 2018 – Feb. 28, 2019 March 1, 2018 – Feb. 28, 2019 March 1, 2018 – Feb. 28, 2019 March 1, 2018 – Feb. 28, 2019 March 1, 2018 – Feb. 28, 2019 Sept. 1, 2017 – Feb. 28, 2019 March 1, 2018 – Feb. 28, 2019 March 1, 2018 – Feb. 28, 2019 March 1, 2017 – Feb. 28, 2019 March 1, 2017 – Feb. 28, 2019 March 1, 2018 – Feb. 28, 2019 March 1, 2018 – Feb. 28, 2019 March 1, 2018 – Feb. 28, 2019 March 1, 2018 – March 30, 2019
Numerator MP - DY2 April 1, 2018 – March 31, 2019 April 1, 2018 – March 31, 2019 April 1, 2018 – March 31, 2019 April 1, 2018 – March 31, 2019 April 1, 2018 – March 31, 2019 Oct. 1, 2017 – March 31, 2019 April 1, 2018 – March 31, 2019 April 1, 2018 – March 31, 2019 April 1, 2017 – March 31, 2019 April 1, 2017 – March 31, 2019 April 1, 2018 – March 31, 2019 April 1, 2018 – March 31, 2019 April 1, 2018 – March 31, 2019 April 1, 2018 – April 30, 2019
Numerator MP - DY2 May 1, 2018 – April 30, 2019 May 1, 2018 – April 30, 2019 May 1, 2018 – April 30, 2019 May 1, 2018 – April 30, 2019 May 1, 2018 – April 30, 2019 Nov. 1, 2017 – April 30, 2019 May 1, 2018 – April 30, 2019 May 1, 2018 – April 30, 2019 May 1, 2017 – April 30, 2019 May 1, 2017 – April 30, 2019 May 1, 2018 – April 30, 2019 May 1, 2018 – April 30, 2019 May 1, 2018 – April 30, 2019 May 1, 2018 – May 30, 2019
Numerator MP - DY2 June 1, 2018 – May 31, 2019 June 1, 2018 – May 31, 2019 June 1, 2018 – May 31, 2019 June 1, 2018 – May 31, 2019 June 1, 2018 – May 31, 2019 Dec. 1, 2017 – May 31, 2019 June 1, 2018 – May 31, 2019 June 1, 2018 – May 31, 2019 June 1, 2017 – May 31, 2019 June 1, 2017 – May 31, 2019 June 1, 2018 – May 31, 2019 June 1, 2018 – May 31, 2019 June 1, 2018 – May 31, 2019 June 1, 2018 – June 30, 2019
Numerator MP - DY2 July 1, 2018 – June 30, 2019 July 1, 2018 – June 30, 2019 July 1, 2018 – June 30, 2019 July 1, 2018 – June 30, 2019 July 1, 2018 – June 30, 2019 Jan. 1, 2018 – June 30, 2019 July 1, 2018 – June 30, 2019 July 1, 2018 – June 30, 2019 July 1, 2017 – June 30, 2019 July 1, 2017 – June 30, 2019 July 1, 2018 – June 30, 2019 July 1, 2018 – June 30, 2019 July 1, 2018 – June 30, 2019 July 1, 2018 – July 30, 2019
End of Worksheet

Sheet 42: State Measurement Periods

Use the arrow keys to read through the document.
Table 2. State-Reported Measures Measurement Periods (MPs) for CCBHCs -- Demonstration Years (DY) 1 and 2
Factor and Time Period Housing Status






(HOU)
Suicide Attempts






(SU-A)
Patient Experience of Care Survey





(PEC)
Youth/Family Experience of Care Survey





(Y/FEC )
Follow-up After Emergency Department Visit for Mental Illness




(FUM)
Follow-up After Emergency Department Visit for Alcohol or Other Drug Dependence




(FUA)
Plan All-Cause Readmissions Rate





(PCR-BH)
Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications



(SSD)
Diabetes Care For People With Serious Mental Illness: Hemoglobin A1c (Hba1c) Poor Control (>9.0%)



(SMI-PC)
Metabolic Monitoring for Children and Adolescents on Antipsychotics




(APM)
Cardiovascular Monitoring for People With Cardiovascular Disease and Schizophrenia




(SMC)
Adherence to Mood Stabilizers for Individuals with Bipolar I Disorder




(AMS-BD)
Adherence to Antipsychotic Medications for Individuals With Schizophrenia




(SAA-BH)
Adult Follow-up After Hospitalization for Mental Illness






(FUH-BH-A)
Child Follow-Up After Hospitalization For Mental Illness






(FUH-BH-C)
Follow-up Care for Children Prescribed Attention-Deficit Hyperactivity Disorder (ADHD) Medication





(ADD-BH)
Antidepressant Medication Management






(AMM-BH)
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment





(IET-BH)
Denominator MP - DY1 Jan. 1, 2017 – June 30, 2017 and July 1, 2017 – Dec. 31, 2017 Jan. 1, 2017 – Nov. 30, 2017 Jan. 1, 2017 – Dec. 31, 2017 Jan. 1, 2017 – Dec. 31, 2017 Jan. 1, 2017 – Dec. 1, 2017 Jan. 1, 2017 – Dec. 1, 2017 Jan. 1, 2017 – Dec. 1, 2017 Jan. 1, 2016 – Dec. 31, 2017 Jan. 1, 2016 – Dec. 31, 2017 Jan. 1, 2017 – Dec. 31, 2017 Jan. 1, 2016 – Dec. 31, 2017 Jan. 1, 2017 – Dec. 31, 2017 Jan. 1, 2017 – Dec. 31, 2017 Jan. 1, 2017 – Dec. 1, 2017 Jan. 1, 2017 – Dec. 1, 2017 March 1, 2016 – Feb. 28, 2017 and Nov. 2, 2015 – Oct. 31, 2016 June 1, 2016 – April 30, 2017 and Feb. 17, 2016 – Jan. 15, 2017 Jan. 1, 2017 – Nov. 15, 2017 and Nov. 2, 2016 – Sept. 16, 2017
Denominator MP - DY1 Feb. 1, 2017 – July 31, 2017 and Aug. 1, 2017 – Jan. 31, 2018 Feb. 1, 2017 – Dec. 31, 2017 Feb. 1, 2017 – Jan. 31, 2018 Feb. 1, 2017 – Jan. 31, 2018 Feb. 1, 2017 – Jan. 1, 2018 Feb. 1, 2017 – Jan. 1, 2018 Feb. 1, 2017 – Jan. 1, 2018 Feb. 1, 2016 – Jan. 31, 2018 Feb. 1, 2016 – Jan. 31, 2018 Feb. 1, 2017 – Jan. 31, 2018 Feb. 1, 2016 – Jan. 31, 2018 Feb. 1, 2017 – Jan. 31, 2018 Feb. 1, 2017 – Jan. 31, 2018 Feb. 1, 2017 – Jan. 1, 2018 Feb. 1, 2017 – Jan. 1, 2018 April 1, 2016 – March 31, 2017 and Dec. 3, 2015 – Dec. 1, 2016 July 1, 2016 – May 31, 2017 and March 18, 2016 – Feb. 15, 2017 Feb. 1, 2017 – Dec. 15, 2017 and Dec. 3, 2016 – Oct. 16, 2017
Denominator MP - DY1 March 1, 2017 – Aug. 31, 2017 and Sept. 1, 2017 – Feb. 28, 2018 March 1, 2017 – Jan. 31, 2018 March 1, 2017 – Feb. 28, 2018 March 1, 2017 – Feb. 28, 2018 March 1, 2017 – Jan. 29, 2018 March 1, 2017 – Jan. 29, 2018 March 1, 2017 – Jan. 29, 2018 March 1, 2016 – Feb. 28, 2018 March 1, 2016 – Feb. 28, 2018 March 1, 2017 – Feb. 28, 2018 March 1, 2016 – Feb. 28, 2018 March 1, 2017 – Feb. 28, 2018 March 1, 2017 – Feb. 28, 2018 March 1, 2017 – Jan. 29, 2018 March 1, 2017 – Jan. 29, 2018 May 1, 2016 – April 30, 2017 and Jan. 2, 2016 – Dec. 31, 2016 Aug. 1, 2016 – June 30, 2017 and April 18, 2016 – March 17, 2017 March 1, 2017 – Jan. 15, 2018 and Dec. 31, 2016 – Nov. 16, 2017
Denominator MP - DY1 April 1, 2017 – Sept. 31, 2017 and Oct. 1, 2017 – March 31, 2018 April 1, 2017 – Feb. 28, 2018 April 1, 2017 – March 31, 2018 April 1, 2017 – March 31, 2018 April 1, 2017 – March 1, 2018 April 1, 2017 – March 1, 2018 April 1, 2017 – March 1, 2018 April 1, 2016 – March 31, 2018 April 1, 2016 – March 31, 2018 April 1, 2017 – March 31, 2018 April 1, 2016 – March 31, 2018 April 1, 2017 – March 31, 2018 April 1, 2017 – March 31, 2018 April 1, 2017 – March 1, 2018 April 1, 2017 – March 1, 2018 June 1, 2016 – May 31, 2017 and Feb. 2, 2016 – Jan. 31, 2017 Sept. 1, 2016 – July 31, 2017 and May 19, 2016 – April 17, 2017 April 1, 2017 – Feb. 15, 2018 and Jan. 31, 2017 – Dec. 17, 2017
Denominator MP - DY1 May 1, 2017 – Oct. 31, 2017 and Nov. 1, 2017 – April 30, 2018 May 1, 2017 – March 31, 2018 May 1, 2017 – April 30, 2018 May 1, 2017 – April 30, 2018 May 1, 2017 – March 31, 2018 May 1, 2017 – March 31, 2018 May 1, 2017 – March 31, 2018 May 1, 2016 – April 30, 2018 May 1, 2016 – April 30, 2018 May 1, 2017 – April 30, 2018 May 1, 2016 – April 30, 2018 May 1, 2017 – April 30, 2018 May 1, 2017 – April 30, 2018 May 1, 2017 – March 31, 2018 May 1, 2017 – March 31, 2018 July 1, 2016 – June 30, 2017 and March 3, 2016 – March 2, 2017 Oct. 1, 2016 – Aug. 31, 2017 and June 18, 2016 – May 18, 2017 May 1, 2017 – March 15, 2018 and March 2, 2017 – Jan. 14, 2018
Denominator MP - DY1 June 1, 2017 – Nov. 30, 2017 and Dec. 1, 2017 – May 31, 2018 June 1, 2017 – April 30, 2018 June 1, 2017 – May 31, 2018 June 1, 2017 – May 31, 2018 June 1, 2017 – May 1, 2018 June 1, 2017 – May 1, 2018 June 1, 2017 – May 1, 2018 June 1, 2016 – May 31, 2018 June 1, 2016 – May 31, 2018 June 1, 2017 – May 31, 2018 June 1, 2016 – May 31, 2018 June 1, 2017 – May 31, 2018 June 1, 2017 – May 31, 2018 June 1, 2017 – May 1, 2018 June 1, 2017 – May 1, 2018 Aug. 1, 2016 – July 31, 2017 and April 3, 2016 – April 2, 2017 Nov. 1, 2016 – Sep. 30, 2017 and July 19, 2016 – June 17, 2017 June 1, 2017 – April 15, 2018 and April 2, 2017 – Feb. 14, 2018
Denominator MP - DY1 July 1, 2017 – Dec. 31, 2017 and Jan. 1, 2018 – June 30, 2018 July 1, 2017 – May 31, 2018 July 1, 2017 – June 30, 2018 July 1, 2017 – June 30, 2018 July 1, 2017 – May 31, 2018 July 1, 2017 – May 31, 2018 July 1, 2017 – May 31, 2018 July 1, 2016 – June 30, 2018 July 1, 2016 – June 30, 2018 July 1, 2017 – June 30, 2018 July 1, 2016 – June 30, 2018 July 1, 2017 – June 30, 2018 July 1, 2017 – June 30, 2018 July 1, 2017 – May 31, 2018 July 1, 2017 – May 31, 2018 Sept. 1, 2016 – Aug. 31, 2017 and May 4, 2016 – May 3, 2017 Dec. 1, 2016 – Oct. 31, 2017 and Aug. 18, 2016 – July 18, 2017 July 1, 2017 – May 15, 2018 and May 2, 2017 – March 16, 2018
Denominator MP - DY2 Jan. 1, 2018 – June 30, 2018 and July 1, 2018 – Dec. 31, 2018 Jan. 1, 2018 – Nov. 30, 2018 Jan. 1, 2018 – Dec. 31, 2018 Jan. 1, 2018 – Dec. 31, 2018 Jan. 1, 2018– Dec. 1, 2018 Jan. 1, 2018– Dec. 1, 2018 Jan. 1, 2018– Dec. 1, 2018 Jan. 1, 2017 – Dec. 31, 2018 Jan. 1, 2017 – Dec. 31, 2018 Jan. 1, 2018 – Dec. 31, 2018 Jan. 1, 2017 – Dec. 31, 2018 Jan. 1, 2018 – Dec. 31, 2018 Jan. 1, 2018 – Dec. 31, 2018 Jan. 1, 2018– Dec. 1, 2018 Jan. 1, 2018– Dec. 1, 2018 March 1, 2017 – Feb. 28, 2018 and Nov. 1, 2016 – Oct. 31, 2017 June 1, 2017 – April 30, 2018 and Feb. 16, 2017 – Jan. 15, 2018 Jan. 1, 2018 – Nov. 15, 2018 and Nov. 2, 2017 – Sept. 16, 2018
Denominator MP - DY2 Feb. 1, 2018 – July 31, 2018 and Aug. 1, 2018 – Jan. 31, 2019 Feb. 1, 2018 – Dec. 31, 2018 Feb. 1, 2018 – Jan. 31, 2019 Feb. 1, 2018 – Jan. 31, 2019 Feb. 1, 2018 – Jan. 1, 2019 Feb. 1, 2018 – Jan. 1, 2019 Feb. 1, 2018 – Jan. 1, 2019 Feb. 1, 2017 – Jan. 31, 2019 Feb. 1, 2017 – Jan. 31, 2019 Feb. 1, 2018 – Jan. 31, 2019 Feb. 1, 2017 – Jan. 31, 2019 Feb. 1, 2018 – Jan. 31, 2019 Feb. 1, 2018 – Jan. 31, 2019 Feb. 1, 2018 – Jan. 1, 2019 Feb. 1, 2018 – Jan. 1, 2019 April 1, 2017 – March 31, 2018 and Dec. 2, 2016 – Dec. 1, 2017 July 1, 2017 – May 31, 2018 and March 18, 2017 – Feb. 15, 2018 Feb. 1, 2018 – Dec. 15, 2018 and Dec. 3, 2017 – Oct. 16, 2018
Denominator MP - DY2 March 1, 2018 – Aug. 31, 2018 and Sept. 1, 2018 – Feb. 28, 2019 March 1, 2018 – Jan. 31, 2019 March 1, 2018 – Feb. 28, 2019 March 1, 2018 – Feb. 28, 2019 March 1, 2018 – Jan. 29, 2019 March 1, 2018 – Jan. 29, 2019 March 1, 2018 – Jan. 29, 2019 March 1, 2017 – Feb. 28, 2019 March 1, 2017 – Feb. 28, 2019 March 1, 2018 – Feb. 28, 2019 March 1, 2017 – Feb. 28, 2019 March 1, 2018 – Feb. 28, 2019 March 1, 2018 – Feb. 28, 2019 March 1, 2018 – Jan. 29, 2019 March 1, 2018 – Jan. 29, 2019 May 1, 2017 – April 30, 2018 and Jan. 1, 2017 – Dec. 31, 2017 Aug. 1, 2017 – June 30, 2018 and April 18, 2017 – March 17, 2018 March 1, 2018 – Jan. 15, 2019 and Dec. 31, 2017 – Nov. 16, 2018
Denominator MP - DY2 April 1, 2018 – Sept. 31, 2018 and Oct. 1, 2018 – March 31, 2019 April 1, 2018 – Feb. 28, 2019 April 1, 2018 – March 31, 2019 April 1, 2018 – March 31, 2019 April 1, 2018 – March 1, 2019 April 1, 2018 – March 1, 2019 April 1, 2018 – March 1, 2019 April 1, 2017 – March 31, 2019 April 1, 2017 – March 31, 2019 April 1, 2018 – March 31, 2019 April 1, 2017 – March 31, 2019 April 1, 2018 – March 31, 2019 April 1, 2018 – March 31, 2019 April 1, 2018 – March 1, 2019 April 1, 2018 – March 1, 2019 June 1, 2017 – May 31, 2018 and Feb. 1, 2017 – Jan. 31, 2018 Sept. 1, 2017 – July 31, 2018 and May 19, 2017 – April 17, 2018 April 1, 2018 – Feb. 15, 2019 and Jan. 31, 2018 – Dec. 17, 2018
Denominator MP - DY2 May 1, 2018 – Oct. 31, 2018 and Nov. 1, 2018 – April 30, 2019 May 1, 2018 – March 31, 2019 May 1, 2018 – April 30, 2019 May 1, 2018 – April 30, 2019 May 1, 2018 – March 31, 2019 May 1, 2018 – March 31, 2019 May 1, 2018 – March 31, 2019 May 1, 2017 – April 30, 2019 May 1, 2017 – April 30, 2019 May 1, 2018 – April 30, 2019 May 1, 2017 – April 30, 2019 May 1, 2018 – April 30, 2019 May 1, 2018 – April 30, 2019 May 1, 2018 – March 31, 2019 May 1, 2018 – March 31, 2019 July 1, 2017 – June 30, 2018 and March 3, 2017 – March 2, 2018 Oct. 1, 2017 – Aug. 31, 2018 and June 18, 2017 – May 18, 2018 May 1, 2018 – March 15, 2019 and March 2, 2018 – Jan. 14, 2019
Denominator MP - DY2 June 1, 2018 – Nov. 30, 2018 and Dec. 1, 2018 – May 31, 2019 June 1, 2018 – April 30, 2019 June 1, 2018 – May 31, 2019 June 1, 2018 – May 31, 2019 June 1, 2018 – May 1, 2019 June 1, 2018 – May 1, 2019 June 1, 2018 – May 1, 2019 June 1, 2017 – May 31, 2019 June 1, 2017 – May 31, 2019 June 1, 2018 – May 31, 2019 June 1, 2017 – May 31, 2019 June 1, 2018 – May 31, 2019 June 1, 2018 – May 31, 2019 June 1, 2018 – May 1, 2019 June 1, 2018 – May 1, 2019 Aug. 1, 2017 – July 31, 2018 and April 3, 2017 – April 2, 2018 Nov. 1, 2017 – Sep. 30, 2018 and July 19, 2017 – June 17, 2018 June 1, 2018 – April 15, 2019 and April 2, 2018 – Feb. 14, 2019
Denominator MP - DY2 July 1, 2018 – Dec. 31, 2018 and Jan. 1, 2019 – June 30, 2019 July 1, 2018 – May 31, 2019 July 1, 2018 – June 30, 2019 July 1, 2018 – June 30, 2019 July 1, 2018 – May 31, 2019 July 1, 2018 – May 31, 2019 July 1, 2018 – May 31, 2019 July 1, 2017 – June 30, 2019 July 1, 2017 – June 30, 2019 July 1, 2018 – June 30, 2019 July 1, 2017 – June 30, 2019 July 1, 2018 – June 30, 2019 July 1, 2018 – June 30, 2019 July 1, 2018 – May 31, 2019 July 1, 2018 – May 31, 2019 Sept. 1, 2017 – Aug. 31, 2018 and May 4, 2017 – May 3, 2018 Dec. 1, 2017 – Oct. 31, 2018 and Aug. 18, 2017 – July 18, 2018 July 1, 2018 – May 15, 2019 and May 2, 2018 – March 16, 2019
Numerator MP - DY1 Jan. 1, 2017 – June 30, 2017 and July 1, 2017 – Dec. 31, 2017 Jan. 1, 2017 – Dec. 31, 2017 Jan. 1, 2017 – Dec. 31, 2017 Jan. 1, 2017 – Dec. 31, 2017 Jan. 1, 2017 – Dec. 31, 2017 Jan. 1, 2017 – Dec. 31, 2017 Jan. 1, 2017 – Dec. 31, 2017 Jan. 1, 2017 – Dec. 31, 2017 Jan. 1, 2017 – Dec. 31, 2017 Jan. 1, 2017 – Dec. 31, 2017 Jan. 1, 2017 – Dec. 31, 2017 Jan. 1, 2017 – Dec. 31, 2017 Jan. 1, 2017 – Dec. 31, 2017 Jan. 1, 2017 – Dec. 8, 2017 and Jan. 1, 2017 – Dec. 31, 2017 Jan. 1, 2017 – Dec. 8, 2017 and Jan. 1, 2017 – Dec. 31, 2017 March 31, 2016 – March 30, 2017 and Dec. 26, 2016 – Dec. 25, 2017 Sept. 23, 2016 – Aug. 22, 2017 and Jan. 18, 2017 – Dec. 17, 2017 Jan. 1, 2017 – Nov. 28, 2017 and Jan. 2, 2017 – Dec. 27, 2017
Numerator MP - DY1 Feb. 1, 2017 – July 31, 2017 and Aug. 1, 2017 – Jan. 31, 2018 Feb. 1, 2017 – Jan. 31, 2018 Feb. 1, 2017 – Jan. 31, 2018 Feb. 1, 2017 – Jan. 31, 2018 Feb. 1, 2017 – Jan. 31, 2018 Feb. 1, 2017 – Jan. 31, 2018 Feb. 1, 2017 – Jan. 31, 2018 Feb. 1, 2017 – Jan. 31, 2018 Feb. 1, 2017 – Jan. 31, 2018 Feb. 1, 2017 – Jan. 31, 2018 Feb. 1, 2017 – Jan. 31, 2018 Feb. 1, 2017 – Jan. 31, 2018 Feb. 1, 2017 – Jan. 31, 2018 Feb. 1, 2017 – Jan. 8, 2018 and Feb. 1, 2017 – Jan. 31, 2018 Feb. 1, 2017 – Jan. 8, 2018 and Feb. 1, 2017 – Jan. 31, 2018 May 1, 2016 – April 30, 2017 and Jan. 26, 2017 – Jan. 25, 2018 Oct. 23, 2016 – Sept. 22, 2017 and Feb. 17, 2017 – Jan. 17, 2018 Feb. 1, 2017 – Dec. 28, 2017 and Feb. 2, 2017 – Jan. 26, 2018
Numerator MP - DY1 March 1, 2017 – Aug. 31, 2017 and Sept. 1, 2017 – Feb. 28, 2018 March 1, 2017 – Feb. 28, 2018 March 1, 2017 – Feb. 28, 2018 March 1, 2017 – Feb. 28, 2018 March 1, 2017 – Feb. 28, 2018 March 1, 2017 – Feb. 28, 2018 March 1, 2017 – Feb. 28, 2018 March 1, 2017 – Feb. 28, 2018 March 1, 2017 – Feb. 28, 2018 March 1, 2017 – Feb. 28, 2018 March 1, 2017 – Feb. 28, 2018 March 1, 2017 – Feb. 28, 2018 March 1, 2017 – Feb. 28, 2018 March 1, 2017 – Feb. 5, 2018 and March 1, 2017 – Feb. 28, 2018 March 1, 2017 – Feb. 5, 2018 and March 1, 2017 – Feb. 28, 2018 May 31, 2016 – May 30, 2017 and Feb. 25, 2017 – Feb. 24, 2018 Nov. 23, 2016 – Oct. 22, 2017 and March 20, 2017 – Feb. 16, 2018 March 1, 2017 – Jan. 28, 2018 and March 2, 2017 – Feb. 26, 2018
Numerator MP - DY1 April 1, 2017 – Sept. 31, 2017 and Oct. 1, 2017 – March 31, 2018 April 1, 2017 – March 31, 2018 April 1, 2017 – March 31, 2018 April 1, 2017 – March 31, 2018 April 1, 2017 – March 31, 2018 April 1, 2017 – March 31, 2018 April 1, 2017 – March 31, 2018 April 1, 2017 – March 31, 2018 April 1, 2017 – March 31, 2018 April 1, 2017 – March 31, 2018 April 1, 2017 – March 31, 2018 April 1, 2017 – March 31, 2018 April 1, 2017 – March 31, 2018 April 1, 2017 – March 8, 2018 and April 1, 2017 – March 31, 2018 April 1, 2017 – March 8, 2018 and April 1, 2017 – March 31, 2018 July 1, 2016 – June 30, 2017 and March 28, 2017 – March 27, 2018 Dec. 24, 2016 – Nov. 22, 2017 and April 20, 2017 – March 19, 2018 April 1, 2017 – Feb. 28, 2018 and April 2, 2017 – March 29, 2018
Numerator MP - DY1 May 1, 2017 – Oct. 31, 2017 and Nov. 1, 2017 – April 30, 2018 May 1, 2017 – April 30, 2018 May 1, 2017 – April 30, 2018 May 1, 2017 – April 30, 2018 May 1, 2017 – April 30, 2018 May 1, 2017 – April 30, 2018 May 1, 2017 – April 30, 2018 May 1, 2017 – April 30, 2018 May 1, 2017 – April 30, 2018 May 1, 2017 – April 30, 2018 May 1, 2017 – April 30, 2018 May 1, 2017 – April 30, 2018 May 1, 2017 – April 30, 2018 May 1, 2017 – April 7, 2018 and May 1, 2017 – April 30, 2018 May 1, 2017 – April 7, 2018 and May 1, 2017 – April 30, 2018 July 31, 2016 – July 30, 2017 and April 27, 2017 – April 26, 2018 Jan. 23, 2017 – Dec. 23, 2017 and May 20, 2017 – April 19, 2018 May 1, 2017 – March 28, 2018 and May 2, 2017 – April 26, 2018
Numerator MP - DY1 June 1, 2017 – Nov. 30, 2017 and Dec. 1, 2017 – May 31, 2018 June 1, 2017 – May 31, 2018 June 1, 2017 – May 31, 2018 June 1, 2017 – May 31, 2018 June 1, 2017 – May 31, 2018 June 1, 2017 – May 31, 2018 June 1, 2017 – May 31, 2018 June 1, 2017 – May 31, 2018 June 1, 2017 – May 31, 2018 June 1, 2017 – May 31, 2018 June 1, 2017 – May 31, 2018 June 1, 2017 – May 31, 2018 June 1, 2017 – May 31, 2018 June 1, 2017 – May 8, 2018 and June 1, 2017 – May 31, 2018 June 1, 2017 – May 8, 2018 and June 1, 2017 – May 31, 2018 Aug. 31, 2016 – Aug. 30, 2017 and May 28, 2017 – May 27, 2018 Feb. 23, 2017 – Jan. 22, 2018 and June 20, 2017 – May 19, 2018 June 1, 2017 – April 28, 2018 and June 2, 2017 – May 27, 2018
Numerator MP - DY1 July 1, 2017 – Dec. 31, 2017 and Jan. 1, 2018 – June 30, 2018 July 1, 2017 – June 30, 2018 July 1, 2017 – June 30, 2018 July 1, 2017 – June 30, 2018 July 1, 2017 – June 30, 2018 July 1, 2017 – June 30, 2018 July 1, 2017 – June 30, 2018 July 1, 2017 – June 30, 2018 July 1, 2017 – June 30, 2018 July 1, 2017 – June 30, 2018 July 1, 2017 – June 30, 2018 July 1, 2017 – June 30, 2018 July 1, 2017 – June 30, 2018 July 1, 2017 – June 7, 2018 and July 1, 2017 – June 30, 2018 July 1, 2017 – June 7, 2018 and July 1, 2017 – June 30, 2018 Oct. 1, 2016 – Sept. 30, 2017 and June 28, 2017 – June 27, 2018 March 25, 2017 – Feb. 22, 2018 and July 20, 2017 – June 19, 2018 July 1, 2017 – May 28, 2018 and July 2, 2017 – June 26, 2018
Numerator MP - DY2 Jan. 1, 2018 – June 30, 2018 and July 1, 2018 – Dec. 31, 2018 Jan. 1, 2018 – Dec. 31, 2018 Jan. 1, 2018 – Dec. 31, 2018 Jan. 1, 2018 – Dec. 31, 2018 Jan. 1, 2018 – Dec. 31, 2018 Jan. 1, 2018 – Dec. 31, 2018 Jan. 1, 2018 – Dec. 31, 2018 Jan. 1, 2018 – Dec. 31, 2018 Jan. 1, 2018 – Dec. 31, 2018 Jan. 1, 2018 – Dec. 31, 2018 Jan. 1, 2018 – Dec. 31, 2018 Jan. 1, 2018 – Dec. 31, 2018 Jan. 1, 2018 – Dec. 31, 2018 Jan. 1, 2018 – Dec. 8, 2018 and Jan. 1, 2018 – Dec. 31, 2018 Jan. 1, 2018 – Dec. 8, 2018 and Jan. 1, 2018 – Dec. 31, 2018 March 31, 2017 – March 30, 2018 and Dec. 26, 2017 – Dec. 25, 2018 Sept. 23, 2017 – Aug. 22, 2018 and Jan. 18, 2018 – Dec. 17, 2018 Jan. 1, 2018 – Nov. 28, 2018 and Jan. 2, 2018 – Dec. 27, 2018
Numerator MP - DY2 Feb. 1, 2018 – July 31, 2018 and Aug. 1, 2018 – Jan. 31, 2019 Feb. 1, 2018 – Jan. 31, 2019 Feb. 1, 2018 – Jan. 31, 2019 Feb. 1, 2018 – Jan. 31, 2019 Feb. 1, 2018 – Jan. 31, 2019 Feb. 1, 2018 – Jan. 31, 2019 Feb. 1, 2018 – Jan. 31, 2019 Feb. 1, 2018 – Jan. 31, 2019 Feb. 1, 2018 – Jan. 31, 2019 Feb. 1, 2018 – Jan. 31, 2019 Feb. 1, 2018 – Jan. 31, 2019 Feb. 1, 2018 – Jan. 31, 2019 Feb. 1, 2018 – Jan. 31, 2019 Feb. 1, 2018 – Jan. 8, 2019 and Feb. 1, 2018 – Jan. 31, 2019 Feb. 1, 2018 – Jan. 8, 2019 and Feb. 1, 2018 – Jan. 31, 2019 May 1, 2017 – April 30, 2018 and Jan. 26, 2018 – Jan. 25, 2019 Oct. 23, 2017 – Sept. 22, 2018 and Feb. 17, 2018 – Jan. 17, 2019 Feb. 1, 2018 – Dec. 28, 2018 and Feb. 2, 2018 – Jan. 26, 2019
Numerator MP - DY2 March 1, 2018 – Aug. 31, 2018 and Sept. 1, 2018 – Feb. 28, 2019 March 1, 2018 – Feb. 28, 2019 March 1, 2018 – Feb. 28, 2019 March 1, 2018 – Feb. 28, 2019 March 1, 2018 – Feb. 28, 2019 March 1, 2018 – Feb. 28, 2019 March 1, 2018 – Feb. 28, 2019 March 1, 2018 – Feb. 28, 2019 March 1, 2018 – Feb. 28, 2019 March 1, 2018 – Feb. 28, 2019 March 1, 2018 – Feb. 28, 2019 March 1, 2018 – Feb. 28, 2019 March 1, 2018 – Feb. 28, 2019 March 1, 2018 – Feb. 5, 2019 and March 1, 2018 – Feb. 28, 2019 March 1, 2018 – Feb. 5, 2019 and March 1, 2018 – Feb. 28, 2019 May 31, 2017 – May 30, 2018 and Feb. 25, 2018 – Feb. 24, 2019 Nov. 23, 2017 – Sept. 22, 2018 and March 20, 2018 – Feb. 16, 2019 March 1, 2018 – Jan. 28, 2019 and March 2, 2018 – Feb. 26, 2019
Numerator MP - DY2 April 1, 2018 – Sept. 31, 2018 and Oct. 1, 2018 – March 31, 2019 April 1, 2018 – March 31, 2019 April 1, 2018 – March 31, 2019 April 1, 2018 – March 31, 2019 April 1, 2018 – March 31, 2019 April 1, 2018 – March 31, 2019 April 1, 2018 – March 31, 2019 April 1, 2018 – March 31, 2019 April 1, 2018 – March 31, 2019 April 1, 2018 – March 31, 2019 April 1, 2018 – March 31, 2019 April 1, 2018 – March 31, 2019 April 1, 2018 – March 31, 2019 April 1, 2018 – March 8, 2019 and April 1, 2018 – March 31, 2019 April 1, 2018 – March 8, 2019 and April 1, 2018 – March 31, 2019 July 1, 2017 – June 30, 2018 and March 28, 2018 – March 27, 2019 Dec. 24, 2017 – Nov. 22, 2018 and April 20, 2018 – March 19, 2019 April 1, 2018 – Feb. 28, 2019 and April 2, 2018 – March 29, 2019
Numerator MP - DY2 May 1, 2018 – Oct. 31, 2018 and Nov. 1, 2018 – April 30, 2019 May 1, 2018 – April 30, 2019 May 1, 2018 – April 30, 2019 May 1, 2018 – April 30, 2019 May 1, 2018 – April 30, 2019 May 1, 2018 – April 30, 2019 May 1, 2018 – April 30, 2019 May 1, 2018 – April 30, 2019 May 1, 2018 – April 30, 2019 May 1, 2018 – April 30, 2019 May 1, 2018 – April 30, 2019 May 1, 2018 – April 30, 2019 May 1, 2018 – April 30, 2019 May 1, 2018 – April 7, 2019 and May 1, 2018 – April 30, 2019 May 1, 2018 – April 7, 2019 and May 1, 2018 – April 30, 2019 July 31, 2017 – July 30, 2018 and April 27, 2018 – April 26, 2019 Jan. 23, 2018 – Dec. 23, 2018 and May 20, 2018 – April 19, 2019 May 1, 2018 – March 28, 2019 and May 2, 2018 – April 26, 2019
Numerator MP - DY2 June 1, 2018 – Nov. 30, 2018 and Dec. 1, 2018 – May 31, 2019 June 1, 2018 – May 31, 2019 June 1, 2018 – May 31, 2019 June 1, 2018 – May 31, 2019 June 1, 2018 – May 31, 2019 June 1, 2018 – May 31, 2019 June 1, 2018 – May 31, 2019 June 1, 2018 – May 31, 2019 June 1, 2018 – May 31, 2019 June 1, 2018 – May 31, 2019 June 1, 2018 – May 31, 2019 June 1, 2018 – May 31, 2019 June 1, 2018 – May 31, 2019 June 1, 2018 – May 8, 2019 and June 1, 2018 – May 31, 2019 June 1, 2018 – May 8, 2019 and June 1, 2018 – May 31, 2019 Aug. 31, 2017 – Aug. 30, 2018 and May 28, 2018 – May 27, 2019 Feb. 23, 2018 – Jan. 22, 2019 and June 20, 2018 – May 19, 2019 June 1, 2018 – April 28, 2019 and June 2, 2018 – May 27, 2019
Numerator MP - DY2 July 1, 2018 – Dec. 31, 2018 and Jan. 1, 2019 – June 30, 2019 July 1, 2018 – June 30, 2019 July 1, 2018 – June 30, 2019 July 1, 2018 – June 30, 2019 July 1, 2018 – June 30, 2019 July 1, 2018 – June 30, 2019 July 1, 2018 – June 30, 2019 July 1, 2018 – June 30, 2019 July 1, 2018 – June 30, 2019 July 1, 2018 – June 30, 2019 July 1, 2018 – June 30, 2019 July 1, 2018 – June 30, 2019 July 1, 2018 – June 30, 2019 July 1, 2018 – June 7, 2019 and July 1, 2018 – June 30, 2019 July 1, 2018 – June 7, 2019 and July 1, 2018 – June 30, 2019 Oct. 1, 2017 – Sept. 30, 2018 and June 28, 2018 – June 27, 2019 March 25, 2018 – Feb. 22, 2019 and July 20, 2018 – June 19, 2019 July 1, 2018 – May 28, 2019 and July 2, 2018 – June 26, 2019
End of Worksheet
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File Modified0000-00-00
File Created0000-00-00

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