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pdf10/1/2015
Annual Report Admin Screen
Maternal and Infant Health Initiative Developmental Measure: Use of
Contraceptive Methods by Postpartum Women
Medicaid Adult Core Quality Measure OR 2015
Federal Fiscal Year
Request Technical Assistance
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View All Responses
2015
Are you reporting on this measure? *
View Implementation Guide
Yes
No
Status of Data Reported
+/
What is the status of the data being reported? *
Provisional
Final
Same data as reported in a previous year’s annual report
Specify the year of annual report in which data previously reported *
2014
Measurement Specification
+/
Rate 1: Most effective or moderately effective contraception
Office of Population Affairs/Centers for Disease Control and Prevention
Other
Explain *
Rate 2: Longacting reversible contraception
Office of Population Affairs/Centers for Disease Control and Prevention
Other
Explain *
Data Source
+/
Rate 1: Most effective or moderately effective contraception
Administrative Data
From where is the Administrative Data coming?
Must select one or more
Medicaid Management Information System (MMIS)
Other
* Specify
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Other
Rate 2: Longacting reversible contraception
Administrative Data
Specify *
From where is the Administrative Data coming?
Must select one or more
Medicaid Management Information System (MMIS)
Other
* Specify
Other
Specify *
Date Range
+/
For all measures, states should report start and end dates for the measurement period. For some measures, the specifications require a “lookback period”
before or after the measurement period to determine eligibility or utilization. The measurement period entered in the Start and End Date fields should not
include the “lookback period."
Start Date
April
Month
2009
Year
End Date
August
Month
2013
Year
Definition of Population Included in the Measure
+/
Definition of Denominator
Select all that apply (Must select at least one)
Denominator includes Medicaid population
Denominator includes CHIP population (e.g. pregnant women.)
Denominator includes Medicare and Medicaid DuallyEligible population
Other
Specify *
Does this denominator represent your total measure eligible population
as defined by the Technical Specifications for this measure? *
Explain which populations are excluded and why *
Yes
No
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Specify Total Measure Eligible Population *
Which delivery systems are represented in the Denominator?
Select all delivery systems that apply in your state (must select at least one); for each delivery system selected, enter the percentage of the measure eligible population
represented by that service delivery system. For example, if the measureeligible population represents all managed care enrollees, enter 100 percent for MCO.
FeeforService
Percentage of total state FFS population represented *
The percentage provided here should represent the percentage of the denominator
population(s) included in the measure (i.e., Medicaid, CHIP, etc.) that receives
items/services through the selected delivery system. For example, if the population
included in the reported data represents all managed care enrollees and half of
your state’s feeforservice enrollees, select managed care and enter 100, and
select feeforservice and enter 50.
Primary Care Case Management (PCCM)
Percentage of total state PCCM population represented *
The percentage provided here should represent the percentage of the denominator
population(s) included in the measure (i.e., Medicaid, CHIP, etc.) that receives
items/services through the selected delivery system. For example, if the population
included in the reported data represents all managed care enrollees and half of
your state’s feeforservice enrollees, select managed care and enter 100, and
select feeforservice and enter 50.
Managed Care Organization / Prepaid Inpatient Health Plan (MCO / PIHP)
Number of Health Plans *
Percentage of total state MCO/PIHP population represented *
The percentage provided here should represent the percentage of the denominator
population(s) included in the measure (i.e., Medicaid, CHIP, etc.) that receives
items/services through the selected delivery system. For example, if the population
included in the reported data represents all managed care enrollees and half of
your state’s feeforservice enrollees, select managed care and enter 100, and
select feeforservice and enter 50.
Integrated Care Models (ICM)
Percentage of total state ICM population represented *
The percentage provided here should represent the percentage of the denominator
population(s) included in the measure (i.e., Medicaid, CHIP, etc.) that receives
items/services through the selected delivery system. For example, if the population
included in the reported data represents all managed care enrollees and half of
your state’s feeforservice enrollees, select managed care and enter 100, and
select feeforservice and enter 50.
Other
Describe *
Percentage of total other population represented *
The percentage provided here should represent the percentage of the denominator
population(s) included in the measure (i.e., Medicaid, CHIP, etc.) that receives
items/services through the selected delivery system. For example, if the population
included in the reported data represents all managed care enrollees and half of
your state’s feeforservice enrollees, select managed care and enter 100, and
select feeforservice and enter 50.
If applicable, list the number of Health Plans represented *
Other Performance Measure
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Other Performance Measure
+/
Rate 1: Most effective or moderately effective contraception
Please describe the other methodology used *
Character count: 0/100
Please describe the rate (e.g.,
1864)
Numerator
Denominator
Rate
No items available
+ Additional/Other Rate(s)
Rate 2: Longacting reversible contraception
Please describe the other methodology used *
Character count: 0/100
Please describe the rate (e.g.,
1864)
Numerator
Denominator
Rate
No items available
+ Additional/Other Rate(s)
Combined Rate(s) from Multiple Reporting Units
+/
Rate 1: Most effective or moderately effective contraception
If yes, indicate whether the statelevel rate is weighted
Did you Combine Rates from Multiple Reporting Units (e.g., health
plans, delivery systems, programs) to Create a StateLevel Rate? *
Must select one *
Yes
No
The rates are weighted based on the size of the measureeligible
population for each reporting unit
The rates are weighted based on another weighting factor
The rates are not weighted
Rate 2: Longacting reversible contraception
If yes, indicate whether the statelevel rate is weighted
Did you Combine Rates from Multiple Reporting Units (e.g., health
plans, delivery systems, programs) to Create a StateLevel Rate? *
Must select one *
Yes
No
The rates are weighted based on the size of the measureeligible
population for each reporting unit
The rates are weighted based on another weighting factor
The rates are not weighted
Additional Notes
+/
Rate 1: Most effective or moderately effective contraception
Additional Notes/Comments on Measure (Optional)
Character count: 0/2000
Rate 2: Longacting reversible contraception
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Additional Notes/Comments on Measure (Optional)
Character count: 0/2000
Optional Measure Stratification
+/
If this measure is also reported by additional classifications/subcategories, e.g. racial, ethnic, gender, language, disability status, or geography,
complete the following as applicable.
Check all that apply
Race (NonHispanic)
White
Rate 1: Most effective or moderately effective contraception
Classification/Subcategory
Numerator
Denominator
Rate
Age Range: 1520
0
0
Clear
Row
Age Range: 2144
0
0
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Row
0
0
0
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Row
+ Additional/Alternative Classification/Subcategory
Rate 2: Longacting reversible contraception
Classification/Subcategory
Numerator
Denominator
Rate
Age Range: 1520
0
0
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Row
Age Range: 2144
0
0
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Row
0
0
0
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Row
+ Additional/Alternative Classification/Subcategory
Black or African American
Rate 1: Most effective or moderately effective contraception
Classification/Subcategory
Numerator
Denominator
Rate
Age Range: 1520
0
0
Clear
Row
Age Range: 2144
0
0
Clear
Row
0
0
0
Clear
Row
+ Additional/Alternative Classification/Subcategory
Rate 2: Longacting reversible contraception
Classification/Subcategory
Numerator
Denominator
Rate
Age Range: 1520
0
0
Clear
Row
Age Range: 2144
0
0
Clear
Row
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0
0
0
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Row
+ Additional/Alternative Classification/Subcategory
American Indian or Alaska Native
Rate 1: Most effective or moderately effective contraception
Classification/Subcategory
Numerator
Denominator
Rate
Age Range: 1520
0
0
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Row
Age Range: 2144
0
0
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Row
0
0
0
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Row
+ Additional/Alternative Classification/Subcategory
Rate 2: Longacting reversible contraception
Classification/Subcategory
Numerator
Denominator
Rate
Age Range: 1520
0
0
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Row
Age Range: 2144
0
0
Clear
Row
0
0
0
Clear
Row
+ Additional/Alternative Classification/Subcategory
Asian
Rate 1: Most effective or moderately effective contraception
Classification/Subcategory
Numerator
Denominator
Rate
Age Range: 1520
0
0
Clear
Row
Age Range: 2144
0
0
Clear
Row
0
0
0
Clear
Row
+ Additional/Alternative Classification/Subcategory
Rate 2: Longacting reversible contraception
Classification/Subcategory
Numerator
Denominator
Rate
Age Range: 1520
0
0
Clear
Row
Age Range: 2144
0
0
Clear
Row
0
0
0
Clear
Row
+ Additional/Alternative Classification/Subcategory
Native Hawaiian or Other Pacific Islander
Rate 1: Most effective or moderately effective contraception
Classification/Subcategory
Age Range: 1520
Numerator
Denominator
0
0
Rate
Clear
Row
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Age Range: 2144
0
0
0
0
Clear
Row
0
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Row
+ Additional/Alternative Classification/Subcategory
Rate 2: Longacting reversible contraception
Classification/Subcategory
Numerator
Denominator
Rate
Age Range: 1520
0
0
Clear
Row
Age Range: 2144
0
0
Clear
Row
0
0
0
Clear
Row
+ Additional/Alternative Classification/Subcategory
Please define the race *
Delete Race
dd
Rate 1: Most effective or moderately effective contraception
Classification/Subcategory
Numerator
Denominator
Rate
Age Range: 1520
0
0
0
Clear
Row
Age Range: 2144
0
0
0
Clear
Row
0
0
0
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Row
+ Additional/Alternative Classification/Subcategory
Rate 2: Longacting reversible contraception
Classification/Subcategory
Numerator
Denominator
Rate
Age Range: 1520
0
0
0
Clear
Row
Age Range: 2144
0
0
0
Clear
Row
0
0
0
Clear
Row
+ Additional/Alternative Classification/Subcategory
+ Additional Race(s)
Ethnicity
Hispanic or Latino
Rate 1: Most effective or moderately effective contraception
Classification/Subcategory
Numerator
Denominator
Rate
Age Range: 1520
0
0
Clear
Row
Age Range: 2144
0
0
Clear
Row
0
0
0
Clear
Row
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+ Additional/Alternative Classification/Subcategory
Rate 2: Longacting reversible contraception
Classification/Subcategory
Numerator
Denominator
Rate
Age Range: 1520
0
0
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Row
Age Range: 2144
0
0
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Row
0
0
0
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Row
+ Additional/Alternative Classification/Subcategory
Not Hispanic or Latino
Rate 1: Most effective or moderately effective contraception
Classification/Subcategory
Numerator
Denominator
Rate
Age Range: 1520
0
0
Clear
Row
Age Range: 2144
0
0
Clear
Row
0
0
0
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Row
+ Additional/Alternative Classification/Subcategory
Rate 2: Longacting reversible contraception
Classification/Subcategory
Numerator
Denominator
Rate
Age Range: 1520
0
0
Clear
Row
Age Range: 2144
0
0
Clear
Row
0
0
0
Clear
Row
+ Additional/Alternative Classification/Subcategory
Please define the ethnicity *
Delete Ethnicity
ff
Rate 1: Most effective or moderately effective contraception
Classification/Subcategory
Numerator
Denominator
Rate
Age Range: 1520
0
0
0
Clear
Row
Age Range: 2144
0
0
0
Clear
Row
0
0
0
Clear
Row
+ Additional/Alternative Classification/Subcategory
Rate 2: Longacting reversible contraception
Classification/Subcategory
Numerator
Denominator
Rate
Age Range: 1520
0
0
0
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Row
Age Range: 2144
0
0
0
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Row
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0
0
Clear
Row
+ Additional/Alternative Classification/Subcategory
+ Additional Ethnicity(ies)
Sex
Male
Rate 1: Most effective or moderately effective contraception
Classification/Subcategory
Numerator
Denominator
Rate
Age Range: 1520
0
0
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Row
Age Range: 2144
0
0
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Row
0
0
0
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Row
+ Additional/Alternative Classification/Subcategory
Rate 2: Longacting reversible contraception
Classification/Subcategory
Numerator
Denominator
Rate
Age Range: 1520
0
0
Clear
Row
Age Range: 2144
0
0
Clear
Row
0
0
0
Clear
Row
+ Additional/Alternative Classification/Subcategory
Female
Rate 1: Most effective or moderately effective contraception
Classification/Subcategory
Numerator
Denominator
Rate
Age Range: 1520
0
0
Clear
Row
Age Range: 2144
0
0
Clear
Row
0
0
0
Clear
Row
+ Additional/Alternative Classification/Subcategory
Rate 2: Longacting reversible contraception
Classification/Subcategory
Numerator
Denominator
Rate
Age Range: 1520
0
0
Clear
Row
Age Range: 2144
0
0
Clear
Row
0
0
0
Clear
Row
+ Additional/Alternative Classification/Subcategory
Primary Spoken Language
English
Rate 1: Most effective or moderately effective contraception
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Rate 1: Most effective or moderately effective contraception
Classification/Subcategory
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Denominator
Rate
Age Range: 1520
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0
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Row
Age Range: 2144
0
0
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Row
0
0
0
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Row
+ Additional/Alternative Classification/Subcategory
Rate 2: Longacting reversible contraception
Classification/Subcategory
Numerator
Denominator
Rate
Age Range: 1520
0
0
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Row
Age Range: 2144
0
0
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Row
0
0
0
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Row
+ Additional/Alternative Classification/Subcategory
Spanish
Rate 1: Most effective or moderately effective contraception
Classification/Subcategory
Numerator
Denominator
Rate
Age Range: 1520
0
0
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Row
Age Range: 2144
0
0
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Row
0
0
0
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Row
+ Additional/Alternative Classification/Subcategory
Rate 2: Longacting reversible contraception
Classification/Subcategory
Numerator
Denominator
Rate
Age Range: 1520
0
0
Clear
Row
Age Range: 2144
0
0
Clear
Row
0
0
0
Clear
Row
+ Additional/Alternative Classification/Subcategory
Please define the language *
Delete Language
df
Rate 1: Most effective or moderately effective contraception
Classification/Subcategory
Numerator
Denominator
Rate
Age Range: 1520
0
0
0
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Row
Age Range: 2144
0
0
0
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Row
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Row
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0
0
+ Additional/Alternative Classification/Subcategory
Rate 2: Longacting reversible contraception
Classification/Subcategory
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Rate
Age Range: 1520
0
0
0
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Row
Age Range: 2144
0
0
0
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Row
0
0
0
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Row
+ Additional/Alternative Classification/Subcategory
+ Additional Primary Spoken Language(s)
Disability Status
SSI
Rate 1: Most effective or moderately effective contraception
Classification/Subcategory
Numerator
Denominator
Rate
Age Range: 1520
0
0
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Row
Age Range: 2144
0
0
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Row
0
0
0
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Row
+ Additional/Alternative Classification/Subcategory
Rate 2: Longacting reversible contraception
Classification/Subcategory
Numerator
Denominator
Rate
Age Range: 1520
0
0
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Row
Age Range: 2144
0
0
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Row
0
0
0
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Row
+ Additional/Alternative Classification/Subcategory
NonSSI
Rate 1: Most effective or moderately effective contraception
Classification/Subcategory
Numerator
Denominator
Rate
Age Range: 1520
0
0
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Row
Age Range: 2144
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0
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0
0
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Row
+ Additional/Alternative Classification/Subcategory
Rate 2: Longacting reversible contraception
Classification/Subcategory
Numerator
Denominator
Rate
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Age Range: 1520
0
0
Age Range: 2144
0
0
0
0
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Row
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Row
0
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Row
+ Additional/Alternative Classification/Subcategory
Please define the disability status *
Delete Disability Status
gh
Rate 1: Most effective or moderately effective contraception
Classification/Subcategory
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Rate
Age Range: 1520
0
0
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Age Range: 2144
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Rate 2: Longacting reversible contraception
Classification/Subcategory
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Denominator
Rate
Age Range: 1520
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Age Range: 2144
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0
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+ Additional/Alternative Classification/Subcategory
+ Additional Disability Status(es)
Geography
Urban
Rate 1: Most effective or moderately effective contraception
Classification/Subcategory
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Age Range: 1520
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Age Range: 2144
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+ Additional/Alternative Classification/Subcategory
Rate 2: Longacting reversible contraception
Classification/Subcategory
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Rate
Age Range: 1520
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Row
Age Range: 2144
0
0
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Row
0
0
0
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Row
+ Additional/Alternative Classification/Subcategory
Rural
Rate 1: Most effective or moderately effective contraception
Classification/Subcategory
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Rate 2: Longacting reversible contraception
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Age Range: 1520
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Age Range: 2144
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0
0
0
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+ Additional/Alternative Classification/Subcategory
Please define the geographical region *
Delete Geographical Region
kl
Rate 1: Most effective or moderately effective contraception
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Rate
Age Range: 1520
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Age Range: 2144
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Age Range: 1520
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Age Range: 2144
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+ Additional/Alternative Classification/Subcategory
+ Additional Geographical Region(s)
Program Authority
Waiver/SPA
Rate 1: Most effective or moderately effective contraception
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Age Range: 1520
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General Medicaid
Rate 1: Most effective or moderately effective contraception
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Age Range: 1520
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Age Range: 1520
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+ Additional/Alternative Classification/Subcategory
Delivery System
Managed Care
Rate 1: Most effective or moderately effective contraception
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+ Additional/Alternative Classification/Subcategory
Rate 2: Longacting reversible contraception
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FeeforService
Rate 1: Most effective or moderately effective contraception
Classification/Subcategory
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Age Range: 1520
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Rate 2: Longacting reversible contraception
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Age Range: 1520
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Age Range: 2144
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+ Additional/Alternative Classification/Subcategory
Primary Care Case Management(PCCM)
Rate 1: Most effective or moderately effective contraception
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Age Range: 1520
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Age Range: 2144
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Clear
Row
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Rate 2: Longacting reversible contraception
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Age Range: 1520
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Age Range: 2144
0
0
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0
0
0
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Rate 1: Most effective or moderately effective contraception
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Age Range: 1520
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Age Range: 2144
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Rate 2: Longacting reversible contraception
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Age Range: 1520
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0
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Age Range: 2144
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0
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0
0
0
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| File Created | 0000-00-00 |