E Appendix E_SCDTDP Measure Specifications

Sickle Cell Disease Treatment Demonstration Program - Quality Improvement Data Collection

Appendix E_SCDTDP Measure Specifications.xlsx

Sickle Cell Disease Treatment Demonstration Program - Quality Improvement Data Collection

OMB: 0906-0019

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Overview

Measure Specifications
National_Drug_Code_Directory


Sheet 1: Measure Specifications

Appendix E: SCDTDP Measure Specifications




Sickle Cell Treatment Demonstration Program

Meaure Specifications and Codes




Aim 1: Increase the number of providers treating persons with sickle cell disease




Measure 1a: Number of providers in Plan who saw at least one patient younger than 18 years of age with SCD two or more times during the past 12 months

Denominator Population: Providers who had at least one claim submitted to the plan during the 12 month period ending with the reference month.
Numerator Population: Providers from the denominator population who saw at least one patient with SCD who was less than 18 years old at the time of the visit for at least two non-emergent outpatient visits (Table 2) during the 12 month period ending with the reference month.
Exclusions: Patients who also have a diagnosis of sickle cell trait (Table 3) only should be excluded.
Reporting Outputs: Denominator and numerator counts and percent.
Reporting Interval: Monthly
Comments: Claims include those paid, suspended, pending or denied.



Measure 1b: Number of providers in Plan who saw at least one adult patient with SCD two or more times during the past 12 months

Denominator Population: Providers who had at least one claim submitted to the plan during the 12 month period ending with the reference month.
Numerator Population: Providers from the denominator population who saw at least one patient with SCD who was 18 years of age or older at the time of the visit for at least two non-emergent outpatient visits (Table 2) during the 12 month period ending with the reference month.
Exclusions: Patients who also have a diagnosis of sickle cell trait (Table 3) only should be excluded.
Reporting Outputs: Denominator and numerator counts and percent.
Reporting Interval: Monthly
Comments: Claims include those paid, suspended, pending or denied.



Measure 1c: Number of providers in Plan who saw any patient with SCD two or more times during the past 12 months

Denominator Population: Providers who had at least one claim submitted to the plan during the 12 month period ending with the reference month.
Numerator Population: Providers from the denominator population who saw any patient with SCD for at least two non-emergent outpatient visits (Table 2) during the 12 month period ending with the reference month.
Exclusions: Patients who also have a diagnosis of sickle cell trait (Table 3) only should be excluded.
Reporting Outputs: Denominator and numerator counts and percent.
Reporting Interval: Monthly
Comments: Claims include those paid, suspended, pending or denied.



Measure 1d: Number of children in Plan with SCD who had at least 2 outpatient visits in the past 12 months.

Denominator Population: Patients less than 18 years old as of the end of the reference month who have ever had a diagnosis of sickle cell disease (Table 1) and who had at least one health care event (any claim) during the 12 month period ending with the reference month.
Numerator Population: Patients from the denominator population who had at least two non-emergent outpatient visits (Table 2) during the 12 month period ending with the reference month.
Exclusions: Patients who also have a diagnosis of sickle cell trait (Table 3) only should be excluded.
Reporting Outputs: Denominator and numerator counts and percent.
Reporting Interval: Monthly
Comments: Claims include those paid, suspended, pending or denied.



Measure 1e: Number of adults in Plan with SCD who had at least 2 outpatient visits in the past 12 months.

Denominator Population: Patients who were 18 years old or older as of the end of the reference month who have ever had a diagnosis of sickle cell disease (Table 1) and who had at least one health care event (any claim) during the 12 month period ending with the reference month.
Numerator Population: Patients from the denominator population who had at least two non-emergent outpatient visits (Table 2) during the 12 month period ending with the reference month.
Exclusions: Patients who also have a diagnosis of sickle cell trait (Table 3) only should be excluded.
Reporting Outputs: Denominator and numerator counts and percent.
Reporting Interval: Monthly
Comments: Claims include those paid, suspended, pending or denied.



Aim 2: Increase the number of providers prescribing hydroxyurea




Measure 2a: Number of providers in Plan who prescribed hydroxyurea to a child with SCD at least once during the past 12 months

Denominator Population: Providers who submitted at least one claim to the plan during the 12 month period ending with the reference month.
Numerator Population: Providers from the denominator population who had a patient under 18 years old and who have a diagnosis of sickle cell disease (Table 1) and who filled at least one hydroxyurea prescription during the 12 month period ending with the reference month.
Exclusions: Providers whose patients also have a diagnosis of sickle cell trait (Table 3) only should be excluded.
Reporting Outputs: Denominator and numerator counts and percent.
Reporting Interval: Monthly
Comments: Claims include those paid, suspended, pending or denied.



Measure 2b: Number of providers in Plan who prescribed hydroxyurea to an adult with SCD at least once during the past 12 months

Denominator Population: Providers who submitted at least one claim to the plan during the 12 month period ending with the reference month.
Numerator Population: Providers from the denominator population who had a patient over 18 years old and who have a diagnosis of sickle cell disease (Table 1) and who filled at least one hydroxyurea prescription during the 12 month period ending with the reference month.
Exclusions: Providers whose patients also have a diagnosis of sickle cell trait (Table 3) only should be excluded.
Reporting Outputs: Denominator and numerator counts and percent.
Reporting Interval: Monthly
Comments: Claims include those paid, suspended, pending or denied.



Measure 2c: Number of providers in Plan who prescribed hydroxyurea at least once during the past 12 months

Denominator Population: Providers who submitted at least one claim to the plan during the 12 month period ending with the reference month.
Numerator Population: Providers from the denominator population who had any patient with a diagnosis of sickle cell disease (Table 1) who filled at least one hydroxyurea prescription during the 12 month period ending with the reference month.
Exclusions: Providers whose patients also have a diagnosis of sickle cell trait (Table 3) only should be excluded.
Reporting Outputs: Denominator and numerator counts and percent.
Reporting Interval: Monthly
Comments: Claims include those paid, suspended, pending or denied.



Measure 2d: Number of children with SCD who filled a prescription for hydroxyurea at least once during the past 12 months

Denominator Population: Patients less than 18 years old as of the end of the reference month who have ever had a diagnosis of sickle cell disease (Table 1) and who had at least one health care event (any claim) during the 12 month period ending with the reference month.
Numerator Population: Patients from the denominator population who filled at least one hydroxyurea prescription during the 12 month period ending with the reference month.
Exclusions: Patients who also have a diagnosis of sickle cell trait (Table 3) only should be excluded.
Reporting Outputs: Denominator and numerator counts and percent.
Reporting Interval: Monthly
Comments: Claims include those paid, suspended, pending or denied.



Measure 2e: Number of adults with SCD who filled a prescription for hydroxyurea at least once during the past 12 months

Denominator Population: Patients 18 years of age or older as of the end of the reference month who have ever had a diagnosis of sickle cell disease (Table 1) and who had at least one health care event (any claim) during the 12 month period ending with the reference month.
Numerator Population: Patients from the denominator population who filled at least one hydroxyurea prescription during the 12 month period ending with the reference month.
Exclusions: Patients who also have a diagnosis of sickle cell trait (Table 3) only should be excluded.
Reporting Outputs: Denominator and numerator counts and percent.
Reporting Interval: Monthly
Comments: Claims include those paid, suspended, pending or denied.



Table 1: Codes to Identify Sickle Cell Disease

Condition Name ICD-9 ICD-10
Hb S beta‐thalassemia 282.41, 282.42 D57.40, D57.41
Hb SS‐disease (sickle cell anemia) 282.6, 282.61, 282.62 D57 Sickle cell disorders
D57.0 Sickle cell anemia with crisis
D57.1 Sickle cell anemia without crisis
Hb SC‐disease 282.63, 282.64 D57.20, D57.21
Hb SD‐disease 282.68, 282.69 D57.80, D57.81
Hb SE‐disease 282.68, 282.69 D57.80, D57.81
Condition Name Hemoglobin Screening Result ICD‐9 Code(s)

Table 2: Codes to Identify Outpatient Care

Description CPT ICD-9
Office or other outpatient services 99201‐99205, 99211‐99215, 99241‐
99245
Preventive medicine 99381‐99385, 99391‐99395, 99401‐
99404, 99411‐99412, 99420, 99429
General medical examination
V20.2, V70.0, V70.3,
V70.5, V70.6, V70.8



Table 3: Excluded Sickle Cell Related Codes

Condition Name ICD-9 ICD-10
Hb S (sickle)‐carrier (sickle cell trait) 282.5 D57.3

Sheet 2: National_Drug_Code_Directory

Proprietary Name Dosage Form name Application Number Package Description Product NDC Strength Product Type Name Non-Proprietary Name Route Name Market Category Name Labeler Name Substance Name Pharm Class DEA Start date End date
HYDROXYUREA CAPSULE ANDA075143 30 CAPSULE in 1 BOTTLE, PLASTIC (54868-4773-0) 54868-4773 500 mg/1 HUMAN PRESCRIPTION DRUG Hydroxyurea ORAL ANDA Physicians Total Care, Inc. HYDROXYUREA N/A N/A 4/11/2003 N/A
HYDROXYUREA CAPSULE ANDA075143 100 CAPSULE in 1 BOTTLE, PLASTIC (54868-4773-1) 54868-4773 500 mg/1 HUMAN PRESCRIPTION DRUG Hydroxyurea ORAL ANDA Physicians Total Care, Inc. HYDROXYUREA N/A N/A 4/11/2003 N/A
HYDROXYUREA CAPSULE ANDA075143 50 CAPSULE in 1 BOTTLE, PLASTIC (54868-4773-2) 54868-4773 500 mg/1 HUMAN PRESCRIPTION DRUG Hydroxyurea ORAL ANDA Physicians Total Care, Inc. HYDROXYUREA N/A N/A 4/11/2003 N/A
HYDROXYUREA CAPSULE ANDA075143 60 CAPSULE in 1 BOTTLE, PLASTIC (54868-4773-3) 54868-4773 500 mg/1 HUMAN PRESCRIPTION DRUG Hydroxyurea ORAL ANDA Physicians Total Care, Inc. HYDROXYUREA N/A N/A 4/11/2003 N/A
HYDROXYUREA CAPSULE ANDA075143 40 CAPSULE in 1 BOTTLE, PLASTIC (54868-4773-4) 54868-4773 500 mg/1 HUMAN PRESCRIPTION DRUG Hydroxyurea ORAL ANDA Physicians Total Care, Inc. HYDROXYUREA N/A N/A 4/11/2003 N/A
Hydroxyurea CAPSULE ANDA075340 100 CAPSULE in 1 BOTTLE (60429-265-01) 60429-265 500 mg/1 HUMAN PRESCRIPTION DRUG Hydroxyurea ORAL ANDA Golden State Medical Supply, Inc. HYDROXYUREA N/A N/A 2/24/1999 N/A
Hydroxyurea CAPSULE ANDA075340 100 BLISTER PACK in 1 BOX, UNIT-DOSE (68084-284-01) > 1 CAPSULE in 1 BLISTER PACK (68084-284-11) 68084-284 500 mg/1 HUMAN PRESCRIPTION DRUG Hydroxyurea ORAL ANDA American Health Packaging HYDROXYUREA N/A N/A 8/12/2008 N/A
HYDREA CAPSULE NDA016295 100 CAPSULE in 1 BOTTLE (0003-0830-50) 0003-0830 500 mg/1 HUMAN PRESCRIPTION DRUG HYDROXYUREA ORAL NDA E.R. Squibb & Sons, L.L.C. HYDROXYUREA N/A N/A 6/1/2009 N/A
DROXIA CAPSULE NDA016295 60 CAPSULE in 1 BOTTLE (0003-6335-17) 0003-6335 200 mg/1 HUMAN PRESCRIPTION DRUG HYDROXYUREA ORAL NDA E.R. Squibb & Sons, L.L.C. HYDROXYUREA N/A N/A 6/1/2009 N/A
DROXIA CAPSULE NDA016295 60 CAPSULE in 1 BOTTLE (0003-6336-17) 0003-6336 300 mg/1 HUMAN PRESCRIPTION DRUG HYDROXYUREA ORAL NDA E.R. Squibb & Sons, L.L.C. HYDROXYUREA N/A N/A 6/1/2009 N/A
DROXIA CAPSULE NDA016295 60 CAPSULE in 1 BOTTLE (0003-6337-17) 0003-6337 400 mg/1 HUMAN PRESCRIPTION DRUG HYDROXYUREA ORAL NDA E.R. Squibb & Sons, L.L.C. HYDROXYUREA N/A N/A 6/1/2009 N/A
HYDROXYUREA CAPSULE ANDA075143 100 CAPSULE in 1 BOTTLE (0555-0882-02) 0555-0882 500 mg/1 HUMAN PRESCRIPTION DRUG Hydroxyurea ORAL ANDA Barr Laboratories Inc. HYDROXYUREA N/A N/A 10/19/1998 N/A
HYDROXYUREA CAPSULE ANDA075143 100 CAPSULE in 1 BOTTLE (42291-321-01) 42291-321 500 mg/1 HUMAN PRESCRIPTION DRUG Hydroxyurea ORAL ANDA AvKARE, Inc. HYDROXYUREA N/A N/A 7/19/2013 N/A
Hydroxyurea CAPSULE ANDA075340 100 CAPSULE in 1 BOTTLE (49884-724-01) 49884-724 500 mg/1 HUMAN PRESCRIPTION DRUG Hydroxyurea ORAL ANDA Par Pharmaceutical, Inc. HYDROXYUREA N/A N/A 2/24/1999 N/A
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