F Appendix F_SCDTDP_Data Request Form

Sickle Cell Disease Treatment Demonstration Program - Quality Improvement Data Collection

Appendix F_SCDTDP_Data Request Form.xlsx

Sickle Cell Disease Treatment Demonstration Program - Quality Improvement Data Collection

OMB: 0906-0019

Document [xlsx]
Download: xlsx | pdf

Overview

01_Data Form
02_Definitions Measure Concepts
03_Logic Specifications


Sheet 1: 01_Data Form

Appendix D: SCDTDP Data Request Form
















Sickle Cell Treatment Demonstration Program








Data Request - Sample Data Form to request data from MCO or State Medicaid


















Measure ID Measure Type (Provider, Location, Zip3, Zip5, or State) Population ID (based on measure type) Reference Period Reference Period Start Date (mm/dd/yyyy) Reference Period End Date (mm/dd/yyyy) Numerator Count Denominator Count System Date Data Source
(ex. Measure 1a) (ex. Provider) (ex. Zip3 = 019 or State = MD) (ex. Month-Year (10-2014) for monthly measures, Quarter-Year (Q1-2014) for Quarterly Measures) Date when reference period begins Date when reference period ends (ex. # 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 during the 12 month period ending with the reference month) (ex. # Providers who had at least one claim submitted to the plan during the 12 month period ending with the reference month) (Date report was run) (ex. CMS data, Managed Care Plan data, etc.)










* See definitions of measure concepts and logic specifications on Tabs 2-3









Sheet 2: 02_Definitions Measure Concepts

Sickle Cell Treatment Demonstration Program
NICHQ, Inc.: I added the parenthetical Medicaid (state or MCO) Data Request


Measure Concepts
Provider NPI codes, other de-identified provider ID
Provider Location* Provider group practice location, etc.
Patient Monthly reporting: age as of last day of reference month

Quarterly reporting: age as of last day of reference quarter

Age at time of visit

Patient filled prescription
Geographical Area Zip codes (5 digit or 3 digit) for practice
Visit Type Non-emergent or outpatient visit - see specifications in Tab 3
Reference Month Monthly reports: that month

Quarterly reports: last month of quarter
Claims Paid claims (confirming whether states can also do pending, suspended, and/or denied)
Outcomes Visit: outpatient, exclude ER or inpatient visits

Medication Prescription: Filled prescriptions for Hydroxyurea
* This measure can be rolled into geographical measure

Sheet 3: 03_Logic Specifications

Sickle Cell Treatment Demonstration Program

Medicaid (state or MCO) Data Request - Logic 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) should be excluded from denominator.
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) should be excluded from denominator.
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) should be excluded from denominator.
Reporting Outputs: Denominator and numerator counts and percent.
Reporting Interval: Monthly
Comments: Claims include those paid, suspended, pending or denied.



Measure 1d: Percent 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) should be excluded from denominator.
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) should be excluded from denominator.
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) should be excluded from numerator.
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) should be excluded from numerator.
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) should be excluded from numerator.
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) should be excluded from denominator.
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) should be excluded from denominator.
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
File Typeapplication/vnd.openxmlformats-officedocument.spreadsheetml.sheet
File Modified0000-00-00
File Created0000-00-00

© 2024 OMB.report | Privacy Policy