Cms-10434 #26 Cqm2017-cis

Centers for Medicare & Medicaid
Services
CMS eXpedited Life Cycle (XLC)

Medicaid and CHIP Program (MACPro)
CQM 2017 - Childhood Immunization Status (CIS)
Core Measure PRA Document
Version 1.0
08/25/2017

Document Number: 265-QSSI-MACPro-PRA-CQM2017-CIS-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

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Table of Contents

Table of Contents
1. Childhood Immunization Status (CIS) Screenshots ............................................. 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
1.10
1.11
1.12
1.13
1.14
1.15
1.16
1.17
1.18
1.19
1.20
1.21
1.22
1.23
1.24
1.25
1.26

Measurement Specifications – Path 1 ............................................................. 1
Measurement Specifications – Path 2 ............................................................. 1
Data Source .................................................................................................... 1
Performance Measure - Path 1 – Screenshot 1 .............................................. 2
Performance Measure - Path 1 – Screenshot 2 .............................................. 2
Performance Measure - Path 1 – Screenshot 3 .............................................. 3
Performance Measure - Path 1 – Screenshot 4 .............................................. 3
Performance Measure - Path 1 – Screenshot 5 .............................................. 4
Performance Measure - Path 2 – Screenshot 1 .............................................. 4
Performance Measure - Path 2 – Screenshot 2 .............................................. 5
Performance Measure - Path 2 – Screenshot 3 .............................................. 5
Deviations from Measure Specifications – Screenshot 1 ................................ 6
Deviations from Measure Specifications – Screenshot 2 ................................ 6
Deviations from Measure Specifications – Screenshot 3 ................................ 7
Deviations from Measure Specifications – Screenshot 4 ................................ 7
Deviations from Measure Specifications – Screenshot 5 ................................ 8
Deviations from Measure Specifications – Screenshot 6 ................................ 8
Deviations from Measure Specifications – Screenshot 7 ................................ 9
Deviations from Measure Specifications – Screenshot 8 ................................ 9
Deviations from Measure Specifications – Screenshot 9 .............................. 10
Deviations from Measure Specifications – Screenshot 10 ............................ 10
Deviations from Measure Specifications – Screenshot 11 ............................ 11
Deviations from Measure Specifications – Screenshot 12 ............................ 11
Optional Measure Stratification – Screenshot 1 ............................................ 12
Optional Measure Stratification – Screenshot 2 ............................................ 13
Optional Measure Stratification – Screenshot 3 ............................................ 13

Appendix A: Acronyms ............................................................................................... 14

List of Figures
Figure 1: Measurement Specifications – Path 1 .............................................................. 1
Figure 2: Measurement Specifications – Path 2 .............................................................. 1
Figure 3 : Data Source .................................................................................................... 1
Figure 4: Performance Measure - Path 1 – Screenshot 1 ............................................... 2
Figure 5: Performance Measure - Path 1 – Screenshot 2 ............................................... 2
Figure 6: Performance Measure - Path 1 – Screenshot 3 ............................................... 3

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List of Tables

Figure 7: Performance Measure - Path 1 – Screenshot 4 ............................................... 3
Figure 8: Performance Measure - Path 1 – Screenshot 5 ............................................... 4
Figure 9: Performance Measure - Path 2 – Screenshot 1 ............................................... 4
Figure 10: Performance Measure - Path 2 – Screenshot 2 ............................................. 5
Figure 11: Performance Measure - Path 2 – Screenshot 3 ............................................. 5
Figure 12: Deviations from Measure Specifications – Screenshot 1 ............................... 6
Figure 13: Deviations from Measure Specifications – Screenshot 2 ............................... 6
Figure 14: Deviations from Measure Specifications – Screenshot 3 ............................... 7
Figure 15: Deviations from Measure Specifications – Screenshot 4 ............................... 7
Figure 16: Deviations from Measure Specifications – Screenshot 5 ............................... 8
Figure 17: Deviations from Measure Specifications – Screenshot 6 ............................... 8
Figure 18: Deviations from Measure Specifications – Screenshot 7 ............................... 9
Figure 19: Deviations from Measure Specifications – Screenshot 8 ............................... 9
Figure 20: Deviations from Measure Specifications – Screenshot 9 ............................. 10
Figure 21: Deviations from Measure Specifications – Screenshot 10 ........................... 10
Figure 22: Deviations from Measure Specifications – Screenshot 11 ........................... 11
Figure 23: Deviations from Measure Specifications – Screenshot 12 ........................... 11
Figure 24: Optional Measure Stratification – Screenshot 1 ........................................... 12
Figure 25: Optional Measure Stratification – Screenshot 2 ........................................... 13
Figure 26: Optional Measure Stratification – Screenshot 3 ........................................... 13

List of Tables
No table of figures entries found.

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Measurement Specifications – Path 1

1. Childhood Immunization Status (CIS) Screenshots
1.1

Measurement Specifications – Path 1

Figure 1: Measurement Specifications – Path 1

1.2

Measurement Specifications – Path 2

Figure 2: Measurement Specifications – Path 2

1.3

Data Source

Figure 3 : Data Source

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1.4

Performance Measure - Path 1 – Screenshot 1

Performance Measure - Path 1 – Screenshot 1

Figure 4: Performance Measure - Path 1 – Screenshot 1

1.5

Performance Measure - Path 1 – Screenshot 2

Figure 5: Performance Measure - Path 1 – Screenshot 2

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1.6

Performance Measure - Path 1 – Screenshot 3

Performance Measure - Path 1 – Screenshot 3

Figure 6: Performance Measure - Path 1 – Screenshot 3

1.7

Performance Measure - Path 1 – Screenshot 4

Figure 7: Performance Measure - Path 1 – Screenshot 4

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1.8

Performance Measure - Path 1 – Screenshot 5

Performance Measure - Path 1 – Screenshot 5

Figure 8: Performance Measure - Path 1 – Screenshot 5

1.9

Performance Measure - Path 2 – Screenshot 1

Figure 9: Performance Measure - Path 2 – Screenshot 1

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Performance Measure - Path 2 – Screenshot 2

1.10 Performance Measure - Path 2 – Screenshot 2

Figure 10: Performance Measure - Path 2 – Screenshot 2

1.11 Performance Measure - Path 2 – Screenshot 3

Figure 11: Performance Measure - Path 2 – Screenshot 3

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Deviations from Measure Specifications – Screenshot 1

1.12 Deviations from Measure Specifications – Screenshot 1

Figure 12: Deviations from Measure Specifications – Screenshot 1

1.13 Deviations from Measure Specifications – Screenshot 2

Figure 13: Deviations from Measure Specifications – Screenshot 2

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Deviations from Measure Specifications – Screenshot 3

1.14 Deviations from Measure Specifications – Screenshot 3

Figure 14: Deviations from Measure Specifications – Screenshot 3

1.15 Deviations from Measure Specifications – Screenshot 4

Figure 15: Deviations from Measure Specifications – Screenshot 4

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Deviations from Measure Specifications – Screenshot 5

1.16 Deviations from Measure Specifications – Screenshot 5

Figure 16: Deviations from Measure Specifications – Screenshot 5

1.17 Deviations from Measure Specifications – Screenshot 6

Figure 17: Deviations from Measure Specifications – Screenshot 6

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Deviations from Measure Specifications – Screenshot 7

1.18 Deviations from Measure Specifications – Screenshot 7

Figure 18: Deviations from Measure Specifications – Screenshot 7

1.19 Deviations from Measure Specifications – Screenshot 8

Figure 19: Deviations from Measure Specifications – Screenshot 8

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Deviations from Measure Specifications – Screenshot 9

1.20 Deviations from Measure Specifications – Screenshot 9

Figure 20: Deviations from Measure Specifications – Screenshot 9

1.21 Deviations from Measure Specifications – Screenshot 10

Figure 21: Deviations from Measure Specifications – Screenshot 10

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Deviations from Measure Specifications – Screenshot 11

1.22 Deviations from Measure Specifications – Screenshot 11

Figure 22: Deviations from Measure Specifications – Screenshot 11

1.23 Deviations from Measure Specifications – Screenshot 12

Figure 23: Deviations from Measure Specifications – Screenshot 12

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Optional Measure Stratification – Screenshot 1

1.24 Optional Measure Stratification – Screenshot 1
Note: Same N/D/R sets are displayed under each of the stratification categories

Figure 24: Optional Measure Stratification – Screenshot 1

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Optional Measure Stratification – Screenshot 2

1.25 Optional Measure Stratification – Screenshot 2

Figure 25: Optional Measure Stratification – Screenshot 2

1.26 Optional Measure Stratification – Screenshot 3

Figure 26: Optional Measure Stratification – Screenshot 3

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Optional Measure Stratification – Screenshot 3

Appendix A: Acronyms
Table 1: Acronyms
Acronym

Definition

CQM

Child Quality Measures

PRA

Paperwork Reduction Act of 1995

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