CMS-10398 #45 Maternal and Infant Health (MIH) Quality Screenshot #6 (

10/1/2015

Annual Report Admin Screen

Maternal and Infant Health Initiative Developmental Measure: Use of
Contraceptive Methods by Women
Medicaid Adult Core Quality Measure ­ OR ­ 2015

Federal Fiscal Year

Request Technical Assistance

Clear

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
+/­
For non­grantee states, both measures are optional. Submission of the Maternal and Infant Health report is not required. If reporting on one measure only (e.g. 
"Use of contraceptive Methods by Postpartum Women"),the state must also access the screen for the other measure which is not being reported (e.g. 
"Maternal and Infant Health Initiative Developmental Measure:Use of Contraceptive Methods by Postpartum Women") and select "No" to the question "Are you
reporting on this measure?" and complete the "Not reporting on Measure" section.
Rate 1: Most effective or moderately effective contraception
Office of Population Affairs/Centers for Disease Control and Prevention
Rate 2: Long­acting reversible contraception
Office of Population Affairs/Centers for Disease Control and Prevention

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

Other

Rate 2: Long­acting reversible contraception
Administrative Data

Specify *

From where is the Administrative Data coming?
Must select one or more

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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
October
Month

2013
Year

End Date
August
Month

2014
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

Specify Total Measure Eligible Population *

Which delivery systems are represented in the Denominator?

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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 *

Combined Rate(s) from Multiple Reporting Units
+/­

Additional Notes
+/­

Rate 1: Most effective or moderately effective contraception

https://gmacbistest.appiancloud.com/suite/tempo/actions/item/ksBbrxGjzbwMkxqSHejGZN_ZSosJLv6Nrrrb8n7aYwTAzlYDD­POsL­zSgvZF_z5YQuT3MqN…

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Additional Notes/Comments on Measure (Optional)

Character count: 0/2000

Rate 2:  Long­acting reversible contraception
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

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0

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0

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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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+ 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

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Row

Age Range: 21­44

0

0

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Row

0

0

0

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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
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

Clear
Row

Age Range: 21­44

0

0

Clear
Row

0

0

0

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Row

+ Additional/Alternative Classification/Sub­category
Asian
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

Clear

https://gmacbistest.appiancloud.com/suite/tempo/actions/item/ksBbrxGjzbwMkxqSHejGZN_ZSosJLv6Nrrrb8n7aYwTAzlYDD­POsL­zSgvZF_z5YQuT3MqN…

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Row

+ Additional/Alternative Classification/Sub­category
Native Hawaiian or Other Pacific Islander
Rate 1: Most effective or moderately effective contraception
Classification/Sub­category

Numerator

Denominator

Rate

Age Range: 15­20

0

0

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Age Range: 21­44

0

0

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Row

0

0

0

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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

Clear
Row

0

0

0

Clear
Row

+ Additional/Alternative Classification/Sub­category
Please define the race *

Delete Race

uii
Rate 1: Most effective or moderately effective contraception
Classification/Sub­category

Numerator

Denominator

Rate

Age Range: 15­20

0

0

0

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Row

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0

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+ 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

0

0

0

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Row

+ Additional/Alternative Classification/Sub­category
+ Additional Race(s)
Ethnicity
Hispanic or Latino
Rate 1: Most effective or moderately effective contraception

https://gmacbistest.appiancloud.com/suite/tempo/actions/item/ksBbrxGjzbwMkxqSHejGZN_ZSosJLv6Nrrrb8n7aYwTAzlYDD­POsL­zSgvZF_z5YQuT3MqN…

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0

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Age Range: 21­44

0

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0

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0

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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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+ 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

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Row

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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
Please define the ethnicity *

Delete Ethnicity

tyuty
Rate 1: Most effective or moderately effective contraception
Classification/Sub­category

Numerator

Denominator

Rate

Age Range: 15­20

0

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0

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Age Range: 21­44

0

0

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0

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+ Additional/Alternative Classification/Sub­category

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+ Additional/Alternative Classification/Sub­category
+ Additional Ethnicity(ies)
Sex
Male
Rate 1: Most effective or moderately effective contraception
Classification/Sub­category

Numerator

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Age Range: 15­20

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+ Additional/Alternative Classification/Sub­category
Rate 2: Long­acting reversible contraception
Classification/Sub­category

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0

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0

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0

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+ Additional/Alternative Classification/Sub­category
Female
Rate 1: Most effective or moderately effective contraception
Classification/Sub­category

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0

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+ Additional/Alternative Classification/Sub­category
Rate 2: Long­acting reversible contraception
Classification/Sub­category
Age Range: 15­20

Numerator

Denominator

0

0

Rate
Clear
Row

https://gmacbistest.appiancloud.com/suite/tempo/actions/item/ksBbrxGjzbwMkxqSHejGZN_ZSosJLv6Nrrrb8n7aYwTAzlYDD­POsL­zSgvZF_z5YQuT3MqN…

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+ Additional/Alternative Classification/Sub­category
Primary Spoken Language
English
Rate 1: Most effective or moderately effective contraception
Classification/Sub­category

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Rate 2: Long­acting reversible contraception
Classification/Sub­category

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+ Additional/Alternative Classification/Sub­category
Spanish
Rate 1: Most effective or moderately effective contraception
Classification/Sub­category

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0

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+ Additional/Alternative Classification/Sub­category
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Classification/Sub­category

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0

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0

0

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0

0

0

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+ Additional/Alternative Classification/Sub­category
Please define the language *
tyuty
Rate 1: Most effective or moderately effective contraception

Delete Language

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+ Additional/Alternative Classification/Sub­category
Rate 2: Long­acting reversible contraception
Classification/Sub­category

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+ Additional/Alternative Classification/Sub­category
+ Additional Primary Spoken Language(s)
Disability Status
SSI
Rate 1: Most effective or moderately effective contraception
Classification/Sub­category

Numerator

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Rate

Age Range: 15­20

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+ Additional/Alternative Classification/Sub­category
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Classification/Sub­category

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+ Additional/Alternative Classification/Sub­category
Non­SSI
Rate 1: Most effective or moderately effective contraception
Classification/Sub­category

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Age Range: 15­20

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https://gmacbistest.appiancloud.com/suite/tempo/actions/item/ksBbrxGjzbwMkxqSHejGZN_ZSosJLv6Nrrrb8n7aYwTAzlYDD­POsL­zSgvZF_z5YQuT3Mq…

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+ Additional/Alternative Classification/Sub­category
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+ Additional/Alternative Classification/Sub­category
Please define the disability status *

Delete Disability Status

dfgdf
Rate 1: Most effective or moderately effective contraception
Classification/Sub­category

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+ Additional/Alternative Classification/Sub­category
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+ Additional/Alternative Classification/Sub­category
+ Additional Disability Status(es)
Geography
Urban
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+ Additional/Alternative Classification/Sub­category
Rate 2: Long­acting reversible contraception

https://gmacbistest.appiancloud.com/suite/tempo/actions/item/ksBbrxGjzbwMkxqSHejGZN_ZSosJLv6Nrrrb8n7aYwTAzlYDD­POsL­zSgvZF_z5YQuT3Mq…

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+ Additional/Alternative Classification/Sub­category
Rural
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Please define the geographical region *

Delete Geographical Region

dfgdf
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https://gmacbistest.appiancloud.com/suite/tempo/actions/item/ksBbrxGjzbwMkxqSHejGZN_ZSosJLv6Nrrrb8n7aYwTAzlYDD­POsL­zSgvZF_z5YQuT3Mq…

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+ Additional/Alternative Classification/Sub­category
+ Additional Geographical Region(s)

Program Authority
Waiver/SPA
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+ Additional/Alternative Classification/Sub­category
General Medicaid
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Delivery System
Managed Care
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https://gmacbistest.appiancloud.com/suite/tempo/actions/item/ksBbrxGjzbwMkxqSHejGZN_ZSosJLv6Nrrrb8n7aYwTAzlYDD­POsL­zSgvZF_z5YQuT3Mq…

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Fee­for­Service
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+ Additional/Alternative Classification/Sub­category
Primary Care Case Management(PCCM)
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https://gmacbistest.appiancloud.com/suite/tempo/actions/item/ksBbrxGjzbwMkxqSHejGZN_ZSosJLv6Nrrrb8n7aYwTAzlYDD­POsL­zSgvZF_z5YQuT3Mq…

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+ Additional/Alternative Classification/Sub­category
Please describe the stratification

Other

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+ Additional/Alternative Classification/Sub­category

Report Documents
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Saved Documents
Maximum documents that can be uploaded for this report: 84
Maximum file size : 2MB
Valid file extensions : pdf; ppt; doc; docx; xlsx; xls; pptx
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before the report can be submitted to CMS).

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