| Data Reporting Templates for Behavioral Health Clinic Quality Measures |
| End of Worksheet |
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| Quality Measures Data Reporting Instructions |
| These templates are to be used to report the set of Behavioral Health Clinic (BHCs) quality measures. For the Section 223 Demonstration Program for Certified Community Behavioral Health Clinics (CCBHCs), states are required to report all measures to Substance Abuse and Mental Health Services Administration (SAMHSA), including those performance measures that are reported by the clinics to the states as part of the CCBHC Demonstration Program. Users are referred to the Technical Specifications and Resource Manual for additional detailed instructions regarding each measure as well as general instructions for the set as a whole. |
| These measures are specified at the clinic level. Some of the measures are drawn from established specified measures and others are not; those derived from existing measures have been respecified to the clinic level unless they were already specified at the provider level. |
| Organization: |
| The templates are divided into 4 parts: 1) BHC-Lead Measures Required for the CCBHC Demonstration; 2) BHC-Lead Measures Not Required for the CCBHC Demonstration; 3) State-Lead Measures Required for the CCBHC Demonstration; and 4) State-Lead Measures Not Required for the CCBHC Demonstration, followed by a roll-up sheet and sheet related to CCBHC measurement periods. |
| Data Issues: |
| Although states may not be accustomed to reporting data or measures with small denominators, for the CCBHC Demonstration Program, all required measures must be reported. Those with denominators less than 30 will not be used for Quality Bonus Payment or be publically reported, but will be considered in the evaluation and should be treated by the CCBHCs and states as information to be used in internal quality improvement. |
| Data used for reporting should be final. |
| Optional Measure Stratification: |
| This reporting template includes only the stratification required by the measure specification. If states wish to designate other stratification categories in addition to those specified, the reporter (clinic or state) may add additional stratification groups provided they encompass the specified stratification and are reported separately from the rates required by the specifications. States should keep in mind that, if they require reporting of additional stratification categories, the numbers may not be sufficiently large to be meaningful. For reporting of any other stratification categories, provide the results in Section F Additional Notes. |
| Case Load Characteristics Instructions: |
| A table is provided for reporting numbers and percentages of the population of BHC consumers who fall into different categories. This information is being requested for the Section 223 evaluation. States may elect to require additional information. The spreadsheet is formatted to automatically calculate the percentages once numbers are entered. |
| A CCBHC consumer is anyone who has an enumerated visit at the clinic during the demonstration year. |
| Ethnicity and race are reported separately. For each consumer, both ethnicity and race should be reported. |
| Section-by-Section Instructions for Measure Templates: |
| A. Measurement Year: Insert the Measurement Year. For CCBHCs, the measurement year will be the demonstration year (DY1 or DY2) with DY1 running from the date when the demonstration services begin. For other purposes, the measurement year typically will be the calendar year (e.g., MY2017). |
| B. Data Source: With the exception of the PEC, Y/FEC, and HOU measures, there are three potential data sources: (1) administrative (claims data/encounter records); (2) medical records (typically electronic health records (EHR), registries, and/or paper records); and (3) hybrid (a combination of (1) and (2)). Each measure is specified for one of these data sources and the corresponding reporting template indicates which it is. The template for a measure will ask if you used the specified data source. If the answer is yes, further information about that data source is requested. If the answer is "Other," information about the non-specified data source is required. |
| C. Date Range (mm/dd/yyyy): Define the date range for the reporting period based on the “Start” time period as the month, day, and year that corresponds to the beginning period in which utilization took place and report the “End” time period as the month, day, and year that corresponds to the end period in which utilization took place (for the denominator and numerator separately). If a measure reports utilization of services during the measurement year and prior year(s) (the “look-back period”), the full measurement period for utilization should be reported in the Date Range. Do not report the year in which data were collected, or the version of HEDIS® used to calculate the measure, if it is a HEDIS-derived measure. If reporting on a CCBHC, please see Appendix A of the technical specifications and the final two worksheets (Measurement Periods) for help in calculating appropriate measurement periods. |
| D. Performance Measure: The measure is described. A table is then provided for the reporter to insert the numerator and denominator. The rate for each stratification and the total are automatically calculated. All numbers provided are rounded to the second decimal place (e.g., denominator = 550.37894= 550.38; 550.37443 = 550.37). |
| E. Adherence to Measure Specifications: This section, first, provides a space to identify the population included in the denominator. It then addresses adherence to the specifications. Reporters are expected to follow the specifications. If, for any reason, there is a deviation from those specifications, this section provides a place to so indicate. Examples of deviations include: coding issues (numerator); different age groups (denominator), definition of continuous enrollment (denominator); start/end dates; data sources. If a deviation is indicated, the reporter first must indicate if the denominator represents the total measure eligible population as defined by the technical specifications for this measure. If not, a description of excluded populations must be provided, as well as the size of the denominator used and the size of the actual eligible population as specified. Additionally, the reporter is asked to provide the actual numerator, denominator, and any other changes for each stratification specified for the measure (e.g., by age, payer status). |
| F. Additional Notes: Space is provided for the reporter to provide any additional information they feel is important. Please use this space to provide further explanations of any aspects of your state's reporting for the measure. Examples of such information may include context about why a data field cannot be reported; a change in the state's methodology, population, or program that would affect trendability of the measure; sampling approach used for hybrid measures; indication of external quality review or state validation if applicable. |
| Roll-up Report Instructions: |
| A table is provided to summarize the results of each measure. The contents are automatically inserted from the measure worksheets. |
| End of Worksheet |
| Press TAB to move to input areas. Use the arrow keys to read through the document. | |
| BHC-Lead Measures Required for the CCBHC Demonstration Program | |
| State Name: | |
| BHC Name: | |
| BHC Identifier: | |
| End of Worksheet | |
| Press TAB to move to input areas. Use the arrow keys to read through the document. | ||
| Case Load Characteristics | ||
| Characteristic | Number | Percent |
| Age | ||
| 0-11 years | ||
| 12-17 years | ||
| 18-64 years | ||
| 65+ years | ||
| Gender | ||
| Women | ||
| Men | ||
| Other | ||
| Unknown | ||
| Ethnicity | ||
| Not Hispanic or Latino | ||
| Hispanic or Latino | ||
| Unknown | ||
| Race | ||
| White | ||
| Black or African American | ||
| American Indian or Alaskan Native | ||
| Asian | ||
| Native Hawaiian or Pacific Islander | ||
| More than one Race | ||
| Unknown | ||
| Insurance Status | ||
| Medicaid | ||
| CHIP | ||
| Medicare | ||
| Medicare and Medicaid Dually-Eligible | ||
| VHA/TRICARE | ||
| Commercially insured | ||
| Uninsured | ||
| Other | ||
| Veteran or Military Status | ||
| Active Duty Military | ||
| Prior Military Service/Veteran | ||
| Neither | ||
| Total Clinic Population | ||
| End of Worksheet | ||
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| Time to Initial Evaluation (I-EVAL) | |||
| A SAMHSA-Developed Metric | |||
| A. Measurement Year: | |||
| Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017. | |||
| B. Data Source: | |||
| Select the data source type (Medical Records or Other): | If medical records data, select source (EHR, Paper Records, Both): | ||
| If other data source selected, specify source: | No Data | ||
| C. Date Range: | |||
| Denominator Start Date (mm/dd/yyyy) | No Data | ||
| Denominator End Date (mm/dd/yyyy) | No Data | ||
| Numerator Start Date (mm/dd/yyyy) | No Data | ||
| Numerator End Date (mm/dd/yyyy) | No Data | ||
| D. Performance Measure: | |||
| Metric 1. The percentage of new consumers with initial evaluation provided within 10 business days of first contact | |||
| Metric 2. The mean number of days until initial evaluation for new consumers | |||
| These metrics are stratified to report by age (12–17 years, 18 years and older) and are stratified to report by Medicaid, Medicare & Medicaid, other, and total population. | |||
| Metric #1: Percentage of New Clients with Initial Evaluation within 10 Business Days | |||
| Measure | Numerator | Denominator | Rate |
| Age 12-17 years | 0 | 0 | |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| Age 18+ years | 0 | 0 | |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| Total (all Age Groups) | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| Metric #2: Mean Number of Days until Initial Evaluation | |||
| Measure | Numerator | Denominator | Rate |
| Age 12-17 years | 0 | 0 | |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| Age 18+ years | 0 | 0 | |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| Total (all Age Groups) | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| E. Adherence to Measure Specifications: | |||
| Population included in the denominator (indicate yes or no for each of the options below): | |||
| Medicaid population | No Data | ||
| Title XIX-eligible CHIP population | No Data | ||
| Title XXI-eligible CHIP population | No Data | ||
| Other CHIP enrollees | |||
| Medicare population | No Data | ||
| Medicare and Medicaid Dually-Eligible population | No Data | ||
| VHA/TRICARE population | No Data | ||
| Commercially insured population | No Data | ||
| Uninsured population | No Data | ||
| Other | If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded: | ||
| Did your calculation of the measure deviate from the measure specification in any way? | If Yes, the measure differs: Explain how the calculation differed and why. | ||
| Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure? | If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell: | ||
| Specify the size of the population included in the denominator: | Specify the size of the measure-eligible population: | ||
| Provide the following information for each rate/stratification: | |||
| For Metric #1: Percentage of New Clients with Initial Eval within 10 Business Days | |||
| Age Range: 12-17 years | |||
| Did the numerator differ for the 12-17 years age range? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the 12-17 years age range? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the 12-17 years age range? | If other, explain the deviation in the next cell: | ||
| Age Range: 18+ years | |||
| Did the numerator differ for the 18+ years age range? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the 18+ years age range? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the 18+ years age range? | If other, explain the deviation in the next cell: | ||
| Medicaid Population: | |||
| Did the numerator differ for the Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicaid population? | If other, explain the deviation in the next cell: | ||
| Medicare & Medicaid Population: | |||
| Did the numerator differ for the Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Neither Medicaid nor Medicare & Medicaid Population: | |||
| Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Total Eligible Population: | |||
| Did the numerator differ for the Total Eligible population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Total Eligible population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Total Eligible population? | If other, explain the deviation in the next cell: | ||
| For Metric #2: Mean Number of Days until Initial Evaluation: | |||
| Age Range: 12-17 years | |||
| Did the numerator differ for the 12-17 years age range? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the 12-17 years age range? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the 12-17 years age range? | If other, explain the deviation in the next cell: | ||
| Age Range: 18+ years | |||
| Did the numerator differ for the 18+ years age range? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the 18+ years age range? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the 18+ years age range? | If other, explain the deviation in the next cell: | ||
| Medicaid Population: | |||
| Did the numerator differ for the Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicaid population? | If other, explain the deviation in the next cell: | ||
| Medicare & Medicaid Population: | |||
| Did the numerator differ for the Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Neither Medicaid nor Medicare & Medicaid Population: | |||
| Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Total Eligible Population: | |||
| Did the numerator differ for the Total Eligible population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Total Eligible population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Total Eligible population? | If other, explain the deviation in the next cell: | ||
| F. Additional Notes: | |||
| End of Worksheet | |||
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| Preventive Care and Screening: Adult Body Mass Index (BMI) Screening and Follow-Up (BMI-SF) | |||
| Based on a measure stewarded by the Centers for Medicare & Medicaid Services (NQF #0421, PQRS #128) | |||
| A. Measurement Year: | |||
| Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017. | |||
| B. Data Source: | |||
| Select the data source type (Medical Records or Other): | If medical records data, select source (EHR, Paper Records, Both): | ||
| If other data source selected, specify source: | No Data | ||
| C. Date Range: | |||
| Denominator Start Date (mm/dd/yyyy) | No Data | ||
| Denominator End Date (mm/dd/yyyy) | No Data | ||
| Numerator Start Date (mm/dd/yyyy) | No Data | ||
| Numerator End Date (mm/dd/yyyy) | No Data | ||
| D. Performance Measure: | |||
| The percentage of consumers aged 18 years and older with a BMI documented during the current encounter or during the previous six months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous six months of the current encounter | |||
| Normal Parameters: Age 65 years and older BMI ≥ 23 and < 30 kg/m2, Age 18 - 64 years BMI ≥ 18.5 and < 25 kg/m2 | |||
| The measure is stratified to report Medicaid, Medicare & Medicaid, other, and total population | |||
| Measure | Numerator | Denominator | Rate |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| Total | 0 | 0 | |
| E. Adherence to Measure Specifications: | |||
| Population included in the denominator (indicate yes or no for each of the options below): | |||
| Medicaid population | No Data | ||
| Title XIX-eligible CHIP population | No Data | ||
| Title XXI-eligible CHIP population | No Data | ||
| Other CHIP enrollees | No Data | ||
| Medicare population | No Data | ||
| Medicare and Medicaid Dually-Eligible population | No Data | ||
| VHA/TRICARE population | No Data | ||
| Commercially insured population | No Data | ||
| Uninsured population | No Data | ||
| Other | If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded: | ||
| Did your calculation of the measure deviate from the measure specification in any way? | If Yes, the measure differs: Explain how the calculation differed and why. | ||
| Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure? | If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell: | ||
| Specify the size of the population included in the denominator: | Specify the size of the measure-eligible population. | ||
| Medicaid Population: | |||
| Did the numerator differ for the Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicaid population? | If other, explain the deviation in the next cell: | ||
| Medicare & Medicaid Population: | |||
| Did the numerator differ for the Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Neither Medicaid nor Medicare & Medicaid Population: | |||
| Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Total Eligible Population: | |||
| Did the numerator differ for the Total Eligible population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Total Eligible population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Total Eligible population? | If other, explain the deviation in the next cell: | ||
| F. Additional Notes: | |||
| End of Worksheet | |||
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| Weight Assessment for Children/Adolescents: Body Mass Index Assessment for Children/Adolescents (WCC-BH) | |||
| Based on a measure stewarded by the National Committee for Quality Assurance (NQF #0024, HEDIS 2016, Medicaid Child and Adolescent Core Set) | |||
| A. Measurement Year: | |||
| Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017. | |||
| B. Data Source: | |||
| Select the data source type: | No Data | ||
| If administrative data only, select source (Medicaid Management Information System (MMIS) or Other): | If other administrative data, specify data source: | ||
| If hybrid data, select administrative data source (Medicaid Management Information System (MMIS) or Other): | If other for administrative hybrid data, specify data source: | ||
| If hybrid data, select medical records source (EHR, Paper Records, Both): | No Data | ||
| If hybrid data, what is the sample size? | No Data | ||
| If hybrid, what is the measure-eligible population? | No Data | ||
| If source other than administrative or hybrid selected, provide source: | No Data | ||
| C. Date Range: | |||
| Denominator Start Date (mm/dd/yyyy) | No Data | ||
| Denominator End Date (mm/dd/yyyy) | No Data | ||
| Numerator Start Date (mm/dd/yyyy) | No Data | ||
| Numerator End Date (mm/dd/yyyy) | No Data | ||
| D. Performance Measure: | |||
| Percentage of children ages 3 to 17 who had an outpatient visit with a primary care practitioner (PCP) or obstetrical/ gynecological (OB/GYN) practitioner and who had evidence of body mass index (BMI) percentile documentation during the measurement year. Because BMI norms for youth vary with age and gender, this measure evaluates whether BMI percentile is assessed rather than the absolute BMI value. | |||
| The measure is stratified to report by age (3-11, 12-17, and total (all age groups)), and by the Medicaid, Medicare & Medicaid, and other population. | |||
| Measure | Numerator | Denominator | Rate |
| 3-11 years | |||
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| Total | 0 | 0 | |
| 12-17 years | |||
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| Total | 0 | 0 | |
| E. Adherence to Measure Specifications: | |||
| Population included in the denominator (indicate yes or no for each of the options below): | |||
| Medicaid population | No Data | ||
| Title XIX-eligible CHIP population | No Data | ||
| Title XXI-eligible CHIP population | No Data | ||
| Other CHIP enrollees | No Data | ||
| Medicare population | No Data | ||
| Medicare and Medicaid Dually-Eligible population | No Data | ||
| VHA/TRICARE population | No Data | ||
| Commercially insured population | No Data | ||
| Uninsured population | No Data | ||
| Other | If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded: | ||
| Did your calculation of the measure deviate from the measure specification in any way? | If Yes, the measure differs: Explain how the calculation differed and why. | ||
| Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure? | If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell: | ||
| Specify the size of the population included in the denominator: | Specify the size of the measure-eligible population: | ||
| Provide the following information for each rate/stratification: | |||
| Age Range: 3-11 years | |||
| Did the numerator differ for the 3-11 years age range? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the 3-11 years age range? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the 3-11 years age range? | If other, explain the deviation in the next cell: | ||
| Age Range: 12-17 years | |||
| Did the numerator differ for the 12-17 years age range? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the 12-17 years age range? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the 12-17 years age range? | If other, explain the deviation in the next cell: | ||
| Medicaid Population: | |||
| Did the numerator differ for the Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicaid population? | If other, explain the deviation in the next cell: | ||
| Medicare & Medicaid Population: | |||
| Did the numerator differ for the Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Neither Medicaid nor Medicare & Medicaid Population: | |||
| Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Total Eligible Population: | |||
| Did the numerator differ for the Total Eligible population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Total Eligible population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Total Eligible population? | If other, explain the deviation in the next cell: | ||
| F. Additional Notes: | |||
| End of Worksheet | |||
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| Preventive Care & Screening: Tobacco Use: Screening & Cessation Intervention (TSC) | |||
| Based on a measure stewarded by the American Medical Association (AMA) and PCPI® Foundation (PCPI®) (NQF #0028, PQRS #226) | |||
| A. Measurement Year: | |||
| Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017. | |||
| B. Data Source: | |||
| Select the data source type (Medical Records or Other): | If medical records data, select source (EHR, Paper Records, Both): | ||
| If other data source selected, specify source: | No Data | ||
| C. Date Range: | |||
| Denominator Start Date (mm/dd/yyyy) | No Data | ||
| Denominator End Date (mm/dd/yyyy) | No Data | ||
| Numerator Start Date (mm/dd/yyyy) | No Data | ||
| Numerator End Date (mm/dd/yyyy) | No Data | ||
| D. Performance Measure: | |||
| Percentage of consumers aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received cessation counseling intervention if identified as a tobacco user | |||
| The measure is stratified to report Medicaid, Medicare & Medicaid, other, and total population. | |||
| Measure | Numerator | Denominator | Rate |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| Total | 0 | 0 | |
| E. Adherence to Measure Specifications: | |||
| Population included in the denominator (indicate yes or no for each of the options below): | |||
| Medicaid population | No Data | ||
| Title XIX-eligible CHIP population | No Data | ||
| Title XXI-eligible CHIP population | No Data | ||
| Other CHIP enrollees | No Data | ||
| Medicare population | No Data | ||
| Medicare and Medicaid Dually-Eligible population | No Data | ||
| VHA/TRICARE population | No Data | ||
| Commercially insured population | No Data | ||
| Uninsured population | No Data | ||
| Other | If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded: | ||
| Did your calculation of the measure deviate from the measure specification in any way? | If Yes, the measure differs: Explain how the calculation differed and why. | ||
| Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure? | If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell: | ||
| Specify the size of the population included in the denominator: | Specify the size of the measure-eligible population. | ||
| Provide the following information for each rate/stratification: | |||
| Medicaid Population: | |||
| Did the numerator differ for the Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicaid population? | If other, explain the deviation in the next cell: | ||
| Medicare & Medicaid Population: | |||
| Did the numerator differ for the Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Neither Medicaid nor Medicare & Medicaid Population: | |||
| Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Total Eligible Population: | |||
| Did the numerator differ for the Total Eligible population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Total Eligible population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Total Eligible population? | If other, explain the deviation in the next cell: | ||
| F. Additional Notes: | |||
| End of Worksheet | |||
| Press TAB to move to input areas. Use the arrow keys to read through the document. Use the alt and down arrow keys to use the drop down options. | |||
| Preventive Care and Screening: Unhealthy Alcohol Use: Screening & Brief Counseling (ASC) | |||
| Based on a measure stewarded by the American Medical Association (AMA) and PCPI® Foundation (PCPI®) (NQF #2152, PQRS #431) | |||
| A. Measurement Year: | |||
| Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017. | |||
| B. Data Source: | |||
| Select the data source type (Medical Records or Other): | If medical records data, select source (EHR, Paper Records, Both): | ||
| If other data source selected, specify source: | No Data | ||
| C. Date Range: | |||
| Denominator Start Date (mm/dd/yyyy) | No Data | ||
| Denominator End Date (mm/dd/yyyy) | No Data | ||
| Numerator Start Date (mm/dd/yyyy) | No Data | ||
| Numerator End Date (mm/dd/yyyy) | No Data | ||
| D. Performance Measure: | |||
| Percentage of consumers aged 18 years and older who were screened at least once within the last 24 months for unhealthy alcohol use using a systematic screening method AND who received brief counseling if identified as an unhealthy alcohol user. | |||
| The measure is stratified to report Medicaid, Medicare & Medicaid, other, and total population. | |||
| Measure | Numerator | Denominator | Rate |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| Total | 0 | 0 | |
| E. Adherence to Measure Specifications: | |||
| Population included in the denominator (indicate yes or no for each of the options below): | |||
| Medicaid population | No Data | ||
| Title XIX-eligible CHIP population | No Data | ||
| Title XXI-eligible CHIP population | No Data | ||
| Other CHIP enrollees | No Data | ||
| Medicare population | No Data | ||
| Medicare and Medicaid Dually-Eligible population | No Data | ||
| VHA/TRICARE population | No Data | ||
| Commercially insured population | No Data | ||
| Uninsured population | No Data | ||
| Other | If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded: | ||
| Did your calculation of the measure deviate from the measure specification in any way? | If Yes, the measure differs: Explain how the calculation differed and why. | ||
| Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure? | If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell: | ||
| Specify the size of the population included in the denominator: | Specify the size of the measure-eligible population. | ||
| Provide the following information for each rate/stratification: | |||
| Medicaid Population: | |||
| Did the numerator differ for the Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicaid population? | If other, explain the deviation in the next cell: | ||
| Medicare & Medicaid Population: | |||
| Did the numerator differ for the Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Neither Medicaid nor Medicare & Medicaid Population: | |||
| Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Total Eligible Population: | |||
| Did the numerator differ for the Total Eligible population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Total Eligible population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Total Eligible population? | If other, explain the deviation in the next cell: | ||
| F. Additional Notes: | |||
| End of Worksheet | |||
| Press TAB to move to input areas. Use the arrow keys to read through the document. Use the alt and down arrow keys to use the drop down options. | |||
| Child and Adolescent Major Depressive Disorder: Suicide Risk Assessment (SRA-BH-C) | |||
| Based on a measure stewarded by the American Medical Association (AMA) and PCPI® Foundation (PCPI®) (NQF #1365, Medicaid Child and Adolescent Core Set) | |||
| A. Measurement Year: | |||
| Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017. | |||
| B. Data Source: | |||
| Select the data source type (Medical Records or Other): | If medical records data, select source (EHR, Paper Records, Both): | ||
| If other data source selected, specify source: | No Data | ||
| C. Date Range: | |||
| Denominator Start Date (mm/dd/yyyy) | No Data | ||
| Denominator End Date (mm/dd/yyyy) | No Data | ||
| Numerator Start Date (mm/dd/yyyy) | No Data | ||
| Numerator End Date (mm/dd/yyyy) | No Data | ||
| D. Performance Measure: | |||
| The percentage of consumer visits for those consumers aged 6 through 17 years with a diagnosis of Major Depressive Disorder (MDD) with an assessment for suicide risk | |||
| The measure is stratified to report Medicaid, Medicare & Medicaid, other, and total population. | |||
| Measure | Numerator | Denominator | Rate |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| Total | 0 | 0 | |
| E. Adherence to Measure Specifications: | |||
| Population included in the denominator (indicate yes or no for each of the options below): | |||
| Medicaid population | No Data | ||
| Title XIX-eligible CHIP population | No Data | ||
| Title XXI-eligible CHIP population | No Data | ||
| Other CHIP enrollees | No Data | ||
| Medicare population | No Data | ||
| Medicare and Medicaid Dually-Eligible population | No Data | ||
| VHA/TRICARE population | No Data | ||
| Commercially insured population | No Data | ||
| Uninsured population | No Data | ||
| Other | If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded: | ||
| Did your calculation of the measure deviate from the measure specification in any way? | If Yes, the measure differs: Explain how the calculation differed and why. | ||
| Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure? | If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell: | ||
| Specify the size of the population included in the denominator: | Specify the size of the measure-eligible population. | ||
| Provide the following information for each rate/stratification: | |||
| Medicaid Population: | |||
| Did the numerator differ for the Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicaid population? | If other, explain the deviation in the next cell: | ||
| Medicare & Medicaid Population: | |||
| Did the numerator differ for the Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Neither Medicaid nor Medicare & Medicaid Population: | |||
| Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Total Eligible Population: | |||
| Did the numerator differ for the Total Eligible population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Total Eligible population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Total Eligible population? | If other, explain the deviation in the next cell: | ||
| F. Additional Notes: | |||
| End of Worksheet | |||
| Press TAB to move to input areas. Use the arrow keys to read through the document. Use the alt and down arrow keys to use the drop down options. | |||
| Adult Major Depressive Disorder (MDD): Suicide Risk Assessment (SRA-A) | |||
| Based on a measure stewarded by the American Medical Association (AMA) and PCPI® Foundation (PCPI®) (NQF #0104) | |||
| A. Measurement Year: | |||
| Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017. | |||
| B. Data Source: | |||
| Select the data source type (Medical Records or Other): | If medical records data, select source (EHR, Paper Records, Both): | ||
| If other data source selected, specify source: | No Data | ||
| C. Date Range: | |||
| Denominator Start Date (mm/dd/yyyy) | No Data | ||
| Denominator End Date (mm/dd/yyyy) | No Data | ||
| Numerator Start Date (mm/dd/yyyy) | No Data | ||
| Numerator End Date (mm/dd/yyyy) | No Data | ||
| D. Performance Measure: | |||
| Percentage of consumers aged 18 years and older with a diagnosis of major depressive disorder (MDD) with a suicide risk assessment completed during the visit in which a new diagnosis or recurrent episode was identified | |||
| The measure is stratified to report Medicaid, Medicare & Medicaid, other, and total population. | |||
| Measure | Numerator | Denominator | Rate |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| Total | 0 | 0 | |
| E. Adherence to Measure Specifications: | |||
| Population included in the denominator (indicate yes or no for each of the options below): | |||
| Medicaid population | No Data | ||
| Title XIX-eligible CHIP population | No Data | ||
| Title XXI-eligible CHIP population | No Data | ||
| Other CHIP enrollees | No Data | ||
| Medicare population | No Data | ||
| Medicare and Medicaid Dually-Eligible population | No Data | ||
| VHA/TRICARE population | No Data | ||
| Commercially insured population | No Data | ||
| Uninsured population | No Data | ||
| Other | If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded: | ||
| Did your calculation of the measure deviate from the measure specification in any way? | If Yes, the measure differs: Explain how the calculation differed and why. | ||
| Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure? | If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell: | ||
| Specify the size of the population included in the denominator: | Specify the size of the measure-eligible population. | ||
| Provide the following information for each rate/stratification: | |||
| Medicaid Population: | |||
| Did the numerator differ for the Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicaid population? | If other, explain the deviation in the next cell: | ||
| Medicare & Medicaid Population: | |||
| Did the numerator differ for the Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Neither Medicaid nor Medicare & Medicaid Population: | |||
| Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Total Eligible Population: | |||
| Did the numerator differ for the Total Eligible population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Total Eligible population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Total Eligible population? | If other, explain the deviation in the next cell: | ||
| F. Additional Notes: | |||
| End of Worksheet | |||
| Press TAB to move to input areas. Use the arrow keys to read through the document. Use the alt and down arrow keys to use the drop down options. | |||
| Screening for Clinical Depression and Follow-up Plan (CDF-BH) | |||
| Based on a measure stewarded by the Centers for Medicare & Medicaid Services (NQF #0418, Medicaid Adult Core Set) |
|||
| A. Measurement Year: | |||
| Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017. | |||
| B. Data Source: | |||
| Select the data source type: | No Data | ||
| If hybrid data, select administrative data source (Medicaid Management Information System (MMIS) or Other): | If other hybrid data, specify data source: | ||
| If hybrid data, select medical records source (EHR, Paper Records, Both): | No Data | ||
| If hybrid data, what is the sample size? | No Data | ||
| If Hybrid, what is the measure-eligible population? | No Data | ||
| If source other than hybrid selected, provide source: | No Data | ||
| C. Date Range: | |||
| Denominator Start Date (mm/dd/yyyy) | No Data | ||
| Denominator End Date (mm/dd/yyyy) | No Data | ||
| Numerator Start Date (mm/dd/yyyy) | No Data | ||
| Numerator End Date (mm/dd/yyyy) | No Data | ||
| D. Performance Measure: | |||
| Percentage of consumers aged 12 years and older screened for clinical depression on the date of the encounter using an age-appropriate standardized depression screening tool, and if positive, a follow-up plan is documented on the date of the positive screen | |||
| The measure is stratified to report by age (12-17, 18-64, 65 and older), and by the Medicaid, Medicare & Medicaid, and other population. | |||
| Measure | Numerator | Denominator | Rate |
| 12-17 years | 0 | 0 | |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| 18-64 years | 0 | 0 | |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| 65+ years | 0 | 0 | |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| E. Adherence to Measure Specifications: | |||
| Population included in the denominator (indicate yes or no for each of the options below): | |||
| Medicaid population | No Data | ||
| Title XIX-eligible CHIP population | No Data | ||
| Title XXI-eligible CHIP population | No Data | ||
| Other CHIP enrollees | No Data | ||
| Medicare population | No Data | ||
| Medicare and Medicaid Dually-Eligible population | No Data | ||
| VHA/TRICARE population | No Data | ||
| Commercially insured population | No Data | ||
| Uninsured population | No Data | ||
| Other | If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded: | ||
| Did your calculation of the measure deviate from the measure specification in any way? | If Yes, the measure differs: Explain how the calculation differed and why. | ||
| Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure? | If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell: | ||
| Specify the size of the population included in the denominator: | Specify the size of the measure-eligible population. | ||
| Provide the following information for each rate/stratification: | |||
| Age Range: 12-17 years | |||
| Did the numerator differ for the 12-17 years age range? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the 12-17 years age range? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the 12-17 years age range? | If other, explain the deviation in the next cell: | ||
| Age Range: 18-64 years | |||
| Did the numerator differ for the 18-64 years age range? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the 18-64 years age range? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the 18-64 years age range? | If other, explain the deviation in the next cell: | ||
| Age Range: 65+ years | |||
| Did the numerator differ for the 65+ years age range? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the 65+ years age range? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the 65+ years age range? | If other, explain the deviation in the next cell: | ||
| Medicaid Population: | |||
| Did the numerator differ for the Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicaid population? | If other, explain the deviation in the next cell: | ||
| Medicare & Medicaid Population: | |||
| Did the numerator differ for the Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Neither Medicaid nor Medicare & Medicaid Population: | |||
| Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| F. Additional Notes: | |||
| End of Worksheet | |||
| Press TAB to move to input areas. Use the arrow keys to read through the document. Use the alt and down arrow keys to use the drop down options. | |||
| Depression Remission at Twelve Months (DEP-REM-12) | |||
| Based on a measure stewarded by Minnesota Community Measurement (NQF #0710) | |||
| A. Measurement Year: | |||
| Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017. | |||
| B. Data Source: | |||
| Select the data source type (Medical Records or Other): | If medical records data, select source (EHR, Paper Records, Both): | ||
| If other data source selected, specify source: | No Data | ||
| C. Date Range: | |||
| Denominator Start Date (mm/dd/yyyy) | No Data | ||
| Denominator End Date (mm/dd/yyyy) | No Data | ||
| Numerator Start Date (mm/dd/yyyy) | No Data | ||
| Numerator End Date (mm/dd/yyyy) | No Data | ||
| D. Performance Measure: | |||
| Adult consumers 18 years of age or older with Major Depression or Dysthymia who reached remission 12 months (± 30 days) after an index visit. This measure applies to consumers with both newly diagnosed and existing Depression whose current PHQ-9 score indicates a need for treatment. | |||
| The measure is stratified to report Medicaid, Medicare & Medicaid, other, and total population. | |||
| Measure | Numerator | Denominator | Rate |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| Total | 0 | 0 | |
| E. Adherence to Measure Specifications: | |||
| Population included in the denominator (indicate yes or no for each of the options below): | |||
| Medicaid population | No Data | ||
| Title XIX-eligible CHIP population | No Data | ||
| Title XXI-eligible CHIP population | No Data | ||
| Other CHIP enrollees | No Data | ||
| Medicare population | No Data | ||
| Medicare and Medicaid Dually-Eligible population | No Data | ||
| VHA/TRICARE population | No Data | ||
| Commercially insured population | No Data | ||
| Uninsured population | No Data | ||
| Other | If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded: | ||
| Did your calculation of the measure deviate from the measure specification in any way? | If Yes, the measure differs: Explain how the calculation differed and why. | ||
| Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure? | If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell: | ||
| Specify the size of the population included in the denominator: | Specify the size of the measure-eligible population. | ||
| Provide the following information for each rate/stratification: | |||
| Medicaid Population: | |||
| Did the numerator differ for the Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicaid population? | If other, explain the deviation in the next cell: | ||
| Medicare & Medicaid Population: | |||
| Did the numerator differ for the Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Neither Medicaid nor Medicare & Medicaid Population: | |||
| Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Total Eligible Population: | |||
| Did the numerator differ for the Total Eligible population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Total Eligible population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Total Eligible population? | If other, explain the deviation in the next cell: | ||
| F. Additional Notes: | |||
| End of Worksheet | |||
| Press TAB to move to input areas. Use the arrow keys to read through the document. | |
| Other BHC-Lead Measures Not Required for the CCBHC Demonstration Program | |
| State Name: | |
| BHC Name: | |
| BHC Identifier: | |
| End of Worksheet | |
| Press TAB to move to input areas. Use the arrow keys to read through the document. Use the alt and down arrow keys to use the drop down options. | |||
| Routine Care Needs (ROUT) | |||
| A SAMHSA-Developed Metric | |||
| A. Measurement Year: | |||
| Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017. | |||
| B. Data Source: | |||
| Select the data source type (Medical Records or Other): | If medical records data, select source (EHR, Paper Records, Both): | ||
| If other data source selected, specify source: | No Data | ||
| C. Date Range: | |||
| Denominator Start Date (mm/dd/yyyy) | No Data | ||
| Denominator End Date (mm/dd/yyyy) | No Data | ||
| Numerator Start Date (mm/dd/yyyy) | No Data | ||
| Numerator End Date (mm/dd/yyyy) | No Data | ||
| D. Performance Measure: | |||
| Percentage of new consumers requesting services who were determined to need routine care | |||
| The measure is stratified to report Medicaid, Medicare & Medicaid, other, and total population. | |||
| Measure | Numerator | Denominator | Rate |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| Total | 0 | 0 | |
| E. Adherence to Measure Specifications: | |||
| Population included in the denominator (indicate yes or no for each of the options below): | |||
| Medicaid population | No Data | ||
| Title XIX-eligible CHIP population | No Data | ||
| Title XXI-eligible CHIP population | No Data | ||
| Other CHIP enrollees | No Data | ||
| Medicare population | No Data | ||
| Medicare and Medicaid Dually-Eligible population | No Data | ||
| VHA/TRICARE population | No Data | ||
| Commercially insured population | No Data | ||
| Uninsured population | No Data | ||
| Other | If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded: | ||
| Did your calculation of the measure deviate from the measure specification in any way? | If Yes, the measure differs: Explain how the calculation differed and why. | ||
| Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure? | If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell: | ||
| Specify the size of the population included in the denominator: | Specify the size of the measure-eligible population. | ||
| Provide the following information for each rate/stratification: | |||
| Medicaid Population: | |||
| Did the numerator differ for the Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicaid population? | If other, explain the deviation in the next cell: | ||
| Medicare & Medicaid Population: | |||
| Did the numerator differ for the Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Neither Medicaid nor Medicare & Medicaid Population: | |||
| Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Total Eligible Population: | |||
| Did the numerator differ for the Total Eligible population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Total Eligible population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Total Eligible population? | If other, explain the deviation in the next cell: | ||
| F. Additional Notes: | |||
| End of Worksheet | |||
| Press TAB to move to input areas. Use the arrow keys to read through the document. Use the alt and down arrow keys to use the drop down options. | |||
| Time to Comprehensive Person- and Family-Centered Diagnostic and Treatment Planning Evaluation (TX-EVAL) | |||
| A SAMHSA-Developed Metric | |||
| A. Measurement Year: | |||
| Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017. | |||
| B. Data Source: | |||
| Select the data source type (Medical Records or Other): | If medical records data, select source (EHR, Paper Records, Both): | ||
| If other data source selected, specify source: | No Data | ||
| C. Date Range: | |||
| Denominator Start Date (mm/dd/yyyy) | No Data | ||
| Denominator End Date (mm/dd/yyyy) | No Data | ||
| Numerator Start Date (mm/dd/yyyy) | No Data | ||
| Numerator End Date (mm/dd/yyyy) | No Data | ||
| D. Performance Measure: | |||
| Mean number of days after first contact until comprehensive person-centered and family-centered diagnostic and treatment planning evaluation is performed for new consumers | |||
| These metrics are stratified to report by age (12–17 years, 18 years and older) and are stratified to report by Medicaid, Medicare & Medicaid, other, and total population. | |||
| Measure | Numerator | Denominator | Mean |
| Age 12-17 years | 0 | 0 | |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| Age 18+ years | 0 | 0 | |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| Total (all Age Groups) | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| E. Adherence to Measure Specifications: | |||
| Population included in the denominator (indicate yes or no for each of the options below): | |||
| Medicaid population | No Data | ||
| Title XIX-eligible CHIP population | No Data | ||
| Title XXI-eligible CHIP population | No Data | ||
| Other CHIP enrollees | No Data | ||
| Medicare population | No Data | ||
| Medicare and Medicaid Dually-Eligible population | No Data | ||
| VHA/TRICARE population | No Data | ||
| Commercially insured population | No Data | ||
| Uninsured population | No Data | ||
| Other | If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded: | ||
| Did your calculation of the measure deviate from the measure specification in any way? | If Yes, the measure differs: Explain how the calculation differed and why. | ||
| Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure? | If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell: | ||
| Specify the size of the population included in the denominator: | Specify the size of the measure-eligible population. | ||
| Provide the following information for each rate/stratification: | |||
| Age Range: 12-17 years | |||
| Did the numerator differ for the 12-17 years age range? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the 12-17 years age range? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the 12-17 years age range? | If other, explain the deviation in the next cell: | ||
| Age Range: 18+ years | |||
| Did the numerator differ for the 18+ years age range? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the 18+ years age range? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the 18+ years age range? | If other, explain the deviation in the next cell: | ||
| Medicaid Population: | |||
| Did the numerator differ for the Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicaid population? | If other, explain the deviation in the next cell: | ||
| Medicare & Medicaid Population: | |||
| Did the numerator differ for the Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Neither Medicaid nor Medicare & Medicaid Population: | |||
| Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Total Eligible Population: | |||
| Did the numerator differ for the Total Eligible population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Total Eligible population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Total Eligible population? | If other, explain the deviation in the next cell: | ||
| F. Additional Notes: | |||
| End of Worksheet | |||
| Press TAB to move to input areas. Use the arrow keys to read through the document. Use the alt and down arrow keys to use the drop down options. | |||
| Deaths by Suicide (SUIC) | |||
| A SAMHSA-Developed Metric | |||
| A. Measurement Year: | |||
| Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017. | |||
| B. Data Source: | |||
| Select the data source type (Medical Records or Other): | If medical records data, select source (EHR, Paper Records, Both): | ||
| If other data source selected, specify source: | No Data | ||
| C. Date Range: | |||
| Denominator Start Date (mm/dd/yyyy) | No Data | ||
| Denominator End Date (mm/dd/yyyy) | No Data | ||
| Numerator Start Date (mm/dd/yyyy) | No Data | ||
| Numerator End Date (mm/dd/yyyy) | No Data | ||
| D. Performance Measure: | |||
| The percentage of consumers aged 12 years and older who died by suicide during the measurement year | |||
| These metrics are stratified to report by age (12-17 years, 18-64 years, 65 years and older, and total (all age groups) and are stratified to report by Medicaid, Medicare & Medicaid, other, and total population. | |||
| Measure | Numerator | Denominator | Rate |
| Age 12-17 years | 0 | 0 | |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| Age 18-64 years | 0 | 0 | |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| Age 65+ years | 0 | 0 | |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| Total (all Age Groups) | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| E. Adherence to Measure Specifications: | |||
| Population included in the denominator (indicate yes or no for each of the options below): | |||
| Medicaid population | No Data | ||
| Title XIX-eligible CHIP population | No Data | ||
| Title XXI-eligible CHIP population | No Data | ||
| Other CHIP enrollees | No Data | ||
| Medicare population | No Data | ||
| Medicare and Medicaid Dually-Eligible population | No Data | ||
| VHA/TRICARE population | No Data | ||
| Commercially insured population | No Data | ||
| Uninsured population | No Data | ||
| Other | If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded: | ||
| Did your calculation of the measure deviate from the measure specification in any way? | If Yes, the measure differs: Explain how the calculation differed and why. | ||
| Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure? | If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell: | ||
| Specify the size of the population included in the denominator: | Specify the size of the measure-eligible population. | ||
| Provide the following information for each rate/stratification: | |||
| Age Range: 12-17 years | |||
| Did the numerator differ for the 12-17 years age range? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the 12-17 years age range? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the 12-17 years age range? | If other, explain the deviation in the next cell: | ||
| Age Range: 18-64 years | |||
| Did the numerator differ for the 18-64 years age range? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the 18-64 years age range? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the 18-64 years age range? | If other, explain the deviation in the next cell: | ||
| Age Range: 65+ years | |||
| Did the numerator differ for the 65+ years age range? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the 65+ years age range? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the 65+ years age range? | If other, explain the deviation in the next cell: | ||
| Medicaid Population: | |||
| Did the numerator differ for the Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicaid population? | If other, explain the deviation in the next cell: | ||
| Medicare & Medicaid Population: | |||
| Did the numerator differ for the Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Neither Medicaid nor Medicare & Medicaid Population: | |||
| Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Total Eligible Population: | |||
| Did the numerator differ for the Total Eligible population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Total Eligible population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Total Eligible population? | If other, explain the deviation in the next cell: | ||
| F. Additional Notes: | |||
| End of Worksheet | |||
| Press TAB to move to input areas. Use the arrow keys to read through the document. Use the alt and down arrow keys to use the drop down options. | |||
| Documentation of Current Medications in the Medical Record (DOC) | |||
| Based on a measure stewarded by the Centers for Medicare & Medicaid Services (NQF #0419, PQRS #130) | |||
| A. Measurement Year: | |||
| Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017. | |||
| B. Data Source: | |||
| Select the data source type (Medical Records or Other): | If medical records data, select source (EHR, Paper Records, Both): | ||
| If other data source selected, specify source: | No Data | ||
| C. Date Range: | |||
| Denominator Start Date (mm/dd/yyyy) | No Data | ||
| Denominator End Date (mm/dd/yyyy) | No Data | ||
| Numerator Start Date (mm/dd/yyyy) | No Data | ||
| Numerator End Date (mm/dd/yyyy) | No Data | ||
| D. Performance Measure: | |||
| The percentage of visits for consumers aged 18 years and older for which the eligible professional attests to documenting a list of current medications using all immediate resources available on the date of the encounter. This list must include ALL known prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications’ name, dosage, frequency, and route of administration. | |||
| The measure is stratified to report Medicaid, Medicare & Medicaid, other, and total population. | |||
| Measure | Numerator | Denominator | Rate |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| Total | 0 | 0 | |
| E. Adherence to Measure Specifications: | |||
| Population included in the denominator (indicate yes or no for each of the options below): | |||
| Medicaid population | No Data | ||
| Title XIX-eligible CHIP population | No Data | ||
| Title XXI-eligible CHIP population | No Data | ||
| Other CHIP enrollees | No Data | ||
| Medicare population | No Data | ||
| Medicare and Medicaid Dually-Eligible population | No Data | ||
| VHA/TRICARE population | No Data | ||
| Commercially insured population | No Data | ||
| Uninsured population | No Data | ||
| Other | If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded: | ||
| Did your calculation of the measure deviate from the measure specification in any way? | If Yes, the measure differs: Explain how the calculation differed and why. | ||
| Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure? | If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell: | ||
| Specify the size of the population included in the denominator: | Specify the size of the measure-eligible population. | ||
| Provide the following information for each rate/stratification: | |||
| Medicaid Population: | |||
| Did the numerator differ for the Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicaid population? | If other, explain the deviation in the next cell: | ||
| Medicare & Medicaid Population: | |||
| Did the numerator differ for the Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Neither Medicaid nor Medicare & Medicaid Population: | |||
| Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Total Eligible Population: | |||
| Did the numerator differ for the Total Eligible population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Total Eligible population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Total Eligible population? | If other, explain the deviation in the next cell: | ||
| F. Additional Notes: | |||
| End of Worksheet | |||
| Press TAB to move to input areas. Use the arrow keys to read through the document. Use the alt and down arrow keys to use the drop down options. | |||
| Controlling High Blood Pressure (CBP-BH) |
|||
| Based on a measure stewarded by the National Committee for Quality Assurance (NQF #0018, HEDIS 2016, Medicaid Adult Core Set) |
|||
| A. Measurement Year: | |||
| Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017. | |||
| B. Data Source: | |||
| Select the data source type: | No Data | ||
| If hybrid data, select administrative data source (Medicaid Management Information System (MMIS) or Other): | If other administrative hybrid data, specify data source: | ||
| If hybrid data, select medical records source (EHR, Paper Records, Both): | No Data | ||
| If hybrid data, what is the sample size? | No Data | ||
| If Hybrid, what is the measure-eligible population? | No Data | ||
| If source other than hybrid selected, provide source: | No Data | ||
| C. Date Range: | |||
| Denominator Start Date (mm/dd/yyyy) | No Data | ||
| Denominator End Date (mm/dd/yyyy) | No Data | ||
| Numerator Start Date (mm/dd/yyyy) | No Data | ||
| Numerator End Date (mm/dd/yyyy) | No Data | ||
| D. Performance Measure: | |||
| Percentage of consumers ages 18 to 85 who had a diagnosis of hypertension (HTN) and whose blood pressure (BP) was adequately controlled during the measurement year based on the following criteria: | |||
| • Consumers ages 18 to 59 whose BP was <140/90 mm Hg | |||
| • Consumers ages 60 to 85 with a diagnosis of diabetes whose BP was <140/90 mm Hg | |||
| • Consumers ages 60 to 85 without a diagnosis of diabetes whose BP was <150/90 mm Hg | |||
| Measure | Numerator | Denominator | Rate |
| 18-64 years | 0 | 0 | |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| 65-85 years | 0 | 0 | |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| E. Adherence to Measure Specifications: | |||
| Population included in the denominator (indicate yes or no for each of the options below): | |||
| Medicaid population | No Data | ||
| Title XIX-eligible CHIP population | No Data | ||
| Title XXI-eligible CHIP population | No Data | ||
| Other CHIP enrollees | No Data | ||
| Medicare population | No Data | ||
| Medicare and Medicaid Dually-Eligible population | No Data | ||
| VHA/TRICARE population | No Data | ||
| Commercially insured population | No Data | ||
| Uninsured population | No Data | ||
| Other | If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded: | ||
| Did your calculation of the measure deviate from the measure specification in any way? | If Yes, the measure differs: Explain how the calculation differed and why. | ||
| Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure? | If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell: | ||
| Specify the size of the population included in the denominator: | Specify the size of the measure-eligible population. | ||
| Provide the following information for each rate/stratification: | |||
| Age Range: 18-64 years | |||
| Did the numerator differ for the 18-64 years age range? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the 18-64 years age range? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the 18-64 years age range? | If other, explain the deviation in the next cell: | ||
| Age Range: 65-85 years | |||
| Did the numerator differ for the 65+ years age range? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the 65+ years age range? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the 65+ years age range? | If other, explain the deviation in the next cell: | ||
| Medicaid Population: | |||
| Did the numerator differ for the Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicaid population? | If other, explain the deviation in the next cell: | ||
| Medicare & Medicaid Population: | |||
| Did the numerator differ for the Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Neither Medicaid nor Medicare & Medicaid Population: | |||
| Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| F. Additional Notes: | |||
| End of Worksheet | |||
| Press TAB to move to input areas. Use the arrow keys to read through the document. | |
| State-Lead Measures Required for the CCBHC Demonstration Program | |
| State Name: | |
| BHC Name: | |
| BHC Identifier: | |
| End of Worksheet | |
| Press TAB to move to input areas. Use the arrow keys to read through the document. Use the alt and down arrow keys to use the drop down options. | |||
| Housing Status (HOU) | |||
| A SAMHSA-Developed Metric | |||
| A. Measurement Year: | |||
| Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017. | |||
| B. Data Source: | |||
| Select the data source type (Uniform Reporting System (URS) or Other): | No Data | ||
| If other data source selected, specify source: | No Data | ||
| C. Date Range: | |||
| Measurement Year Part One Start Date (mm/dd/yyyy) | No Data | ||
| Measurement Year Part One End Date (mm/dd/yyyy) | No Data | ||
| Measurement Year Part Two Start Date (mm/dd/yyyy) | No Data | ||
| Measurement Year Part Two End Date (mm/dd/yyyy) | No Data | ||
| D. Performance Measure: | |||
| The percentage of consumers in 10 categories of living situation | |||
| Living situation | Numerator | Denominator | Percentage |
| Private residence | 0 | ||
| Foster home | 0 | ||
| Residential care | 0 | ||
| Crisis residence | 0 | ||
| Residential treatment center | 0 | ||
| Institutional setting | 0 | ||
| Jail (correctional facility) | 0 | ||
| Homeless (shelter) | 0 | ||
| Other | 0 | ||
| Not available | 0 | ||
| Total | 0 | 0 | |
| E. Adherence to Measure Specifications: | |||
| Population included in the denominator (indicate yes or no for each of the options below): | |||
| Medicaid population | No Data | ||
| Title XIX-eligible CHIP population | No Data | ||
| Title XXI-eligible CHIP population | No Data | ||
| Other CHIP enrollees | No Data | ||
| Medicare population | No Data | ||
| Medicare and Medicaid Dually-Eligible population | No Data | ||
| VHA/TRICARE population | No Data | ||
| Commercially insured population | No Data | ||
| Uninsured population | No Data | ||
| Other | If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded: | ||
| Did your calculation of the measure deviate from the measure specification in any way? | If Yes, the measure differs: Explain how the calculation differed and why. | ||
| Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure? | If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell: | ||
| Specify the size of the population included in the denominator: | Specify the size of the measure-eligible population. | ||
| F. Additional Notes: | |||
| End of Worksheet | |||
| Press TAB to move to input areas. Use the arrow keys to read through the document. Use the alt and down arrow keys to use the drop down options. | |||
| Patient Experience of Care Survey (PEC ) | |||
| A SAMHSA-Developed Metric | |||
| A. Measurement Year: | |||
| Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017. | |||
| B. Data Source: | |||
| Select the data source type (Mental Health Statistics Improvement Program (MHSIP) Adult Consumer Experience of Care Survey or Other): | No Data | ||
| If other data source selected, specify source: | No Data | ||
| C. Date Range: | |||
| Survey Start Date (mm/dd/yyyy) | No Data | ||
| Survey End Date (mm/dd/yyyy) | No Data | ||
| D. Performance Measure: | |||
| Annual completion and submission of Mental Health Statistics Improvement Program (MHSIP) Adult Consumer Experience of Care Survey, for the CCBHC Demonstration Program identifying results separately for CCBHCs and comparison clinics and oversampling those clinics. | |||
| For this BHC, complete a copy of Tables 11 and 11a of the URS reporting template that is current at the time of the survey (http://www.nri-inc.org/#!urs-forms--info/c1xvm) (Table 22A for the Mental Health Block Grant), including required information on sampling methodology and response rates. For CCBHCs, identify results separately for CCBHCs and comparison clinics. | |||
| E. Adherence to Measure Specifications: | |||
| Population included in the denominator (indicate yes or no for each of the options below): | |||
| Medicaid population | No Data | ||
| Title XIX-eligible CHIP population | No Data | ||
| Title XXI-eligible CHIP population | No Data | ||
| Other CHIP enrollees | No Data | ||
| Medicare population | No Data | ||
| Medicare and Medicaid Dually-Eligible population | No Data | ||
| VHA/TRICARE population | No Data | ||
| Commercially insured population | No Data | ||
| Uninsured population | No Data | ||
| Other | If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded: | ||
| Did your calculation of the measure deviate from the measure specification in any way? | If Yes, the measure differs, explain how the calculation differed and why: | ||
| If Yes, the measure differs, did you oversample this clinic? | If Yes, the measure differs, specify the size of the sample: | ||
| F. Additional Notes: | |||
| End of Worksheet | |||
| Press TAB to move to input areas. Use the arrow keys to read through the document. Use the alt and down arrow keys to use the drop down options. | |||
| Youth/Family Experience of Care Survey (Y/FEC ) | |||
| A SAMHSA-Developed Metric | |||
| A. Measurement Year: | |||
| Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017. | |||
| B. Data Source: | |||
| Select the data source type (Youth/Family Services Survey for Families (YSS-F) Experience of Care Survey or Other): | No Data | ||
| If other data source selected, specify source: | No Data | ||
| C. Date Range: | |||
| Survey Start Date (mm/dd/yyyy) | No Data | ||
| Survey End Date (mm/dd/yyyy) | No Data | ||
| D. Performance Measure: | |||
| Annual completion and submission of Youth/Family Services Survey for Families (YSS-F) Experience of Care Survey, for the CCBHC Demonstration Program identifying results separately for CCBHCs and comparison clinics and oversampling those clinics. | |||
| For this BHC, complete a copy of Tables 11 and 11a of the URS reporting template that is current at the time of the survey (http://www.nri-inc.org/#!urs-forms--info/c1xvm (Table 22B for the Mental Health Block Grant)), including required information on sampling methodology and response rates. For CCBHCs, identify results separately for CCBHCs and comparison clinics. | |||
| E. Adherence to Measure Specifications: | |||
| Population included in the denominator (indicate yes or no for each of the options below): | |||
| Medicaid population | No Data | ||
| Title XIX-eligible CHIP population | No Data | ||
| Title XXI-eligible CHIP population | No Data | ||
| Other CHIP enrollees | No Data | ||
| Medicare population | No Data | ||
| Medicare and Medicaid Dually-Eligible population | No Data | ||
| VHA/TRICARE population | No Data | ||
| Commercially insured population | No Data | ||
| Uninsured population | No Data | ||
| Other | If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded: | ||
| Did your calculation of the measure deviate from the measure specification in any way? | If Yes, the measure differs, explain how the calculation differed and why: | ||
| If Yes, the measure differs, did you oversample this clinic? | If Yes, the measure differs, specify the size of the sample: | ||
| F. Additional Notes: | |||
| End of Worksheet | |||
| Press TAB to move to input areas. Use the arrow keys to read through the document. Use the alt and down arrow keys to use the drop down options. | |||
| Follow-up After Emergency Department Visit for Mental Illness (FUM) | |||
| Based on a measure stewarded by the National Committee for Quality Assurance (Draft HEDIS 2017) |
|||
| A. Measurement Year: | |||
| Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017. | |||
| B. Data Source: | |||
| Select the data source type: | No Data | ||
| If administrative data only, select source (Medicaid Management Information System (MMIS) or Other): | If other administrative data, specify data source: | ||
| If source other than administrative selected, provide source: | No Data | ||
| C. Date Range: | |||
| Denominator Start Date (mm/dd/yyyy) | No Data | ||
| Denominator End Date (mm/dd/yyyy) | No Data | ||
| Numerator Start Date (mm/dd/yyyy) | No Data | ||
| Numerator End Date (mm/dd/yyyy) | No Data | ||
| D. Performance Measure: | |||
| The percentage of emergency department (ED) visits for consumers 6 years of age and older with a primary diagnosis of mental illness, who had an outpatient visit, an intensive outpatient encounter or a partial hospitalization for mental illness. Two rates are reported: 1. The percentage of ED visits for which the consumer received follow-up within 30 days of the ED visit. 2. The percentage of ED visits for which the consumer received follow-up within 7 days of the ED visit. |
|||
| The measure is stratified to report Medicaid, Medicare & Medicaid, other, and total population. | |||
| Measure | Numerator | Denominator | Rate |
| ED MH Visits with 7 Day Follow-up | |||
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| Total | 0 | 0 | |
| ED MH Visits with 30 Day Follow-up | |||
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| Total | 0 | 0 | |
| E. Adherence to Measure Specifications: | |||
| Population included in the denominator (indicate yes or no for each of the options below): | |||
| Medicaid population | No Data | ||
| Title XIX-eligible CHIP population | No Data | ||
| Title XXI-eligible CHIP population | No Data | ||
| Other CHIP enrollees | No Data | ||
| Medicare population | No Data | ||
| Medicare and Medicaid Dually-Eligible population | No Data | ||
| VHA/TRICARE population | No Data | ||
| Commercially insured population | No Data | ||
| Uninsured population | No Data | ||
| Other | If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded: | ||
| Did your calculation of the measure deviate from the measure specification in any way? | If Yes, the measure differs: Explain how the calculation differed and why. | ||
| Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure? | If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell: | ||
| Specify the size of the population included in the denominator: | Specify the size of the measure-eligible population. | ||
| Provide the following information for each rate/stratification: | |||
| ED MH Visits with 7 Day Follow-up: | |||
| Medicaid Population: | |||
| Did the numerator differ for the Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicaid population? | If other, explain the deviation in the next cell: | ||
| Medicare & Medicaid Population: | |||
| Did the numerator differ for the Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Neither Medicaid nor Medicare & Medicaid Population: | |||
| Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Total Eligible Population: | |||
| Did the numerator differ for the Total Eligible population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Total Eligible population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Total Eligible population? | If other, explain the deviation in the next cell: | ||
| ED MH Visits with 30 Day Follow-up: | |||
| Medicaid Population: | |||
| Did the numerator differ for the Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicaid population? | If other, explain the deviation in the next cell: | ||
| Medicare & Medicaid Population: | |||
| Did the numerator differ for the Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Neither Medicaid nor Medicare & Medicaid Population: | |||
| Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Total Eligible Population: | |||
| Did the numerator differ for the Total Eligible population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Total Eligible population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Total Eligible population? | If other, explain the deviation in the next cell: | ||
| F. Additional Notes: | |||
| End of Worksheet | |||
| Press TAB to move to input areas. Use the arrow keys to read through the document. Use the alt and down arrow keys to use the drop down options. | |||
| Follow-up After Emergency Department Visit for Alcohol and Other Drug Dependence (FUA) | |||
| Based on a measure stewarded by the National Committee for Quality Assurance (Draft HEDIS 2017) | |||
| A. Measurement Year: | |||
| Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017. | |||
| B. Data Source: | |||
| Select the data source type: | No Data | ||
| If administrative data only, select source (Medicaid Management Information System (MMIS) or Other): | If other administrative data, specify data source: | ||
| If source other than administrative selected, provide source: | No Data | ||
| C. Date Range: | |||
| Denominator Start Date (mm/dd/yyyy) | No Data | ||
| Denominator End Date (mm/dd/yyyy) | No Data | ||
| Numerator Start Date (mm/dd/yyyy) | No Data | ||
| Numerator End Date (mm/dd/yyyy) | No Data | ||
| D. Performance Measure: | |||
| The percentage of emergency department (ED) visits for consumers 13 years of age and older with a primary diagnosis of alcohol or other drug (AOD) dependence, who had an outpatient visit, an intensive outpatient encounter or a partial hospitalization for AOD. Two rates are reported: 1. The percentage of ED visits for which the consumer received follow-up within 30 days of the ED visit. 2. The percentage of ED visits for which the consumer received follow-up within 7 days of the ED visit. |
|||
| The measure is stratified to report Medicaid, Medicare & Medicaid, other, and total population. | |||
| Measure | Numerator | Denominator | Rate |
| ED AOD Visits with 7 Day Follow-up | |||
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| Total | 0 | 0 | |
| ED AOD Visits with 30 Day Follow-up | |||
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| Total | 0 | 0 | |
| E. Adherence to Measure Specifications: | |||
| Population included in the denominator (indicate yes or no for each of the options below): | |||
| Medicaid population | No Data | ||
| Title XIX-eligible CHIP population | No Data | ||
| Title XXI-eligible CHIP population | No Data | ||
| Other CHIP enrollees | No Data | ||
| Medicare population | No Data | ||
| Medicare and Medicaid Dually-Eligible population | No Data | ||
| VHA/TRICARE population | No Data | ||
| Commercially insured population | No Data | ||
| Uninsured population | No Data | ||
| Other | If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded: | ||
| Did your calculation of the measure deviate from the measure specification in any way? | If Yes, the measure differs: Explain how the calculation differed and why. | ||
| Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure? | If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell: | ||
| Specify the size of the population included in the denominator: | Specify the size of the measure-eligible population. | ||
| Provide the following information for each rate/stratification: | |||
| ED AOD Visits with 7 Day Follow-up: | |||
| Medicaid Population: | |||
| Did the numerator differ for the Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicaid population? | If other, explain the deviation in the next cell: | ||
| Medicare & Medicaid Population: | |||
| Did the numerator differ for the Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Neither Medicaid nor Medicare & Medicaid Population: | |||
| Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Total Eligible Population: | |||
| Did the numerator differ for the Total Eligible population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Total Eligible population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Total Eligible population? | If other, explain the deviation in the next cell: | ||
| ED AOD Visits with 30 Day Follow-up: | |||
| Medicaid Population: | |||
| Did the numerator differ for the Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicaid population? | If other, explain the deviation in the next cell: | ||
| Medicare & Medicaid Population: | |||
| Did the numerator differ for the Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Neither Medicaid nor Medicare & Medicaid Population: | |||
| Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Total Eligible Population: | |||
| Did the numerator differ for the Total Eligible population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Total Eligible population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Total Eligible population? | If other, explain the deviation in the next cell: | ||
| F. Additional Notes: | |||
| End of Worksheet | |||
| Press TAB to move to input areas. Use the arrow keys to read through the document. Use the alt and down arrow keys to use the drop down options. | |||
| Plan All-Cause Readmissions Rate (PCR-BH) | |||
| Based on a measure stewarded by the National Committee for Quality Assurance (NQF #1768, HEDIS 2016, Medicaid Adult Core Set) | |||
| A. Measurement Year: | |||
| Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017. | |||
| B. Data Source: | |||
| Select the data source type: | No Data | ||
| If administrative data only, select source (Medicaid Management Information System (MMIS) or Other): | If other administrative data, specify data source: | ||
| If source other than administrative selected, provide source: | No Data | ||
| C. Date Range: | |||
| Denominator Start Date (mm/dd/yyyy) | No Data | ||
| Denominator End Date (mm/dd/yyyy) | No Data | ||
| Numerator Start Date (mm/dd/yyyy) | No Data | ||
| Numerator End Date (mm/dd/yyyy) | No Data | ||
| D. Performance Measure: | |||
| For consumers age 18 and older, the number of acute inpatient stays during the measurement year that were followed by an unplanned acute readmission for any diagnosis within 30 days. | |||
| Data are reported in the following three categories: | |||
| Count of Index Hospital Stays (IHS)(denominator) | |||
| Count of 30-Day Readmissions (numerator) | |||
| Readmission Rate | |||
| The measure is stratified to report by age (18-64 years, 65 and older), and by the Medicaid, Medicare & Medicaid, and other population. | |||
| Measure | Numerator | Denominator | Rate |
| 18-64 years | 0 | 0 | |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| 65+ years | 0 | 0 | |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| E. Adherence to Measure Specifications: | |||
| Population included in the denominator (indicate yes or no for each of the options below): | |||
| Medicaid population | No Data | ||
| Title XIX-eligible CHIP population | No Data | ||
| Title XXI-eligible CHIP population | No Data | ||
| Other CHIP enrollees | No Data | ||
| Medicare population | No Data | ||
| Medicare and Medicaid Dually-Eligible population | No Data | ||
| VHA/TRICARE population | No Data | ||
| Commercially insured population | No Data | ||
| Uninsured population | No Data | ||
| Other | If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded: | ||
| Did your calculation of the measure deviate from the measure specification in any way? | If Yes, the measure differs: Explain how the calculation differed and why. | ||
| Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure? | If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell: | ||
| Specify the size of the population included in the denominator: | Specify the size of the measure-eligible population. | ||
| Provide the following information for each rate/stratification: | |||
| Age Range: 18-64 years | |||
| Did the numerator differ for the 18-64 years age range? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the 18-64 years age range? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the 18-64 years age range? | If other, explain the deviation in the next cell: | ||
| Age Range: 65+ years | |||
| Did the numerator differ for the 65+ years age range? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the 65+ years age range? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the 65+ years age range? | If other, explain the deviation in the next cell: | ||
| Medicaid Population: | |||
| Did the numerator differ for the Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicaid population? | If other, explain the deviation in the next cell: | ||
| Medicare & Medicaid Population: | |||
| Did the numerator differ for the Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Neither Medicaid nor Medicare & Medicaid Population: | |||
| Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| F. Additional Notes: | |||
| End of Worksheet | |||
| Press TAB to move to input areas. Use the arrow keys to read through the document. Use the alt and down arrow keys to use the drop down options. | |||
| Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications (SSD) | |||
| Based on a measure stewarded by the National Committee for Quality Assurance (NQF #1932, HEDIS 2016) | |||
| A. Measurement Year: | |||
| Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017. | |||
| B. Data Source: | |||
| Select the data source type: | No Data | ||
| If administrative data only, select source (Medicaid Management Information System (MMIS) or Other): | If other administrative data, specify data source: | ||
| If source other than administrative selected, provide source: | No Data | ||
| C. Date Range: | |||
| Denominator Start Date (mm/dd/yyyy) | No Data | ||
| Denominator End Date (mm/dd/yyyy) | No Data | ||
| Numerator Start Date (mm/dd/yyyy) | No Data | ||
| Numerator End Date (mm/dd/yyyy) | No Data | ||
| D. Performance Measure: | |||
| The percentage of consumers 18-64 years of age with Schizophrenia or Bipolar Disorder, who were dispensed an antipsychotic medication and had a diabetes screening test during the measurement year | |||
| The measure is stratified to report Medicaid, Medicare & Medicaid, other, and total population. | |||
| Measure | Numerator | Denominator | Rate |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| Total | 0 | 0 | |
| E. Adherence to Measure Specifications: | |||
| Population included in the denominator (indicate yes or no for each of the options below): | |||
| Medicaid population | No Data | ||
| Title XIX-eligible CHIP population | No Data | ||
| Title XXI-eligible CHIP population | No Data | ||
| Other CHIP enrollees | No Data | ||
| Medicare population | No Data | ||
| Medicare and Medicaid Dually-Eligible population | No Data | ||
| VHA/TRICARE population | No Data | ||
| Commercially insured population | No Data | ||
| Uninsured population | No Data | ||
| Other | If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded: | ||
| Did your calculation of the measure deviate from the measure specification in any way? | If Yes, the measure differs: Explain how the calculation differed and why. | ||
| Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure? | If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell: | ||
| Specify the size of the population included in the denominator: | Specify the size of the measure-eligible population. | ||
| Provide the following information for each rate/stratification: | |||
| Medicaid Population: | |||
| Did the numerator differ for the Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicaid population? | If other, explain the deviation in the next cell: | ||
| Medicare & Medicaid Population: | |||
| Did the numerator differ for the Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Neither Medicaid nor Medicare & Medicaid Population: | |||
| Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Total Eligible Population: | |||
| Did the numerator differ for the Total Eligible population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Total Eligible population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Total Eligible population? | If other, explain the deviation in the next cell: | ||
| F. Additional Notes: | |||
| End of Worksheet | |||
| Press TAB to move to input areas. Use the arrow keys to read through the document. Use the alt and down arrow keys to use the drop down options. | |||
| Adherence to Antipsychotic Medications for Individuals With Schizophrenia (SAA-BH) | |||
| Based on a measure stewarded by the Centers for Medicare and Medicaid Services (HEDIS 2016, Medicaid Adult Core Set) | |||
| A. Measurement Year: | |||
| Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017. | |||
| B. Data Source: | |||
| Select the data source type: | No Data | ||
| If administrative data only, select source (Medicaid Management Information System (MMIS) or Other): | If other administrative data, specify data source: | ||
| If source other than administrative selected, provide source: | No Data | ||
| C. Date Range: | |||
| Denominator Start Date (mm/dd/yyyy) | No Data | ||
| Denominator End Date (mm/dd/yyyy) | No Data | ||
| Numerator Start Date (mm/dd/yyyy) | No Data | ||
| Numerator End Date (mm/dd/yyyy) | No Data | ||
| D. Performance Measure: | |||
| The percentage of clients ages 19 to 64 during the measurement year with schizophrenia who were dispensed and remained on an antipsychotic medication for at least 80 percent of their treatment period. | |||
| The measure is stratified to report Medicaid, Medicare & Medicaid, neither, and total population. | |||
| Measure | Numerator | Denominator | Rate |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| Total | 0 | 0 | |
| E. Adherence to Measure Specifications: | |||
| Population included in the denominator (indicate yes or no for each of the options below): | |||
| Medicaid population | No Data | ||
| Title XIX-eligible CHIP population | No Data | ||
| Title XXI-eligible CHIP population | No Data | ||
| Other CHIP enrollees | No Data | ||
| Medicare population | No Data | ||
| Medicare and Medicaid Dually-Eligible population | No Data | ||
| VHA/TRICARE population | No Data | ||
| Commercially insured population | No Data | ||
| Uninsured population | No Data | ||
| Other | If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded: | ||
| Did your calculation of the measure deviate from the measure specification in any way? | If Yes, the measure differs: Explain how the calculation differed and why. | ||
| Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure? | If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell: | ||
| Specify the size of the population included in the denominator: | Specify the size of the measure-eligible population. | ||
| Provide the following information for each rate/stratification: | |||
| Medicaid Population: | |||
| Did the numerator differ for the Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicaid population? | If other, explain the deviation in the next cell: | ||
| Medicare & Medicaid Population: | |||
| Did the numerator differ for the Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Neither Medicaid nor Medicare & Medicaid Population: | |||
| Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Total Eligible Population: | |||
| Did the numerator differ for the Total Eligible population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Total Eligible population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Total Eligible population? | If other, explain the deviation in the next cell: | ||
| F. Additional Notes: | |||
| End of Worksheet | |||
| Press TAB to move to input areas. Use the arrow keys to read through the document. Use the alt and down arrow keys to use the drop down options. | |||
| Follow-up After Hospitalization for Mental Illness (FUH-BH-A) | |||
| Based on a measure stewarded by the National Committee for Quality Assurance (NQF #0576, HEDIS 2016, Medicaid Adult Core Set) | |||
| A. Measurement Year: | |||
| Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017. | |||
| B. Data Source: | |||
| Select the data source type: | No Data | ||
| If administrative data only, select source (Medicaid Management Information System (MMIS) or Other): | If other administrative data, specify data source: | ||
| If source other than administrative selected, provide source: | No Data | ||
| C. Date Range: | |||
| Denominator Start Date (mm/dd/yyyy) | No Data | ||
| Denominator End Date (mm/dd/yyyy) | No Data | ||
| 30 Day Follow-up: | |||
| Numerator Start Date (mm/dd/yyyy) | No Data | ||
| Numerator End Date (mm/dd/yyyy) | No Data | ||
| 7 Day Follow-up: | |||
| Numerator Start Date (mm/dd/yyyy) | No Data | ||
| Numerator End Date (mm/dd/yyyy) | No Data | ||
| D. Performance Measure: | |||
| The percentage of discharges for consumers age 21 and older who were hospitalized for treatment of selected mental illness diagnoses and who had an outpatient visit, an intensive outpatient encounter, or partial hospitalization with a mental health practitioner. Two rates are reported: 1. Percentage of discharges for which the consumer received follow-up within 30 days of discharge 2. Percentage of discharges for which the consumer received follow-up within 7 days of discharge |
|||
| For each of those rates, the measure is stratified to report by age (21-64 years, 65 and older), and by the Medicaid, Medicare & Medicaid, and other population. | |||
| Measure | Numerator | Denominator | Rate |
| 30-Day Follow-up | |||
| 21-64 years | 0 | 0 | |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| 65+ years | 0 | 0 | |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| 7-Day Follow-up | |||
| 21-64 years | 0 | 0 | |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| 65+ years | 0 | 0 | |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| E. Adherence to Measure Specifications: | |||
| Population included in the denominator (indicate yes or no for each of the options below): | |||
| Medicaid population | No Data | ||
| Title XIX-eligible CHIP population | No Data | ||
| Title XXI-eligible CHIP population | No Data | ||
| Other CHIP enrollees | No Data | ||
| Medicare population | No Data | ||
| Medicare and Medicaid Dually-Eligible population | No Data | ||
| VHA/TRICARE population | No Data | ||
| Commercially insured population | No Data | ||
| Uninsured population | No Data | ||
| Other | If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded: | ||
| Did your calculation of the measure deviate from the measure specification in any way? | If Yes, the measure differs: Explain how the calculation differed and why. | ||
| Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure? | If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell: | ||
| Specify the size of the population included in the denominator: | Specify the size of the measure-eligible population. | ||
| Provide the following information for each rate/stratification: | |||
| Follow-up Within 30 Days of Discharge: | |||
| Age Range: 21-64 years | |||
| Did the numerator differ for the 21-64 years age range? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the 21-64 years age range? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the 21-64 years age range? | If other, explain the deviation in the next cell: | ||
| Age Range: 65+ years | |||
| Did the numerator differ for the 65+ years age range? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the 65+ years age range? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the 65+ years age range? | If other, explain the deviation in the next cell: | ||
| Medicaid Population: | |||
| Did the numerator differ for the Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicaid population? | If other, explain the deviation in the next cell: | ||
| Medicare & Medicaid Population: | |||
| Did the numerator differ for the Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Neither Medicaid nor Medicare & Medicaid Population: | |||
| Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Follow-up Within 7 days of Discharge: | |||
| Age Range: 21-64 years | |||
| Did the numerator differ for the 21-64 years age range? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the 21-64 years age range? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the 21-64 years age range? | If other, explain the deviation in the next cell: | ||
| Age Range: 65+ years | |||
| Did the numerator differ for the 65+ years age range? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the 65+ years age range? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the 65+ years age range? | If other, explain the deviation in the next cell: | ||
| Medicaid Population: | |||
| Did the numerator differ for the Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicaid population? | If other, explain the deviation in the next cell: | ||
| Medicare & Medicaid Population: | |||
| Did the numerator differ for the Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Neither Medicaid nor Medicare & Medicaid Population: | |||
| Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| F. Additional Notes: | |||
| End of Worksheet | |||
| Press TAB to move to input areas. Use the arrow keys to read through the document. Use the alt and down arrow keys to use the drop down options. | |||
| Follow-Up After Hospitalization For Mental Illness (FUH-BH-C) | |||
| Based on a measure stewarded by the National Committee for Quality Assurance (NQF #0576, HEDIS 2016, Medicaid Child and Adolescent Core Set) |
|||
| A. Measurement Year: | |||
| Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017. | |||
| B. Data Source: | |||
| Select the data source type: | No Data | ||
| If administrative data only, select source (Medicaid Management Information System (MMIS) or Other): | If other administrative data, specify data source: | ||
| If source other than administrative selected, provide source: | No Data | ||
| C. Date Range: | |||
| Denominator Start Date (mm/dd/yyyy) | No Data | ||
| Denominator End Date (mm/dd/yyyy) | No Data | ||
| 30 Day Follow-up: | |||
| Numerator Start Date (mm/dd/yyyy) | No Data | ||
| Numerator End Date (mm/dd/yyyy) | No Data | ||
| 7 Day Follow-up: | |||
| Numerator Start Date (mm/dd/yyyy) | No Data | ||
| Numerator End Date (mm/dd/yyyy) | No Data | ||
| D. Performance Measure: | |||
| Percentage of discharges for children and adolescents ages 6 to 20 who were hospitalized for treatment of selected mental illness diagnoses and who had an outpatient visit, an intensive outpatient encounter, or partial hospitalization with a mental health practitioner. Two rates are reported: 1. Percentage of discharges for which children received follow-up within 30 days of discharge 2. Percentage of discharges for which children received follow-up within 7 days of discharge |
|||
| For each of those rates, the measure is stratified to report by the Medicaid, Medicare & Medicaid, other, and total population. | |||
| Measure | Numerator | Denominator | Rate |
| 30-Day Follow-up | |||
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| Total | 0 | 0 | |
| 7-Day Follow-up | |||
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| Total | 0 | 0 | |
| E. Adherence to Measure Specifications: | |||
| Population included in the denominator (indicate yes or no for each of the options below): | |||
| Medicaid population | No Data | ||
| Title XIX-eligible CHIP population | No Data | ||
| Title XXI-eligible CHIP population | No Data | ||
| Other CHIP enrollees | No Data | ||
| Medicare population | No Data | ||
| Medicare and Medicaid Dually-Eligible population | No Data | ||
| VHA/TRICARE population | No Data | ||
| Commercially insured population | No Data | ||
| Uninsured population | No Data | ||
| Other | If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded: | ||
| Did your calculation of the measure deviate from the measure specification in any way? | If Yes, the measure differs: Explain how the calculation differed and why. | ||
| Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure? | If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell: | ||
| Specify the size of the population included in the denominator: | Specify the size of the measure-eligible population. | ||
| Provide the following information for each rate/stratification: | |||
| 30-Day Follow-up | |||
| Medicaid Population: | |||
| Did the numerator differ for the Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicaid population? | If other, explain the deviation in the next cell: | ||
| Medicare & Medicaid Population: | |||
| Did the numerator differ for the Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Neither Medicaid nor Medicare & Medicaid Population: | |||
| Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| 7-Day Follow-up | |||
| Medicaid Population: | |||
| Did the numerator differ for the Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicaid population? | If other, explain the deviation in the next cell: | ||
| Medicare & Medicaid Population: | |||
| Did the numerator differ for the Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Neither Medicaid nor Medicare & Medicaid Population: | |||
| Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| F. Additional Notes: | |||
| End of Worksheet | |||
| Press TAB to move to input areas. Use the arrow keys to read through the document. Use the alt and down arrow keys to use the drop down options. | |||
| Follow-up Care for Children Prescribed Attention-Deficit Hyperactivity Disorder (ADHD) Medication (ADD-BH) | |||
| Based on a measure stewarded by the National Committee for Quality Assurance (NQF #0108, Medicaid Child and Adolescent Core Set) | |||
| A. Measurement Year: | |||
| Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017. | |||
| B. Data Source: | |||
| Select the data source type: | No Data | ||
| If administrative data only, select source (Medicaid Management Information System (MMIS) or Other): | If other administrative data, specify data source: | ||
| If source other than administrative selected, provide source: | No Data | ||
| C. Date Range: | |||
| Index Prescription Start Date (IPSD): | |||
| Denominator Start Date (mm/dd/yyyy) | No Data | ||
| Denominator End Date (mm/dd/yyyy) | No Data | ||
| Negative Medication History Review: | |||
| Denominator Start Date (mm/dd/yyyy) | No Data | ||
| Denominator End Date (mm/dd/yyyy) | No Data | ||
| Initiation Phase: | |||
| Numerator Start Date (mm/dd/yyyy) | No Data | ||
| Numerator End Date (mm/dd/yyyy) | No Data | ||
| Continuation and Maintenance Phase: | |||
| Numerator Start Date (mm/dd/yyyy) | No Data | ||
| Numerator End Date (mm/dd/yyyy) | No Data | ||
| D. Performance Measure: | |||
| Percentage of children newly prescribed attention-deficit/hyperactivity disorder (ADHD) medication who had at least three follow-up care visits within a 10-month period, one of which was within 30 days of when the first ADHD medication was dispensed. Two rates are reported. Initiation Phase: Percentage of children ages 6 to 12 as of the Index Prescription Start Date (IPSD) with an ambulatory prescription dispensed for ADHD medication who had one follow-up visit with practitioner with prescribing authority during the 30-day Initiation Phase. Continuation and Maintenance (C&M) Phase: Percentage of children 6 to 12 years old as of the IPSD with an ambulatory prescription dispensed for ADHD medication who remained on the medication for at least 210 days and, in addition to the visit in the Initiation Phase, had at least two follow-up visits with a practitioner within 270 days (9 months) after the Initiation Phase ended. |
|||
| For each of those rates, the measure is stratified to report by the Medicaid, Medicare & Medicaid, other, and total population. | |||
| Measure | Numerator | Denominator | Rate |
| Initiation Phase | |||
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| Total | 0 | 0 | |
| Continuation & Maintenance Phase | |||
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| Total | 0 | 0 | |
| E. Adherence to Measure Specifications: | |||
| Population included in the denominator (indicate yes or no for each of the options below): | |||
| Medicaid population | No Data | ||
| Title XIX-eligible CHIP population | No Data | ||
| Title XXI-eligible CHIP population | No Data | ||
| Other CHIP enrollees | No Data | ||
| Medicare population | No Data | ||
| Medicare and Medicaid Dually-Eligible population | No Data | ||
| VHA/TRICARE population | No Data | ||
| Commercially insured population | No Data | ||
| Uninsured population | No Data | ||
| Other | If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded: | ||
| Did your calculation of the measure deviate from the measure specification in any way? | If Yes, the measure differs: Explain how the calculation differed and why. | ||
| Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure? | If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell: | ||
| Specify the size of the population included in the denominator: | Specify the size of the measure-eligible population. | ||
| Provide the following information for each rate/stratification: | |||
| Initiation Phase Treatment: | |||
| Medicaid Population: | |||
| Did the numerator differ for the Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicaid population? | If other, explain the deviation in the next cell: | ||
| Medicare & Medicaid Population: | |||
| Did the numerator differ for the Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Neither Medicaid nor Medicare & Medicaid Population: | |||
| Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Total Eligible Population: | |||
| Did the numerator differ for the Total Eligible population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Total Eligible population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Total Eligible population? | If other, explain the deviation in the next cell: | ||
| C&M Phase Treatment: | |||
| Medicaid Population: | |||
| Did the numerator differ for the Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicaid population? | If other, explain the deviation in the next cell: | ||
| Medicare & Medicaid Population: | |||
| Did the numerator differ for the Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Neither Medicaid nor Medicare & Medicaid Population: | |||
| Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Total Eligible Population: | |||
| Did the numerator differ for the Total Eligible population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Total Eligible population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Total Eligible population? | If other, explain the deviation in the next cell: | ||
| F. Additional Notes: | |||
| End of Worksheet | |||
| Press TAB to move to input areas. Use the arrow keys to read through the document. Use the alt and down arrow keys to use the drop down options. | |||
| Antidepressant Medication Management (AMM-BH) | |||
| Based on a measure stewarded by the National Committee for Quality Assurance (NQF #0105, HEDIS 2016, Medicaid Adult Core Set) | |||
| A. Measurement Year: | |||
| Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017. | |||
| B. Data Source: | |||
| Select the data source type: | No Data | ||
| If administrative data only, select source (Medicaid Management Information System (MMIS) or Other): | If other administrative data, specify data source: | ||
| If source other than administrative selected, provide source: | No Data | ||
| C. Date Range: | |||
| Index Prescription Start Date (IPSD): | |||
| Denominator Start Date (mm/dd/yyyy) | No Data | ||
| Denominator End Date (mm/dd/yyyy) | No Data | ||
| Negative Medication History Review: | |||
| Denominator Start Date (mm/dd/yyyy) | No Data | ||
| Denominator End Date (mm/dd/yyyy) | No Data | ||
| Acute Phase: | |||
| Numerator Start Date (mm/dd/yyyy) | No Data | ||
| Numerator End Date (mm/dd/yyyy) | No Data | ||
| Continuation Phase: | |||
| Numerator Start Date (mm/dd/yyyy) | No Data | ||
| Numerator End Date (mm/dd/yyyy) | No Data | ||
| D. Performance Measure: | |||
| The percentage of consumers age 18 and older who were treated with antidepressant medication, had a diagnosis of Major Depression and who remained on an antidepressant medication treatment. Two rates are reported: 1. Effective Acute Phase Treatment. Percentage of consumers who remained on an antidepressant medication for at least 84 days (12 weeks). 2. Effective Continuation Phase Treatment. Percentage of consumers who remained on an antidepressant medication for at least 180 days (6 months). |
|||
| For each of those rates, the measure is stratified to report by age (18-64 years, 65 and older), and by the Medicaid, Medicare & Medicaid, and other population. | |||
| Measure | Numerator | Denominator | Rate |
| Acute Phase | |||
| 18-64 years | 0 | 0 | |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| 65+ years | 0 | 0 | |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| Continuation & Maintenance Phase | |||
| 18-64 years | 0 | 0 | |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| 65+ years | 0 | 0 | |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| E. Adherence to Measure Specifications: | |||
| Population included in the denominator (indicate yes or no for each of the options below): | |||
| Medicaid population | No Data | ||
| Title XIX-eligible CHIP population | No Data | ||
| Title XXI-eligible CHIP population | No Data | ||
| Other CHIP enrollees | No Data | ||
| Medicare population | No Data | ||
| Medicare and Medicaid Dually-Eligible population | No Data | ||
| VHA/TRICARE population | No Data | ||
| Commercially insured population | No Data | ||
| Uninsured population | No Data | ||
| Other | If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded: | ||
| Did your calculation of the measure deviate from the measure specification in any way? | If Yes, the measure differs: Explain how the calculation differed and why. | ||
| Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure? | If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell: | ||
| Specify the size of the population included in the denominator: | Specify the size of the measure-eligible population. | ||
| Provide the following information for each rate/stratification: | |||
| Acute Phase Treatment: | |||
| Age Range: 18-64 years | |||
| Did the numerator differ for the 18-64 years age range? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the 18-64 years age range? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the 18-64 years age range? | If other, explain the deviation in the next cell: | ||
| Age Range: 65+ years | |||
| Did the numerator differ for the 65+ years age range? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the 65+ years age range? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the 65+ years age range? | If other, explain the deviation in the next cell: | ||
| Medicaid Population: | |||
| Did the numerator differ for the Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicaid population? | If other, explain the deviation in the next cell: | ||
| Medicare & Medicaid Population: | |||
| Did the numerator differ for the Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Neither Medicaid nor Medicare & Medicaid Population: | |||
| Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Continuation and Maintenance Phase Treatment: | |||
| Age Range: 18-64 years | |||
| Did the numerator differ for the 18-64 years age range? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the 18-64 years age range? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the 18-64 years age range? | If other, explain the deviation in the next cell: | ||
| Age Range: 65+ years | |||
| Did the numerator differ for the 65+ years age range? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the 65+ years age range? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the 65+ years age range? | If other, explain the deviation in the next cell: | ||
| Medicaid Population: | |||
| Did the numerator differ for the Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicaid population? | If other, explain the deviation in the next cell: | ||
| Medicare & Medicaid Population: | |||
| Did the numerator differ for the Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Neither Medicaid nor Medicare & Medicaid Population: | |||
| Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| F. Additional Notes: | |||
| End of Worksheet | |||
| Press TAB to move to input areas. Use the arrow keys to read through the document. Use the alt and down arrow keys to use the drop down options. | |||
| Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (IET-BH) | |||
| Based on a measure stewarded by the National Committee for Quality Assurance (NQF #0004, HEDIS 2016) | |||
| A. Measurement Year: | |||
| Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017. | |||
| B. Data Source: | |||
| Select the data source type: | No Data | ||
| If administrative data only, select source (Medicaid Management Information System (MMIS) or Other): | If other administrative data, specify data source: | ||
| If source other than administrative selected, provide source: | No Data | ||
| C. Date Range: | |||
| Index Episode Start Date (IESD): | |||
| Denominator Start Date (mm/dd/yyyy) | No Data | ||
| Denominator End Date (mm/dd/yyyy) | No Data | ||
| Negative Diagnosis History Review: | |||
| Denominator Start Date (mm/dd/yyyy) | No Data | ||
| Denominator End Date (mm/dd/yyyy) | No Data | ||
| Initiation of AOD Treatment: | |||
| Numerator Start Date (mm/dd/yyyy) | No Data | ||
| Numerator End Date (mm/dd/yyyy) | No Data | ||
| Engagement of AOD Treatment: | |||
| Numerator Start Date (mm/dd/yyyy) | No Data | ||
| Numerator End Date (mm/dd/yyyy) | No Data | ||
| D. Performance Measure: | |||
| The percentage of consumers age 13 and older with a new episode of alcohol or other drug (AOD) dependence who received the following: 1. Initiated treatment through an inpatient AOD admission, outpatient visit, intensive outpatient encounter or partial hospitalization within 14 days of the diagnosis 2. Initiated treatment and who had two or more additional services with a diagnosis of AOD within 30 days of the initiation visit |
|||
| For each of those rates, the measure is stratified to report by age (13-17, 18-64, 65 and older), and by the Medicaid, Medicare & Medicaid, and other population. | |||
| Measure | Numerator | Denominator | Rate |
| Initiation of AOD Treatment | |||
| 13-17 years | 0 | 0 | |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| 18-64 years | 0 | 0 | |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| 65+ years | 0 | 0 | |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| Engagement of AOD Treatment | |||
| 13-17 years | 0 | 0 | |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| 18-64 years | 0 | 0 | |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| 65+ years | 0 | 0 | |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| E. Adherence to Measure Specifications: | |||
| Population included in the denominator (indicate yes or no for each of the options below): | |||
| Medicaid population | No Data | ||
| Title XIX-eligible CHIP population | No Data | ||
| Title XXI-eligible CHIP population | No Data | ||
| Other CHIP enrollees | No Data | ||
| Medicare population | No Data | ||
| Medicare and Medicaid Dually-Eligible population | No Data | ||
| VHA/TRICARE population | No Data | ||
| Commercially insured population | No Data | ||
| Uninsured population | No Data | ||
| Other | If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded: | ||
| Did your calculation of the measure deviate from the measure specification in any way? | If Yes, the measure differs: Explain how the calculation differed and why. | ||
| Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure? | If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell: | ||
| Specify the size of the population included in the denominator: | Specify the size of the measure-eligible population. | ||
| Provide the following information for each rate/stratification: | |||
| Initiation of AOD Treatment: | |||
| Age Range: 13-17 years | |||
| Did the numerator differ for the 13-17 years age range? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the 13-17 years age range? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the 13-17 years age range? | If other, explain the deviation in the next cell: | ||
| Age Range: 18-64 years | |||
| Did the numerator differ for the 18-64 years age range? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the 18-64 years age range? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the 18-64 years age range? | If other, explain the deviation in the next cell: | ||
| Age Range: 65+ years | |||
| Did the numerator differ for the 65+ years age range? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the 65+ years age range? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the 65+ years age range? | If other, explain the deviation in the next cell: | ||
| Medicaid Population: | |||
| Did the numerator differ for the Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicaid population? | If other, explain the deviation in the next cell: | ||
| Medicare & Medicaid Population: | |||
| Did the numerator differ for the Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Neither Medicaid nor Medicare & Medicaid Population: | |||
| Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Engagement of AOD Treatment: | |||
| Age Range: 13-17 years | |||
| Did the numerator differ for the 13-17 years age range? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the 13-17 years age range? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the 13-17 years age range? | If other, explain the deviation in the next cell: | ||
| Age Range: 18-64 years | |||
| Did the numerator differ for the 18-64 years age range? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the 18-64 years age range? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the 18-64 years age range? | If other, explain the deviation in the next cell: | ||
| Age Range: 65+ years | |||
| Did the numerator differ for the 65+ years age range? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the 65+ years age range? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the 65+ years age range? | If other, explain the deviation in the next cell: | ||
| Medicaid Population: | |||
| Did the numerator differ for the Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicaid population? | If other, explain the deviation in the next cell: | ||
| Medicare & Medicaid Population: | |||
| Did the numerator differ for the Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Neither Medicaid nor Medicare & Medicaid Population: | |||
| Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| F. Additional Notes: | |||
| End of Worksheet | |||
| Press TAB to move to input areas. Use the arrow keys to read through the document. | |
| State-Lead Measures Not Required for the CCBHC Demonstration Program | |
| State Name: | |
| BHC Name: | |
| BHC Identifier: | |
| End of Worksheet | |
| Press TAB to move to input areas. Use the arrow keys to read through the document. Use the alt and down arrow keys to use the drop down options. | |||
| Suicide Attempts (SU-A) | |||
| A SAMHSA-Developed Metric | |||
| A. Measurement Year: | |||
| Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017. | |||
| B. Data Source: | |||
| Select the data source type: | No Data | ||
| If administrative data only, select source (Medicaid Management Information System (MMIS) or Other): | If other administrative data, specify data source: | ||
| If source other than administrative selected, provide source: | No Data | ||
| C. Date Range: | |||
| Denominator Start Date (mm/dd/yyyy) | No Data | ||
| Denominator End Date (mm/dd/yyyy) | No Data | ||
| Numerator Start Date (mm/dd/yyyy) | No Data | ||
| Numerator End Date (mm/dd/yyyy) | No Data | ||
| D. Performance Measure: | |||
| The percentage of consumers aged 12 years and older who attempted suicide during the measurement year, where the suicide attempt resulted in injury requiring medical services | |||
| The measure is stratified to report by age (12–17 years, 18–64 years, 65 years and older, and total (all age groups)), and by the Medicaid, Medicare & Medicaid, other, and total population. | |||
| Measure | Numerator | Denominator | Rate |
| 12-17 years | 0 | 0 | |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| 18-64 years | 0 | 0 | |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| 65+ years | 0 | 0 | |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| Total (all age groups) | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| E. Adherence to Measure Specifications: | |||
| Population included in the denominator (indicate yes or no for each of the options below): | |||
| Medicaid population | No Data | ||
| Title XIX-eligible CHIP population | No Data | ||
| Title XXI-eligible CHIP population | No Data | ||
| Other CHIP enrollees | No Data | ||
| Medicare population | No Data | ||
| Medicare and Medicaid Dually-Eligible population | No Data | ||
| VHA/TRICARE population | No Data | ||
| Commercially insured population | No Data | ||
| Uninsured population | No Data | ||
| Other | If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded: | ||
| Did your calculation of the measure deviate from the measure specification in any way? | If Yes, the measure differs: Explain how the calculation differed and why. | ||
| Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure? | If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell: | ||
| Specify the size of the population included in the denominator: | Specify the size of the measure-eligible population. | ||
| Provide the following information for each rate/stratification: | |||
| Age Range: 12-17 years | |||
| Did the numerator differ for the 12-17 years age range? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the 12-17 years age range? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the 12-17 years age range? | If other, explain the deviation in the next cell: | ||
| Age Range: 18-64 years | |||
| Did the numerator differ for the 18-64 years age range? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the 18-64 years age range? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the 18-64 years age range? | If other, explain the deviation in the next cell: | ||
| Age Range: 65+ years | |||
| Did the numerator differ for the 65+ years age range? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the 65+ years age range? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the 65+ years age range? | If other, explain the deviation in the next cell: | ||
| Medicaid Population: | |||
| Did the numerator differ for the Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicaid population? | If other, explain the deviation in the next cell: | ||
| Medicare & Medicaid Population: | |||
| Did the numerator differ for the Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Neither Medicaid nor Medicare & Medicaid Population: | |||
| Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Total Eligible Population: | |||
| Did the numerator differ for the Total Eligible population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Total Eligible population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Total Eligible population? | If other, explain the deviation in the next cell: | ||
| F. Additional Notes: | |||
| End of Worksheet | |||
| Press TAB to move to input areas. Use the arrow keys to read through the document. Use the alt and down arrow keys to use the drop down options. | |||
| Diabetes Care For People With Serious Mental Illness: Hemoglobin A1c (Hba1c) Poor Control (>9.0%) (SMI-PC) | |||
| Based on a measure stewarded by the National Committee for Quality Assurance (NQF #2607) | |||
| A. Measurement Year: | |||
| Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017. | |||
| B. Data Source: | |||
| Select the data source type: | No Data | ||
| If administrative data only, select source (Medicaid Management Information System (MMIS) or Other): | If other administrative data, specify data source: | ||
| If source other than administrative selected, provide source: | No Data | ||
| C. Date Range: | |||
| Denominator Start Date (mm/dd/yyyy) | No Data | ||
| Denominator End Date (mm/dd/yyyy) | No Data | ||
| Numerator Start Date (mm/dd/yyyy) | No Data | ||
| Numerator End Date (mm/dd/yyyy) | No Data | ||
| D. Performance Measure: | |||
| The percentage of consumers 18–75 years of age with a serious mental illness and diabetes (type 1 and type 2) whose most recent Hemoglobin A1c (HbA1c) level during the measurement year is >9.0%. | |||
| The measure is stratified to report Medicaid, Medicare & Medicaid, other, and total population. | |||
| Measure | Numerator | Denominator | Rate |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| Total | 0 | 0 | |
| E. Adherence to Measure Specifications: | |||
| Population included in the denominator (indicate yes or no for each of the options below): | |||
| Medicaid population | No Data | ||
| Title XIX-eligible CHIP population | No Data | ||
| Title XXI-eligible CHIP population | No Data | ||
| Other CHIP enrollees | No Data | ||
| Medicare population | No Data | ||
| Medicare and Medicaid Dually-Eligible population | No Data | ||
| VHA/TRICARE population | No Data | ||
| Commercially insured population | No Data | ||
| Uninsured population | No Data | ||
| Other | If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded: | ||
| Did your calculation of the measure deviate from the measure specification in any way? | If Yes, the measure differs: Explain how the calculation differed and why. | ||
| Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure? | If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell: | ||
| Specify the size of the population included in the denominator: | Specify the size of the measure-eligible population. | ||
| Provide the following information for each rate/stratification: | |||
| Medicaid Population: | |||
| Did the numerator differ for the Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicaid population? | If other, explain the deviation in the next cell: | ||
| Medicare & Medicaid Population: | |||
| Did the numerator differ for the Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Neither Medicaid nor Medicare & Medicaid Population: | |||
| Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Total Eligible Population: | |||
| Did the numerator differ for the Total Eligible population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Total Eligible population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Total Eligible population? | If other, explain the deviation in the next cell: | ||
| F. Additional Notes: | |||
| End of Worksheet | |||
| Press TAB to move to input areas. Use the arrow keys to read through the document. Use the alt and down arrow keys to use the drop down options. | |||
| Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM) | |||
| Based on a measure stewarded by the National Committee for Quality Assurance (HEDIS 2016) |
|||
| A. Measurement Year: | |||
| Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017. | |||
| B. Data Source: | |||
| Select the data source type: | No Data | ||
| If administrative data only, select source (Medicaid Management Information System (MMIS) or Other): | If other administrative data, specify data source: | ||
| If source other than administrative selected, provide source: | No Data | ||
| C. Date Range: | |||
| Denominator Start Date (mm/dd/yyyy) | No Data | ||
| Denominator End Date (mm/dd/yyyy) | No Data | ||
| Numerator Start Date (mm/dd/yyyy) | No Data | ||
| Numerator End Date (mm/dd/yyyy) | No Data | ||
| D. Performance Measure: | |||
| The percentage of children and adolescents aged 1–17 years who had two or more antipsychotic prescriptions and had metabolic testing | |||
| The measure is stratified to report by age (1-5 years, 6-11, 12-17, and total), and by the Medicaid, Medicare & Medicaid, other, and total population. | |||
| Measure | Numerator | Denominator | Rate |
| 1-5 years | 0 | 0 | |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| 6-11 years | 0 | 0 | |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| 12-17 years | 0 | 0 | |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| Total (all age groups) | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| E. Adherence to Measure Specifications: | |||
| Population included in the denominator (indicate yes or no for each of the options below): | |||
| Medicaid population | No Data | ||
| Title XIX-eligible CHIP population | No Data | ||
| Title XXI-eligible CHIP population | No Data | ||
| Other CHIP enrollees | No Data | ||
| Medicare population | No Data | ||
| Medicare and Medicaid Dually-Eligible population | No Data | ||
| VHA/TRICARE population | No Data | ||
| Commercially insured population | No Data | ||
| Uninsured population | No Data | ||
| Other | If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded: | ||
| Did your calculation of the measure deviate from the measure specification in any way? | If Yes, the measure differs: Explain how the calculation differed and why. | ||
| Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure? | If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell: | ||
| Specify the size of the population included in the denominator: | Specify the size of the measure-eligible population. | ||
| Provide the following information for each rate/stratification: | |||
| Age Range: 1-5 years | |||
| Did the numerator differ for the 1-5 years age range? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the 1-5 years age range? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the 1-5 years age range? | If other, explain the deviation in the next cell: | ||
| Age Range: 6-11 years | |||
| Did the numerator differ for the 6-11 years age range? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the 6-11 years age range? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the 6-11 years age range? | If other, explain the deviation in the next cell: | ||
| Age Range: 12-17 years | |||
| Did the numerator differ for the 12-17 years age range? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the 12-17 years age range? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the 12-17 years age range? | If other, explain the deviation in the next cell: | ||
| Medicaid Population: | |||
| Did the numerator differ for the Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicaid population? | If other, explain the deviation in the next cell: | ||
| Medicare & Medicaid Population: | |||
| Did the numerator differ for the Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Neither Medicaid nor Medicare & Medicaid Population: | |||
| Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Total Eligible Population: | |||
| Did the numerator differ for the Total Eligible population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Total Eligible population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Total Eligible population? | If other, explain the deviation in the next cell: | ||
| F. Additional Notes: | |||
| End of Worksheet | |||
| Press TAB to move to input areas. Use the arrow keys to read through the document. Use the alt and down arrow keys to use the drop down options. | |||
| Cardiovascular Monitoring for People With Cardiovascular Disease and Schizophrenia (SMC) | |||
| Based on measure stewarded by the National Committee for Quality Assurance (NQF #1933, HEDIS 2016) | |||
| A. Measurement Year: | |||
| Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017. | |||
| B. Data Source: | |||
| Select the data source type: | No Data | ||
| If administrative data only, select source (Medicaid Management Information System (MMIS) or Other): | If other administrative data, specify data source: | ||
| If source other than administrative selected, provide source: | No Data | ||
| C. Date Range: | |||
| Denominator Start Date (mm/dd/yyyy) | No Data | ||
| Denominator End Date (mm/dd/yyyy) | No Data | ||
| Numerator Start Date (mm/dd/yyyy) | No Data | ||
| Numerator End Date (mm/dd/yyyy) | No Data | ||
| D. Performance Measure: | |||
| The percentage of consumers 18–64 years of age with Schizophrenia and cardiovascular disease, who had an LDL-C test during the measurement year | |||
| The measure is stratified to report Medicaid, Medicare & Medicaid, other, and total population. | |||
| Measure | Numerator | Denominator | Rate |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| Total | 0 | 0 | |
| E. Adherence to Measure Specifications: | |||
| Population included in the denominator (indicate yes or no for each of the options below): | |||
| Medicaid population | No Data | ||
| Title XIX-eligible CHIP population | No Data | ||
| Title XXI-eligible CHIP population | No Data | ||
| Other CHIP enrollees | No Data | ||
| Medicare population | No Data | ||
| Medicare and Medicaid Dually-Eligible population | No Data | ||
| VHA/TRICARE population | No Data | ||
| Commercially insured population | No Data | ||
| Uninsured population | No Data | ||
| Other | If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded: | ||
| Did your calculation of the measure deviate from the measure specification in any way? | If Yes, the measure differs: Explain how the calculation differed and why. | ||
| Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure? | If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell: | ||
| Specify the size of the population included in the denominator: | Specify the size of the measure-eligible population. | ||
| Provide the following information for each rate/stratification: | |||
| Medicaid Population: | |||
| Did the numerator differ for the Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicaid population? | If other, explain the deviation in the next cell: | ||
| Medicare & Medicaid Population: | |||
| Did the numerator differ for the Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Neither Medicaid nor Medicare & Medicaid Population: | |||
| Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Total Eligible Population: | |||
| Did the numerator differ for the Total Eligible population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Total Eligible population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Total Eligible population? | If other, explain the deviation in the next cell: | ||
| F. Additional Notes: | |||
| End of Worksheet | |||
| Press TAB to move to input areas. Use the arrow keys to read through the document. Use the alt and down arrow keys to use the drop down options. | |||
| Adherence to Mood Stabilizers for Individuals with Bipolar I Disorder (AMS-BD) | |||
| Based on a measure stewarded by the Centers for Medicare & Medicaid Services (NQF #1880) |
|||
| A. Measurement Year: | |||
| Insert measurement year based on CCBHC or non-CCBHC status. For CCBHCs, enter DY1 or DY2. For non-CCBHCs, enter year such as FY2017. | |||
| B. Data Source: | |||
| Select the data source type: | No Data | ||
| If administrative data only, select source (Medicaid Management Information System (MMIS) or Other): | If other administrative data, specify data source: | ||
| If source other than administrative selected, provide source: | No Data | ||
| C. Date Range: | |||
| Denominator Start Date (mm/dd/yyyy) | No Data | ||
| Denominator End Date (mm/dd/yyyy) | No Data | ||
| Numerator Start Date (mm/dd/yyyy) | No Data | ||
| Numerator End Date (mm/dd/yyyy) | No Data | ||
| D. Performance Measure: | |||
| The percentage of consumers at least 18 years of age as of the beginning of the measurement period with Bipolar I Disorder who had at least two prescription drug claims for mood stabilizer medications and had a Proportion of Days Covered (PDC) of at least 0.8 for mood stabilizer medications during the measurement period (12 consecutive months). | |||
| The measure is stratified to report Medicaid, Medicare & Medicaid, other, and total population. | |||
| Measure | Numerator | Denominator | Rate |
| Medicaid | |||
| Medicare & Medicaid | |||
| Other | |||
| Total | 0 | 0 | |
| E. Adherence to Measure Specifications: | |||
| Population included in the denominator (indicate yes or no for each of the options below): | |||
| Medicaid population | No Data | ||
| Title XIX-eligible CHIP population | No Data | ||
| Title XXI-eligible CHIP population | No Data | ||
| Other CHIP enrollees | No Data | ||
| Medicare population | No Data | ||
| Medicare and Medicaid Dually-Eligible population | No Data | ||
| VHA/TRICARE population | No Data | ||
| Commercially insured population | No Data | ||
| Uninsured population | No Data | ||
| Other | If Other, explain whether the denominator is a subset of definitions selected above, please further define the denominator, and indicate the number of consumers excluded: | ||
| Did your calculation of the measure deviate from the measure specification in any way? | If Yes, the measure differs: Explain how the calculation differed and why. | ||
| Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure? | If No, the denominator doesn't represent your total eligible population, explain which populations are excluded and why in the next cell: | ||
| Specify the size of the population included in the denominator: | Specify the size of the measure-eligible population. | ||
| Provide the following information for each rate/stratification: | |||
| Medicaid Population: | |||
| Did the numerator differ for the Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicaid population? | If other, explain the deviation in the next cell: | ||
| Medicare & Medicaid Population: | |||
| Did the numerator differ for the Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Neither Medicaid nor Medicare & Medicaid Population: | |||
| Did the numerator differ for the neither Medicaid nor Medicare & Medicaid population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the neither Medicaid nor Medicare & Medicaid population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the neither Medicaid nor Medicare & Medicaid population? | If other, explain the deviation in the next cell: | ||
| Total Eligible Population: | |||
| Did the numerator differ for the Total Eligible population? | If numerator differs, explain the deviation in the next cell: | ||
| Did the denominator differ for the Total Eligible population? | If denominator differs, explain the deviation in the next cell: | ||
| Did the calculation differ in some other way for the Total Eligible population? | If other, explain the deviation in the next cell: | ||
| F. Additional Notes: | |||
| End of Worksheet | |||
| Use the arrow keys to read through the document. | |||
| Roll-up All Measures | |||
| BHC-Lead CCBHC-Required Measures | |||
| Time to Initial Evaluation (I-EVAL) | |||
| Metric #1:Percentage of New Clients with Initial Evaluation within 10 Business Days | |||
| Measure | Numerator | Denominator | Percentage |
| Age 12-17 years | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| Age 18+ years | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| Total (all age groups) | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| Metric #2: Mean Number of Days until Initial Evaluation | |||
| Measure | Numerator | Denominator | Mean |
| Age 12-17 years | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| Age 18+ years | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| Total (all age groups) | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| No Data - Continue to next measure roll-up | |||
| Preventive Care and Screening: Adult Body Mass Index (BMI) Screening and Follow-Up (BMI-SF) | |||
| Measure | Numerator | Denominator | Rate |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| Total | 0 | 0 | |
| No Data - Continue to next measure roll-up | |||
| Weight Assessment for Children/Adolescents:Body Mass Index Assessment for Children/Adolescents (WCC-BH) | |||
| Measure | Numerator | Denominator | Rate |
| 3-11 years | |||
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| Total | 0 | 0 | |
| 12-17 years | |||
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| Total | 0 | 0 | |
| No Data - Continue to next measure roll-up | |||
| Preventive Care & Screening:Tobacco Use: Screening & Cessation Intervention (TSC) | |||
| CCBHC required measure | |||
| Measure | Numerator | Denominator | Rate |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| Total | 0 | 0 | |
| No Data - Continue to next measure roll-up | |||
| Preventive Care and Screening: Unhealthy Alcohol Use: Screening & Brief Counseling (ASC) | |||
| Measure | Numerator | Denominator | Rate |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| Total | 0 | 0 | |
| No Data - Continue to next measure roll-up | |||
| Child and Adolescent Major Depressive Disorder: Suicide Risk Assessment (SRA-BH-C) | |||
| Measure | Numerator | Denominator | Rate |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| Total | 0 | 0 | |
| No Data - Continue to next measure roll-up | |||
| Adult Major Depressive Disorder (MDD): Suicide Risk Assessment (SRA-A) | |||
| Measure | Numerator | Denominator | Rate |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| Total | 0 | 0 | |
| No Data - Continue to next measure roll-up | |||
| Screening for Clinical Depression and Follow-up Plan (CDF-BH) | |||
| Measure | Numerator | Denominator | Rate |
| 12-17 years | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| 18-64 years | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| 65+ years | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| No Data - Continue to next measure roll-up | |||
| Depression Remission at Twelve Months (DEP-REM-12) | |||
| Measure | Numerator | Denominator | Rate |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| Total | 0 | 0 | |
| No Data - Continue to next measure roll-up | |||
| Other BHC-Lead Measures | |||
| Routine Care Needs (ROUT) | |||
| Measure | Numerator | Denominator | Rate |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| Total | 0 | 0 | |
| No Data - Continue to next measure roll-up | |||
| Time to Comprehensive Person- and Family-Centered Diagnostic and Treatment Planning Evaluation (TX-EVAL) | |||
| Measure | Numerator | Denominator | Mean |
| Age 12-17 years | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| Age 18+ years | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| Total (all age groups) | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| No Data - Continue to next measure roll-up | |||
| Deaths by Suicide (SUIC) | |||
| Measure | Numerator | Denominator | Rate |
| 12-17 years | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| 18-64 years | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| 65 years and older | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| Total (all age groups) | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| No Data - Continue to next measure roll-up | |||
| Documentation of Current Medications in the Medical Record (DOC) | |||
| Measure | Numerator | Denominator | Rate |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| Total | 0 | 0 | |
| No Data - Continue to next measure roll-up | |||
| Controlling High Blood Pressure (CBP-BH) | |||
| Measure | Numerator | Denominator | Rate |
| 18-64 years | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| 65-85 years | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| No Data - Continue to next measure roll-up | |||
| State-Lead CCBHC-Required Measures | |||
| Housing Status (HOU) | |||
| Living Situation | Numerator | Denominator | Percentage |
| Private residence | 0 | 0 | |
| Foster home | 0 | 0 | |
| Residential care | 0 | 0 | |
| Crisis residence | 0 | 0 | |
| Residential treatment center | 0 | 0 | |
| Institutional setting | 0 | 0 | |
| Jail (correctional facility) | 0 | 0 | |
| Homeless (shelter) | 0 | 0 | |
| Other | 0 | 0 | |
| Not Available | 0 | 0 | |
| Total | 0 | 0 | |
| No Data - Continue to next measure roll-up | |||
| Patient Experience of Care Survey (PEC) | |||
| For this BHC, complete a copy of Tables 11 and 11a of the URS reporting template that is current at the time of the survey (http://www.nri-inc.org/#!urs-forms--info/c1xvm) (Table 22A for the Mental Health Block Grant), including required information on sampling methodology and response rates.For CCBHCs, identify results separately for CCBHCs and comparison clinics. | |||
| Youth/Family Experience of Care Survey (Y/FEC ) | |||
| For this BHC, complete a copy of Tables 11 and 11a of the URS reporting template that is current at the time of the survey (http://www.nri-inc.org/#!urs-forms--info/c1xvm (Table 22B for the Mental Health Block Grant)), including required information on sampling methodology and response rates.For CCBHCs, identify results separately for CCBHCs and comparison clinics. | |||
| No Data - Continue to next measure roll-up | |||
| Follow-up After Emergency Department Visit for Mental Illness (FUM) | |||
| Measure | Numerator | Denominator | Rate |
| ED MH Visits with 7 Day Follow-up | |||
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| Total | 0 | 0 | |
| ED MH Visits with 30 Day Follow-up | |||
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| Total | 0 | 0 | |
| No Data - Continue to next measure roll-up | |||
| Follow-up After Emergency Department Visit for Alcohol and Other Drug Dependence (FUA) | |||
| Measure | Numerator | Denominator | Rate |
| ED AOD Visits with 7 Day Follow-up | |||
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| Total | 0 | 0 | |
| ED AOD Visits with 30 Day Follow-up | |||
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| Total | 0 | 0 | |
| No Data - Continue to next measure roll-up | |||
| Plan All-Cause Readmissions Rate (PCR-BH) | |||
| Measure | Numerator | Denominator | Rate |
| 18-64 years | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| 65+ years | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| No Data - Continue to next measure roll-up | |||
| Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications (SSD) | |||
| Measure | Numerator | Denominator | Rate |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| Total | 0 | 0 | |
| No Data - Continue to next measure roll-up | |||
| Adherence to Antipsychotic Medications for Individuals With Schizophrenia (SAA-BH) | |||
| Measure | Numerator | Denominator | Rate |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| Total | 0 | 0 | |
| No Data - Continue to next measure roll-up | |||
| Follow-up After Hospitalization for Mental Illness (FUH-BH-A) | |||
| Measure | Numerator | Denominator | Rate |
| 30-Day Follow-up | |||
| 21-64 years | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| 65+ years | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| 7-Day Follow-up | |||
| 21-64 years | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| 65+ years | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| No Data - Continue to next measure roll-up | |||
| Follow-Up After Hospitalization For Mental Illness (FUH-BH-C) | |||
| Measure | Numerator | Denominator | Rate |
| 30-Day Follow-up | |||
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| Total | 0 | 0 | |
| 7-Day Follow-up | |||
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| Total | 0 | 0 | |
| No Data - Continue to next measure roll-up | |||
| Follow-up Care for Children Prescribed Attention-Deficit Hyperactivity Disorder (ADHD) Medication (ADD-BH) | |||
| Measure | Numerator | Denominator | Rate |
| Initiation Phase | |||
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| Total | 0 | 0 | |
| Continuation & Maintenance Phase | |||
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| Total | 0 | 0 | |
| No Data - Continue to next measure roll-up | |||
| Antidepressant Medication Management (AMM-BH) | |||
| Measure | Numerator | Denominator | Rate |
| Acute Phase | |||
| 18-64 years | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| 65+ years | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| Continuation and Maintenance Phase | |||
| 18-64 years | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| 65+ years | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| No Data - Continue to next measure roll-up | |||
| Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (IET-BH) | |||
| Measure | Numerator | Denominator | Rate |
| Initiation of AOD Treatment | |||
| 13-17 years | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| 18-64 years | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| 65+ years | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| Engagement of AOD Treatment | |||
| 13-17 years | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| 18-64 years | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| 65+ years | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| No Data - Continue to next measure roll-up | |||
| Other State-Lead Measures | |||
| Suicide Attempts (SU-A) | |||
| Measure | Numerator | Denominator | Rate |
| 12-17 years | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| 18-64 years | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| 65 years and older | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| Total (all age groups) | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| No Data - Continue to next measure roll-up | |||
| Diabetes Care For People With Serious Mental Illness: Hemoglobin A1c (Hba1c) Poor Control (>9.0%) (SMI-PC) | |||
| Measure | Numerator | Denominator | Rate |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| Total | 0 | 0 | |
| No Data - Continue to next measure roll-up | |||
| Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM) | |||
| Measure | Numerator | Denominator | Rate |
| 1-5 years | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| 6-11 years | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| 12-17 years | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| Total (all age groups) | 0 | 0 | |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| No Data - Continue to next measure roll-up | |||
| Cardiovascular Monitoring for People With Cardiovascular Disease and Schizophrenia (SMC) | |||
| Measure | Numerator | Denominator | Rate |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| Total | 0 | 0 | |
| No Data - Continue to next measure roll-up | |||
| Adherence to Mood Stabilizers for Individuals with Bipolar I Disorder (AMS-BD) | |||
| Measure | Numerator | Denominator | Rate |
| Medicaid | 0 | 0 | |
| Medicare & Medicaid | 0 | 0 | |
| Other | 0 | 0 | |
| Total | 0 | 0 | |
| Use the arrow keys to read through the table. | ||||||||||||||
| Table 1. BHC-Reported Measures Measurement Periods (MPs) for CCBHCs -- Demonstration Years (DY) 1 and 2 | ||||||||||||||
| Factor and Time Period | Routine Care Needs (ROUT) |
Time to Initial Evaluation (I-EVAL) |
Time to Comprehensive Person- and Family-Centered Diagnostic and Treatment Planning Evaluation (TX-EVAL) |
Deaths by Suicide (SUIC) |
Documentation of Current Medications in the Medical Record (DOC) |
Preventive Care and Screening: Adult Body Mass Index (BMI) Screening and Follow-Up (BMI-SF) |
Weight Assessment for Children/Adolescents: Body Mass Index Assessment for Children/Adolescents (WCC-BH) |
Controlling High Blood Pressure (CBP-BH) |
Preventive Care & Screening: Tobacco Use: Screening & Cessation Intervention (TSC) |
Preventive Care and Screening: Unhealthy Alcohol Use: Screening & Brief Counseling (ASC) |
Child and Adolescent Major Depressive Disorder: Suicide Risk Assessment (SRA-BH-C) |
Adult Major Depressive Disorder (MDD): Suicide Risk Assessment (SRA-BH-A) |
Screening for Clinical Depression and Follow-up Plan (CDF-BH) |
Depression Remission at Twelve Months (DEP-REM-12) |
| Denominator MP - DY1 | July 1, 2016 – Dec. 31, 2017 | July 1, 2016 – Dec. 1, 2017 | July 1, 2016 – Oct. 2, 2017 | Jan. 1, 2017 – Dec. 31, 2017 | Jan. 1, 2017 – Dec. 31, 2017 | Jan. 1, 2017 – Dec. 31, 2017 | Jan. 1, 2017 – Dec. 31, 2017 | Jan. 1, 2017 – Dec. 31, 2017 | Jan. 1, 2017 – Dec. 31, 2017 | Jan. 1, 2017 – Dec. 31, 2017 | Jan. 1, 2017 – Dec. 31, 2017 | Jan. 1, 2017 – Dec. 31, 2017 | Jan. 1, 2017 – Dec. 31, 2017 | Jan. 1, 2017 – Dec. 31, 2017 |
| Denominator MP - DY1 | Aug. 1, 2016 – Jan. 31, 2018 | Aug. 1, 2016 – Jan. 1, 2018 | Aug. 1, 2016 – Nov. 2, 2017 | Feb. 1, 2017 – Jan. 31, 2018 | Feb. 1, 2017 – Jan. 31, 2018 | Feb. 1, 2017 – Jan. 31, 2018 | Feb. 1, 2017 – Jan. 31, 2018 | Feb. 1, 2017 – Jan. 31, 2018 | Feb. 1, 2017 – Jan. 31, 2018 | Feb. 1, 2017 – Jan. 31, 2018 | Feb. 1, 2017 – Jan. 31, 2018 | Feb. 1, 2017 – Jan. 31, 2018 | Feb. 1, 2017 – Jan. 31, 2018 | Feb. 1, 2017 – Jan. 31, 2018 |
| Denominator MP - DY1 | Sept. 1, 2016 – Feb. 28, 2018 | Sept. 1, 2016 – Jan. 29, 2018 | Sept. 1, 2016 – Nov. 30, 2017 | March 1, 2017 – Feb. 28, 2018 | March 1, 2017 – Feb. 28, 2018 | March 1, 2017 – Feb. 28, 2018 | March 1, 2017 – Feb. 28, 2018 | March 1, 2017 – Feb. 28, 2018 | March 1, 2017 – Feb. 28, 2018 | March 1, 2017 – Feb. 28, 2018 | March 1, 2017 – Feb. 28, 2018 | March 1, 2017 – Feb. 28, 2018 | March 1, 2017 – Feb. 28, 2018 | March 1, 2017 – Feb. 28, 2018 |
| Denominator MP - DY1 | Oct. 1, 2016 – March 31, 2018 | Oct. 1, 2016 – March 1, 2018 | Oct. 1, 2016 – Dec. 31, 2017 | April 1, 2017 – March 31, 2018 | April 1, 2017 – March 31, 2018 | April 1, 2017 – March 31, 2018 | April 1, 2017 – March 31, 2018 | April 1, 2017 – March 31, 2018 | April 1, 2017 – March 31, 2018 | April 1, 2017 – March 31, 2018 | April 1, 2017 – March 31, 2018 | April 1, 2017 – March 31, 2018 | April 1, 2017 – March 31, 2018 | April 1, 2017 – March 31, 2018 |
| Denominator MP - DY1 | Nov. 1, 2016 – April 30, 2018 | Nov. 1, 2016 – March 31, 2018 | Nov. 1, 2016 – Jan. 30, 2018 | May 1, 2017 – April 30, 2018 | May 1, 2017 – April 30, 2018 | May 1, 2017 – April 30, 2018 | May 1, 2017 – April 30, 2018 | May 1, 2017 – April 30, 2018 | May 1, 2017 – April 30, 2018 | May 1, 2017 – April 30, 2018 | May 1, 2017 – April 30, 2018 | May 1, 2017 – April 30, 2018 | May 1, 2017 – April 30, 2018 | May 1, 2017 – April 30, 2018 |
| Denominator MP - DY1 | Dec. 1, 2016 – May 31, 2018 | Dec. 1, 2016 – May 1, 2018 | Dec. 1, 2016 – March 2, 2018 | June 1, 2017 – May 31, 2018 | June 1, 2017 – May 31, 2018 | June 1, 2017 – May 31, 2018 | June 1, 2017 – May 31, 2018 | June 1, 2017 – May 31, 2018 | June 1, 2017 – May 31, 2018 | June 1, 2017 – May 31, 2018 | June 1, 2017 – May 31, 2018 | June 1, 2017 – May 31, 2018 | June 1, 2017 – May 31, 2018 | June 1, 2017 – May 31, 2018 |
| Denominator MP - DY1 | Jan. 1, 2017 – June 30, 2018 | Jan. 1, 2017 – May 31, 2018 | Jan. 1, 2017 – April 1, 2018 | July 1, 2017 – June 30, 2018 | July 1, 2017 – June 30, 2018 | July 1, 2017 – June 30, 2018 | July 1, 2017 – June 30, 2018 | July 1, 2017 – June 30, 2018 | July 1, 2017 – June 30, 2018 | July 1, 2017 – June 30, 2018 | July 1, 2017 – June 30, 2018 | July 1, 2017 – June 30, 2018 | July 1, 2017 – June 30, 2018 | July 1, 2017 – June 30, 2018 |
| Denominator MP - DY2 | July 1, 2017 – Dec. 31, 2018 | July 1, 2017 – Dec. 1, 2018 | July 1, 2017 – Oct. 2, 2018 | Jan. 1, 2018 – Dec. 31, 2018 | Jan. 1, 2018 – Dec. 31, 2018 | Jan. 1, 2018 – Dec. 31, 2018 | Jan. 1, 2018 – Dec. 31, 2018 | Jan. 1, 2018 – Dec. 31, 2018 | Jan. 1, 2018 – Dec. 31, 2018 | Jan. 1, 2018 – Dec. 31, 2018 | Jan. 1, 2018 – Dec. 31, 2018 | Jan. 1, 2018 – Dec. 31, 2018 | Jan. 1, 2018 – Dec. 31, 2018 | Jan. 1, 2018 – Dec. 31, 2018 |
| Denominator MP - DY2 | Aug. 1, 2017 – Jan. 31, 2019 | Aug. 1, 2017 – Jan. 1, 2019 | Aug. 1, 2017 – Nov. 2, 2018 | Feb. 1, 2018 – Jan. 31, 2019 | Feb. 1, 2018 – Jan. 31, 2019 | Feb. 1, 2018 – Jan. 31, 2019 | Feb. 1, 2018 – Jan. 31, 2019 | Feb. 1, 2018 – Jan. 31, 2019 | Feb. 1, 2018 – Jan. 31, 2019 | Feb. 1, 2018 – Jan. 31, 2019 | Feb. 1, 2018 – Jan. 31, 2019 | Feb. 1, 2018 – Jan. 31, 2019 | Feb. 1, 2018 – Jan. 31, 2019 | Feb. 1, 2018 – Jan. 31, 2019 |
| Denominator MP - DY2 | Sept. 1, 2017 – Feb. 28, 2019 | Sept. 1, 2017 – Jan. 29, 2019 | Sept. 1, 2017 – Nov. 30, 2018 | March 1, 2018 – Feb. 28, 2019 | March 1, 2018 – Feb. 28, 2019 | March 1, 2018 – Feb. 28, 2019 | March 1, 2018 – Feb. 28, 2019 | March 1, 2018 – Feb. 28, 2019 | March 1, 2018 – Feb. 28, 2019 | March 1, 2018 – Feb. 28, 2019 | March 1, 2018 – Feb. 28, 2019 | March 1, 2018 – Feb. 28, 2019 | March 1, 2018 – Feb. 28, 2019 | March 1, 2018 – Feb. 28, 2019 |
| Denominator MP - DY2 | Oct. 1, 2017 – March 31, 2019 | Oct. 1, 2017 – March 1, 2019 | Oct. 1, 2017 – Dec. 31, 2018 | April 1, 2018 – March 31, 2019 | April 1, 2018 – March 31, 2019 | April 1, 2018 – March 31, 2019 | April 1, 2018 – March 31, 2019 | April 1, 2018 – March 31, 2019 | April 1, 2018 – March 31, 2019 | April 1, 2018 – March 31, 2019 | April 1, 2018 – March 31, 2019 | April 1, 2018 – March 31, 2019 | April 1, 2018 – March 31, 2019 | April 1, 2018 – March 31, 2019 |
| Denominator MP - DY2 | Nov. 1, 2017 – April 30, 2019 | Nov. 1, 2017 – March 31, 2019 | Nov. 1, 2017 – Jan. 30, 2019 | May 1, 2018 – April 30, 2019 | May 1, 2018 – April 30, 2019 | May 1, 2018 – April 30, 2019 | May 1, 2018 – April 30, 2019 | May 1, 2018 – April 30, 2019 | May 1, 2018 – April 30, 2019 | May 1, 2018 – April 30, 2019 | May 1, 2018 – April 30, 2019 | May 1, 2018 – April 30, 2019 | May 1, 2018 – April 30, 2019 | May 1, 2018 – April 30, 2019 |
| Denominator MP - DY2 | Dec. 1, 2017 – May 31, 2019 | Dec. 1, 2017 – May 1, 2019 | Dec. 1, 2017 – March 2, 2019 | June 1, 2018 – May 31, 2019 | June 1, 2018 – May 31, 2019 | June 1, 2018 – May 31, 2019 | June 1, 2018 – May 31, 2019 | June 1, 2018 – May 31, 2019 | June 1, 2018 – May 31, 2019 | June 1, 2018 – May 31, 2019 | June 1, 2018 – May 31, 2019 | June 1, 2018 – May 31, 2019 | June 1, 2018 – May 31, 2019 | June 1, 2018 – May 31, 2019 |
| Denominator MP - DY2 | Jan. 1, 2018 – June 30, 2019 | Jan. 1, 2018 – May 31, 2019 | Jan. 1, 2018 – April 1, 2019 | July 1, 2018 – June 30, 2019 | July 1, 2018 – June 30, 2019 | July 1, 2018 – June 30, 2019 | July 1, 2018 – June 30, 2019 | July 1, 2018 – June 30, 2019 | July 1, 2018 – June 30, 2019 | July 1, 2018 – June 30, 2019 | July 1, 2018 – June 30, 2019 | July 1, 2018 – June 30, 2019 | July 1, 2018 – June 30, 2019 | July 1, 2018 – June 30, 2019 |
| Numerator MP - DY1 | Jan. 1, 2017 – Dec. 31, 2017 | Jan. 1, 2017 – Dec. 31, 2017 | Jan. 1, 2017 – Dec. 31, 2017 | Jan. 1, 2017 – Dec. 31, 2017 | Jan. 1, 2017 – Dec. 31, 2017 | July 1, 2016 – Dec. 31, 2017 | Jan. 1, 2017 – Dec. 31, 2017 | Jan. 1, 2017 – Dec. 31, 2017 | Jan. 1, 2016 – Dec. 31, 2017 | Jan. 1, 2016 – Dec. 31, 2017 | Jan. 1, 2017 – Dec. 31, 2017 | Jan. 1, 2017 – Dec. 31, 2017 | Jan. 1, 2017 – Dec. 31, 2017 | Jan. 1, 2017 – Jan. 30, 2018 |
| Numerator MP - DY1 | Feb. 1, 2017 – Jan. 31, 2018 | Feb. 1, 2017 – Jan. 31, 2018 | Feb. 1, 2017 – Jan. 31, 2018 | Feb. 1, 2017 – Jan. 31, 2018 | Feb. 1, 2017 – Jan. 31, 2018 | Aug. 1, 2016 – Jan. 31, 2018 | Feb. 1, 2017 – Jan. 31, 2018 | Feb. 1, 2017 – Jan. 31, 2018 | Feb. 1, 2016 – Jan. 31, 2018 | Feb. 1, 2016 – Jan. 31, 2018 | Feb. 1, 2017 – Jan. 31, 2018 | Feb. 1, 2017 – Jan. 31, 2018 | Feb. 1, 2017 – Jan. 31, 2018 | Feb. 1, 2017 – March 2, 2018 |
| Numerator MP - DY1 | March 1, 2017 – Feb. 28, 2018 | March 1, 2017 – Feb. 28, 2018 | March 1, 2017 – Feb. 28, 2018 | March 1, 2017 – Feb. 28, 2018 | March 1, 2017 – Feb. 28, 2018 | Sept. 1, 2016 – Feb. 28, 2018 | March 1, 2017 – Feb. 28, 2018 | March 1, 2017 – Feb. 28, 2018 | March 1, 2016 – Feb. 28, 2018 | March 1, 2016 – Feb. 28, 2018 | March 1, 2017 – Feb. 28, 2018 | March 1, 2017 – Feb. 28, 2018 | March 1, 2017 – Feb. 28, 2018 | March 1, 2017 – March 30, 2018 |
| Numerator MP - DY1 | April 1, 2017 – March 31, 2018 | April 1, 2017 – March 31, 2018 | April 1, 2017 – March 31, 2018 | April 1, 2017 – March 31, 2018 | April 1, 2017 – March 31, 2018 | Oct. 1, 2016 – March 31, 2018 | April 1, 2017 – March 31, 2018 | April 1, 2017 – March 31, 2018 | April 1, 2016 – March 31, 2018 | April 1, 2016 – March 31, 2018 | April 1, 2017 – March 31, 2018 | April 1, 2017 – March 31, 2018 | April 1, 2017 – March 31, 2018 | April 1, 2017 – April 30, 2018 |
| Numerator MP - DY1 | May 1, 2017 – April 30, 2018 | May 1, 2017 – April 30, 2018 | May 1, 2017 – April 30, 2018 | May 1, 2017 – April 30, 2018 | May 1, 2017 – April 30, 2018 | Nov. 1, 2016 – April 30, 2018 | May 1, 2017 – April 30, 2018 | May 1, 2017 – April 30, 2018 | May 1, 2016 – April 30, 2018 | May 1, 2016 – April 30, 2018 | May 1, 2017 – April 30, 2018 | May 1, 2017 – April 30, 2018 | May 1, 2017 – April 30, 2018 | May 1, 2017 – May 30, 2018 |
| Numerator MP - DY1 | June 1, 2017 – May 31, 2018 | June 1, 2017 – May 31, 2018 | June 1, 2017 – May 31, 2018 | June 1, 2017 – May 31, 2018 | June 1, 2017 – May 31, 2018 | Dec. 1, 2016 – May 31, 2018 | June 1, 2017 – May 31, 2018 | June 1, 2017 – May 31, 2018 | June 1, 2016 – May 31, 2018 | June 1, 2016 – May 31, 2018 | June 1, 2017 – May 31, 2018 | June 1, 2017 – May 31, 2018 | June 1, 2017 – May 31, 2018 | June 1, 2017 – June 30, 2018 |
| Numerator MP - DY1 | July 1, 2017 – June 30, 2018 | July 1, 2017 – June 30, 2018 | July 1, 2017 – June 30, 2018 | July 1, 2017 – June 30, 2018 | July 1, 2017 – June 30, 2018 | Jan. 1, 2017 – June 30, 2018 | July 1, 2017 – June 30, 2018 | July 1, 2017 – June 30, 2018 | July 1, 2016 – June 30, 2018 | July 1, 2016 – June 30, 2018 | July 1, 2017 – June 30, 2018 | July 1, 2017 – June 30, 2018 | July 1, 2017 – June 30, 2018 | July 1, 2017 – July 30, 2018 |
| Numerator MP - DY2 | Jan. 1, 2018 – Dec. 31, 2018 | Jan. 1, 2018 – Dec. 31, 2018 | Jan. 1, 2018 – Dec. 31, 2018 | Jan. 1, 2018 – Dec. 31, 2018 | Jan. 1, 2018 – Dec. 31, 2018 | July 1, 2017 – Dec. 31, 2018 | Jan. 1, 2018 – Dec. 31, 2018 | Jan. 1, 2018 – Dec. 31, 2018 | Jan. 1, 2017 – Dec. 31, 2018 | Jan. 1, 2017 – Dec. 31, 2018 | Jan. 1, 2018 – Dec. 31, 2018 | Jan. 1, 2018 – Dec. 31, 2018 | Jan. 1, 2018 – Dec. 31, 2018 | Jan. 1, 2018 – Jan. 30, 2019 |
| Numerator MP - DY2 | Feb. 1, 2018 – Jan. 31, 2019 | Feb. 1, 2018 – Jan. 31, 2019 | Feb. 1, 2018 – Jan. 31, 2019 | Feb. 1, 2018 – Jan. 31, 2019 | Feb. 1, 2018 – Jan. 31, 2019 | Aug. 1, 2017 – Jan. 31, 2019 | Feb. 1, 2018 – Jan. 31, 2019 | Feb. 1, 2018 – Jan. 31, 2019 | Feb. 1, 2017 – Jan. 31, 2019 | Feb. 1, 2017 – Jan. 31, 2019 | Feb. 1, 2018 – Jan. 31, 2019 | Feb. 1, 2018 – Jan. 31, 2019 | Feb. 1, 2018 – Jan. 31, 2019 | Feb. 1, 2018 – March 2, 2019 |
| Numerator MP - DY2 | March 1, 2018 – Feb. 28, 2019 | March 1, 2018 – Feb. 28, 2019 | March 1, 2018 – Feb. 28, 2019 | March 1, 2018 – Feb. 28, 2019 | March 1, 2018 – Feb. 28, 2019 | Sept. 1, 2017 – Feb. 28, 2019 | March 1, 2018 – Feb. 28, 2019 | March 1, 2018 – Feb. 28, 2019 | March 1, 2017 – Feb. 28, 2019 | March 1, 2017 – Feb. 28, 2019 | March 1, 2018 – Feb. 28, 2019 | March 1, 2018 – Feb. 28, 2019 | March 1, 2018 – Feb. 28, 2019 | March 1, 2018 – March 30, 2019 |
| Numerator MP - DY2 | April 1, 2018 – March 31, 2019 | April 1, 2018 – March 31, 2019 | April 1, 2018 – March 31, 2019 | April 1, 2018 – March 31, 2019 | April 1, 2018 – March 31, 2019 | Oct. 1, 2017 – March 31, 2019 | April 1, 2018 – March 31, 2019 | April 1, 2018 – March 31, 2019 | April 1, 2017 – March 31, 2019 | April 1, 2017 – March 31, 2019 | April 1, 2018 – March 31, 2019 | April 1, 2018 – March 31, 2019 | April 1, 2018 – March 31, 2019 | April 1, 2018 – April 30, 2019 |
| Numerator MP - DY2 | May 1, 2018 – April 30, 2019 | May 1, 2018 – April 30, 2019 | May 1, 2018 – April 30, 2019 | May 1, 2018 – April 30, 2019 | May 1, 2018 – April 30, 2019 | Nov. 1, 2017 – April 30, 2019 | May 1, 2018 – April 30, 2019 | May 1, 2018 – April 30, 2019 | May 1, 2017 – April 30, 2019 | May 1, 2017 – April 30, 2019 | May 1, 2018 – April 30, 2019 | May 1, 2018 – April 30, 2019 | May 1, 2018 – April 30, 2019 | May 1, 2018 – May 30, 2019 |
| Numerator MP - DY2 | June 1, 2018 – May 31, 2019 | June 1, 2018 – May 31, 2019 | June 1, 2018 – May 31, 2019 | June 1, 2018 – May 31, 2019 | June 1, 2018 – May 31, 2019 | Dec. 1, 2017 – May 31, 2019 | June 1, 2018 – May 31, 2019 | June 1, 2018 – May 31, 2019 | June 1, 2017 – May 31, 2019 | June 1, 2017 – May 31, 2019 | June 1, 2018 – May 31, 2019 | June 1, 2018 – May 31, 2019 | June 1, 2018 – May 31, 2019 | June 1, 2018 – June 30, 2019 |
| Numerator MP - DY2 | July 1, 2018 – June 30, 2019 | July 1, 2018 – June 30, 2019 | July 1, 2018 – June 30, 2019 | July 1, 2018 – June 30, 2019 | July 1, 2018 – June 30, 2019 | Jan. 1, 2018 – June 30, 2019 | July 1, 2018 – June 30, 2019 | July 1, 2018 – June 30, 2019 | July 1, 2017 – June 30, 2019 | July 1, 2017 – June 30, 2019 | July 1, 2018 – June 30, 2019 | July 1, 2018 – June 30, 2019 | July 1, 2018 – June 30, 2019 | July 1, 2018 – July 30, 2019 |
| End of Worksheet | ||||||||||||||
| Use the arrow keys to read through the document. | ||||||||||||||||||
| Table 2. State-Reported Measures Measurement Periods (MPs) for CCBHCs -- Demonstration Years (DY) 1 and 2 | ||||||||||||||||||
| Factor and Time Period | Housing Status (HOU) |
Suicide Attempts (SU-A) |
Patient Experience of Care Survey (PEC) |
Youth/Family Experience of Care Survey (Y/FEC ) |
Follow-up After Emergency Department Visit for Mental Illness (FUM) |
Follow-up After Emergency Department Visit for Alcohol or Other Drug Dependence (FUA) |
Plan All-Cause Readmissions Rate (PCR-BH) |
Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications (SSD) |
Diabetes Care For People With Serious Mental Illness: Hemoglobin A1c (Hba1c) Poor Control (>9.0%) (SMI-PC) |
Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM) |
Cardiovascular Monitoring for People With Cardiovascular Disease and Schizophrenia (SMC) |
Adherence to Mood Stabilizers for Individuals with Bipolar I Disorder (AMS-BD) |
Adherence to Antipsychotic Medications for Individuals With Schizophrenia (SAA-BH) |
Adult Follow-up After Hospitalization for Mental Illness (FUH-BH-A) |
Child Follow-Up After Hospitalization For Mental Illness (FUH-BH-C) |
Follow-up Care for Children Prescribed Attention-Deficit Hyperactivity Disorder (ADHD) Medication (ADD-BH) |
Antidepressant Medication Management (AMM-BH) |
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (IET-BH) |
| Denominator MP - DY1 | Jan. 1, 2017 – June 30, 2017 and July 1, 2017 – Dec. 31, 2017 | Jan. 1, 2017 – Nov. 30, 2017 | Jan. 1, 2017 – Dec. 31, 2017 | Jan. 1, 2017 – Dec. 31, 2017 | Jan. 1, 2017 – Dec. 1, 2017 | Jan. 1, 2017 – Dec. 1, 2017 | Jan. 1, 2017 – Dec. 1, 2017 | Jan. 1, 2016 – Dec. 31, 2017 | Jan. 1, 2016 – Dec. 31, 2017 | Jan. 1, 2017 – Dec. 31, 2017 | Jan. 1, 2016 – Dec. 31, 2017 | Jan. 1, 2017 – Dec. 31, 2017 | Jan. 1, 2017 – Dec. 31, 2017 | Jan. 1, 2017 – Dec. 1, 2017 | Jan. 1, 2017 – Dec. 1, 2017 | March 1, 2016 – Feb. 28, 2017 and Nov. 2, 2015 – Oct. 31, 2016 | June 1, 2016 – April 30, 2017 and Feb. 17, 2016 – Jan. 15, 2017 | Jan. 1, 2017 – Nov. 15, 2017 and Nov. 2, 2016 – Sept. 16, 2017 |
| Denominator MP - DY1 | Feb. 1, 2017 – July 31, 2017 and Aug. 1, 2017 – Jan. 31, 2018 | Feb. 1, 2017 – Dec. 31, 2017 | Feb. 1, 2017 – Jan. 31, 2018 | Feb. 1, 2017 – Jan. 31, 2018 | Feb. 1, 2017 – Jan. 1, 2018 | Feb. 1, 2017 – Jan. 1, 2018 | Feb. 1, 2017 – Jan. 1, 2018 | Feb. 1, 2016 – Jan. 31, 2018 | Feb. 1, 2016 – Jan. 31, 2018 | Feb. 1, 2017 – Jan. 31, 2018 | Feb. 1, 2016 – Jan. 31, 2018 | Feb. 1, 2017 – Jan. 31, 2018 | Feb. 1, 2017 – Jan. 31, 2018 | Feb. 1, 2017 – Jan. 1, 2018 | Feb. 1, 2017 – Jan. 1, 2018 | April 1, 2016 – March 31, 2017 and Dec. 3, 2015 – Dec. 1, 2016 | July 1, 2016 – May 31, 2017 and March 18, 2016 – Feb. 15, 2017 | Feb. 1, 2017 – Dec. 15, 2017 and Dec. 3, 2016 – Oct. 16, 2017 |
| Denominator MP - DY1 | March 1, 2017 – Aug. 31, 2017 and Sept. 1, 2017 – Feb. 28, 2018 | March 1, 2017 – Jan. 31, 2018 | March 1, 2017 – Feb. 28, 2018 | March 1, 2017 – Feb. 28, 2018 | March 1, 2017 – Jan. 29, 2018 | March 1, 2017 – Jan. 29, 2018 | March 1, 2017 – Jan. 29, 2018 | March 1, 2016 – Feb. 28, 2018 | March 1, 2016 – Feb. 28, 2018 | March 1, 2017 – Feb. 28, 2018 | March 1, 2016 – Feb. 28, 2018 | March 1, 2017 – Feb. 28, 2018 | March 1, 2017 – Feb. 28, 2018 | March 1, 2017 – Jan. 29, 2018 | March 1, 2017 – Jan. 29, 2018 | May 1, 2016 – April 30, 2017 and Jan. 2, 2016 – Dec. 31, 2016 | Aug. 1, 2016 – June 30, 2017 and April 18, 2016 – March 17, 2017 | March 1, 2017 – Jan. 15, 2018 and Dec. 31, 2016 – Nov. 16, 2017 |
| Denominator MP - DY1 | April 1, 2017 – Sept. 31, 2017 and Oct. 1, 2017 – March 31, 2018 | April 1, 2017 – Feb. 28, 2018 | April 1, 2017 – March 31, 2018 | April 1, 2017 – March 31, 2018 | April 1, 2017 – March 1, 2018 | April 1, 2017 – March 1, 2018 | April 1, 2017 – March 1, 2018 | April 1, 2016 – March 31, 2018 | April 1, 2016 – March 31, 2018 | April 1, 2017 – March 31, 2018 | April 1, 2016 – March 31, 2018 | April 1, 2017 – March 31, 2018 | April 1, 2017 – March 31, 2018 | April 1, 2017 – March 1, 2018 | April 1, 2017 – March 1, 2018 | June 1, 2016 – May 31, 2017 and Feb. 2, 2016 – Jan. 31, 2017 | Sept. 1, 2016 – July 31, 2017 and May 19, 2016 – April 17, 2017 | April 1, 2017 – Feb. 15, 2018 and Jan. 31, 2017 – Dec. 17, 2017 |
| Denominator MP - DY1 | May 1, 2017 – Oct. 31, 2017 and Nov. 1, 2017 – April 30, 2018 | May 1, 2017 – March 31, 2018 | May 1, 2017 – April 30, 2018 | May 1, 2017 – April 30, 2018 | May 1, 2017 – March 31, 2018 | May 1, 2017 – March 31, 2018 | May 1, 2017 – March 31, 2018 | May 1, 2016 – April 30, 2018 | May 1, 2016 – April 30, 2018 | May 1, 2017 – April 30, 2018 | May 1, 2016 – April 30, 2018 | May 1, 2017 – April 30, 2018 | May 1, 2017 – April 30, 2018 | May 1, 2017 – March 31, 2018 | May 1, 2017 – March 31, 2018 | July 1, 2016 – June 30, 2017 and March 3, 2016 – March 2, 2017 | Oct. 1, 2016 – Aug. 31, 2017 and June 18, 2016 – May 18, 2017 | May 1, 2017 – March 15, 2018 and March 2, 2017 – Jan. 14, 2018 |
| Denominator MP - DY1 | June 1, 2017 – Nov. 30, 2017 and Dec. 1, 2017 – May 31, 2018 | June 1, 2017 – April 30, 2018 | June 1, 2017 – May 31, 2018 | June 1, 2017 – May 31, 2018 | June 1, 2017 – May 1, 2018 | June 1, 2017 – May 1, 2018 | June 1, 2017 – May 1, 2018 | June 1, 2016 – May 31, 2018 | June 1, 2016 – May 31, 2018 | June 1, 2017 – May 31, 2018 | June 1, 2016 – May 31, 2018 | June 1, 2017 – May 31, 2018 | June 1, 2017 – May 31, 2018 | June 1, 2017 – May 1, 2018 | June 1, 2017 – May 1, 2018 | Aug. 1, 2016 – July 31, 2017 and April 3, 2016 – April 2, 2017 | Nov. 1, 2016 – Sep. 30, 2017 and July 19, 2016 – June 17, 2017 | June 1, 2017 – April 15, 2018 and April 2, 2017 – Feb. 14, 2018 |
| Denominator MP - DY1 | July 1, 2017 – Dec. 31, 2017 and Jan. 1, 2018 – June 30, 2018 | July 1, 2017 – May 31, 2018 | July 1, 2017 – June 30, 2018 | July 1, 2017 – June 30, 2018 | July 1, 2017 – May 31, 2018 | July 1, 2017 – May 31, 2018 | July 1, 2017 – May 31, 2018 | July 1, 2016 – June 30, 2018 | July 1, 2016 – June 30, 2018 | July 1, 2017 – June 30, 2018 | July 1, 2016 – June 30, 2018 | July 1, 2017 – June 30, 2018 | July 1, 2017 – June 30, 2018 | July 1, 2017 – May 31, 2018 | July 1, 2017 – May 31, 2018 | Sept. 1, 2016 – Aug. 31, 2017 and May 4, 2016 – May 3, 2017 | Dec. 1, 2016 – Oct. 31, 2017 and Aug. 18, 2016 – July 18, 2017 | July 1, 2017 – May 15, 2018 and May 2, 2017 – March 16, 2018 |
| Denominator MP - DY2 | Jan. 1, 2018 – June 30, 2018 and July 1, 2018 – Dec. 31, 2018 | Jan. 1, 2018 – Nov. 30, 2018 | Jan. 1, 2018 – Dec. 31, 2018 | Jan. 1, 2018 – Dec. 31, 2018 | Jan. 1, 2018– Dec. 1, 2018 | Jan. 1, 2018– Dec. 1, 2018 | Jan. 1, 2018– Dec. 1, 2018 | Jan. 1, 2017 – Dec. 31, 2018 | Jan. 1, 2017 – Dec. 31, 2018 | Jan. 1, 2018 – Dec. 31, 2018 | Jan. 1, 2017 – Dec. 31, 2018 | Jan. 1, 2018 – Dec. 31, 2018 | Jan. 1, 2018 – Dec. 31, 2018 | Jan. 1, 2018– Dec. 1, 2018 | Jan. 1, 2018– Dec. 1, 2018 | March 1, 2017 – Feb. 28, 2018 and Nov. 1, 2016 – Oct. 31, 2017 | June 1, 2017 – April 30, 2018 and Feb. 16, 2017 – Jan. 15, 2018 | Jan. 1, 2018 – Nov. 15, 2018 and Nov. 2, 2017 – Sept. 16, 2018 |
| Denominator MP - DY2 | Feb. 1, 2018 – July 31, 2018 and Aug. 1, 2018 – Jan. 31, 2019 | Feb. 1, 2018 – Dec. 31, 2018 | Feb. 1, 2018 – Jan. 31, 2019 | Feb. 1, 2018 – Jan. 31, 2019 | Feb. 1, 2018 – Jan. 1, 2019 | Feb. 1, 2018 – Jan. 1, 2019 | Feb. 1, 2018 – Jan. 1, 2019 | Feb. 1, 2017 – Jan. 31, 2019 | Feb. 1, 2017 – Jan. 31, 2019 | Feb. 1, 2018 – Jan. 31, 2019 | Feb. 1, 2017 – Jan. 31, 2019 | Feb. 1, 2018 – Jan. 31, 2019 | Feb. 1, 2018 – Jan. 31, 2019 | Feb. 1, 2018 – Jan. 1, 2019 | Feb. 1, 2018 – Jan. 1, 2019 | April 1, 2017 – March 31, 2018 and Dec. 2, 2016 – Dec. 1, 2017 | July 1, 2017 – May 31, 2018 and March 18, 2017 – Feb. 15, 2018 | Feb. 1, 2018 – Dec. 15, 2018 and Dec. 3, 2017 – Oct. 16, 2018 |
| Denominator MP - DY2 | March 1, 2018 – Aug. 31, 2018 and Sept. 1, 2018 – Feb. 28, 2019 | March 1, 2018 – Jan. 31, 2019 | March 1, 2018 – Feb. 28, 2019 | March 1, 2018 – Feb. 28, 2019 | March 1, 2018 – Jan. 29, 2019 | March 1, 2018 – Jan. 29, 2019 | March 1, 2018 – Jan. 29, 2019 | March 1, 2017 – Feb. 28, 2019 | March 1, 2017 – Feb. 28, 2019 | March 1, 2018 – Feb. 28, 2019 | March 1, 2017 – Feb. 28, 2019 | March 1, 2018 – Feb. 28, 2019 | March 1, 2018 – Feb. 28, 2019 | March 1, 2018 – Jan. 29, 2019 | March 1, 2018 – Jan. 29, 2019 | May 1, 2017 – April 30, 2018 and Jan. 1, 2017 – Dec. 31, 2017 | Aug. 1, 2017 – June 30, 2018 and April 18, 2017 – March 17, 2018 | March 1, 2018 – Jan. 15, 2019 and Dec. 31, 2017 – Nov. 16, 2018 |
| Denominator MP - DY2 | April 1, 2018 – Sept. 31, 2018 and Oct. 1, 2018 – March 31, 2019 | April 1, 2018 – Feb. 28, 2019 | April 1, 2018 – March 31, 2019 | April 1, 2018 – March 31, 2019 | April 1, 2018 – March 1, 2019 | April 1, 2018 – March 1, 2019 | April 1, 2018 – March 1, 2019 | April 1, 2017 – March 31, 2019 | April 1, 2017 – March 31, 2019 | April 1, 2018 – March 31, 2019 | April 1, 2017 – March 31, 2019 | April 1, 2018 – March 31, 2019 | April 1, 2018 – March 31, 2019 | April 1, 2018 – March 1, 2019 | April 1, 2018 – March 1, 2019 | June 1, 2017 – May 31, 2018 and Feb. 1, 2017 – Jan. 31, 2018 | Sept. 1, 2017 – July 31, 2018 and May 19, 2017 – April 17, 2018 | April 1, 2018 – Feb. 15, 2019 and Jan. 31, 2018 – Dec. 17, 2018 |
| Denominator MP - DY2 | May 1, 2018 – Oct. 31, 2018 and Nov. 1, 2018 – April 30, 2019 | May 1, 2018 – March 31, 2019 | May 1, 2018 – April 30, 2019 | May 1, 2018 – April 30, 2019 | May 1, 2018 – March 31, 2019 | May 1, 2018 – March 31, 2019 | May 1, 2018 – March 31, 2019 | May 1, 2017 – April 30, 2019 | May 1, 2017 – April 30, 2019 | May 1, 2018 – April 30, 2019 | May 1, 2017 – April 30, 2019 | May 1, 2018 – April 30, 2019 | May 1, 2018 – April 30, 2019 | May 1, 2018 – March 31, 2019 | May 1, 2018 – March 31, 2019 | July 1, 2017 – June 30, 2018 and March 3, 2017 – March 2, 2018 | Oct. 1, 2017 – Aug. 31, 2018 and June 18, 2017 – May 18, 2018 | May 1, 2018 – March 15, 2019 and March 2, 2018 – Jan. 14, 2019 |
| Denominator MP - DY2 | June 1, 2018 – Nov. 30, 2018 and Dec. 1, 2018 – May 31, 2019 | June 1, 2018 – April 30, 2019 | June 1, 2018 – May 31, 2019 | June 1, 2018 – May 31, 2019 | June 1, 2018 – May 1, 2019 | June 1, 2018 – May 1, 2019 | June 1, 2018 – May 1, 2019 | June 1, 2017 – May 31, 2019 | June 1, 2017 – May 31, 2019 | June 1, 2018 – May 31, 2019 | June 1, 2017 – May 31, 2019 | June 1, 2018 – May 31, 2019 | June 1, 2018 – May 31, 2019 | June 1, 2018 – May 1, 2019 | June 1, 2018 – May 1, 2019 | Aug. 1, 2017 – July 31, 2018 and April 3, 2017 – April 2, 2018 | Nov. 1, 2017 – Sep. 30, 2018 and July 19, 2017 – June 17, 2018 | June 1, 2018 – April 15, 2019 and April 2, 2018 – Feb. 14, 2019 |
| Denominator MP - DY2 | July 1, 2018 – Dec. 31, 2018 and Jan. 1, 2019 – June 30, 2019 | July 1, 2018 – May 31, 2019 | July 1, 2018 – June 30, 2019 | July 1, 2018 – June 30, 2019 | July 1, 2018 – May 31, 2019 | July 1, 2018 – May 31, 2019 | July 1, 2018 – May 31, 2019 | July 1, 2017 – June 30, 2019 | July 1, 2017 – June 30, 2019 | July 1, 2018 – June 30, 2019 | July 1, 2017 – June 30, 2019 | July 1, 2018 – June 30, 2019 | July 1, 2018 – June 30, 2019 | July 1, 2018 – May 31, 2019 | July 1, 2018 – May 31, 2019 | Sept. 1, 2017 – Aug. 31, 2018 and May 4, 2017 – May 3, 2018 | Dec. 1, 2017 – Oct. 31, 2018 and Aug. 18, 2017 – July 18, 2018 | July 1, 2018 – May 15, 2019 and May 2, 2018 – March 16, 2019 |
| Numerator MP - DY1 | Jan. 1, 2017 – June 30, 2017 and July 1, 2017 – Dec. 31, 2017 | Jan. 1, 2017 – Dec. 31, 2017 | Jan. 1, 2017 – Dec. 31, 2017 | Jan. 1, 2017 – Dec. 31, 2017 | Jan. 1, 2017 – Dec. 31, 2017 | Jan. 1, 2017 – Dec. 31, 2017 | Jan. 1, 2017 – Dec. 31, 2017 | Jan. 1, 2017 – Dec. 31, 2017 | Jan. 1, 2017 – Dec. 31, 2017 | Jan. 1, 2017 – Dec. 31, 2017 | Jan. 1, 2017 – Dec. 31, 2017 | Jan. 1, 2017 – Dec. 31, 2017 | Jan. 1, 2017 – Dec. 31, 2017 | Jan. 1, 2017 – Dec. 8, 2017 and Jan. 1, 2017 – Dec. 31, 2017 | Jan. 1, 2017 – Dec. 8, 2017 and Jan. 1, 2017 – Dec. 31, 2017 | March 31, 2016 – March 30, 2017 and Dec. 26, 2016 – Dec. 25, 2017 | Sept. 23, 2016 – Aug. 22, 2017 and Jan. 18, 2017 – Dec. 17, 2017 | Jan. 1, 2017 – Nov. 28, 2017 and Jan. 2, 2017 – Dec. 27, 2017 |
| Numerator MP - DY1 | Feb. 1, 2017 – July 31, 2017 and Aug. 1, 2017 – Jan. 31, 2018 | Feb. 1, 2017 – Jan. 31, 2018 | Feb. 1, 2017 – Jan. 31, 2018 | Feb. 1, 2017 – Jan. 31, 2018 | Feb. 1, 2017 – Jan. 31, 2018 | Feb. 1, 2017 – Jan. 31, 2018 | Feb. 1, 2017 – Jan. 31, 2018 | Feb. 1, 2017 – Jan. 31, 2018 | Feb. 1, 2017 – Jan. 31, 2018 | Feb. 1, 2017 – Jan. 31, 2018 | Feb. 1, 2017 – Jan. 31, 2018 | Feb. 1, 2017 – Jan. 31, 2018 | Feb. 1, 2017 – Jan. 31, 2018 | Feb. 1, 2017 – Jan. 8, 2018 and Feb. 1, 2017 – Jan. 31, 2018 | Feb. 1, 2017 – Jan. 8, 2018 and Feb. 1, 2017 – Jan. 31, 2018 | May 1, 2016 – April 30, 2017 and Jan. 26, 2017 – Jan. 25, 2018 | Oct. 23, 2016 – Sept. 22, 2017 and Feb. 17, 2017 – Jan. 17, 2018 | Feb. 1, 2017 – Dec. 28, 2017 and Feb. 2, 2017 – Jan. 26, 2018 |
| Numerator MP - DY1 | March 1, 2017 – Aug. 31, 2017 and Sept. 1, 2017 – Feb. 28, 2018 | March 1, 2017 – Feb. 28, 2018 | March 1, 2017 – Feb. 28, 2018 | March 1, 2017 – Feb. 28, 2018 | March 1, 2017 – Feb. 28, 2018 | March 1, 2017 – Feb. 28, 2018 | March 1, 2017 – Feb. 28, 2018 | March 1, 2017 – Feb. 28, 2018 | March 1, 2017 – Feb. 28, 2018 | March 1, 2017 – Feb. 28, 2018 | March 1, 2017 – Feb. 28, 2018 | March 1, 2017 – Feb. 28, 2018 | March 1, 2017 – Feb. 28, 2018 | March 1, 2017 – Feb. 5, 2018 and March 1, 2017 – Feb. 28, 2018 | March 1, 2017 – Feb. 5, 2018 and March 1, 2017 – Feb. 28, 2018 | May 31, 2016 – May 30, 2017 and Feb. 25, 2017 – Feb. 24, 2018 | Nov. 23, 2016 – Oct. 22, 2017 and March 20, 2017 – Feb. 16, 2018 | March 1, 2017 – Jan. 28, 2018 and March 2, 2017 – Feb. 26, 2018 |
| Numerator MP - DY1 | April 1, 2017 – Sept. 31, 2017 and Oct. 1, 2017 – March 31, 2018 | April 1, 2017 – March 31, 2018 | April 1, 2017 – March 31, 2018 | April 1, 2017 – March 31, 2018 | April 1, 2017 – March 31, 2018 | April 1, 2017 – March 31, 2018 | April 1, 2017 – March 31, 2018 | April 1, 2017 – March 31, 2018 | April 1, 2017 – March 31, 2018 | April 1, 2017 – March 31, 2018 | April 1, 2017 – March 31, 2018 | April 1, 2017 – March 31, 2018 | April 1, 2017 – March 31, 2018 | April 1, 2017 – March 8, 2018 and April 1, 2017 – March 31, 2018 | April 1, 2017 – March 8, 2018 and April 1, 2017 – March 31, 2018 | July 1, 2016 – June 30, 2017 and March 28, 2017 – March 27, 2018 | Dec. 24, 2016 – Nov. 22, 2017 and April 20, 2017 – March 19, 2018 | April 1, 2017 – Feb. 28, 2018 and April 2, 2017 – March 29, 2018 |
| Numerator MP - DY1 | May 1, 2017 – Oct. 31, 2017 and Nov. 1, 2017 – April 30, 2018 | May 1, 2017 – April 30, 2018 | May 1, 2017 – April 30, 2018 | May 1, 2017 – April 30, 2018 | May 1, 2017 – April 30, 2018 | May 1, 2017 – April 30, 2018 | May 1, 2017 – April 30, 2018 | May 1, 2017 – April 30, 2018 | May 1, 2017 – April 30, 2018 | May 1, 2017 – April 30, 2018 | May 1, 2017 – April 30, 2018 | May 1, 2017 – April 30, 2018 | May 1, 2017 – April 30, 2018 | May 1, 2017 – April 7, 2018 and May 1, 2017 – April 30, 2018 | May 1, 2017 – April 7, 2018 and May 1, 2017 – April 30, 2018 | July 31, 2016 – July 30, 2017 and April 27, 2017 – April 26, 2018 | Jan. 23, 2017 – Dec. 23, 2017 and May 20, 2017 – April 19, 2018 | May 1, 2017 – March 28, 2018 and May 2, 2017 – April 26, 2018 |
| Numerator MP - DY1 | June 1, 2017 – Nov. 30, 2017 and Dec. 1, 2017 – May 31, 2018 | June 1, 2017 – May 31, 2018 | June 1, 2017 – May 31, 2018 | June 1, 2017 – May 31, 2018 | June 1, 2017 – May 31, 2018 | June 1, 2017 – May 31, 2018 | June 1, 2017 – May 31, 2018 | June 1, 2017 – May 31, 2018 | June 1, 2017 – May 31, 2018 | June 1, 2017 – May 31, 2018 | June 1, 2017 – May 31, 2018 | June 1, 2017 – May 31, 2018 | June 1, 2017 – May 31, 2018 | June 1, 2017 – May 8, 2018 and June 1, 2017 – May 31, 2018 | June 1, 2017 – May 8, 2018 and June 1, 2017 – May 31, 2018 | Aug. 31, 2016 – Aug. 30, 2017 and May 28, 2017 – May 27, 2018 | Feb. 23, 2017 – Jan. 22, 2018 and June 20, 2017 – May 19, 2018 | June 1, 2017 – April 28, 2018 and June 2, 2017 – May 27, 2018 |
| Numerator MP - DY1 | July 1, 2017 – Dec. 31, 2017 and Jan. 1, 2018 – June 30, 2018 | July 1, 2017 – June 30, 2018 | July 1, 2017 – June 30, 2018 | July 1, 2017 – June 30, 2018 | July 1, 2017 – June 30, 2018 | July 1, 2017 – June 30, 2018 | July 1, 2017 – June 30, 2018 | July 1, 2017 – June 30, 2018 | July 1, 2017 – June 30, 2018 | July 1, 2017 – June 30, 2018 | July 1, 2017 – June 30, 2018 | July 1, 2017 – June 30, 2018 | July 1, 2017 – June 30, 2018 | July 1, 2017 – June 7, 2018 and July 1, 2017 – June 30, 2018 | July 1, 2017 – June 7, 2018 and July 1, 2017 – June 30, 2018 | Oct. 1, 2016 – Sept. 30, 2017 and June 28, 2017 – June 27, 2018 | March 25, 2017 – Feb. 22, 2018 and July 20, 2017 – June 19, 2018 | July 1, 2017 – May 28, 2018 and July 2, 2017 – June 26, 2018 |
| Numerator MP - DY2 | Jan. 1, 2018 – June 30, 2018 and July 1, 2018 – Dec. 31, 2018 | Jan. 1, 2018 – Dec. 31, 2018 | Jan. 1, 2018 – Dec. 31, 2018 | Jan. 1, 2018 – Dec. 31, 2018 | Jan. 1, 2018 – Dec. 31, 2018 | Jan. 1, 2018 – Dec. 31, 2018 | Jan. 1, 2018 – Dec. 31, 2018 | Jan. 1, 2018 – Dec. 31, 2018 | Jan. 1, 2018 – Dec. 31, 2018 | Jan. 1, 2018 – Dec. 31, 2018 | Jan. 1, 2018 – Dec. 31, 2018 | Jan. 1, 2018 – Dec. 31, 2018 | Jan. 1, 2018 – Dec. 31, 2018 | Jan. 1, 2018 – Dec. 8, 2018 and Jan. 1, 2018 – Dec. 31, 2018 | Jan. 1, 2018 – Dec. 8, 2018 and Jan. 1, 2018 – Dec. 31, 2018 | March 31, 2017 – March 30, 2018 and Dec. 26, 2017 – Dec. 25, 2018 | Sept. 23, 2017 – Aug. 22, 2018 and Jan. 18, 2018 – Dec. 17, 2018 | Jan. 1, 2018 – Nov. 28, 2018 and Jan. 2, 2018 – Dec. 27, 2018 |
| Numerator MP - DY2 | Feb. 1, 2018 – July 31, 2018 and Aug. 1, 2018 – Jan. 31, 2019 | Feb. 1, 2018 – Jan. 31, 2019 | Feb. 1, 2018 – Jan. 31, 2019 | Feb. 1, 2018 – Jan. 31, 2019 | Feb. 1, 2018 – Jan. 31, 2019 | Feb. 1, 2018 – Jan. 31, 2019 | Feb. 1, 2018 – Jan. 31, 2019 | Feb. 1, 2018 – Jan. 31, 2019 | Feb. 1, 2018 – Jan. 31, 2019 | Feb. 1, 2018 – Jan. 31, 2019 | Feb. 1, 2018 – Jan. 31, 2019 | Feb. 1, 2018 – Jan. 31, 2019 | Feb. 1, 2018 – Jan. 31, 2019 | Feb. 1, 2018 – Jan. 8, 2019 and Feb. 1, 2018 – Jan. 31, 2019 | Feb. 1, 2018 – Jan. 8, 2019 and Feb. 1, 2018 – Jan. 31, 2019 | May 1, 2017 – April 30, 2018 and Jan. 26, 2018 – Jan. 25, 2019 | Oct. 23, 2017 – Sept. 22, 2018 and Feb. 17, 2018 – Jan. 17, 2019 | Feb. 1, 2018 – Dec. 28, 2018 and Feb. 2, 2018 – Jan. 26, 2019 |
| Numerator MP - DY2 | March 1, 2018 – Aug. 31, 2018 and Sept. 1, 2018 – Feb. 28, 2019 | March 1, 2018 – Feb. 28, 2019 | March 1, 2018 – Feb. 28, 2019 | March 1, 2018 – Feb. 28, 2019 | March 1, 2018 – Feb. 28, 2019 | March 1, 2018 – Feb. 28, 2019 | March 1, 2018 – Feb. 28, 2019 | March 1, 2018 – Feb. 28, 2019 | March 1, 2018 – Feb. 28, 2019 | March 1, 2018 – Feb. 28, 2019 | March 1, 2018 – Feb. 28, 2019 | March 1, 2018 – Feb. 28, 2019 | March 1, 2018 – Feb. 28, 2019 | March 1, 2018 – Feb. 5, 2019 and March 1, 2018 – Feb. 28, 2019 | March 1, 2018 – Feb. 5, 2019 and March 1, 2018 – Feb. 28, 2019 | May 31, 2017 – May 30, 2018 and Feb. 25, 2018 – Feb. 24, 2019 | Nov. 23, 2017 – Sept. 22, 2018 and March 20, 2018 – Feb. 16, 2019 | March 1, 2018 – Jan. 28, 2019 and March 2, 2018 – Feb. 26, 2019 |
| Numerator MP - DY2 | April 1, 2018 – Sept. 31, 2018 and Oct. 1, 2018 – March 31, 2019 | April 1, 2018 – March 31, 2019 | April 1, 2018 – March 31, 2019 | April 1, 2018 – March 31, 2019 | April 1, 2018 – March 31, 2019 | April 1, 2018 – March 31, 2019 | April 1, 2018 – March 31, 2019 | April 1, 2018 – March 31, 2019 | April 1, 2018 – March 31, 2019 | April 1, 2018 – March 31, 2019 | April 1, 2018 – March 31, 2019 | April 1, 2018 – March 31, 2019 | April 1, 2018 – March 31, 2019 | April 1, 2018 – March 8, 2019 and April 1, 2018 – March 31, 2019 | April 1, 2018 – March 8, 2019 and April 1, 2018 – March 31, 2019 | July 1, 2017 – June 30, 2018 and March 28, 2018 – March 27, 2019 | Dec. 24, 2017 – Nov. 22, 2018 and April 20, 2018 – March 19, 2019 | April 1, 2018 – Feb. 28, 2019 and April 2, 2018 – March 29, 2019 |
| Numerator MP - DY2 | May 1, 2018 – Oct. 31, 2018 and Nov. 1, 2018 – April 30, 2019 | May 1, 2018 – April 30, 2019 | May 1, 2018 – April 30, 2019 | May 1, 2018 – April 30, 2019 | May 1, 2018 – April 30, 2019 | May 1, 2018 – April 30, 2019 | May 1, 2018 – April 30, 2019 | May 1, 2018 – April 30, 2019 | May 1, 2018 – April 30, 2019 | May 1, 2018 – April 30, 2019 | May 1, 2018 – April 30, 2019 | May 1, 2018 – April 30, 2019 | May 1, 2018 – April 30, 2019 | May 1, 2018 – April 7, 2019 and May 1, 2018 – April 30, 2019 | May 1, 2018 – April 7, 2019 and May 1, 2018 – April 30, 2019 | July 31, 2017 – July 30, 2018 and April 27, 2018 – April 26, 2019 | Jan. 23, 2018 – Dec. 23, 2018 and May 20, 2018 – April 19, 2019 | May 1, 2018 – March 28, 2019 and May 2, 2018 – April 26, 2019 |
| Numerator MP - DY2 | June 1, 2018 – Nov. 30, 2018 and Dec. 1, 2018 – May 31, 2019 | June 1, 2018 – May 31, 2019 | June 1, 2018 – May 31, 2019 | June 1, 2018 – May 31, 2019 | June 1, 2018 – May 31, 2019 | June 1, 2018 – May 31, 2019 | June 1, 2018 – May 31, 2019 | June 1, 2018 – May 31, 2019 | June 1, 2018 – May 31, 2019 | June 1, 2018 – May 31, 2019 | June 1, 2018 – May 31, 2019 | June 1, 2018 – May 31, 2019 | June 1, 2018 – May 31, 2019 | June 1, 2018 – May 8, 2019 and June 1, 2018 – May 31, 2019 | June 1, 2018 – May 8, 2019 and June 1, 2018 – May 31, 2019 | Aug. 31, 2017 – Aug. 30, 2018 and May 28, 2018 – May 27, 2019 | Feb. 23, 2018 – Jan. 22, 2019 and June 20, 2018 – May 19, 2019 | June 1, 2018 – April 28, 2019 and June 2, 2018 – May 27, 2019 |
| Numerator MP - DY2 | July 1, 2018 – Dec. 31, 2018 and Jan. 1, 2019 – June 30, 2019 | July 1, 2018 – June 30, 2019 | July 1, 2018 – June 30, 2019 | July 1, 2018 – June 30, 2019 | July 1, 2018 – June 30, 2019 | July 1, 2018 – June 30, 2019 | July 1, 2018 – June 30, 2019 | July 1, 2018 – June 30, 2019 | July 1, 2018 – June 30, 2019 | July 1, 2018 – June 30, 2019 | July 1, 2018 – June 30, 2019 | July 1, 2018 – June 30, 2019 | July 1, 2018 – June 30, 2019 | July 1, 2018 – June 7, 2019 and July 1, 2018 – June 30, 2019 | July 1, 2018 – June 7, 2019 and July 1, 2018 – June 30, 2019 | Oct. 1, 2017 – Sept. 30, 2018 and June 28, 2018 – June 27, 2019 | March 25, 2018 – Feb. 22, 2019 and July 20, 2018 – June 19, 2019 | July 1, 2018 – May 28, 2019 and July 2, 2018 – June 26, 2019 |
| End of Worksheet | ||||||||||||||||||
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |