385-CQM 2018-ADD-C CQM 2018 - Follow-Up Care for Children Prescribed Attent

Medicaid and CHIP Program (MACPro) (CMS-10434)

#26 CQM2018

GenIC #26 (Extension) - Medicaid Adult and Child Core Set Measures

OMB: 0938-1188

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

Medicaid and CHIP Program (MACPro)
CQM 2018 - Follow-Up Care for Children
Prescribed Attention-Deficit/Hyperactivity
Disorder (ADHD) Medication (ADD-CH) Core
Measure PRA Document
Version 1.0
06/25/2018

Document Number: 385-CQM 2018-ADD-CH-PRA-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity
Disorder (ADHD) Medication (ADD-CH) Screenshots ........................................... 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
1.10
1.11
1.12
1.13
1.14

Measurement Specifications – Path 1 ............................................................. 1
Measurement Specifications – Path 2 ............................................................. 1
Data Source .................................................................................................... 1
Date Range ..................................................................................................... 2
Definition of Population Included in the Measure – Screenshot 1 ................... 2
Definition of Population Included in the Measure – Screenshot 2 ................... 3
Performance Measure - Path 1 ....................................................................... 3
Performance Measure - Path 2 ....................................................................... 4
Deviations from Measure Specifications – Screenshot 1 ................................ 4
Deviations from Measure Specifications – Screenshot 2 ................................ 5
Combined Rate(s) from Multiple Reporting Units ............................................ 5
Additional Notes/Comments on Measure (Optional) ....................................... 5
Optional Measure Stratification – Screenshot 1 .............................................. 6
Optional Measure Stratification – Screenshot 2 .............................................. 6

Appendix A: Acronyms ................................................................................................. 7

List of Figures
Figure 1: Measurement Specifications – Path 1 .............................................................. 1
Figure 2: Measurement Specifications – Path 2 .............................................................. 1
Figure 3 : Data Source .................................................................................................... 1
Figure 4: Date Range ...................................................................................................... 2
Figure 5: Definition of Population Included in the Measure – Screenshot 1 .................... 2
Figure 6: Definition of Population Included in the Measure – Screenshot 2 .................... 3
Figure 7: Performance Measure - Path 1 ........................................................................ 3
Figure 8: Performance Measure - Path 2 ........................................................................ 4
Figure 9: Deviations from Measure Specifications – Screenshot 1 ................................. 4
Figure 10: Deviations from Measure Specifications – Screenshot 2 ............................... 5
Figure 11: Combined Rate(s) from Multiple Reporting Units ........................................... 5
Figure 12: Additional Notes/Comments on Measure (Optional) ...................................... 5

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List of Tables

Figure 13 : Optional Measure Stratification – Screenshot 1 ............................................ 6
Figure 14: Optional Measure Stratification – Screenshot 2 ............................................. 6

List of Tables
No table of figures entries found.

CQM 2018 - Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication (ADD-CH) Core Measure PRA
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Measurement Specifications – Path 1

1. Follow-Up Care for Children Prescribed AttentionDeficit/Hyperactivity Disorder (ADHD) Medication
(ADD-CH) Screenshots
1.1

Measurement Specifications – Path 1

Figure 1: Measurement Specifications – Path 1

1.2

Measurement Specifications – Path 2

Figure 2: Measurement Specifications – Path 2

1.3

Data Source

Figure 3 : Data Source

CQM 2018 - Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication (ADD-CH) Core Measure PRA
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1.4

Date Range

Date Range

Figure 4: Date Range

1.5

Definition of Population Included in the Measure – Screenshot 1

Figure 5: Definition of Population Included in the Measure – Screenshot 1

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1.6

Definition of Population Included in the Measure – Screenshot 2

Definition of Population Included in the Measure – Screenshot 2

Figure 6: Definition of Population Included in the Measure – Screenshot 2

1.7

Performance Measure - Path 1

Figure 7: Performance Measure - Path 1

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1.8

Performance Measure - Path 2

Performance Measure - Path 2

Figure 8: Performance Measure - Path 2

1.9

Deviations from Measure Specifications – Screenshot 1

Figure 9: Deviations from Measure Specifications – Screenshot 1

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Deviations from Measure Specifications – Screenshot 2

1.10 Deviations from Measure Specifications – Screenshot 2

Figure 10: Deviations from Measure Specifications – Screenshot 2

1.11 Combined Rate(s) from Multiple Reporting Units

Figure 11: Combined Rate(s) from Multiple Reporting Units

1.12 Additional Notes/Comments on Measure (Optional)

Figure 12: Additional Notes/Comments on Measure (Optional)

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Optional Measure Stratification – Screenshot 1

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

Figure 13 : Optional Measure Stratification – Screenshot 1

1.14 Optional Measure Stratification – Screenshot 2
Note: Same N/D/R sets are displayed under each of the stratification categories

Figure 14: Optional Measure Stratification – Screenshot 2

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Optional Measure Stratification – Screenshot 2

Appendix A: Acronyms
Table 1: Acronyms
Acronym

Definition

CQM

Child Quality Measures

PRA

Paperwork Reduction Act of 1995

CQM 2018 - Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication (ADD-CH) Core Measure PRA
Document Version 1.0
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Centers for Medicare & Medicaid
Services
CMS eXpedited Life Cycle (XLC)

Medicaid and CHIP Program (MACPro)
CQM 2018 – Admin Screen PRA document
Version 1.0
06/25/2018

Document Number: 388-CQM-ADMIN SCREEN PRA-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. Admin Screen Screenshots .................................................................................... 1
1.1
1.2
1.3
1.4
1.5
1.6

Federal Fiscal Year ......................................................................................... 1
Core Measures................................................................................................ 2
Delivery System .............................................................................................. 3
Audit or Validation of Measures ...................................................................... 3
External Contractor ......................................................................................... 3
Report Documents .......................................................................................... 4

Appendix A: Acronyms ................................................................................................. 5

List of Figures
Figure 1: Federal Fiscal Year .......................................................................................... 1
Figure 2: Core Measures ................................................................................................. 2
Figure 3: Delivery System ............................................................................................... 3
Figure 4: Audit or Validation of Measures ....................................................................... 3
Figure 5: External Contractor .......................................................................................... 3
Figure 6: Report Documents ........................................................................................... 4

List of Tables
No table of figures entries found.

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Federal Fiscal Year

1. Admin Screen Screenshots
1.1

Federal Fiscal Year

Figure 1: Federal Fiscal Year

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1.2

Core Measures

Core Measures

Figure 2: Core Measures

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1.3

Delivery System

Delivery System

Figure 3: Delivery System

1.4

Audit or Validation of Measures

Figure 4: Audit or Validation of Measures

1.5

External Contractor

Figure 5: External Contractor

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1.6

Report Documents

Report Documents

Figure 6: Report Documents

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Report Documents

Appendix A: Acronyms
Table 1: Acronyms
Acronym

Definition

CQM

Child Quality Measures

PRA

Paperwork Reduction Act of 1995

CQM 2018 – Admin Screen PRA document Version 1.0

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

Medicaid and CHIP Program (MACPro)
CQM 2018 - Ambulatory Care - Emergency
Department (ED) Visits (AMB-CH) Core Measure
PRA Document
Version 1.0
06/25/2018

Document Number: 381-CQM-2018-AMB-CH-PRA-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. Ambulatory Care - Emergency Department (ED) Visits (AMB-CH) Screenshots 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
1.10
1.11
1.12
1.13
1.14

Measurement Specifications – Path 1 ............................................................. 1
Measurement Specifications – Path 2 ............................................................. 1
Data Source .................................................................................................... 1
Data Range ..................................................................................................... 2
Definition of Population in the Measure – Screenshot 1 .................................. 2
Definition of Population in the Measure – Screenshot 2 .................................. 3
Performance Measure - Path 1 ....................................................................... 4
Performance Measure - Path 2 ....................................................................... 5
Deviations from Measure Specifications – Path 1 ........................................... 6
Deviations from Measure Specifications – Path 2 ........................................... 6
Combined Rate(s) from Multiple Reporting Units ............................................ 7
Additional Notes/Comments on Measure (Optional) ....................................... 8
Optional Measure Stratification – Screenshot 1 .............................................. 8
Optional Measure Stratification – Screenshot 2 .............................................. 9

Appendix A: Acronyms ............................................................................................... 10

List of Figures
Figure 1: Measurement Specifications – Path 1 ............................................................................................ 1
Figure 2: Measurement Specifications – Path 2 ............................................................................................ 1
Figure 3: Data Source.................................................................................................................................... 1
Figure 4: Date Range .................................................................................................................................... 2
Figure 5: Definition of Population in the Measure – Screenshot 1 ................................................................. 2
Figure 6: Definition of Population in the Measure – Screenshot 2 ................................................................. 3
Figure 7: Performance Measure - Path 1....................................................................................................... 4
Figure 8: Performance Measure - Path 2....................................................................................................... 5
Figure 9: Deviations from Measure Specifications – Path 1 .......................................................................... 6
Figure 10: Deviations from Measure Specifications – Path 2 .................................................................. 7
Figure 11: Combined Rate(s) from Multiple Reporting Units ......................................................................... 7
Figure 12: Additional Notes/Comments on Measure (Optional) ..................................................................... 8
Figure 13 : Optional Measure Stratification – Screenshot 1........................................................................... 8

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List of Tables

Figure 14: Optional Measure Stratification – Screenshot 2............................................................................ 9

List of Tables
No table of figures entries found.

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Measurement Specifications – Path 1

1. Ambulatory Care - Emergency Department (ED) Visits
(AMB-CH) Screenshots
1.1

Measurement Specifications – Path 1

Figure 1: Measurement Specifications – Path 1

1.2

Measurement Specifications – Path 2

Figure 2: Measurement Specifications – Path 2

1.3

Data Source

Figure 3: Data Source
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1.4

Data Range

Data Range

Figure 4: Date Range

1.5

Definition of Population in the Measure – Screenshot 1

Figure 5: Definition of Population in the Measure – Screenshot 1

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1.6

Definition of Population in the Measure – Screenshot 2

Definition of Population in the Measure – Screenshot 2

Figure 6: Definition of Population in the Measure – Screenshot 2

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1.7

Performance Measure - Path 1

Performance Measure - Path 1

Figure 7: Performance Measure - Path 1

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1.8

Performance Measure - Path 2

Performance Measure - Path 2

Figure 8: Performance Measure - Path 2

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1.9

Deviations from Measure Specifications – Path 1

Deviations from Measure Specifications – Path 1

Figure 9: Deviations from Measure Specifications – Path 1

1.10 Deviations from Measure Specifications – Path 2
Note: Same N/D/R sets are displayed under each deviation categories

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Combined Rate(s) from Multiple Reporting Units

Figure 10: Deviations from Measure Specifications – Path 2

1.11 Combined Rate(s) from Multiple Reporting Units

Figure 11: Combined Rate(s) from Multiple Reporting Units

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Additional Notes/Comments on Measure (Optional)

1.12 Additional Notes/Comments on Measure (Optional)

Figure 12: Additional Notes/Comments on Measure (Optional)

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

Figure 13 : Optional Measure Stratification – Screenshot 1

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Optional Measure Stratification – Screenshot 2

1.14 Optional Measure Stratification – Screenshot 2
Note: Same N/D/R sets are displayed under each of the stratification categories

Figure 14: Optional Measure Stratification – Screenshot 2

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Optional Measure Stratification – Screenshot 2

Appendix A: Acronyms
Table 1: Acronyms
Acronym

Definition

CQM

Child Quality Measures

PRA

Paperwork Reduction Act of 1995

CQM 2018 - Ambulatory Care - Emergency Department (ED) Visits (AMB-CH) Core Measure PRA Document Version
1.0
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06/25/2018

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

Medicaid and CHIP Program (MACPro)
CQM 2018 - Asthma Medication Ratio: Ages 5-18
(AMR-CH) Core Measure PRA Document
Version 1.0
07/18/2018

Document Number: 382-CQM-2018-AMR-CH-PRA-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. Asthma Medication Ratio: Ages 5-18 (AMR-CH) Screenshots ............................. 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
1.10
1.11
1.12
1.13
1.14
1.15
1.16
1.17
1.18

Measurement Specifications – Path 1 ............................................................. 1
Measurement Specifications – Path 2 ............................................................. 1
Data Source .................................................................................................... 2
Date Range ..................................................................................................... 2
Definition of Population Included in the Measure ............................................ 3
Performance Measure - Path 1 ....................................................................... 4
Performance Measure - Path 2 ....................................................................... 4
Deviations from Measure Specifications – Screenshot 1 ................................ 5
Deviations from Measure Specifications – Screenshot ................................... 5
Combined Rate(s) from Multiple Reporting Units ............................................ 6
Additional Notes/Comments on Measure (Optional) ....................................... 6
Optional Measure Stratification – Screenshot 1 .............................................. 6
Optional Measure Stratification – Screenshot 2 .............................................. 7
Optional Measure Stratification – Screenshot 3 .............................................. 7
Optional Measure Stratification – Screenshot 4 .............................................. 8
Optional Measure Stratification – Screenshot 5 .............................................. 8
Optional Measure Stratification – Screenshot 6 .............................................. 9
Optional Measure Stratification – Screenshot 7 .............................................. 9

Appendix A: Acronyms ............................................................................................... 10

List of Figures
Figure 1: Measurement Specifications – Path 1 ............................................................................................ 1
Figure 2: Measurement Specifications – Path 2 ............................................................................................ 1
Figure 3: Data Source.................................................................................................................................... 2
Figure 4: Date Range .................................................................................................................................... 2
Figure 5: Definition of Population Included in the Measure ............................................................................ 3
Figure 6: Performance Measure - Path 1....................................................................................................... 4
Figure 7: Performance Measure - Path 2....................................................................................................... 4
Figure 8: Deviations from Measure Specifications – Screenshot 1 ................................................................ 5
Figure 9: Deviations from Measure Specifications – Screenshot 2 ................................................................ 5
Figure 10: Combined Rate(s) from Multiple Reporting Units ......................................................................... 6
Figure 11: Additional Notes/Comments on Measure (Optional) ..................................................................... 6
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List of Tables

Figure 12: Optional Measure Stratification – Screenshot 1............................................................................ 6
Figure 13: Optional Measure Stratification – Screenshot 2............................................................................ 7
Figure 14: Optional Measure Stratification - Screenshot 3 ............................................................................ 7
Figure 15: Optional Measure Stratification - Screenshot 4 ............................................................................ 8
Figure 16: Optional Measure Stratification - Screenshot 5 ............................................................................ 8
Figure 17: Optional Measure Stratification - Screenshot 6 ............................................................................ 9
Figure 18: Optional Measure Stratification - Screenshot 7 ............................................................................ 9

List of Tables
No table of figures entries found.

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Measurement Specifications – Path 1

1. Asthma Medication Ratio: Ages 5-18 (AMR-CH)
Screenshots
1.1

Measurement Specifications – Path 1

Figure 1: Measurement Specifications – Path 1

1.2

Measurement Specifications – Path 2

Figure 2: Measurement Specifications – Path 2

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1.3

Data Source

Data Source

Figure 3: Data Source

1.4

Date Range

Figure 4: Date Range

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1.5

Definition of Population Included in the Measure

Definition of Population Included in the Measure

Figure 5: Definition of Population Included in the Measure

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1.6

Performance Measure - Path 1

Performance Measure - Path 1

Figure 6: Performance Measure - Path 1

1.7

Performance Measure - Path 2

Figure 7: Performance Measure - Path 2

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1.8

Deviations from Measure Specifications – Screenshot 1

Deviations from Measure Specifications – Screenshot 1

Note: N/D/R sets are same for each Age

Figure 8: Deviations from Measure Specifications – Screenshot 1

1.9

Deviations from Measure Specifications – Screenshot

Figure 9: Deviations from Measure Specifications – Screenshot 2

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Combined Rate(s) from Multiple Reporting Units

1.10 Combined Rate(s) from Multiple Reporting Units

Figure 10: Combined Rate(s) from Multiple Reporting Units

1.11 Additional Notes/Comments on Measure (Optional)

Figure 11: Additional Notes/Comments on Measure (Optional)

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

Figure 12: Optional Measure Stratification – Screenshot 1

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Optional Measure Stratification – Screenshot 2

1.13 Optional Measure Stratification – Screenshot 2

Figure 13: Optional Measure Stratification – Screenshot 2

1.14 Optional Measure Stratification – Screenshot 3

Figure 14: Optional Measure Stratification - Screenshot 3

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Optional Measure Stratification – Screenshot 4

1.15 Optional Measure Stratification – Screenshot 4

Figure 15: Optional Measure Stratification - Screenshot 4

1.16 Optional Measure Stratification – Screenshot 5

Figure 16: Optional Measure Stratification - Screenshot 5

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Optional Measure Stratification – Screenshot 6

1.17 Optional Measure Stratification – Screenshot 6

Figure 17: Optional Measure Stratification - Screenshot 6

1.18 Optional Measure Stratification – Screenshot 7

Figure 18: Optional Measure Stratification - Screenshot 7

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Appendix A: Acronyms

1.19 Appendix A: Acronyms
Table 1: Acronyms
Acronym

Definition

CQM

Child Quality Measures

PRA

Paperwork Reduction Act of 1995

CQM 2018 - Asthma Medication Ratio: Ages 5-18 (AMR-CH) Core Measure PRA Document Version
1.0
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07/18/2018

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

Medicaid and CHIP Program (MACPro)
CQM 2018 - Use of Multiple Concurrent
Antipsychotics in Children and Adolescents
(APC-CH) Core Measure PRA Document
Version 1.0
06/25/2018

Document Number: 383-CQM 2018 APC-CH-PRA-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. Use of Multiple Concurrent Antipsychotics in Children and Adolescents (APCCH) Screenshots ...................................................................................................... 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
1.10
1.11
1.12

Measurement Specifications – Path 1 ............................................................. 1
Measurement Specifications – Path 2 ............................................................. 1
Data Source .................................................................................................... 1
Date Range ..................................................................................................... 2
Definition of Population Included in the Measure ............................................ 3
Performance Measure - Path 1 ....................................................................... 4
Performance Measure - Path 2 ....................................................................... 4
Deviations from Measure Specifications ......................................................... 5
Combined Rate(s) from Multiple Reporting Units – Path 1 .............................. 6
Additional Notes/Comments on Measure (Optional) ....................................... 6
Optional Measure Stratification – Screenshot 1 .............................................. 6
Optional Measure Stratification – Screenshot 2 .............................................. 7

Appendix A: Acronyms ................................................................................................. 8

List of Figures
Figure 1: Measurement Specifications – Path 1 .............................................................. 1
Figure 2: Measurement Specifications – Path 2 .............................................................. 1
Figure 3: Data Source ..................................................................................................... 1
Figure 4: Date Range ...................................................................................................... 2
Figure 5: Definition of Population Included in the Measure ............................................. 3
Figure 6: Performance Measure - Path 1 ........................................................................ 4
Figure 7: Performance Measure - Path 2 ........................................................................ 4
Figure 8: Deviations from Measure Specifications .......................................................... 5
Figure 9: Combined Rate(s) from Multiple Reporting Units ............................................. 6
Figure 10 : Additional Notes/Comments on Measure ...................................................... 6
Figure 11: Optional Measure Stratification – Screenshot 1 ............................................. 6
Figure 12: Optional Measure Stratification – Screenshot 2 ............................................. 7

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List of Tables

List of Tables
No table of figures entries found.

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Measurement Specifications – Path 1

1. Use of Multiple Concurrent Antipsychotics in Children
and Adolescents (APC-CH) Screenshots
1.1

Measurement Specifications – Path 1

Figure 1: Measurement Specifications – Path 1

1.2

Measurement Specifications – Path 2

Figure 2: Measurement Specifications – Path 2

1.3

Data Source

Figure 3: Data Source

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1.4

Date Range

Date Range

Figure 4: Date Range

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1.5

Definition of Population Included in the Measure

Definition of Population Included in the Measure

Figure 5: Definition of Population Included in the Measure

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1.6

Performance Measure - Path 1

Performance Measure - Path 1

Figure 6: Performance Measure - Path 1

1.7

Performance Measure - Path 2

Figure 7: Performance Measure - Path 2

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1.8

Deviations from Measure Specifications

Deviations from Measure Specifications

Note: Same N/D/R sets are displayed under each of the Age categories

Figure 8: Deviations from Measure Specifications

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1.9

Combined Rate(s) from Multiple Reporting Units – Path 1

Combined Rate(s) from Multiple Reporting Units – Path 1

Figure 9: Combined Rate(s) from Multiple Reporting Units

1.10 Additional Notes/Comments on Measure (Optional)

Figure 10 : Additional Notes/Comments on Measure

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

Figure 11: Optional Measure Stratification – Screenshot 1

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Optional Measure Stratification – Screenshot 2

1.12 Optional Measure Stratification – Screenshot 2
Note: Same N/D/R sets are displayed under each of the stratification categories

Figure 12: Optional Measure Stratification – Screenshot 2

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Optional Measure Stratification – Screenshot 2

Appendix A: Acronyms
Table 1: Acronyms
Acronym

Definition

CQM

Child Quality Measures

PRA

Paperwork Reduction Act of 1995

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1.0
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Centers for Medicare & Medicaid
Services
CMS eXpedited Life Cycle (XLC)

Medicaid and CHIP Program (MACPro)
CQM 2018 - Use of First-Line Psychosocial Care
for Children and Adolescents on Antipsychotics
(APP-CH) Core Measure PRA Document
Version 1.0
07/18/2018

Document Number: 425-CQM 2018- APP-CH-PRA-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. Use of First-Line Psychosocial Care for Children and Adolescents on
Antipsychotics (APP-CH) Screenshots.................................................................. 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
1.10
1.11
1.12

Measurement Specifications – Path 1 ............................................................. 1
Measurement Specifications – Path 2 ............................................................. 1
Data Source .................................................................................................... 2
Date Range ..................................................................................................... 2
Definition of Population Included in the Measure ............................................ 3
Performance Measure – Screenshot 1 ............................................................ 4
Performance Measure – Screenshot 2 ............................................................ 5
Deviations from Measure Specifications ......................................................... 5
Combined Rate(s) from Multiple Reporting Units ............................................ 7
Additional Note/Comments on Measure (Optional) ......................................... 7
Optional Measure Stratification – Screenshot 1 .............................................. 7
Optional Measure Stratification – Screenshot 2 .............................................. 8

Appendix A: Acronyms ................................................................................................. 9

List of Figures
Figure 1: Measurement Specifications – Path 1 .............................................................. 1
Figure 2: Measurement Specifications – Path 2 .............................................................. 1
Figure 3: Data Source ..................................................................................................... 2
Figure 4: Date Range ...................................................................................................... 2
Figure 5: Definition of Population Included in the Measure ............................................. 3
Figure 6: Performance Measure - Screenshot 1 ............................................................. 4
Figure 7: Performance Measure - Screenshot 2 ............................................................. 5
Figure 8: Deviations from Measure Specifications .......................................................... 6
Figure 9: Combined Rate(s) from Multiple Reporting Units ............................................. 7
Figure 10: Additional Notes/Comments on Measure (Optional) ...................................... 7
Figure 11: Optional Measure Stratification – Screenshot 1 ............................................. 7
Figure 12: Optional Measure Stratification – Screenshot 2 ............................................. 8

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List of Tables

List of Tables
No table of figures entries found.

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Measurement Specifications – Path 1

1. Use of First-Line Psychosocial Care for Children and
Adolescents on Antipsychotics (APP-CH)
Screenshots
1.1

Measurement Specifications – Path 1

Figure 1: Measurement Specifications – Path 1

1.2

Measurement Specifications – Path 2

Figure 2: Measurement Specifications – Path 2

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1.3

Data Source

Data Source

Figure 3: Data Source

1.4

Date Range

Figure 4: Date Range

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1.5

Definition of Population Included in the Measure

Definition of Population Included in the Measure

Figure 5: Definition of Population Included in the Measure

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1.6

Performance Measure – Screenshot 1

Performance Measure – Screenshot 1

Figure 6: Performance Measure - Screenshot 1

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1.7

Performance Measure – Screenshot 2

Performance Measure – Screenshot 2

Figure 7: Performance Measure - Screenshot 2

1.8

Deviations from Measure Specifications

Note: Same N/D/R sets are displayed under each of the deviations categories

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Deviations from Measure Specifications

Figure 8: Deviations from Measure Specifications

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1.9

Combined Rate(s) from Multiple Reporting Units

Combined Rate(s) from Multiple Reporting Units

Figure 9: Combined Rate(s) from Multiple Reporting Units

1.10 Additional Note/Comments on Measure (Optional)

Figure 10: Additional Notes/Comments on Measure (Optional)

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

Figure 11: Optional Measure Stratification – Screenshot 1

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Optional Measure Stratification – Screenshot 2

1.12 Optional Measure Stratification – Screenshot 2
Note: Same N/D/R sets are displayed under each of the stratification categories

Figure 12: Optional Measure Stratification – Screenshot 2

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Optional Measure Stratification – Screenshot 2

Appendix A: Acronyms
Table 1: Acronyms
Acronym

Definition

CQM

Child Quality Measures

PRA

Paperwork Reduction Act of 1995

CQM 2018 - Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics (APP-CH) Core Measure PRA Document
Version 1.0
9
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Centers for Medicare & Medicaid
Services
CMS eXpedited Life Cycle (XLC)

Medicaid and CHIP Program (MACPro)
CQM 2018 - Audiological Evaluation No Later
than Three Months of Age (AUD-CH) Core
Measure PRA Document
Version 1.0
06/27/2018

Document Number: 384-CQM 2018-AUD-CH-PRA-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. Audiological Evaluation No Later than Three Months of Age (AUD-CH)
Screenshots ............................................................................................................. 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
1.10
1.11

Measurement Specifications – Path 1 ............................................................. 1
Measurement Specifications – Path 2 ............................................................. 1
Data Source .................................................................................................... 1
Date Range ..................................................................................................... 2
Definition of Population Included in the Measure ............................................ 3
Performance Measure ..................................................................................... 4
Deviations from Measure Specifications ......................................................... 4
Combined Rate(s) from Multiple Reporting Units ............................................ 5
Additional Notes/Comments on Measure ........................................................ 5
Optional Measure Stratification – Screenshot 1 .............................................. 5
Optional Measure Stratification – Screenshot 2 .............................................. 6

Appendix A: Acronyms ................................................................................................. 7

List of Figures
Figure 1: Measurement Specifications – Path 1 .............................................................. 1
Figure 2: Measurement Specifications – Path 2 .............................................................. 1
Figure 3: Data Source ..................................................................................................... 1
Figure 4: Date Range ...................................................................................................... 2
Figure 5: Definition of Population Included in the Measure ............................................. 3
Figure 6: Performance Measure ...................................................................................... 4
Figure 7: Deviations from Measure Specifications .......................................................... 4
Figure 8: Combined Rate(s) from Multiple Reporting Units ............................................. 5
Figure 9: Additional Notes/Comments on Measure ......................................................... 5
Figure 10: Optional Measure Stratification – Screenshot 1 ............................................. 5
Figure 11: Optional Measure Stratification – Screenshot 2 ............................................. 6

List of Tables
No table of figures entries found.

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Measurement Specifications – Path 1

1. Audiological Evaluation No Later than Three Months of
Age (AUD-CH) Screenshots
1.1

Measurement Specifications – Path 1

Figure 1: Measurement Specifications – Path 1

1.2

Measurement Specifications – Path 2

Figure 2: Measurement Specifications – Path 2

1.3

Data Source

Figure 3: Data Source

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1.4

Date Range

Date Range

Figure 4: Date Range

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1.5

Definition of Population Included in the Measure

Definition of Population Included in the Measure

Figure 5: Definition of Population Included in the Measure

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1.6

Performance Measure

Performance Measure

Figure 6: Performance Measure

1.7

Deviations from Measure Specifications

Figure 7: Deviations from Measure Specifications

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1.8

Combined Rate(s) from Multiple Reporting Units

Combined Rate(s) from Multiple Reporting Units

Figure 8: Combined Rate(s) from Multiple Reporting Units

1.9

Additional Notes/Comments on Measure

Figure 9: Additional Notes/Comments on Measure

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

Figure 10: Optional Measure Stratification – Screenshot 1

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Optional Measure Stratification – Screenshot 2

1.11 Optional Measure Stratification – Screenshot 2
Note: Same N/D/R sets are displayed under each of the stratification categories

Figure 11: Optional Measure Stratification – Screenshot 2

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Optional Measure Stratification – Screenshot 2

Appendix A: Acronyms
Table 1: Acronyms
Acronym

Definition

CQM

Child Quality Measures

PRA

Paperwork Reduction Act of 1995

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Version 1.0
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Centers for Medicare & Medicaid
Services
CMS eXpedited Life Cycle (XLC)

Medicaid and CHIP Program (MACPro)
CQM 2018 - Adolescent Well-Care Visit (AWC-CH)
Core Measure PRA Document
Version 1.0
06/29/2018

Document Number: 386-CQM 2018-AWC-CH-PRA-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. Adolescent Well-Care Visit (AWC-CH) Screenshots ............................................. 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
1.10
1.11
1.12

Measurement Specifications – Path 1 ............................................................. 1
Measurement Specifications – Path 2 ............................................................. 1
Data Source - Screenshot 1 ............................................................................ 1
Data Source – Screenshot 2 ........................................................................... 2
Date Range ..................................................................................................... 2
Definition of Population Included in the Measure ............................................ 3
Performance Measure ..................................................................................... 4
Deviations from Measure Specifications ......................................................... 4
Combined Rate(s) from Multiple Reporting Units ............................................ 5
Additional Notes/Comments on Measure ........................................................ 5
Optional Measure Stratification – Screenshot 1 .............................................. 5
Optional Measure Stratification – Screenshot 2 .............................................. 6

Appendix A: Acronyms ................................................................................................. 7

List of Figures
Figure 1: Measurement Specifications – Path 1 .............................................................. 1
Figure 2: Measurement Specifications – Path 2 .............................................................. 1
Figure 3: Data Source – Screenshot 1 ............................................................................ 1
Figure 4: Data Source – Screenshot 2 ............................................................................ 2
Figure 5: Date Range ...................................................................................................... 2
Figure 6: Definition of Population Included in the Measure ............................................. 3
Figure 7: Performance Measure ...................................................................................... 4
Figure 8: Deviations from Measure Specifications .......................................................... 4
Figure 9: Combined Rate(s) from Multiple Reporting Units ............................................. 5
Figure 10: Additional Notes/Comments on Measure (Optional) ...................................... 5
Figure 11: Optional Measure Stratification – Screenshot 1 ............................................. 5
Figure 12: Optional Measure Stratification – Screenshot 2 ............................................. 6

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List of Tables

List of Tables
No table of figures entries found.

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Measurement Specifications – Path 1

1. Adolescent Well-Care Visit (AWC-CH) Screenshots
1.1

Measurement Specifications – Path 1

Figure 1: Measurement Specifications – Path 1

1.2

Measurement Specifications – Path 2

Figure 2: Measurement Specifications – Path 2

1.3

Data Source - Screenshot 1

Figure 3: Data Source – Screenshot 1

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1.4

Data Source – Screenshot 2

Data Source – Screenshot 2

Figure 4: Data Source – Screenshot 2

1.5

Date Range

Figure 5: Date Range

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1.6

Definition of Population Included in the Measure

Definition of Population Included in the Measure

Figure 6: Definition of Population Included in the Measure

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1.7

Performance Measure

Performance Measure

Figure 7: Performance Measure

1.8

Deviations from Measure Specifications

Figure 8: Deviations from Measure Specifications

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1.9

Combined Rate(s) from Multiple Reporting Units

Combined Rate(s) from Multiple Reporting Units

Figure 9: Combined Rate(s) from Multiple Reporting Units

1.10 Additional Notes/Comments on Measure

Figure 10: Additional Notes/Comments on Measure (Optional)

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

Figure 11: Optional Measure Stratification – Screenshot 1

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Optional Measure Stratification – Screenshot 2

1.12 Optional Measure Stratification – Screenshot 2

Figure 12: Optional Measure Stratification – Screenshot 2

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1.0
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Optional Measure Stratification – Screenshot 2

Appendix A: Acronyms
Table 1: Acronyms
Acronym

Definition

CQM

Child Quality Measures

PRA

Paperwork Reduction Act of 1995

CQM 2018 - Adolescent Well-Care Visit (AWC-CH) Core Measure PRA Document Version
1.0
7

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

Medicaid and CHIP Program (MACPro)
CQM 2018 - Children and Adolescents' Access to
Primary Care Practitioners (CAP-CH) Core
Measure PRA Document
Version 1.0
06/29/2018

Document Number: 387-CQM 2018-CAP-CH-PRA-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. Children and Adolescents' Access to Primary Care Practitioners (CAP-CH)
Screenshots ............................................................................................................. 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
1.10
1.11
1.12
1.13

Measurement Specifications – Path 1 ............................................................. 1
Measurement Specifications – Path 2 ............................................................. 1
Data Source .................................................................................................... 1
Date Range ..................................................................................................... 2
Definition of Population Included in the Measure ............................................ 3
Performance Measure - Screenshot 1 ............................................................ 4
Performance Measure - Screenshot 2 ............................................................ 5
Deviations from Measure Specifications – Path 1 ........................................... 6
Deviations from Measure Specifications – Path 2 ........................................... 6
Combined Rate(s) from Multiple Reporting Units ............................................ 7
Additional Notes/Comments on Measure (Optional) ....................................... 8
Optional Measure Stratification – Screenshot 1 .............................................. 8
Optional Measure Stratification – Screenshot 2 .............................................. 8

Appendix A: Acronyms ............................................................................................... 10

List of Figures
Figure 1: Measurement Specifications – Path 1 .............................................................. 1
Figure 2: Measurement Specifications – Path 2 .............................................................. 1
Figure 3: Data Source ..................................................................................................... 1
Figure 4: Date Range ...................................................................................................... 2
Figure 5: Definition of Population Included in the Measure ............................................. 3
Figure 6: Performance Measure - Screenshot 1 ............................................................. 4
Figure 7: Performance Measure –Screenshot 2 .............................................................. 5
Figure 8: Deviations from Measure Specifications – Path 1 ............................................ 6
Figure 9: Deviations from Measure Specifications – Path 2 ............................................ 7
Figure 10: Combined Rate(s) from Multiple Reporting Units ........................................... 7
Figure 11: Additional Notes/Comments on Measure (Optional) ...................................... 8
Figure 12: Optional Stratification – Screenshot 1 ............................................................ 8
Figure 13: Optional Measure Stratification – Screenshot 2 ............................................. 9

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List of Tables

List of Tables
No table of figures entries found.

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Measurement Specifications – Path 1

1. Children and Adolescents' Access to Primary Care
Practitioners (CAP-CH) Screenshots
1.1

Measurement Specifications – Path 1

Figure 1: Measurement Specifications – Path 1

1.2

Measurement Specifications – Path 2

Figure 2: Measurement Specifications – Path 2

1.3

Data Source

Figure 3: Data Source

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1.4

Date Range

Date Range

Figure 4: Date Range

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1.5

Definition of Population Included in the Measure

Definition of Population Included in the Measure

Figure 5: Definition of Population Included in the Measure

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1.6

Performance Measure - Screenshot 1

Performance Measure - Screenshot 1

Figure 6: Performance Measure - Screenshot 1

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1.7

Performance Measure - Screenshot 2

Performance Measure - Screenshot 2

Figure 7: Performance Measure –Screenshot 2

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1.8

Deviations from Measure Specifications – Path 1

Deviations from Measure Specifications – Path 1

Figure 8: Deviations from Measure Specifications – Path 1

1.9

Deviations from Measure Specifications – Path 2

Note: Same N/D/R sets are displayed under each of the deviation ages

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1.0
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Combined Rate(s) from Multiple Reporting Units

Figure 9: Deviations from Measure Specifications – Path 2

1.10 Combined Rate(s) from Multiple Reporting Units

Figure 10: Combined Rate(s) from Multiple Reporting Units

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Additional Notes/Comments on Measure (Optional)

1.11 Additional Notes/Comments on Measure (Optional)

Figure 11: Additional Notes/Comments on Measure (Optional)

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

Figure 12: Optional Stratification – Screenshot 1

1.13 Optional Measure Stratification – Screenshot 2
Note: Same N/D/R sets are displayed under each of the stratification categories

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Figure 13: Optional Measure Stratification – Screenshot 2

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Appendix A: Acronyms
Table 1: Acronyms
Acronym

Definition

CQM

Child Quality Measures

PRA

Paperwork Reduction Act of 1995

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1.0
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Centers for Medicare & Medicaid
Services
CMS eXpedited Life Cycle (XLC)

Medicaid and CHIP Program (MACPro)
CQM 2018 - Contraceptive Care - Postpartum
Women Ages 15-20 (CCP-CH) Core Measure PRA
Document
Version 1.0
07/9/2018

Document Number: 389-CQM 2018-CCP-CH-PRA-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. Contraceptive Care – Postpartum Women Ages 15-20 (CCP-CH) Screenshots . 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
1.10
1.11
1.12
1.13

Measurement Specifications – Path 1 ............................................................. 1
Measurement Specifications – Path 2 ............................................................. 1
Data Source .................................................................................................... 2
Date Range ..................................................................................................... 2
Definition of Population Included in the Measure ............................................ 3
Performance Measure - Path 1 ....................................................................... 4
Performance Measure - Path 2 ....................................................................... 5
Deviations from Measure Specifications – Path 1 ........................................... 6
Deviations from Measure Specifications – Path 2 ........................................... 7
Combined Rate(s) from Multiple Reporting Units ............................................ 7
Additional Notes/Comments on Measure (Optional) ....................................... 8
Optional Measure Stratification – Screenshot 1 .............................................. 8
Optional Measure Stratification – Screenshot 2 .............................................. 9

Appendix A: Acronyms ............................................................................................... 10

List of Figures
Figure 1: Measurement Specifications – Path 1 .............................................................. 1
Figure 2: Measurement Specifications – Path 2 .............................................................. 1
Figure 3: Data Source ..................................................................................................... 2
Figure 4: Date Range ...................................................................................................... 2
Figure 5: Definition of Population Included in the Measure ............................................. 3
Figure 6: Performance Measure - Path 1 ........................................................................ 4
Figure 7: Performance Measure – Path 2 ....................................................................... 5
Figure 8: Deviations from Measure Specifications – Path 1 ............................................ 6
Figure 9: Deviations from Measure Specifications – Path 2 ............................................ 7
Figure 10: Combined Rate(s) from Multiple Reporting Units ........................................... 7
Figure 11: Additional Notes/Comments on Measure (Optional) ...................................... 8
Figure 12: Optional Measure Stratification – Screenshot 1 ............................................. 8
Figure 13: Optional Measure Stratification – Screenshot 2 ............................................. 9

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List of Tables

List of Tables
No table of figures entries found.

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1. Contraceptive Care – Postpartum Women Ages 15-20
(CCP-CH) Screenshots

1.1

Measurement Specifications – Path 1

Figure 1: Measurement Specifications – Path 1

1.2

Measurement Specifications – Path 2

Figure 2: Measurement Specifications – Path 2

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1.3

Data Source

Data Source

Figure 3: Data Source

1.4

Date Range

Figure 4: Date Range

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1.5

Definition of Population Included in the Measure

Definition of Population Included in the Measure

Figure 5: Definition of Population Included in the Measure

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1.6

Performance Measure - Path 1

Performance Measure - Path 1

Figure 6: Performance Measure - Path 1

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1.7

Performance Measure - Path 2

Performance Measure - Path 2

Figure 7: Performance Measure – Path 2

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1.8

Deviations from Measure Specifications – Path 1

Deviations from Measure Specifications – Path 1

Figure 8: Deviations from Measure Specifications – Path 1

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1.9

Deviations from Measure Specifications – Path 2

Deviations from Measure Specifications – Path 2

Note: Same N/D/R sets are displayed under each of the deviation ages

Figure 9: Deviations from Measure Specifications – Path 2

1.10 Combined Rate(s) from Multiple Reporting Units

Figure 10: Combined Rate(s) from Multiple Reporting Units

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Additional Notes/Comments on Measure (Optional)

1.11 Additional Notes/Comments on Measure (Optional)

Figure 11: Additional Notes/Comments on Measure (Optional)

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

Figure 12: Optional Measure Stratification – Screenshot 1

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Optional Measure Stratification – Screenshot 2

1.13 Optional Measure Stratification – Screenshot 2
Note: Same N/D/R sets are displayed under each of the stratification categories

Figure 13: Optional Measure Stratification – Screenshot 2

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Appendix A: Acronyms
Table 1: Acronyms
Acronym

Definition

CQM

Child Quality Measures

PRA

Paperwork Reduction Act of 1995

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

Medicaid and CHIP Program (MACPro)
CQM 2018 - Contraceptive Care – All Women
Ages 15-20 (CCW-CH) Core Measure PRA
Document
Version 1.0
07/10/2018

Document Number: 390-CQM 2018-CCW-CH-PRA-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. Contraceptive Care – All Women Ages 15-20 (CCW-CH) Screenshots ............... 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
1.10
1.11
1.12

Measurement Specifications – Path 1 ............................................................. 1
Measurement Specifications – Path 2 ............................................................. 1
Data Source .................................................................................................... 2
Date Range ..................................................................................................... 2
Definition of Population Included in the Measure ............................................ 3
Performance Measure - Path 1 ....................................................................... 4
Performance Measure - Path 2 ....................................................................... 5
Deviations from Measure Specifications ......................................................... 6
Combined Rate(s) from Multiple Reporting Units ............................................ 7
Additional Notes/Comments on Measure (Optional) ....................................... 7
Optional Measure Stratification – Screenshot 1 .............................................. 7
Optional Measure Stratification – Screenshot 2 .............................................. 8

Appendix A: Acronyms ................................................................................................. 9

List of Figures
Figure 1: Measurement Specifications – Path 1 .............................................................. 1
Figure 2: Measurement Specifications – Path 2 .............................................................. 1
Figure 3: Data Source ..................................................................................................... 2
Figure 4: Date Range ...................................................................................................... 2
Figure 5: Definition of Population Included in the Measure ............................................. 4
Figure 6: Performance Measure - Path 1 ........................................................................ 4
Figure 7: Performance Measure – Path 2 ....................................................................... 5
Figure 8: Deviations from Measure Specifications .......................................................... 6
Figure 9: Combined Rate(s) from Multiple Reporting Units ............................................. 7
Figure 10: Additional Notes/Comments on Measure (Optional) ...................................... 7
Figure 11: Optional Measure Stratification – Screenshot 1 ............................................. 7
Figure 12: Optional Measure Stratification – Screenshot 2 ............................................. 8

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List of Tables

List of Tables
No table of figures entries found.

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Measurement Specifications – Path 1

1. Contraceptive Care – All Women Ages 15-20 (CCWCH) Screenshots
1.1

Measurement Specifications – Path 1

Figure 1: Measurement Specifications – Path 1

1.2

Measurement Specifications – Path 2

Figure 2: Measurement Specifications – Path 2

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1.3

Data Source

Data Source

Figure 3: Data Source

1.4

Date Range

Figure 4: Date Range

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1.5

Definition of Population Included in the Measure

Definition of Population Included in the Measure

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Performance Measure - Path 1

Figure 5: Definition of Population Included in the Measure

1.6

Performance Measure - Path 1

Figure 6: Performance Measure - Path 1

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1.7

Performance Measure - Path 2

Performance Measure - Path 2

Figure 7: Performance Measure – Path 2

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1.8

Deviations from Measure Specifications

Deviations from Measure Specifications

Figure 8: Deviations from Measure Specifications

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1.9

Combined Rate(s) from Multiple Reporting Units

Combined Rate(s) from Multiple Reporting Units

Figure 9: Combined Rate(s) from Multiple Reporting Units

1.10 Additional Notes/Comments on Measure (Optional)

Figure 10: Additional Notes/Comments on Measure (Optional)

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

Figure 11: Optional Measure Stratification – Screenshot 1

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Optional Measure Stratification – Screenshot 2

1.12 Optional Measure Stratification – Screenshot 2
Note: Same N/D/R sets are displayed under each of the stratification categories

Figure 12: Optional Measure Stratification – Screenshot 2

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Optional Measure Stratification – Screenshot 2

Appendix 1: Acronyms
Table 1: Acronyms
Acronym

Definition

CQM

Child Quality Measures

PRA

Paperwork Reduction Act of 1995

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1.0
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Centers for Medicare & Medicaid
Services
CMS eXpedited Life Cycle (XLC)

Medicaid and CHIP Program (MACPro)
CQM 2018 - Screening for Depression and Followup Plan: Ages 12-17 (CDF-CH) Core Measure PRA
Document
Version 1.0
07/19/2018

Document Number: 428-CQM-2018-CDF-CH-PRA-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. Screening for Depression and Follow-up Plan: Ages 12-17 (CDF-CH)
Screenshots ............................................................................................................. 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
1.10
1.11
1.12
1.13
1.14
1.15
1.16
1.17

Measurement Specifications – Path 1 ............................................................. 1
Measurement Specifications – Path 2 ............................................................. 1
Data Source .................................................................................................... 2
Date Range ..................................................................................................... 2
Definition of Population Included in the Measure ............................................ 3
Performance Measure ..................................................................................... 4
Deviations from Measure Specifications- Screenshot 1 .................................. 4
Deviations from Measure Specifications – Screenshot 2 ................................ 5
Combined Rate(s) from Multiple Reporting Units ............................................ 5
Additional Notes/Comments on Measure (Optional) ....................................... 5
Optional Measure Stratification – Screenshot 1 .............................................. 6
Optional Measure Stratification – Screenshot 2 .............................................. 6
Optional Measure Stratification – Screenshot 3 .............................................. 7
Optional Measure Stratification – Screenshot 4 .............................................. 7
Optional Measure Stratification – Screenshot 5 .............................................. 8
Optional Measure Stratification – Screenshot 6 .............................................. 8
Optional Measure Stratification – Screenshot 7 .............................................. 9

Appendix A: Acronyms ............................................................................................... 10

List of Figures
Figure 1: Measurement Specifications – Path 1........................................................................................ 1
Figure 2: Measurement Specifications – Path 2 ............................................................................................ 1
Figure 3 : Data Source................................................................................................................................... 2
Figure 4: Date Range .................................................................................................................................... 2
Figure 5: Definition of Population Included in the Measure ............................................................................ 3
Figure 6: Performance Measure .................................................................................................................... 4
Figure 7: Deviations from Measure Specifications – Screenshot 1 ................................................................ 4
Figure 8: Deviations from Measure Specifications – Screenshot 2 ................................................................ 5
Figure 9: Combined Rate(s) from Multiple Reporting Units ........................................................................... 5
Figure 10: Additional Notes/Comments on Measure (Optional) ..................................................................... 5
Figure 11: Optional Measure Stratification – Screenshot 1............................................................................ 6
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List of Tables

Figure 12: Optional Measure Stratification – Screenshot 2............................................................................ 6
Figure 13: Optional Measure Stratification- Screenshot 3 ............................................................................. 7
Figure 14: Optional Measure Stratification-Screenshot 4 .............................................................................. 7
Figure 15: Optional Measure Stratification - Screenshot 5 ............................................................................ 8
Figure 16: Optional Measure Stratification- Screenshot 6 ............................................................................. 8
Figure 17: Optional Measure Stratification - Screenshot 7 ............................................................................ 9

List of Tables
No table of figures entries found.

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Measurement Specifications – Path 1

1. Screening for Depression and Follow-up Plan: Ages
12-17 (CDF-CH) Screenshots
1.1

Measurement Specifications – Path 1

Figure 1: Measurement Specifications – Path 1

1.2

Measurement Specifications – Path 2

Figure 2: Measurement Specifications – Path 2

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1.3

Data Source

Data Source

Figure 3 : Data Source

1.4

Date Range

Figure 4: Date Range

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1.5

Definition of Population Included in the Measure

Definition of Population Included in the Measure

Figure 5: Definition of Population Included in the Measure

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1.6

Performance Measure

Performance Measure

Figure 6: Performance Measure

1.7

Deviations from Measure Specifications- Screenshot 1

Figure 7: Deviations from Measure Specifications – Screenshot 1

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1.8

Deviations from Measure Specifications – Screenshot 2

Deviations from Measure Specifications – Screenshot 2

Figure 8: Deviations from Measure Specifications – Screenshot 2

1.9

Combined Rate(s) from Multiple Reporting Units

Figure 9: Combined Rate(s) from Multiple Reporting Units

1.10 Additional Notes/Comments on Measure (Optional)

Figure 10: Additional Notes/Comments on Measure (Optional)

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Optional Measure Stratification – Screenshot 1

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

Figure 11: Optional Measure Stratification – Screenshot 1

1.12 Optional Measure Stratification – Screenshot 2

Figure 12: Optional Measure Stratification – Screenshot 2

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Optional Measure Stratification – Screenshot 3

1.13 Optional Measure Stratification – Screenshot 3

Figure 13: Optional Measure Stratification- Screenshot 3

1.14 Optional Measure Stratification – Screenshot 4

Figure 14: Optional Measure Stratification-Screenshot 4

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Optional Measure Stratification – Screenshot 5

1.15 Optional Measure Stratification – Screenshot 5

Figure 15: Optional Measure Stratification - Screenshot 5

1.16 Optional Measure Stratification – Screenshot 6

Figure 16: Optional Measure Stratification- Screenshot 6

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Optional Measure Stratification – Screenshot 7

1.17 Optional Measure Stratification – Screenshot 7

Figure 17: Optional Measure Stratification - Screenshot 7

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Appendix A: Acronyms
Table 1: Acronyms
Acronym

Definition

CQM

Child Quality Measures

PRA

Paperwork Reduction Act of 1995

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1.0
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Centers for Medicare & Medicaid
Services
CMS eXpedited Life Cycle (XLC)

Medicaid and CHIP Program (MACPro)
CQM 2018 - Chlamydia Screening in Women Ages
16-20 (CHL-CH) Core Measure PRA Document
Version 1.0
07/10/2018

Document Number: 391-CQM 2018-CHL-CH-PRA-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. Chlamydia Screening in Women Ages 16-20 (CHL-CH) Screenshots ................. 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
1.10
1.11

Measurement Specifications – Path 1 ............................................................. 1
Measurement Specifications – Path 2 ............................................................. 1
Data Source .................................................................................................... 1
Date Range ..................................................................................................... 2
Definition of Population Included in the Measure ............................................ 3
Performance Measure ..................................................................................... 4
Deviations from Measure Specifications ......................................................... 4
Combined Rate(s) from Multiple Reporting Units ............................................ 5
Additional Notes/Comments on Measure ........................................................ 5
Optional Measure Stratification – Screenshot 1 .............................................. 5
Optional Measure Stratification – Screenshot 2 .............................................. 6

Appendix A: Acronyms ................................................................................................. 7

List of Figures
Figure 1: Measurement Specifications – Path 1 .............................................................. 1
Figure 2: Measurement Specifications – Path 2 .............................................................. 1
Figure 3: Data Source ..................................................................................................... 1
Figure 4: Date Range ...................................................................................................... 2
Figure 5: Definition of Population Included in the Measure ............................................. 3
Figure 6: Performance Measure ...................................................................................... 4
Figure 7: Deviations from Measure Specifications .......................................................... 4
Figure 8: Combined Rate(s) from Multiple Reporting Units ............................................. 5
Figure 9: Additional Notes/Comments on Measure (Optional) ........................................ 5
Figure 10: Optional Measure Stratification – Screenshot 1 ............................................. 5
Figure 11: Optional Measure Stratification – Screenshot 2 ............................................. 6

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List of Tables

List of Tables
No table of figures entries found.

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Measurement Specifications – Path 1

1. Chlamydia Screening in Women Ages 16-20 (CHL-CH)
Screenshots
1.1

Measurement Specifications – Path 1

Figure 1: Measurement Specifications – Path 1

1.2

Measurement Specifications – Path 2

Figure 2: Measurement Specifications – Path 2

1.3

Data Source

Figure 3: Data Source

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1.4

Date Range

Date Range

Figure 4: Date Range

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1.5

Definition of Population Included in the Measure

Definition of Population Included in the Measure

Figure 5: Definition of Population Included in the Measure

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1.6

Performance Measure

Performance Measure

Figure 6: Performance Measure

1.7

Deviations from Measure Specifications

Figure 7: Deviations from Measure Specifications

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1.8

Combined Rate(s) from Multiple Reporting Units

Combined Rate(s) from Multiple Reporting Units

Figure 8: Combined Rate(s) from Multiple Reporting Units

1.9

Additional Notes/Comments on Measure

Figure 9: Additional Notes/Comments on Measure (Optional)

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

Figure 10: Optional Measure Stratification – Screenshot 1

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Optional Measure Stratification – Screenshot 2

1.11 Optional Measure Stratification – Screenshot 2
Note: Same N/D/R sets are displayed under each of the stratification categories

Figure 11: Optional Measure Stratification – Screenshot 2

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Optional Measure Stratification – Screenshot 2

Appendix A: Acronyms
Table 1: Acronyms
Acronym

Definition

CQM

Child Quality Measures

PRA

Paperwork Reduction Act of 1995

CQM 2018 - Chlamydia Screening in Women Ages 16-20 (CHL-CH) Core Measure PRA Document Version
1.0
7

07/10/2018

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

Medicaid and CHIP Program (MACPro)
CQM 2018 - Childhood Immunization Status (CISCH) Core Measure PRA Document
Version 1.0
06/29/2018

Document Number: 392-CQM 2018-CIS-CH-PRA-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

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

Are you reporting on this measure? ................................................................ 1
Measurement Specifications – Path 1 ............................................................. 1
Measurement Specifications – Path 2 ............................................................. 1
Data Source .................................................................................................... 2
Date Range ..................................................................................................... 2
Definition of Population Included in the Measure ............................................ 3
Performance Measure - Path 1 – Screenshot 1 .............................................. 4
Performance Measure - Path 1 – Screenshot 2 .............................................. 5
Performance Measure - Path 1 – Screenshot 3 .............................................. 6
Performance Measure - Path 1 – Screenshot 4 .............................................. 7
Performance Measure – Path 2- Screenshot 1 ............................................... 8
Performance Measure – Path 2 – Screenshot 2 ............................................. 8
Performance Measure – Path 2 – Screenshot 3, 4, 5 ..................................... 9
Deviations from Measure Specifications – Path 1-Screenshot 1 ................... 11
Deviations from Measure Specifications – Path 1- Screenshot 2 .................. 12
Deviations from Measure Specifications- Path 2 ........................................... 12
Combined Rate(s) from Multiple Reporting Units .......................................... 13
Additional Notes/Comments on Measure ...................................................... 13
Optional Measure Stratification – Screenshot 1 ............................................ 14
Optional Measure Stratification – Screenshot 2 ............................................ 15
Optional Measure Stratification – Screenshot 3 ............................................ 15

Appendix A: Acronyms ............................................................................................... 16

List of Figures
Figure 1: Are you reporting on this measure? ................................................................. 1
Figure 2: Measurement Specifications – Path 1 .............................................................. 1
Figure 3: Measurement Specifications – Path 2 .............................................................. 1
Figure 4 : Data Source .................................................................................................... 2
Figure 5: Date Range ...................................................................................................... 2
Figure 6: Definition of Population Included in the Measure ............................................. 3
Figure 7: Performance Measure - Path 1 – Screenshot 1 ............................................... 4
Figure 8: Performance Measure - Path 1 – Screenshot 2 ............................................... 5
Figure 9: Performance Measure - Path 1 – Screenshot 3 ............................................... 6

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List of Tables

Figure 10: Performance Measure - Path 1 – Screenshot 4 ............................................. 7
Figure 11: Performance Measure – Path 2- Screenshot 1 .............................................. 8
Figure 12: Performance Measure – Path 2 – Screenshot 2 ............................................ 8
Figure 13: Performance Measure – Path 2- Screenshot 3 .............................................. 9
Figure 14: Performance Measure – Path 2- Screenshot 4 .............................................. 9
Figure 15: Performance Measure – Path 2- Screenshot 5 ............................................ 10
Figure 16: Deviations from Measure Specifications – Path 1 Screenshot 1 .................. 11
Figure 17: Deviations from Measure Specifications – Path 1 - Screenshot 2 ................ 12
Figure 18: Deviations from Measure Specifications – Path 2 ........................................ 13
Figure 19: Combined Rate(s) from Multiple Reporting Units ......................................... 13
Figure 20: Additional Notes/Comments on Measure (Optional) .................................... 13
Figure 21: Optional Measure Stratification – Screenshot 1 ........................................... 14
Figure 22: Optional Measure Stratification – Screenshot 2 ........................................... 15
Figure 23: Optional Measure Stratification – Screenshot 3 ........................................... 15

List of Tables
No table of figures entries found.

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Are you reporting on this measure?

1. Childhood Immunization Status (CIS-CH) Screenshots
1.1

Are you reporting on this measure?

Figure 1: Are you reporting on this measure?

1.2

Measurement Specifications – Path 1

Figure 2: Measurement Specifications – Path 1

1.3

Measurement Specifications – Path 2

Figure 3: Measurement Specifications – Path 2

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1.4

Data Source

Data Source

Figure 4 : Data Source

1.5

Date Range

Figure 5: Date Range

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1.6

Definition of Population Included in the Measure

Definition of Population Included in the Measure

Figure 6: Definition of Population Included in the Measure

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1.7

Performance Measure - Path 1 – Screenshot 1

Performance Measure - Path 1 – Screenshot 1

Figure 7: Performance Measure - Path 1 – Screenshot 1

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1.8

Performance Measure - Path 1 – Screenshot 2

Performance Measure - Path 1 – Screenshot 2

Figure 8: Performance Measure - Path 1 – Screenshot 2

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1.9

Performance Measure - Path 1 – Screenshot 3

Performance Measure - Path 1 – Screenshot 3

Figure 9: Performance Measure - Path 1 – Screenshot 3

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Performance Measure - Path 1 – Screenshot 4

1.10 Performance Measure - Path 1 – Screenshot 4

Figure 10: Performance Measure - Path 1 – Screenshot 4

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Performance Measure – Path 2- Screenshot 1

1.11 Performance Measure – Path 2- Screenshot 1

Figure 11: Performance Measure – Path 2- Screenshot 1

1.12 Performance Measure – Path 2 – Screenshot 2

Figure 12: Performance Measure – Path 2 – Screenshot 2

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Performance Measure – Path 2 – Screenshot 3, 4, 5

1.13 Performance Measure – Path 2 – Screenshot 3, 4, 5

Figure 13: Performance Measure – Path 2- Screenshot 3

Figure 14: Performance Measure – Path 2- Screenshot 4

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Performance Measure – Path 2 – Screenshot 3, 4, 5

Figure 15: Performance Measure – Path 2- Screenshot 5

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Deviations from Measure Specifications – Path 1-Screenshot 1

1.14 Deviations from Measure Specifications – Path 1-Screenshot 1

Figure 16: Deviations from Measure Specifications – Path 1 Screenshot 1

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Deviations from Measure Specifications – Path 1- Screenshot 2

1.15 Deviations from Measure Specifications – Path 1- Screenshot 2

Figure 17: Deviations from Measure Specifications – Path 1 - Screenshot 2

1.16 Deviations from Measure Specifications- Path 2
Note: Same N/D/R sets are displayed under each of the specification categories shown above

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Combined Rate(s) from Multiple Reporting Units

Figure 18: Deviations from Measure Specifications – Path 2

1.17 Combined Rate(s) from Multiple Reporting Units

Figure 19: Combined Rate(s) from Multiple Reporting Units

1.18 Additional Notes/Comments on Measure

Figure 20: Additional Notes/Comments on Measure (Optional)

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Optional Measure Stratification – Screenshot 1

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

Figure 21: Optional Measure Stratification – Screenshot 1

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Optional Measure Stratification – Screenshot 2

1.20 Optional Measure Stratification – Screenshot 2

Figure 22: Optional Measure Stratification – Screenshot 2

1.21 Optional Measure Stratification – Screenshot 3

Figure 23: Optional Measure Stratification – Screenshot 3

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Optional Measure Stratification – Screenshot 3

Appendix A: Acronyms
Table 1: Acronyms
Acronym

Definition

CQM

Child Quality Measures

PRA

Paperwork Reduction Act of 1995

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

Medicaid and CHIP Program (MACPro)
CQM 2018 - CLABSI-CH: Pediatric Central LineAssociated Blood Stream Infections Core
Measure PRA Document
Version 1.0
07/01/2018

Document Number: 423-CQM 2018-CLABSI-CH-PRA-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. CLABSI-CH: Pediatric Central Line-Associated Blood Stream Infections
Screenshots ............................................................................................................. 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
1.10
1.11

Header ............................................................................................................ 1
Measurement Specifications ........................................................................... 2
Data Source .................................................................................................... 2
Date Range ..................................................................................................... 2
Definition of Population Included in the Measure ............................................ 3
Performance Measure ..................................................................................... 4
Deviations from Measure Specification ........................................................... 5
Other Performance Measure ........................................................................... 6
Combined Rate(s) from Mulitiple Reporting Units ........................................... 6
Additional Notes/Comments on Measure (Optional) ....................................... 7
Optional Measure Stratification – Screenshot 1, 2, 3, 4, 5 .............................. 7

Appendix A: Acronyms ............................................................................................... 10

List of Figures
Figure 1: Header for “Read Only” .................................................................................... 1
Figure 2: Measurement Specifications ............................................................................ 2
Figure 3: Data Source ..................................................................................................... 2
Figure 4: Date Range ...................................................................................................... 2
Figure 5: Definition of Population Included in the Measure ............................................. 3
Figure 6: Performance Measure ...................................................................................... 4
Figure 7: Deviations from Measure Specification ............................................................ 5
Figure 8: Other Performance Measure ............................................................................ 6
Figure 9: Combined Rate(s) from Multiple Reporting Units ............................................. 6
Figure 10: Additional Notes/Comments on Measure (Optional) ...................................... 7
Figure 11: Optional Measure Stratification – Screenshot 1 ............................................. 7
Figure 12: Optional Measure Stratification – Screenshot 2 ............................................. 8
Figure 13: Optional Measure Stratification – Screenshot 3 ............................................. 8
Figure 14: Optional Measure Stratification – Screenshot 4 ............................................. 9

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List of Tables

Figure 15: Optional Measure Stratification – Screenshot 5 ............................................. 9

List of Tables
No table of figures entries found.

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Header

1. CLABSI-CH: Pediatric Central Line-Associated Blood
Stream Infections Screenshots
1.1

Header

Figure 1: Header for “Read Only”

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1.2

Measurement Specifications

Measurement Specifications

Figure 2: Measurement Specifications

1.3

Data Source

Figure 3: Data Source

1.4

Date Range

Figure 4: Date Range

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1.5

Definition of Population Included in the Measure

Definition of Population Included in the Measure

Figure 5: Definition of Population Included in the Measure

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1.6

Performance Measure

Performance Measure

Figure 6: Performance Measure

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1.7

Deviations from Measure Specification

Deviations from Measure Specification

Figure 7: Deviations from Measure Specification

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1.8

Other Performance Measure

Other Performance Measure

Figure 8: Other Performance Measure

1.9

Combined Rate(s) from Mulitiple Reporting Units

Figure 9: Combined Rate(s) from Multiple Reporting Units

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Additional Notes/Comments on Measure (Optional)

1.10 Additional Notes/Comments on Measure (Optional)

Figure 10: Additional Notes/Comments on Measure (Optional)

1.11 Optional Measure Stratification – Screenshot 1, 2, 3, 4, 5

Figure 11: Optional Measure Stratification – Screenshot 1

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Optional Measure Stratification – Screenshot 1, 2, 3, 4, 5

Figure 12: Optional Measure Stratification – Screenshot 2

Figure 13: Optional Measure Stratification – Screenshot 3

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Optional Measure Stratification – Screenshot 1, 2, 3, 4, 5

Figure 14: Optional Measure Stratification – Screenshot 4

Figure 15: Optional Measure Stratification – Screenshot 5

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Optional Measure Stratification – Screenshot 1, 2, 3, 4, 5

Appendix A: Acronyms
Table 1: Acronyms
Acronym

Definition

CQM

Child Quality Measures

PRA

Paperwork Reduction Act of 1995

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

Medicaid and CHIP Program (MACPro)
CQM 2018 - (CPC-CH) Core Measure PRA
Document
Version 1.0
07/18/2018

Document Number: 424-CQM 2018-CPC-CH-PRA-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. (CAHPS®) Health Plan Survey 5.0H – Child Version Including Medicaid and
Children with Chronic Conditions Supplemental Items (CPC-CH) Screenshots 1
1.1
1.2
1.3
1.4
1.5

Measurement Specifications – Path 1 ............................................................. 1
Measurement Specifications – Path 2 ............................................................. 1
Data Source .................................................................................................... 2
Definition of Population Included in the Measure ............................................ 2
Performance Measure ..................................................................................... 2

Appendix A: Acronyms ................................................................................................. 3

List of Figures
Figure 1: Measurement Specifications – Path 1 .............................................................. 1
Figure 2: Measurement Specifications – Path 2 .............................................................. 1
Figure 3: Data Source ..................................................................................................... 2
Figure 4: Definition of Population Included in the Measure ............................................. 2
Figure 5: Performance Measure ...................................................................................... 2

List of Tables
No table of figures entries found.

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Measurement Specifications – Path 1

1. (CAHPS®) Health Plan Survey 5.0H – Child Version
Including Medicaid and Children with Chronic
Conditions Supplemental Items (CPC-CH)
Screenshots
1.1

Measurement Specifications – Path 1

Figure 1: Measurement Specifications – Path 1

1.2

Measurement Specifications – Path 2

Figure 2: Measurement Specifications – Path 2

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1.3

Data Source

Data Source

Figure 3: Data Source

1.4

Definition of Population Included in the Measure

Figure 4: Definition of Population Included in the Measure

1.5

Performance Measure

Figure 5: Performance Measure

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Performance Measure

Appendix A: Acronyms
Table 1: Acronyms
Acronym

Definition

CQM

Child Quality Measures

PRA

Paperwork Reduction Act of 1995

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

Medicaid and CHIP Program (MACPro)
CQM 2018 - Developmental Screening in the First
Three Years of Life (DEV-CH) Core Measure PRA
Document
Version 1.0
07/01/2018

Document Number: 404-CQM 2018-DEV-CH-PRA-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. Developmental Screening in the First Three Years of Life (DEV-CH)
Screenshots ............................................................................................................. 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
1.10
1.11
1.12
1.13
1.14

Measurement Specifications – Path 1 ............................................................. 1
Measurement Specifications – Path 2 ............................................................. 1
Data Source .................................................................................................... 2
Date Range ..................................................................................................... 2
Definition of Population Included in the Measure ............................................ 3
Performance Measure - Path 1 ....................................................................... 4
Performance Measure - Path 2 ....................................................................... 5
Deviations from Measure Specifications – Screenshot 1 ................................ 5
Deviations from Measure Specifications – Screenshot 2 ................................ 6
Deviations from Measure Specifications – Screenshot 3 ................................ 6
Combined Rate(s) from Multiple Reports Units ............................................... 7
Additional Notes/Comments on Measure ........................................................ 7
Optional Measure Stratification – Screenshot 1 .............................................. 7
Optional Measure Stratification – Screenshot 2 .............................................. 8

Appendix A: Acronyms ................................................................................................. 9

List of Figures
Figure 1: Measurement Specifications – Path 1 ............................................................................................ 1
Figure 2: Measurement Specifications – Path 2 ............................................................................................ 1
Figure 3: Data Source.................................................................................................................................... 2
Figure 4: Date Range .................................................................................................................................... 2
Figure 5: Definition of Population Included in the Measure ............................................................................ 3
Figure 6: Performance Measure - Path 1....................................................................................................... 4
Figure 7: Performance Measure - Path 2....................................................................................................... 5
Figure 8: Deviations from Measure Specifications – Screenshot 1 ................................................................ 5
Figure 9: Deviations from Measure Specifications – Screenshot 2 ................................................................ 6
Figure 10: Deviations from Measure Specifications – Screenshot 3 .............................................................. 6
Figure 11: Combined Rate(s) from Multiple Reporting Units ......................................................................... 7
Figure 12: Additional Notes/Comments on Measure (Optional) ..................................................................... 7

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List of Tables

Figure 13: Optional Measure Stratification – Screenshot 1............................................................................ 7
Figure 14: Optional Measure Stratification – Screenshot 2............................................................................ 8

List of Tables
No table of figures entries found.

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Measurement Specifications – Path 1

1. Developmental Screening in the First Three Years of
Life (DEV-CH) Screenshots
1.1

Measurement Specifications – Path 1

Figure 1: Measurement Specifications – Path 1

1.2

Measurement Specifications – Path 2

Figure 2: Measurement Specifications – Path 2

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1.3

Data Source

Data Source

Figure 3: Data Source

1.4

Date Range

Figure 4: Date Range

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1.5

Definition of Population Included in the Measure

Definition of Population Included in the Measure

Figure 5: Definition of Population Included in the Measure

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1.6

Performance Measure - Path 1

Performance Measure - Path 1

Figure 6: Performance Measure - Path 1

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1.7

Performance Measure - Path 2

Performance Measure - Path 2

Figure 7: Performance Measure - Path 2

1.8

Deviations from Measure Specifications – Screenshot 1

Figure 8: Deviations from Measure Specifications – Screenshot 1

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1.9

Deviations from Measure Specifications – Screenshot 2

Deviations from Measure Specifications – Screenshot 2

Figure 9: Deviations from Measure Specifications – Screenshot 2

1.10 Deviations from Measure Specifications – Screenshot 3

Figure 10: Deviations from Measure Specifications – Screenshot 3

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Combined Rate(s) from Multiple Reports Units

1.11 Combined Rate(s) from Multiple Reports Units

Figure 11: Combined Rate(s) from Multiple Reporting Units

1.12 Additional Notes/Comments on Measure

Figure 12: Additional Notes/Comments on Measure (Optional)

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

Figure 13: Optional Measure Stratification – Screenshot 1

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Optional Measure Stratification – Screenshot 2

1.14 Optional Measure Stratification – Screenshot 2
Note: Same N/D/R sets are displayed under each of the stratification categories

Figure 14: Optional Measure Stratification – Screenshot 2

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Optional Measure Stratification – Screenshot 2

Appendix A: Acronyms
Table 1: Acronyms
Acronym

Definition

CQM

Child Quality Measures

PRA

Paperwork Reduction Act of 1995

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Version 1.0
9

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

Medicaid and CHIP Program (MACPro)
CQM 2018 - Follow-Up After Hospitalization for
Mental Illness: Ages 6-20 (FUH-CH) Core Measure
PRA Document
Version 1.0
07/01/2018

Document Number: 413- CQM 2018-FUH-CH-PRA-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. Follow-Up After Hospitalization for Mental Illness: Ages 6-20 (FUH-CH)
Screenshots ............................................................................................................. 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
1.10
1.11
1.12
1.13

Measurement Specifications – Path 1 ............................................................. 1
Measurement Specifications – Path 2 ............................................................. 1
Data Source .................................................................................................... 1
Date Range ..................................................................................................... 2
Definition of Population Included in the Measure ............................................ 3
Performance Measure - Path 1 ....................................................................... 4
Performance Measure - Path 2 ....................................................................... 4
Deviations from Measure Specifications – Screenshot 1 ................................ 5
Deviations from Measure Specifications – Screenshot 2 ................................ 5
Combined Rate(s) from Multiple Reporting Units ............................................ 6
Additional Note/Comments on Measure (Optional) ......................................... 6
Optional Measure Stratification – Screenshot 1 .............................................. 6
Optional Measure Stratification – Screenshot 2 .............................................. 7

Appendix A: Acronyms ................................................................................................. 8

List of Figures
Figure 1: Measurement Specifications – Path 1 .............................................................. 1
Figure 2: Measurement Specifications – Path 2 .............................................................. 1
Figure 3: Data Source ..................................................................................................... 1
Figure 4: Date Range ...................................................................................................... 2
Figure 5: Definition of Population Included in the Measure ............................................. 3
Figure 6: Performance Measure - Path 1 ........................................................................ 4
Figure 7: Performance Measure - Path 2 ........................................................................ 4
Figure 8: Deviations from Measure Specifications – Screenshot 1 ................................. 5
Figure 9 : Deviations from Measure Specifications – Screenshot 2 ................................ 5
Figure 10: Combined Rate(s) from Multiple Reporting Units ........................................... 6
Figure 11: Additional Notes/Comments on Measure (Optional) ...................................... 6
Figure 12: Optional Measure Stratification – Screenshot 1 ............................................. 6
Figure 13: Optional Measure Stratification – Screenshot 2 ............................................. 7

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List of Tables

List of Tables
No table of figures entries found.

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Measurement Specifications – Path 1

1. Follow-Up After Hospitalization for Mental Illness: Ages
6-20 (FUH-CH) Screenshots
1.1

Measurement Specifications – Path 1

Figure 1: Measurement Specifications – Path 1

1.2

Measurement Specifications – Path 2

Figure 2: Measurement Specifications – Path 2

1.3

Data Source

Figure 3: Data Source

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1.4

Date Range

Date Range

Figure 4: Date Range

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1.5

Definition of Population Included in the Measure

Definition of Population Included in the Measure

Figure 5: Definition of Population Included in the Measure

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1.6

Performance Measure - Path 1

Performance Measure - Path 1

Figure 6: Performance Measure - Path 1

1.7

Performance Measure - Path 2

Figure 7: Performance Measure - Path 2

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1.8

Deviations from Measure Specifications – Screenshot 1

Deviations from Measure Specifications – Screenshot 1

Figure 8: Deviations from Measure Specifications – Screenshot 1

1.9

Deviations from Measure Specifications – Screenshot 2

Figure 9 : Deviations from Measure Specifications – Screenshot 2

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Combined Rate(s) from Multiple Reporting Units

1.10 Combined Rate(s) from Multiple Reporting Units

Figure 10: Combined Rate(s) from Multiple Reporting Units

1.11 Additional Note/Comments on Measure (Optional)

Figure 11: Additional Notes/Comments on Measure (Optional)

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

Figure 12: Optional Measure Stratification – Screenshot 1

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Optional Measure Stratification – Screenshot 2

1.13 Optional Measure Stratification – Screenshot 2
Note: Same N/D/R sets are displayed under each of the stratification categories

Figure 13: Optional Measure Stratification – Screenshot 2

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Optional Measure Stratification – Screenshot 2

Appendix A: Acronyms
Table 1: Acronyms
Acronym

Definition

CQM

Child Quality Measures

PRA

Paperwork Reduction Act of 1995

CQM 2018 - Follow-Up After Hospitalization for Mental Illness: Ages 6-20 (FUH-CH) Core Measure PRA Document Version
1.0
8

07/01/2018

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

Medicaid and CHIP Program (MACPro)
CQM 2018 - Immunizations for Adolescents (IMACH) Core Measure PRA Document
Version 1.0
07/01/2018

Document Number: 414-CQM 2018-IMA-CH-PRA-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. Immunizations for Adolescents (IMA-CH) Screenshots ....................................... 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
1.10
1.11
1.12

Measurement Specifications – Path 1 ............................................................. 1
Measurement Specifications – Path 2 ............................................................. 1
Data Source .................................................................................................... 2
Date Range ..................................................................................................... 2
Definition of Population Included in the Measure ............................................ 3
Performance Measure – Path 1 – Screenshot 1 ............................................. 4
Performance Measure – Path 1 – Screenshot 2 ............................................. 5
Deviations from Measure Specifications ......................................................... 5
Combined Rate(s) from Multiple Reporting Units ............................................ 6
Additional Notes/Comments on Measure (Optional) ....................................... 7
Optional Measure Stratification – Screenshot 1 .............................................. 7
Optional Measure Stratification – Screenshot 2 .............................................. 8

Appendix A: Acronyms ................................................................................................. 9

List of Figures
Figure 1: Measurement Specifications – Path 1 .............................................................. 1
Figure 2: Measurement Specifications – Path 2 .............................................................. 1
Figure 3: Data Source ..................................................................................................... 2
Figure 4: Date Range ...................................................................................................... 2
Figure 5: Definition of Population Included in the Measure ............................................. 3
Figure 6: Performance Measure – Screenshot 1 ............................................................. 4
Figure 7: Performance Measure – Screenshot 2 ............................................................. 5
Figure 8: Deviations from Measure Specifications .......................................................... 6
Figure 9: Combined Rate(s) from Multiple Reporting Units ............................................. 6
Figure 10: Additional Notes/Comments on Measure (Optional) ...................................... 7
Figure 11: Optional Measure Stratification – Screenshot 1 ............................................. 7
Figure 12: Optional Measure Stratification – Screenshot 2 ............................................. 8

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List of Tables

List of Tables
No table of figures entries found.

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Measurement Specifications – Path 1

1. Immunizations for Adolescents (IMA-CH) Screenshots
1.1

Measurement Specifications – Path 1

Figure 1: Measurement Specifications – Path 1

1.2

Measurement Specifications – Path 2

Figure 2: Measurement Specifications – Path 2

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1.3

Data Source

Data Source

Figure 3: Data Source

1.4

Date Range

Figure 4: Date Range

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1.5

Definition of Population Included in the Measure

Definition of Population Included in the Measure

Figure 5: Definition of Population Included in the Measure

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1.6

Performance Measure – Path 1 – Screenshot 1

Performance Measure – Path 1 – Screenshot 1

Figure 6: Performance Measure – Screenshot 1

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1.7

Performance Measure – Path 1 – Screenshot 2

Performance Measure – Path 1 – Screenshot 2

Figure 7: Performance Measure – Screenshot 2

1.8

Deviations from Measure Specifications

Note: Same N/D/R sets are displayed under each of the deviation categories

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Combined Rate(s) from Multiple Reporting Units

Figure 8: Deviations from Measure Specifications

1.9

Combined Rate(s) from Multiple Reporting Units

Figure 9: Combined Rate(s) from Multiple Reporting Units
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Additional Notes/Comments on Measure (Optional)

1.10 Additional Notes/Comments on Measure (Optional)

Figure 10: Additional Notes/Comments on Measure (Optional)

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

Figure 11: Optional Measure Stratification – Screenshot 1

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Optional Measure Stratification – Screenshot 2

1.12 Optional Measure Stratification – Screenshot 2
Note: Same N/D/R sets are displayed under each of the stratification categories

Figure 12: Optional Measure Stratification – Screenshot 2

CQM 2018 - Immunizations for Adolescents (IMA-CH) Core Measure PRA Document Version
1.0
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CMS XLC

Optional Measure Stratification – Screenshot 2

Appendix A: Acronyms
Table 1: Acronyms
Acronym

Definition

CQM

Child Quality Measures

PRA

Paperwork Reduction Act of 1995

CQM 2018 - Immunizations for Adolescents (IMA-CH) Core Measure PRA Document Version
1.0
9

07/01/2018

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

Medicaid and CHIP Program (MACPro)
CQM 2018 - Live Births Weighing Less Than 2,500
Grams (LBW-CH) Core Measure PRA Document
Version 1.0
06/29/2018

Document Number: 415-CQM 2018-LBW-CH-PRA-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. Live Births Weighing Less Than 2,500 Grams (LBW-CH) Screenshots .............. 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
1.10
1.11

Measurement Specifications – Path 1 ............................................................. 1
Measurement Specifications – Path 2 ............................................................. 1
Data Source .................................................................................................... 2
Date Range ..................................................................................................... 2
Definition of Population Included in the Measure ............................................ 3
Performance Measure ..................................................................................... 4
Deviations from Measure Specifications ......................................................... 4
Combined Rate(s) from Multiple Reporting Units ............................................ 5
Additional Notes/Comments on Measure (Optional) ....................................... 5
Optional Measure Stratification – Screenshot 1 .............................................. 5
Optional Measure Stratification – Screenshot 2 .............................................. 6

Appendix A: Acronyms ................................................................................................. 7

List of Figures
Figure 1: Measurement Specifications – Path 1 .............................................................. 1
Figure 2: Measurement Specifications – Path 2 .............................................................. 1
Figure 3: Data Source ..................................................................................................... 2
Figure 4: Date Range ...................................................................................................... 2
Figure 5: Definition of Population Included in the Measure ............................................. 3
Figure 6: Performance Measure ...................................................................................... 4
Figure 7: Deviations from Measure Specifications .......................................................... 4
Figure 8: Combined Rate(s) from Multiple Reporting Units ............................................. 5
Figure 9: Additional Notes/Comments on Measure (Optional) ........................................ 5
Figure 10: Optional Measure Stratification – Screenshot 1 ............................................. 5
Figure 11: Optional Measure Stratification – Screenshot 2 ............................................. 6

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List of Tables

List of Tables
No table of figures entries found.

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Measurement Specifications – Path 1

1. Live Births Weighing Less Than 2,500 Grams (LBWCH) Screenshots
1.1

Measurement Specifications – Path 1

Figure 1: Measurement Specifications – Path 1

1.2

Measurement Specifications – Path 2

Figure 2: Measurement Specifications – Path 2

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1.3

Data Source

Data Source

Figure 3: Data Source

1.4

Date Range

Figure 4: Date Range

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1.5

Definition of Population Included in the Measure

Definition of Population Included in the Measure

Figure 5: Definition of Population Included in the Measure

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1.6

Performance Measure

Performance Measure

Figure 6: Performance Measure

1.7

Deviations from Measure Specifications

Figure 7: Deviations from Measure Specifications

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1.8

Combined Rate(s) from Multiple Reporting Units

Combined Rate(s) from Multiple Reporting Units

Figure 8: Combined Rate(s) from Multiple Reporting Units

1.9

Additional Notes/Comments on Measure (Optional)

Figure 9: Additional Notes/Comments on Measure (Optional)

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

Figure 10: Optional Measure Stratification – Screenshot 1

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Optional Measure Stratification – Screenshot 2

1.11 Optional Measure Stratification – Screenshot 2
Note: Same N/D/R sets are displayed under each of the stratification categories

Figure 11: Optional Measure Stratification – Screenshot 2

CQM 2018 - Live Births Weighing Less Than 2,500 Grams (LBW-CH) Core Measure PRA Document
Version 1.0
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CMS XLC

Optional Measure Stratification – Screenshot 2

Appendix A: Acronyms
Table 1: Acronyms
Acronym

Definition

CQM

Child Quality Measures

PRA

Paperwork Reduction Act of 1995

CQM 2018 - Live Births Weighing Less Than 2,500 Grams (LBW-CH) Core Measure PRA Document
Version 1.0
7

06/29/2018

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

Medicaid and CHIP Program (MACPro)
CQM 2018 – PC-02: Cesarean Section (PC02-CH)
Core Measure PRA Document
Version 1.0
06/29/2018

Document Number: 416-CQM 2018-PC02-CH-PRA-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. PC-02: Cesarean Section (PC02-CH) Screenshots ............................................... 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
1.10
1.11

Measurement Specifications – Path 1 ............................................................. 1
Measurement Specifications – Path 2 ............................................................. 1
Data Source .................................................................................................... 1
Date Range ..................................................................................................... 2
Definition of Population Included in the Measure ............................................ 3
Performance Measure ..................................................................................... 4
Deviations from Measure Specifications ......................................................... 4
Combines Rate(s) from Multiple Reporting Units ............................................ 5
Additional Notes/Comments (Optional) ........................................................... 5
Optional Measure Stratification – Screenshot 1 .............................................. 5
Optional Measure Stratification – Screenshot 2 .............................................. 6

Appendix A: Acronyms ................................................................................................. 7

List of Figures
Figure 1: Measurement Specifications – Path 1 .............................................................. 1
Figure 2: Measurement Specifications – Path 2 .............................................................. 1
Figure 3: Data Source ..................................................................................................... 1
Figure 4: Date Range ...................................................................................................... 2
Figure 5: Definition of Population Included in the Measure ............................................. 3
Figure 6: Performance Measure ...................................................................................... 4
Figure 7: Deviations from Measure Specifications .......................................................... 4
Figure 8: Combined Rate(s) from Multiple Reporting Units ............................................. 5
Figure 9: Additional Notes/Comments on Measure (Optional) ........................................ 5
Figure 10: Optional Measure Stratification – Screenshot 1 ............................................. 5
Figure 11: Optional Measure Stratification – Screenshot 2 ............................................. 6

List of Tables
No table of figures entries found.

CQM 2018 – PC-02: Cesarean Section (PC02-CH) Core Measure PRA Document
Version 1.0
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CMS XLC

Measurement Specifications – Path 1

1. PC-02: Cesarean Section (PC02-CH) Screenshots
1.1

Measurement Specifications – Path 1

Figure 1: Measurement Specifications – Path 1

1.2

Measurement Specifications – Path 2

Figure 2: Measurement Specifications – Path 2

1.3

Data Source

Figure 3: Data Source

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1.4

Date Range

Date Range

Figure 4: Date Range

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1.5

Definition of Population Included in the Measure

Definition of Population Included in the Measure

Figure 5: Definition of Population Included in the Measure

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1.6

Performance Measure

Performance Measure

Figure 6: Performance Measure

1.7

Deviations from Measure Specifications

Figure 7: Deviations from Measure Specifications

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1.8

Combines Rate(s) from Multiple Reporting Units

Combines Rate(s) from Multiple Reporting Units

Figure 8: Combined Rate(s) from Multiple Reporting Units

1.9

Additional Notes/Comments (Optional)

Figure 9: Additional Notes/Comments on Measure (Optional)

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

Figure 10: Optional Measure Stratification – Screenshot 1

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Optional Measure Stratification – Screenshot 2

1.11 Optional Measure Stratification – Screenshot 2
Note: Same N/D/R sets are displayed under each of the stratification categories

Figure 11: Optional Measure Stratification – Screenshot 2

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Version 1.0
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CMS XLC

Optional Measure Stratification – Screenshot 2

Appendix A: Acronyms
Table 1: Acronyms
Acronym

Definition

CQM

Child Quality Measures

PRA

Paperwork Reduction Act of 1995

CQM 2018 – PC-02: Cesarean Section (PC02-CH) Core Measure PRA Document
Version 1.0
7

06/29/2018

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

Medicaid and CHIP Program (MACPro)
CQM 2018 - PDENT-CH: Percentage of Eligibles
Who Received Preventive Dental Services Core
Measure PRA Document
Version 1.0
06/29/2018

Document Number: 417-CQM-2018-PDENT-CH-PRA-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. PDENT-CH: Percentage of Eligibles Who Received Preventive Dental Services
Screenshots ............................................................................................................. 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
1.10
1.11

PDENT- CH - Header ...................................................................................... 1
Measurement Specifications ........................................................................... 2
Data Source .................................................................................................... 2
Date Range ..................................................................................................... 2
Definition of Population Incuded in the Measure ............................................. 3
Performance Measure ..................................................................................... 4
Deviations from Measure Specification ........................................................... 4
Other Performance Measure ........................................................................... 5
Combined Rate(s) from Multiple Reporting Units ............................................ 5
Additional Notes/Comments on Measure (Optional) ....................................... 5
Optional Measure Stratification ....................................................................... 6

Appendix A: Acronyms ................................................................................................. 7

List of Figures
Figure 1: PDENT- CH Header (READ ONLY) ................................................................. 1
Figure 2: Measurement Specifications ............................................................................ 2
Figure 3: Data Source ..................................................................................................... 2
Figure 4: Date Range ...................................................................................................... 2
Figure 5: Definition of Population Included in the Measure ............................................. 3
Figure 6: Performance Measure ...................................................................................... 4
Figure 7: Deviations from Measure Specification ............................................................ 4
Figure 8: Other Performance Measure ............................................................................ 5
Figure 9: Combined Rate(s) from Multiple Reporting Units ............................................. 5
Figure 10: Additional Notes/Comments on Measure (Optional) ...................................... 5
Figure 11: Optional Measure Stratification ...................................................................... 6

List of Tables
No table of figures entries found.

CQM 2018 - PDENT-CH: Percentage of Eligibles Who Received Preventive Dental Services Core Measure PRA Document
Version 1.0
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CMS XLC

PDENT- CH - Header

1. PDENT-CH: Percentage of Eligibles Who Received
Preventive Dental Services Screenshots
1.1

PDENT- CH - Header

Figure 1: PDENT- CH Header (READ ONLY)

CQM 2018 - PDENT-CH: Percentage of Eligibles Who Received Preventive Dental Services Core Measure PRA Document
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1.2

Measurement Specifications

Measurement Specifications

Figure 2: Measurement Specifications

1.3

Data Source

Figure 3: Data Source

1.4

Date Range

Figure 4: Date Range

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1.5

Definition of Population Incuded in the Measure

Definition of Population Incuded in the Measure

Figure 5: Definition of Population Included in the Measure

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1.6

Performance Measure

Performance Measure

Figure 6: Performance Measure

1.7

Deviations from Measure Specification

Figure 7: Deviations from Measure Specification

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1.8

Other Performance Measure

Other Performance Measure

Figure 8: Other Performance Measure

1.9

Combined Rate(s) from Multiple Reporting Units

Figure 9: Combined Rate(s) from Multiple Reporting Units

1.10 Additional Notes/Comments on Measure (Optional)

Figure 10: Additional Notes/Comments on Measure (Optional)

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Version 1.0
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CMS XLC

Optional Measure Stratification

1.11 Optional Measure Stratification

Figure 11: Optional Measure Stratification

CQM 2018 - PDENT-CH: Percentage of Eligibles Who Received Preventive Dental Services Core Measure PRA Document
Version 1.0
6

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CMS XLC

Optional Measure Stratification

Appendix A: Acronyms
Table 1: Acronyms
Acronym

Definition

CQM

Child Quality Measures

PRA

Paperwork Reduction Act of 1995

CQM 2018 - PDENT-CH: Percentage of Eligibles Who Received Preventive Dental Services Core Measure PRA Document
Version 1.0
7

06/29/2018

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

Medicaid and CHIP Program (MACPro)
CQM 2018 - Prenatal and Postpartum Care:
Timeliness of Prenatal Care (PPC-CH) Core
Measure PRA Document
Version 1.0
06/29/2018

Document Number: 418-CQM 2018-PPC-CH-PRA-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. Prenatal and Postpartum Care: Timeliness of Prenatal Care (PPC-CH)
Screenshots ............................................................................................................. 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
1.10
1.11

Measurement Specifications – Path 1 ............................................................. 1
Measurement Specifications – Path 2 ............................................................. 1
Data Source .................................................................................................... 2
Date Range ..................................................................................................... 2
Definition of Population Included in the Measure ............................................ 3
Performance Measure ..................................................................................... 4
Deviations from Measure Specifications ......................................................... 4
Combined Rate(s) from Multiple Reporting Units ............................................ 5
Additional Notes/Comments (Optional) ........................................................... 5
Optional Measure Stratification – Screenshot 1 .............................................. 6
Optional Measure Stratification – Screenshot 2 .............................................. 6

Appendix A: Acronyms ................................................................................................. 7

List of Figures
Figure 1: Measurement Specifications – Path 1 .............................................................. 1
Figure 2: Measurement Specifications – Path 2 .............................................................. 1
Figure 3: Data Source ..................................................................................................... 2
Figure 4: Date Range ...................................................................................................... 2
Figure 5: Definition of Population Included in the Measure ............................................. 3
Figure 6: Performance Measure ...................................................................................... 4
Figure 7: Deviations from Measure Specifications .......................................................... 4
Figure 8: Combined Rate(s) from Multiple Reporting Units ............................................. 5
Figure 9: Additional Notes/Comments on Measure (Optional) ........................................ 5
Figure 10: Optional Measure Stratification - Screenshot 1 .............................................. 6
Figure 11: Optional Measure Stratification – Screenshot 2 ............................................. 6

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List of Tables

List of Tables
No table of figures entries found.

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Version 1.0
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Measurement Specifications – Path 1

1. Prenatal and Postpartum Care: Timeliness of Prenatal
Care (PPC-CH) Screenshots
1.1

Measurement Specifications – Path 1

Figure 1: Measurement Specifications – Path 1

1.2

Measurement Specifications – Path 2

Figure 2: Measurement Specifications – Path 2

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1.3

Data Source

Data Source

Figure 3: Data Source

1.4

Date Range

Figure 4: Date Range

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1.5

Definition of Population Included in the Measure

Definition of Population Included in the Measure

Figure 5: Definition of Population Included in the Measure

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1.6

Performance Measure

Performance Measure

Figure 6: Performance Measure

1.7

Deviations from Measure Specifications

Figure 7: Deviations from Measure Specifications

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1.8

Combined Rate(s) from Multiple Reporting Units

Combined Rate(s) from Multiple Reporting Units

Figure 8: Combined Rate(s) from Multiple Reporting Units

1.9

Additional Notes/Comments (Optional)

Figure 9: Additional Notes/Comments on Measure (Optional)

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Version 1.0
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CMS XLC

Optional Measure Stratification – Screenshot 1

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

Figure 10: Optional Measure Stratification - Screenshot 1

1.11 Optional Measure Stratification – Screenshot 2
Note: Same N/D/R sets are displayed under each of the stratification categories

Figure 11: Optional Measure Stratification – Screenshot 2

CQM 2018 - Prenatal and Postpartum Care: Timeliness of Prenatal Care (PPC-CH) Core Measure PRA Document
Version 1.0
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CMS XLC

Optional Measure Stratification – Screenshot 2

Appendix A: Acronyms
Table 1: Acronyms
Acronym

Definition

CQM

Child Quality Measures

PRA

Paperwork Reduction Act of 1995

CQM 2018 - Prenatal and Postpartum Care: Timeliness of Prenatal Care (PPC-CH) Core Measure PRA Document
Version 1.0
7

06/29/2018

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

Medicaid and CHIP Program (MACPro)
CQM 2018 - Dental Sealants for 6-9 Year Old
Children at Elevated Caries Risk (SEAL-CH) Core
Measure PRA Document
Version 1.0
06/29/2018

Document Number: 419-CQM 2018-SEAL-CH-PRA-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. Dental Sealants for 6-9 Year Old Children at Elevated Caries Risk (SEAL-CH)
Screenshots ............................................................................................................. 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
1.10
1.11

Measurement Specifications – Path 1 ............................................................. 1
Measurement Specifications – Path 2 ............................................................. 1
Data Source .................................................................................................... 1
Date Range ..................................................................................................... 2
Definition of Population Included in the Measure ............................................ 3
Performance Measure ..................................................................................... 4
Deviations from Measure Specifications ......................................................... 4
Combined Rate(s) from Multiple Reporting Units ............................................ 4
Additional Notes/Comments on Measure (Optional) ....................................... 5
Optional Measure Stratification – Screenshot 1 .............................................. 5
Optional Measure Stratification – Screenshot 2 .............................................. 6

Appendix A: Acronyms ................................................................................................. 7

List of Figures
Figure 1: Measurement Specifications – Path 1 .............................................................. 1
Figure 2: Measurement Specifications – Path 2 .............................................................. 1
Figure 3: Data Source ..................................................................................................... 1
Figure 4: Date Range ...................................................................................................... 2
Figure 5: Definition of Population Included in the Measure ............................................. 3
Figure 6: Performance Measure ...................................................................................... 4
Figure 7: Deviations from Measure Specifications .......................................................... 4
Figure 8: Combined Rate(s) from Multiple Reporting Units ............................................. 4
Figure 9: Additional Notes/Comments on Measure (Optional) ........................................ 5
Figure 10: Optional Measure Stratification – Screenshot 1 ............................................. 5
Figure 11: Optional Measure Stratification – Screenshot 2 ............................................. 6

List of Tables
No table of figures entries found.

CQM 2018 - Dental Sealants for 6-9 Year Old Children at Elevated Caries Risk (SEAL-CH) Core Measure PRA Document
Version 1.0
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CMS XLC

Measurement Specifications – Path 1

1. Dental Sealants for 6-9 Year Old Children at Elevated
Caries Risk (SEAL-CH) Screenshots
1.1

Measurement Specifications – Path 1

Figure 1: Measurement Specifications – Path 1

1.2

Measurement Specifications – Path 2

Figure 2: Measurement Specifications – Path 2

1.3

Data Source

Figure 3: Data Source
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1.4

Date Range

Date Range

Figure 4: Date Range

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1.5

Definition of Population Included in the Measure

Definition of Population Included in the Measure

Figure 5: Definition of Population Included in the Measure

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1.6

Performance Measure

Performance Measure

Figure 6: Performance Measure

1.7

Deviations from Measure Specifications

Figure 7: Deviations from Measure Specifications

1.8

Combined Rate(s) from Multiple Reporting Units

Figure 8: Combined Rate(s) from Multiple Reporting Units

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Version 1.0
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CMS XLC

1.9

Additional Notes/Comments on Measure (Optional)

Additional Notes/Comments on Measure (Optional)

Figure 9: Additional Notes/Comments on Measure (Optional)

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

Figure 10: Optional Measure Stratification – Screenshot 1

CQM 2018 - Dental Sealants for 6-9 Year Old Children at Elevated Caries Risk (SEAL-CH) Core Measure PRA Document
Version 1.0
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CMS XLC

Optional Measure Stratification – Screenshot 2

1.11 Optional Measure Stratification – Screenshot 2
Note: Same N/D/R sets are displayed under each of the stratification categories

Figure 11: Optional Measure Stratification – Screenshot 2

CQM 2018 - Dental Sealants for 6-9 Year Old Children at Elevated Caries Risk (SEAL-CH) Core Measure PRA Document
Version 1.0
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CMS XLC

Optional Measure Stratification – Screenshot 2

Appendix A: Acronyms
Table 1: Acronyms
Acronym

Definition

CQM

Child Quality Measures

PRA

Paperwork Reduction Act of 1995

CQM 2018 - Dental Sealants for 6-9 Year Old Children at Elevated Caries Risk (SEAL-CH) Core Measure PRA Document
Version 1.0
7

06/29/2018

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

Medicaid and CHIP Program (MACPro)
CQM 2018 - Well-Child Visits in the First 15
Months of Life (W15-CH) Core Measure PRA
Document
Version 1.0
06/29/2018

Document Number: 420-CQM 2018-W15-CH-PRA-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. Well-Child Visits in the First 15 Months of Life (W15-CH) Screenshots .............. 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
1.10
1.11
1.12
1.13

Measurement Specifications – Path 1 ............................................................. 1
Measurement Specifications – Path 2 ............................................................. 1
Data Source .................................................................................................... 2
Date Range ..................................................................................................... 2
Definition of Population Included in the Measure ............................................ 3
Performance Measure - Path 1 ....................................................................... 4
Performance Measure - Path 2 ....................................................................... 5
Deviations from Measure Specifications – Screenshot 1 ................................ 6
Deviations from Measure Specifications – Screenshot 2 ................................ 7
Combined Rate(s) from Multiple Reporting Units ............................................ 8
Additional Notes/Comments on Measure (Optional) ....................................... 8
Optional Measure Stratification – Screenshot 1 .............................................. 8
Optional Measure Stratification – Screenshot 2 .............................................. 9

Appendix A: Acronyms ............................................................................................... 10

List of Figures
Figure 1: Measurement Specifications – Path 1 .............................................................. 1
Figure 2: Measurement Specifications – Path 2 .............................................................. 1
Figure 3: Data Source ..................................................................................................... 2
Figure 4: Date Range ...................................................................................................... 2
Figure 5: Definition of Population Included in the Measure ............................................. 3
Figure 6: Performance Measure - Path 1 – Screenshot 1 ............................................... 4
Figure 7: Performance Measure - Path 1 – Screenshot 2 ............................................... 5
Figure 8: Deviations from Measure Specifications – Screenshot 1 ................................. 6
Figure 9: Deviations from Measure Specifications – Screenshot 2 ................................. 7
Figure 10: Combined Rate(s) from Multiple Reporting Units ........................................... 8
Figure 11: Additional Notes/Comments on Measure (Optional) ...................................... 8
Figure 12: Optional Measure Stratification – Screenshot 1 ............................................. 8
Figure 13: Optional Measure Stratification – Screenshot 2 ............................................. 9

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List of Tables

List of Tables
No table of figures entries found.

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Measurement Specifications – Path 1

1. Well-Child Visits in the First 15 Months of Life (W15CH) Screenshots
1.1

Measurement Specifications – Path 1

Figure 1: Measurement Specifications – Path 1

1.2

Measurement Specifications – Path 2

Figure 2: Measurement Specifications – Path 2

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1.3

Data Source

Data Source

Figure 3: Data Source

1.4

Date Range

Figure 4: Date Range

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1.5

Definition of Population Included in the Measure

Definition of Population Included in the Measure

Figure 5: Definition of Population Included in the Measure

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1.6

Performance Measure - Path 1

Performance Measure - Path 1

Figure 6: Performance Measure - Path 1 – Screenshot 1

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1.7

Performance Measure - Path 2

Performance Measure - Path 2

Figure 7: Performance Measure - Path 1 – Screenshot 2

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1.8

Deviations from Measure Specifications – Screenshot 1

Deviations from Measure Specifications – Screenshot 1

Note: Same N/D/R sets are displayed under each of the Measure categories

Figure 8: Deviations from Measure Specifications – Screenshot 1

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1.9

Deviations from Measure Specifications – Screenshot 2

Deviations from Measure Specifications – Screenshot 2

Note: Same N/D/R sets are displayed under each of the Measure categories

Figure 9: Deviations from Measure Specifications – Screenshot 2

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Combined Rate(s) from Multiple Reporting Units

1.10 Combined Rate(s) from Multiple Reporting Units

Figure 10: Combined Rate(s) from Multiple Reporting Units

1.11 Additional Notes/Comments on Measure (Optional)

Figure 11: Additional Notes/Comments on Measure (Optional)

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

Figure 12: Optional Measure Stratification – Screenshot 1

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Optional Measure Stratification – Screenshot 2

1.13 Optional Measure Stratification – Screenshot 2

Figure 13: Optional Measure Stratification – Screenshot 2

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Optional Measure Stratification – Screenshot 2

Appendix A: Acronyms
Table 1: Acronyms
Acronym

Definition

CQM

Child Quality Measures

PRA

Paperwork Reduction Act of 1995

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Services
CMS eXpedited Life Cycle (XLC)

Medicaid and CHIP Program (MACPro)
CQM 2018 - Well-Child Visits in the Third, Fourth,
Fifth, and Sixth Years of Life (W34-CH) Core
Measure PRA Document
Version 1.0
06/29/2018

Document Number: 421-CQM 2018-W34-CH-PRA-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. Well-Child Visits in the Third, Fourth, Fifth, and Sixth Years of Life (W34-CH)
Screenshots ............................................................................................................. 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
1.10
1.11

Measurement Specifications – Path 1 ............................................................. 1
Measurement Specifications – Path 2 ............................................................. 1
Data Source .................................................................................................... 2
Date Range ..................................................................................................... 2
Definition of Population Included in the Measure ............................................ 3
Performance Measure ..................................................................................... 4
Deviations from Measure Specifications ......................................................... 4
Combined Rate(s) from Multiple Reporting Units ............................................ 5
Additional Notes/Comments (Optional) ........................................................... 5
Optional Measure Stratification – Screenshot 1 .............................................. 5
Optional Measure Stratification – Screenshot 2 .............................................. 6

Appendix A: Acronyms ................................................................................................. 7

List of Figures
Figure 1: Measurement Specifications – Path 1 .............................................................. 1
Figure 2: Measurement Specifications – Path 2 .............................................................. 1
Figure 3: Data Source ..................................................................................................... 2
Figure 4: Date Range ...................................................................................................... 2
Figure 5: Definition of Population Included in the Measure ............................................. 3
Figure 6: Performance Measure ...................................................................................... 4
Figure 7: Deviations from Measure Specifications .......................................................... 4
Figure 8: Combined Rate(s) from Multiple Reporting Units ............................................. 5
Figure 9: Additional Notes/Comments on Measure (Optional) ........................................ 5
Figure 10: Optional Measure Stratification – Screenshot 1 ............................................. 5
Figure 11: Optional Measure Stratification – Screenshot 2 ............................................. 6

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List of Tables

List of Tables
No table of figures entries found.

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Measurement Specifications – Path 1

1. Well-Child Visits in the Third, Fourth, Fifth, and Sixth
Years of Life (W34-CH) Screenshots
1.1

Measurement Specifications – Path 1

Figure 1: Measurement Specifications – Path 1

1.2

Measurement Specifications – Path 2

Figure 2: Measurement Specifications – Path 2

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1.3

Data Source

Data Source

Figure 3: Data Source

1.4

Date Range

Figure 4: Date Range

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1.5

Definition of Population Included in the Measure

Definition of Population Included in the Measure

Figure 5: Definition of Population Included in the Measure

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1.6

Performance Measure

Performance Measure

Figure 6: Performance Measure

1.7

Deviations from Measure Specifications

Figure 7: Deviations from Measure Specifications

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1.8

Combined Rate(s) from Multiple Reporting Units

Combined Rate(s) from Multiple Reporting Units

Figure 8: Combined Rate(s) from Multiple Reporting Units

1.9

Additional Notes/Comments (Optional)

Figure 9: Additional Notes/Comments on Measure (Optional)

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

Figure 10: Optional Measure Stratification – Screenshot 1

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Optional Measure Stratification – Screenshot 2

1.11 Optional Measure Stratification – Screenshot 2
Note: Same N/D/R sets are displayed under each of the stratification categories

Figure 11: Optional Measure Stratification – Screenshot 2

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Optional Measure Stratification – Screenshot 2

Appendix A: Acronyms
Table 1: Acronyms
Acronym

Definition

CQM

Child Quality Measures

PRA

Paperwork Reduction Act of 1995

CQM 2018 - Well-Child Visits in the Third, Fourth, Fifth, and Sixth Years of Life (W34-CH) Core Measure PRA Document Version
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Centers for Medicare & Medicaid
Services
CMS eXpedited Life Cycle (XLC)

Medicaid and CHIP Program (MACPro)
CQM 2018 – WCC-CH Core Measure PRA
Document
Version 1.0
06/29/2018

Document Number: 422-CQM 2018-WCC-CH-PRA-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. WCC-CH Screenshots ............................................................................................. 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
1.10
1.11
1.12

Measurement Specifications – Path 1 ............................................................. 1
Measurement Specifications – Path 2 ............................................................. 1
Data Source .................................................................................................... 2
Date Range ..................................................................................................... 2
Definition of Population Included in the Measure ............................................ 3
Performance Measure - Path 1 ....................................................................... 4
Performance Measure - Path 2 ....................................................................... 4
Deviations from Measure Specifications ......................................................... 5
Combined Rate(s) from Multiple Reporting Units ............................................ 5
Additional Notes/Comments on Measure (Optional) ....................................... 6
Optional Measure Stratification – Screenshot 1 .............................................. 6
Optional Measure Stratification – Screenshot 2 .............................................. 7

Appendix A: Acronyms ................................................................................................. 8

List of Figures
Figure 1: Measurement Specifications – Path 1 .............................................................. 1
Figure 2: Measurement Specifications – Path 2 .............................................................. 1
Figure 3: Data Source ..................................................................................................... 2
Figure 4: Date Range ...................................................................................................... 2
Figure 5: Definition of Population Included in the Measure ............................................. 3
Figure 6: Performance Measure - Path 1 ........................................................................ 4
Figure 7: Performance Measure - Path 2 ........................................................................ 4
Figure 8: Deviations from Measure Specifications .......................................................... 5
Figure 9: Combined Rate(s) from Multiple Reporting Units ............................................. 5
Figure 10: Additional Notes/Comments on Measure (Optional) ...................................... 6
Figure 11: Optional Measure Stratification – Screenshot 1 ............................................. 6
Figure 12: Optional Measure Stratification – Screenshot 2 ............................................. 7

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List of Tables

List of Tables
No table of figures entries found.

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Measurement Specifications – Path 1

1. WCC-CH Screenshots
1.1

Measurement Specifications – Path 1

Figure 1: Measurement Specifications – Path 1

1.2

Measurement Specifications – Path 2

Figure 2: Measurement Specifications – Path 2

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1.3

Data Source

Data Source

Figure 3: Data Source

1.4

Date Range

Figure 4: Date Range

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1.5

Definition of Population Included in the Measure

Definition of Population Included in the Measure

Figure 5: Definition of Population Included in the Measure

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1.6

Performance Measure - Path 1

Performance Measure - Path 1

Figure 6: Performance Measure - Path 1

1.7

Performance Measure - Path 2

Figure 7: Performance Measure - Path 2

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1.8

Deviations from Measure Specifications

Deviations from Measure Specifications

Note: Same N/D/R sets are displayed under each of the deviation categories

Figure 8: Deviations from Measure Specifications

1.9

Combined Rate(s) from Multiple Reporting Units

Figure 9: Combined Rate(s) from Multiple Reporting Units

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Additional Notes/Comments on Measure (Optional)

1.10 Additional Notes/Comments on Measure (Optional)

Figure 10: Additional Notes/Comments on Measure (Optional)

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

Figure 11: Optional Measure Stratification – Screenshot 1

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Optional Measure Stratification – Screenshot 2

1.12 Optional Measure Stratification – Screenshot 2
Note: Same N/D/R sets are displayed under each of the stratification categories

Figure 12: Optional Measure Stratification – Screenshot 2

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Optional Measure Stratification – Screenshot 2

Appendix A: Acronyms
Table 1: Acronyms
Acronym

Definition

CQM

Child Quality Measures

WCC

Weight Assessment and Counseling for Nutrition and Physical Activity for
Children/Adolescents: Body Mass Index Assessment for
Children/Adolescents

PRA

Paperwork Reduction Act of 1995

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