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

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

#26 CQM2017

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

OMB: 0938-1188

Document [pdf]
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Centers for Medicare & Medicaid
Services
CMS eXpedited Life Cycle (XLC)

Medicaid and CHIP Program (MACPro)
CQM 2017 - Follow-Up Care for Children
Prescribed Attention-Deficit/Hyperactivity
Disorder (ADHD) Medication (ADD) Core Measure
PRA Document
Version 1.0
08/24/2017

Document Number: 260-QSSI-MACPro-PRA-CQM2017-ADD-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) Screenshots ................................................. 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9

Measurement Specifications – Path 1 ............................................................. 1
Measurement Specifications – Path 2 ............................................................. 1
Data Source .................................................................................................... 1
Performance Measure - Path 1 ....................................................................... 2
Performance Measure - Path 2 ....................................................................... 2
Deviations from Measure Specifications – Screenshot 1 ................................ 3
Deviations from Measure Specifications – Screenshot 2 ................................ 3
Optional Measure Stratification – Screenshot 1 .............................................. 4
Optional Measure Stratification – Screenshot 2 .............................................. 4

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

List of Figures
Figure 1: Measurement Specifications – Path 1 .............................................................. 1
Figure 2: Measurement Specifications – Path 2 .............................................................. 1
Figure 3 : Data Source .................................................................................................... 1
Figure 4: Performance Measure - Path 1 ........................................................................ 2
Figure 5: Performance Measure - Path 2 ........................................................................ 2
Figure 6: Deviations from Measure Specifications – Screenshot 1 ................................. 3
Figure 7 : Deviations from Measure Specifications – Screenshot 2 ................................ 3
Figure 8 : Optional Measure Stratification – Screenshot 1 .............................................. 4
Figure 9: Optional Measure Stratification – Screenshot 2 ............................................... 4

List of Tables
No table of figures entries found.

CQM 2017 - Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication (ADD) Core Measure PRA
Document Version 1.0
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Measurement Specifications – Path 1

1. Follow-Up Care for Children Prescribed AttentionDeficit/Hyperactivity Disorder (ADHD) Medication
(ADD) 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 2017 - Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication (ADD) Core Measure PRA
Document Version 1.0
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1.4

Performance Measure - Path 1

Performance Measure - Path 1

Figure 4: Performance Measure - Path 1

1.5

Performance Measure - Path 2

Figure 5: Performance Measure - Path 2

CQM 2017 - Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication (ADD) Core Measure PRA
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1.6

Deviations from Measure Specifications – Screenshot 1

Deviations from Measure Specifications – Screenshot 1

Figure 6: Deviations from Measure Specifications – Screenshot 1

1.7

Deviations from Measure Specifications – Screenshot 2

Figure 7 : Deviations from Measure Specifications – Screenshot 2

CQM 2017 - Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication (ADD) Core Measure PRA
Document Version 1.0
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1.8

Optional Measure Stratification – Screenshot 1

Optional Measure Stratification – Screenshot 1

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

Figure 8 : Optional Measure Stratification – Screenshot 1

1.9

Optional Measure Stratification – Screenshot 2

Figure 9: Optional Measure Stratification – Screenshot 2

CQM 2017 - Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication (ADD) Core Measure PRA
Document Version 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 2017 - Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication (ADD) Core Measure PRA
Document Version 1.0
5
08/24/2017

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

Medicaid and CHIP Program (MACPro)
CQM 2017 – Admin Screen PRA document
Version 1.0
08/30/2017

Document Number: 308-QSSI-MACPro-PRA-CQM2017-AdminScreen-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 – Screenshot 1....................................................................... 1
Core Measures – Screenshot 2....................................................................... 2
Delivery System .............................................................................................. 2
Audit or Validation of Measures ...................................................................... 2
External Contractor ......................................................................................... 3

Appendix A: Acronyms ................................................................................................. 4

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

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

1.2

Core Measures – Screenshot 1

Figure 2 : Core Measures – Screenshot 1

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1.3

Core Measures – Screenshot 2

Core Measures – Screenshot 2

Figure 3: Core Measures – Screenshot 2

1.4

Delivery System

Figure 4: Delivery System

1.5

Audit or Validation of Measures

Figure 5: Audit or Validation of Measures

CQM 2017 – Admin Screen PRA document Version 1.0

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1.6

External Contractor

External Contractor

Figure 6: External Contractor

CQM 2017 – Admin Screen PRA document Version 1.0

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External Contractor

Appendix A: Acronyms
Table 1: Acronyms
Acronym

Definition

CQM

Child Quality Measures

PRA

Paperwork Reduction Act of 1995

CQM 2017 – Admin Screen PRA document Version 1.0

4

08/30/2017

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

Medicaid and CHIP Program (MACPro)
CQM 2017 - Ambulatory Care - Emergency
Department (ED) Visits (AMB) Core Measure PRA
Document
Version 1.0
08/25/2017

Document Number: 261-QSSI-MACPro-PRA-CQM2017-AMB-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) 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
Performance Measure - Path 1 ....................................................................... 2
Performance Measure - Path 2 – Screenshot 1 .............................................. 2
Performance Measure - Path 2 – Screenshot 2 .............................................. 3
Deviations from Measure Specifications – Screenshot 1 ................................ 3
Deviations from Measure Specifications – Screenshot 2 ................................ 4
Deviations from Measure Specifications – Screenshot 3 ................................ 4
Deviations from Measure Specifications – Screenshot 4 ................................ 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: Performance Measure - Path 1....................................................................................................... 2
Figure 5: Performance Measure - Path 2 – Screenshot 1 .............................................................................. 2
Figure 6: Performance Measure - Path 2 – Screenshot 2 .............................................................................. 3
Figure 7: Deviations from Measure Specifications – Screenshot 1 ................................................................ 3
Figure 8 : Deviations from Measure Specifications – Screenshot 2 ............................................................... 4
Figure 9: Deviations from Measure Specifications – Screenshot 3 ................................................................ 4
Figure 10: Deviations from Measure Specifications – Screenshot 4 .............................................................. 5
Figure 11 : Optional Measure Stratification – Screenshot 1........................................................................... 5
Figure 12: Optional Measure Stratification – Screenshot 2............................................................................ 6

CQM 2017 - Ambulatory Care - Emergency Department (ED) Visits (AMB) Core Measure PRA Document Version
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List of Tables

List of Tables
No table of figures entries found.

CQM 2017 - Ambulatory Care - Emergency Department (ED) Visits (AMB) Core Measure PRA Document Version
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Measurement Specifications – Path 1

1. Ambulatory Care - Emergency Department (ED) Visits
(AMB) 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 2017 - Ambulatory Care - Emergency Department (ED) Visits (AMB) Core Measure PRA Document Version
1.0
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1.4

Performance Measure - Path 1

Performance Measure - Path 1

Figure 4: Performance Measure - Path 1

1.5

Performance Measure - Path 2 – Screenshot 1

Figure 5: Performance Measure - Path 2 – Screenshot 1

CQM 2017 - Ambulatory Care - Emergency Department (ED) Visits (AMB) Core Measure PRA Document Version
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1.6

Performance Measure - Path 2 – Screenshot 2

Performance Measure - Path 2 – Screenshot 2

Figure 6: Performance Measure - Path 2 – Screenshot 2

1.7

Deviations from Measure Specifications – Screenshot 1

Figure 7: Deviations from Measure Specifications – Screenshot 1

CQM 2017 - Ambulatory Care - Emergency Department (ED) Visits (AMB) Core Measure PRA Document Version
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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

Deviations from Measure Specifications – Screenshot 3

Figure 9: Deviations from Measure Specifications – Screenshot 3

CQM 2017 - Ambulatory Care - Emergency Department (ED) Visits (AMB) Core Measure PRA Document Version
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Deviations from Measure Specifications – Screenshot 4

1.10 Deviations from Measure Specifications – Screenshot 4

Figure 10: Deviations from Measure Specifications – Screenshot 4

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

CQM 2017 - Ambulatory Care - Emergency Department (ED) Visits (AMB) Core Measure PRA Document Version
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Optional Measure Stratification – Screenshot 2

1.12 Optional Measure Stratification – Screenshot 2

Figure 12: Optional Measure Stratification – Screenshot 2

CQM 2017 - Ambulatory Care - Emergency Department (ED) Visits (AMB) Core Measure PRA Document Version
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 2017 - Ambulatory Care - Emergency Department (ED) Visits (AMB) Core Measure PRA Document Version
1.0
7

08/25/2017

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

Medicaid and CHIP Program (MACPro)
CQM 2017 - Use of Multiple Concurrent
Antipsychotics in Children and Adolescents
(APC) Core Measure PRA Document
Version 1.0
08/24/2017

Document Number: 281-QSSI-MACPro-PRA-CQM2017-APC-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 (APC)
Screenshots ............................................................................................................. 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
1.10

Measurement Specifications – Path 1 ............................................................. 1
Measurement Specifications – Path 2 ............................................................. 1
Data Source .................................................................................................... 1
Performance Measure - Path 1 ....................................................................... 2
Performance Measure - Path 2 ....................................................................... 2
Deviations from Measure Specifications – Screenshot 1 ................................ 3
Deviations from Measure Specifications – Screenshot 2 ................................ 3
Deviations from Measure Specifications – Screenshot 3 ................................ 4
Optional Measure Stratification – Screenshot 1 .............................................. 4
Optional Measure Stratification – Screenshot 2 .............................................. 5

Appendix A: Acronyms ................................................................................................. 6

List of Figures
Figure 1: Measurement Specifications – Path 1 .............................................................. 1
Figure 2: Measurement Specifications – Path 2 .............................................................. 1
Figure 3 : Data Source .................................................................................................... 1
Figure 4: Performance Measure - Path 1 ........................................................................ 2
Figure 5: Performance Measure - Path 2 ........................................................................ 2
Figure 6: Deviations from Measure Specifications – Screenshot 1 ................................. 3
Figure 7 : Deviations from Measure Specifications – Screenshot 2 ................................ 3
Figure 8 : Deviations from Measure Specifications – Screenshot 3 ................................ 4
Figure 9 : Optional Measure Stratification – Screenshot 1 .............................................. 4
Figure 10: Optional Measure Stratification – Screenshot 2 ............................................. 5

List of Tables
No table of figures entries found.

CQM 2017 - Use of Multiple Concurrent Antipsychotics in Children and Adolescents (APC) Core Measure PRA Document Version
1.0
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Measurement Specifications – Path 1

1. Use of Multiple Concurrent Antipsychotics in Children
and Adolescents (APC) 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 2017 - Use of Multiple Concurrent Antipsychotics in Children and Adolescents (APC) Core Measure PRA Document Version
1.0
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1.4

Performance Measure - Path 1

Performance Measure - Path 1

Figure 4: Performance Measure - Path 1

1.5

Performance Measure - Path 2

Figure 5: Performance Measure - Path 2

CQM 2017 - Use of Multiple Concurrent Antipsychotics in Children and Adolescents (APC) Core Measure PRA Document Version
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1.6

Deviations from Measure Specifications – Screenshot 1

Deviations from Measure Specifications – Screenshot 1

Figure 6: Deviations from Measure Specifications – Screenshot 1

1.7

Deviations from Measure Specifications – Screenshot 2

Figure 7 : Deviations from Measure Specifications – Screenshot 2

CQM 2017 - Use of Multiple Concurrent Antipsychotics in Children and Adolescents (APC) Core Measure PRA Document Version
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1.8

Deviations from Measure Specifications – Screenshot 3

Deviations from Measure Specifications – Screenshot 3

Figure 8 : Deviations from Measure Specifications – Screenshot 3

1.9

Optional Measure Stratification – Screenshot 1

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

Figure 9 : Optional Measure Stratification – Screenshot 1

CQM 2017 - Use of Multiple Concurrent Antipsychotics in Children and Adolescents (APC) Core Measure PRA Document Version
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Optional Measure Stratification – Screenshot 2

1.10 Optional Measure Stratification – Screenshot 2

Figure 10: Optional Measure Stratification – Screenshot 2

CQM 2017 - Use of Multiple Concurrent Antipsychotics in Children and Adolescents (APC) Core Measure PRA Document Version
1.0
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08/24/2017

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 2017 - Use of Multiple Concurrent Antipsychotics in Children and Adolescents (APC) Core Measure PRA Document Version
1.0
6
08/24/2017

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

Medicaid and CHIP Program (MACPro)
CQM 2017 - Use of First-Line Psychosocial Care
for Children and Adolescents on Antipsychotics
(APP) Core Measure PRA Document
Version 1.0
08/24/2017

Document Number: 282-QSSI-MACPro-PRA-CQM2017-APP-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) Screenshots ........................................................................ 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
1.10

Measurement Specifications – Path 1 ............................................................. 1
Measurement Specifications – Path 2 ............................................................. 1
Data Source .................................................................................................... 1
Performance Measure - Path 1 ....................................................................... 2
Performance Measure - Path 2 ....................................................................... 2
Deviations from Measure Specifications – Screenshot 1 ................................ 3
Deviations from Measure Specifications – Screenshot 2 ................................ 3
Deviations from Measure Specifications – Screenshot 3 ................................ 4
Optional Measure Stratification – Screenshot 1 .............................................. 4
Optional Measure Stratification – Screenshot 2 .............................................. 5

Appendix A: Acronyms ................................................................................................. 6

List of Figures
Figure 1: Measurement Specifications – Path 1 .............................................................. 1
Figure 2: Measurement Specifications – Path 2 .............................................................. 1
Figure 3 : Data Source .................................................................................................... 1
Figure 4: Performance Measure - Path 1 ........................................................................ 2
Figure 5: Performance Measure - Path 2 ........................................................................ 2
Figure 6: Deviations from Measure Specifications – Screenshot 1 ................................. 3
Figure 7 : Deviations from Measure Specifications – Screenshot 2 ................................ 3
Figure 8 : Deviations from Measure Specifications – Screenshot 3 ................................ 4
Figure 9 : Optional Measure Stratification – Screenshot 1 .............................................. 4
Figure 10: Optional Measure Stratification – Screenshot 2 ............................................. 5

List of Tables
No table of figures entries found.

CQM 2017 - Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics (APP) Core Measure PRA Document Version
1.0
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CMS XLC

Measurement Specifications – Path 1

1. Use of First-Line Psychosocial Care for Children and
Adolescents on Antipsychotics (APP) 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 2017 - Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics (APP) Core Measure PRA Document Version
1.0
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1.4

Performance Measure - Path 1

Performance Measure - Path 1

Figure 4: Performance Measure - Path 1

1.5

Performance Measure - Path 2

Figure 5: Performance Measure - Path 2

CQM 2017 - Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics (APP) Core Measure PRA Document Version
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1.6

Deviations from Measure Specifications – Screenshot 1

Deviations from Measure Specifications – Screenshot 1

Figure 6: Deviations from Measure Specifications – Screenshot 1

1.7

Deviations from Measure Specifications – Screenshot 2

Figure 7 : Deviations from Measure Specifications – Screenshot 2

CQM 2017 - Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics (APP) Core Measure PRA Document Version
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1.8

Deviations from Measure Specifications – Screenshot 3

Deviations from Measure Specifications – Screenshot 3

Figure 8 : Deviations from Measure Specifications – Screenshot 3

1.9

Optional Measure Stratification – Screenshot 1

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

Figure 9 : Optional Measure Stratification – Screenshot 1

CQM 2017 - Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics (APP) Core Measure PRA Document Version
1.0
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Optional Measure Stratification – Screenshot 2

1.10 Optional Measure Stratification – Screenshot 2

Figure 10: Optional Measure Stratification – Screenshot 2

CQM 2017 - Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics (APP) 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 2017 - Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics (APP) Core Measure PRA Document Version
1.0
6
08/24/2017

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

Medicaid and CHIP Program (MACPro)
CQM 2017 - Audiological Evaluation No Later
than Three Months of Age (AUD) Core Measure
PRA Document
Version 1.0
08/30/2017

Document Number: 301-QSSI-MACPro-PRA-CQM2017-AUD-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)
Screenshots ............................................................................................................. 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7

Measurement Specifications – Path 1 ............................................................. 1
Measurement Specifications – Path 2 ............................................................. 1
Data Source .................................................................................................... 1
Performance Measure ..................................................................................... 2
Deviations from Measure Specifications ......................................................... 2
Optional Measure Stratification – Screenshot 1 .............................................. 3
Optional Measure Stratification – Screenshot 2 .............................................. 4

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

List of Figures
Figure 1: Measurement Specifications – Path 1 .............................................................. 1
Figure 2: Measurement Specifications – Path 2 .............................................................. 1
Figure 3 : Data Source .................................................................................................... 1
Figure 4: Performance Measure ...................................................................................... 2
Figure 5: Deviations from Measure Specifications .......................................................... 2
Figure 6: Optional Measure Stratification – Screenshot 1 ............................................... 3
Figure 7: Optional Measure Stratification – Screenshot 2 ............................................... 4

List of Tables
No table of figures entries found.

CQM 2017 - Audiological Evaluation No Later than Three Months of Age (AUD) Core Measure PRA Document
Version 1.0
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CMS XLC

Measurement Specifications – Path 1

1. Audiological Evaluation No Later than Three Months of
Age (AUD) 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 2017 - Audiological Evaluation No Later than Three Months of Age (AUD) Core Measure PRA Document
Version 1.0
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CMS XLC

1.4

Performance Measure

Performance Measure

Figure 4: Performance Measure

1.5

Deviations from Measure Specifications

Figure 5: Deviations from Measure Specifications

CQM 2017 - Audiological Evaluation No Later than Three Months of Age (AUD) Core Measure PRA Document
Version 1.0
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CMS XLC

1.6

Optional Measure Stratification – Screenshot 1

Optional Measure Stratification – Screenshot 1

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

Figure 6: Optional Measure Stratification – Screenshot 1

CQM 2017 - Audiological Evaluation No Later than Three Months of Age (AUD) Core Measure PRA Document
Version 1.0
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CMS XLC

1.7

Optional Measure Stratification – Screenshot 2

Optional Measure Stratification – Screenshot 2

Figure 7: Optional Measure Stratification – Screenshot 2

CQM 2017 - Audiological Evaluation No Later than Three Months of Age (AUD) Core Measure PRA Document
Version 1.0
4

08/30/2017

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 2017 - Audiological Evaluation No Later than Three Months of Age (AUD) Core Measure PRA Document
Version 1.0
5

08/30/2017

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

Medicaid and CHIP Program (MACPro)
CQM 2017 - Adolescent Well-Care Visit (AWC)
Core Measure PRA Document
Version 1.0
08/25/2017

Document Number: 262-QSSI-MACPro-PRA-CQM2017-AWC-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. Adolescent Well-Care Visit (AWC) Screenshots ................................................... 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7

Measurement Specifications – Path 1 ............................................................. 1
Measurement Specifications – Path 2 ............................................................. 1
Data Source .................................................................................................... 1
Performance Measure ..................................................................................... 2
Deviations from Measure Specifications ......................................................... 2
Optional Measure Stratification – Screenshot 1 .............................................. 3
Optional Measure Stratification – Screenshot 2 .............................................. 3

Appendix A: Acronyms ................................................................................................. 4

List of Figures
Figure 1: Measurement Specifications – Path 1 .............................................................. 1
Figure 2: Measurement Specifications – Path 2 .............................................................. 1
Figure 3 : Data Source .................................................................................................... 1
Figure 4: Performance Measure - Path 1 ........................................................................ 2
Figure 5: Deviations from Measure Specifications .......................................................... 2
Figure 6 : Optional Measure Stratification – Screenshot 1 .............................................. 3
Figure 7: Optional Measure Stratification – Screenshot 2 ............................................... 3

List of Tables
No table of figures entries found.

CQM 2017 - Adolescent Well-Care Visit (AWC) Core Measure PRA Document Version
1.0
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CMS XLC

Measurement Specifications – Path 1

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

Measurement Specifications – Path 1

Figure 1: Measurement Specifications – Path 1

1.2

Measurement Specifications – Path 2

Figure 2: Measurement Specifications – Path 2

1.3

Data Source

Figure 3 : Data Source

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1.4

Performance Measure

Performance Measure

Figure 4: Performance Measure - Path 1

1.5

Deviations from Measure Specifications

Figure 5: Deviations from Measure Specifications

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1.6

Optional Measure Stratification – Screenshot 1

Optional Measure Stratification – Screenshot 1

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

Figure 6 : Optional Measure Stratification – Screenshot 1

1.7

Optional Measure Stratification – Screenshot 2

Figure 7: 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 2017 - Adolescent Well-Care Visit (AWC) 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 2017 - Behavioral Health Risk Assessment
(for Pregnant Women) (BHRA) Core Measure PRA
Document
Version 1.0
08/29/2017

Document Number: 279-QSSI-MACPro-PRA-CQM2017-BHRA-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. Behavioral Health Risk Assessment (for Pregnant Women) (BHRA)
Screenshots ............................................................................................................. 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7

Measurement Specifications – Path 1 ............................................................. 1
Measurement Specifications – Path 2 ............................................................. 1
Data Source .................................................................................................... 1
Performance Measure ..................................................................................... 2
Deviations from Measure Specifications ......................................................... 2
Optional Measure Stratification – Screenshot 1 .............................................. 3
Optional Measure Stratification – Screenshot 2 .............................................. 4

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

List of Figures
Figure 1: Measurement Specifications – Path 1 .............................................................. 1
Figure 2: Measurement Specifications – Path 2 .............................................................. 1
Figure 3 : Data Source .................................................................................................... 1
Figure 4: Performance Measure ...................................................................................... 2
Figure 5: Deviations from Measure Specifications .......................................................... 2
Figure 6: Optional Measure Stratification – Screenshot 1 ............................................... 3
Figure 7: Optional Measure Stratification – Screenshot 2 ............................................... 4

List of Tables
No table of figures entries found.

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Measurement Specifications – Path 1

1. Behavioral Health Risk Assessment (for Pregnant
Women) (BHRA) Screenshots
1.1

Measurement Specifications – Path 1

Figure 1: Measurement Specifications – Path 1

1.2

Measurement Specifications – Path 2

Figure 2: Measurement Specifications – Path 2

1.3

Data Source

Figure 3 : Data Source

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1.4

Performance Measure

Performance Measure

Figure 4: Performance Measure

1.5

Deviations from Measure Specifications

Figure 5: Deviations from Measure Specifications

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1.6

Optional Measure Stratification – Screenshot 1

Optional Measure Stratification – Screenshot 1

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

Figure 6: Optional Measure Stratification – Screenshot 1

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1.7

Optional Measure Stratification – Screenshot 2

Optional Measure Stratification – Screenshot 2

Figure 7: 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 2017 - Behavioral Health Risk Assessment (for Pregnant Women) (BHRA) Core Measure PRA Document Version
1.0
5

08/29/2017

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

Medicaid and CHIP Program (MACPro)
CQM 2017 - Children and Adolescents' Access to
Primary Care Practitioners (CAP) Core Measure
PRA Document
Version 1.0
08/25/2017

Document Number: 263-QSSI-MACPro-PRA-CQM2017-CAP-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)
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
Performance Measure - Path 1 ....................................................................... 2
Performance Measure - Path 2 ....................................................................... 2
Performance Measure - Path 3 ....................................................................... 3
Deviations from Measure Specifications – Screenshot 1 ................................ 3
Deviations from Measure Specifications – Screenshot 2 ................................ 4
Deviations from Measure Specifications – Screenshot 3 ................................ 4
Optional Measure Stratification – Screenshot 1 .............................................. 5
Optional Measure Stratification – Screenshot 2 .............................................. 5
Optional Measure Stratification – Screenshot 3 .............................................. 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: Performance Measure - Path 1 ........................................................................ 2
Figure 5 : Performance Measure - Path 2 ...................................................................... 2
Figure 6: Performance Measure - Path 3 ........................................................................ 3
Figure 7: Deviations from Measure Specifications – Screenshot 1 ................................. 3
Figure 8 : Deviations from Measure Specifications – Screenshot 2 ................................ 4
Figure 9 : Deviations from Measure Specifications – Screenshot 3 ................................ 4
Figure 10 : Optional Measure Stratification – Screenshot 1 ............................................ 5
Figure 11: Optional Measure Stratification – Screenshot 2 ............................................. 5
Figure 12: Optional Measure Stratification – Screenshot 3 ............................................. 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. Children and Adolescents' Access to Primary Care
Practitioners (CAP) Screenshots
1.1

Measurement Specifications – Path 1

Figure 1: Measurement Specifications – Path 1

1.2

Measurement Specifications – Path 2

Figure 2: Measurement Specifications – Path 2

1.3

Data Source

Figure 3 : Data Source

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1.4

Performance Measure - Path 1

Performance Measure - Path 1

Figure 4: Performance Measure - Path 1

1.5

Performance Measure - Path 2

Figure 5 : Performance Measure - Path 2

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1.6

Performance Measure - Path 3

Performance Measure - Path 3

Figure 6: Performance Measure - Path 3

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

Deviations from Measure Specifications – Screenshot 3

Figure 9 : Deviations from Measure Specifications – Screenshot 3

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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

Figure 11: Optional Measure Stratification – Screenshot 2

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1.12 Optional Measure Stratification – Screenshot 3

Figure 12: 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

CQM 2017 - Children and Adolescents' Access to Primary Care Practitioners (CAP) Core Measure PRA Document Version
1.0
7

08/25/2017

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

Medicaid and CHIP Program (MACPro)
CQM 2017 - Chlamydia Screening in Women Ages
16-20 (CHL) Core Measure PRA Document
Version 1.0
08/25/2017

Document Number: 264-QSSI-MACPro-PRA-CQM2017-CHL-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) Screenshots ....................... 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7

Measurement Specifications – Path 1 ............................................................. 1
Measurement Specifications – Path 2 ............................................................. 1
Data Source .................................................................................................... 1
Performance Measure ..................................................................................... 2
Deviations from Measure Specifications ......................................................... 2
Optional Measure Stratification – Screenshot 1 .............................................. 3
Optional Measure Stratification – Screenshot 2 .............................................. 4

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

List of Figures
Figure 1: Measurement Specifications – Path 1 .............................................................. 1
Figure 2: Measurement Specifications – Path 2 .............................................................. 1
Figure 3 : Data Source .................................................................................................... 1
Figure 4: Performance Measure ...................................................................................... 2
Figure 5: Deviations from Measure Specifications .......................................................... 2
Figure 6: Optional Measure Stratification – Screenshot 1 ............................................... 3
Figure 7: Optional Measure Stratification – Screenshot 2 ............................................... 4

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)
Screenshots
1.1

Measurement Specifications – Path 1

Figure 1: Measurement Specifications – Path 1

1.2

Measurement Specifications – Path 2

Figure 2: Measurement Specifications – Path 2

1.3

Data Source

Figure 3 : Data Source

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1.4

Performance Measure

Performance Measure

Figure 4: Performance Measure

1.5

Deviations from Measure Specifications

Figure 5: Deviations from Measure Specifications

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1.6

Optional Measure Stratification – Screenshot 1

Optional Measure Stratification – Screenshot 1

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

Figure 6: Optional Measure Stratification – Screenshot 1

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1.7

Optional Measure Stratification – Screenshot 2

Optional Measure Stratification – Screenshot 2

Figure 7: Optional Measure Stratification – Screenshot 2

CQM 2017 - Chlamydia Screening in Women Ages 16-20 (CHL) Core Measure PRA Document Version
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 2017 - Chlamydia Screening in Women Ages 16-20 (CHL) Core Measure PRA Document Version
1.0
5

08/25/2017

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

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

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

CMS XLC

Table of Contents

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

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

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

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

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List of Tables

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

List of Tables
No table of figures entries found.

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Measurement Specifications – Path 1

1. Childhood Immunization Status (CIS) Screenshots
1.1

Measurement Specifications – Path 1

Figure 1: Measurement Specifications – Path 1

1.2

Measurement Specifications – Path 2

Figure 2: Measurement Specifications – Path 2

1.3

Data Source

Figure 3 : Data Source

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1.4

Performance Measure - Path 1 – Screenshot 1

Performance Measure - Path 1 – Screenshot 1

Figure 4: Performance Measure - Path 1 – Screenshot 1

1.5

Performance Measure - Path 1 – Screenshot 2

Figure 5: Performance Measure - Path 1 – Screenshot 2

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1.6

Performance Measure - Path 1 – Screenshot 3

Performance Measure - Path 1 – Screenshot 3

Figure 6: Performance Measure - Path 1 – Screenshot 3

1.7

Performance Measure - Path 1 – Screenshot 4

Figure 7: Performance Measure - Path 1 – Screenshot 4

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1.8

Performance Measure - Path 1 – Screenshot 5

Performance Measure - Path 1 – Screenshot 5

Figure 8: Performance Measure - Path 1 – Screenshot 5

1.9

Performance Measure - Path 2 – Screenshot 1

Figure 9: Performance Measure - Path 2 – Screenshot 1

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Performance Measure - Path 2 – Screenshot 2

1.10 Performance Measure - Path 2 – Screenshot 2

Figure 10: Performance Measure - Path 2 – Screenshot 2

1.11 Performance Measure - Path 2 – Screenshot 3

Figure 11: Performance Measure - Path 2 – Screenshot 3

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Deviations from Measure Specifications – Screenshot 1

1.12 Deviations from Measure Specifications – Screenshot 1

Figure 12: Deviations from Measure Specifications – Screenshot 1

1.13 Deviations from Measure Specifications – Screenshot 2

Figure 13: Deviations from Measure Specifications – Screenshot 2

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Deviations from Measure Specifications – Screenshot 3

1.14 Deviations from Measure Specifications – Screenshot 3

Figure 14: Deviations from Measure Specifications – Screenshot 3

1.15 Deviations from Measure Specifications – Screenshot 4

Figure 15: Deviations from Measure Specifications – Screenshot 4

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Deviations from Measure Specifications – Screenshot 5

1.16 Deviations from Measure Specifications – Screenshot 5

Figure 16: Deviations from Measure Specifications – Screenshot 5

1.17 Deviations from Measure Specifications – Screenshot 6

Figure 17: Deviations from Measure Specifications – Screenshot 6

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Deviations from Measure Specifications – Screenshot 7

1.18 Deviations from Measure Specifications – Screenshot 7

Figure 18: Deviations from Measure Specifications – Screenshot 7

1.19 Deviations from Measure Specifications – Screenshot 8

Figure 19: Deviations from Measure Specifications – Screenshot 8

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Deviations from Measure Specifications – Screenshot 9

1.20 Deviations from Measure Specifications – Screenshot 9

Figure 20: Deviations from Measure Specifications – Screenshot 9

1.21 Deviations from Measure Specifications – Screenshot 10

Figure 21: Deviations from Measure Specifications – Screenshot 10

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CMS XLC

Deviations from Measure Specifications – Screenshot 11

1.22 Deviations from Measure Specifications – Screenshot 11

Figure 22: Deviations from Measure Specifications – Screenshot 11

1.23 Deviations from Measure Specifications – Screenshot 12

Figure 23: Deviations from Measure Specifications – Screenshot 12

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CMS XLC

Optional Measure Stratification – Screenshot 1

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

Figure 24: Optional Measure Stratification – Screenshot 1

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Optional Measure Stratification – Screenshot 2

1.25 Optional Measure Stratification – Screenshot 2

Figure 25: Optional Measure Stratification – Screenshot 2

1.26 Optional Measure Stratification – Screenshot 3

Figure 26: Optional Measure Stratification – Screenshot 3

CQM 2017 - Childhood Immunization Status (CIS) Core Measure PRA Document Version
1.0
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CMS XLC

Optional Measure Stratification – Screenshot 3

Appendix A: Acronyms
Table 1: Acronyms
Acronym

Definition

CQM

Child Quality Measures

PRA

Paperwork Reduction Act of 1995

CQM 2017 - Childhood Immunization Status (CIS) Core Measure PRA Document Version
1.0
14

08/25/2017

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

Medicaid and CHIP Program (MACPro)
CQM 2017 - CLABSI-CH: Pediatric Central LineAssociated Blood Stream Infections Core
Measure PRA Document
Version 1.0
08/30/2017

Document Number: 314-QSSI-MACPro-PRA-CQM017-CLABSI-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

Measurement Specifications ........................................................................... 1
Data Source .................................................................................................... 1
Performance Measure ..................................................................................... 1
Deviations from Measure Specification – Screenshot 1 .................................. 2
Deviations from Measure Specification – Screenshot 2 .................................. 2
Optional Measure Stratification – Screenshot 1 .............................................. 3
Optional Measure Stratification – Screenshot 2 .............................................. 3
Optional Measure Stratification – Screenshot 3 .............................................. 4
Optional Measure Stratification – Screenshot 4 .............................................. 4

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

List of Figures
Figure 1: Measurement Specifications ............................................................................ 1
Figure 2 : Data Source .................................................................................................... 1
Figure 3: Performance Measure ...................................................................................... 1
Figure 4: Deviations from Measure Specification – Screenshot 1 ................................... 2
Figure 5: Deviations from Measure Specification – Screenshot 2 ................................... 2
Figure 6: Optional Measure Stratification – Screenshot 1 ............................................... 3
Figure 7: Optional Measure Stratification – Screenshot 2 ............................................... 3
Figure 8: Optional Measure Stratification – Screenshot 3 ............................................... 4
Figure 9: Optional Measure Stratification – Screenshot 4 ............................................... 4

List of Tables
No table of figures entries found.

CQM 2017 - CLABSI-CH: Pediatric Central Line-Associated Blood Stream Infections Core Measure PRA Document
Version 1.0
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Measurement Specifications

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

Measurement Specifications

Figure 1: Measurement Specifications

1.2

Data Source

Figure 2 : Data Source

1.3

Performance Measure

Figure 3: Performance Measure

CQM 2017 - CLABSI-CH: Pediatric Central Line-Associated Blood Stream Infections Core Measure PRA Document
Version 1.0
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CMS XLC

1.4

Deviations from Measure Specification – Screenshot 1

Deviations from Measure Specification – Screenshot 1

Figure 4: Deviations from Measure Specification – Screenshot 1

1.5

Deviations from Measure Specification – Screenshot 2

Figure 5: Deviations from Measure Specification – Screenshot 2

CQM 2017 - CLABSI-CH: Pediatric Central Line-Associated Blood Stream Infections Core Measure PRA Document
Version 1.0
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CMS XLC

1.6

Optional Measure Stratification – Screenshot 1

Optional Measure Stratification – Screenshot 1

Figure 6: Optional Measure Stratification – Screenshot 1

1.7

Optional Measure Stratification – Screenshot 2

Figure 7: Optional Measure Stratification – Screenshot 2

CQM 2017 - CLABSI-CH: Pediatric Central Line-Associated Blood Stream Infections Core Measure PRA Document
Version 1.0
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CMS XLC

1.8

Optional Measure Stratification – Screenshot 3

Optional Measure Stratification – Screenshot 3

Figure 8: Optional Measure Stratification – Screenshot 3

1.9

Optional Measure Stratification – Screenshot 4

Figure 9: Optional Measure Stratification – Screenshot 4

CQM 2017 - CLABSI-CH: Pediatric Central Line-Associated Blood Stream Infections Core Measure PRA Document
Version 1.0
4

08/30/2017

CMS XLC

Optional Measure Stratification – Screenshot 4

Appendix A: Acronyms
Table 1: Acronyms
Acronym

Definition

CQM

Child Quality Measures

PRA

Paperwork Reduction Act of 1995

CQM 2017 - CLABSI-CH: Pediatric Central Line-Associated Blood Stream Infections Core Measure PRA Document
Version 1.0
5

08/30/2017

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

Medicaid and CHIP Program (MACPro)
CQM 2017 –CPC Core Measure PRA document
Version 1.0
08/29/2017

Document Number: 307-QSSI-MACPro-PRA-CQM2017-CPC-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. CPC Core Measure Screenshots ............................................................................ 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7

Did you collect this measure - Path 1 – Screenshot 1 ..................................... 1
Did you collect this measure - Path 1 – Screenshot 2 ..................................... 2
Did you collect this measure - Path 2 .............................................................. 2
Measurement Specification – Path 1 ............................................................... 3
Measurement Specification – Path 2 ............................................................... 3
Data Source .................................................................................................... 3
Definition of Population Included in the Measure ............................................ 4

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

List of Figures
Figure 1: Did you collect this measure ............................................................................ 2
Figure 2: Measurement Specification – Path 1................................................................ 3
Figure 3: Measurement Specification – Path 2................................................................ 3
Figure 4: Data Source ..................................................................................................... 3
Figure 5: Definition of Population Included in the Measure ............................................. 4

List of Tables
No table of figures entries found.

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Version 1.0

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CPC Core Measure Screenshots

1. CPC Core Measure Screenshots
1.1

Did you collect this measure - Path 1 – Screenshot 1

Figure 1: Did you collect this measure - Path 1 – Screenshot 1

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1.2

CPC Core Measure Screenshots

Did you collect this measure - Path 1 – Screenshot 2

Figure 2: Did you collect this measure - Path 1 – Screenshot 2

1.3

Did you collect this measure - Path 2

Figure 3: Did you collect this measure – Path 2

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1.4

CPC Core Measure Screenshots

Measurement Specification – Path 1

Figure 4: Measurement Specification – Path 1

1.5

Measurement Specification – Path 2

Figure 5: Measurement Specification – Path 2

1.6

Data Source

Figure 6: Data Source

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1.7

CPC Core Measure Screenshots

Definition of Population Included in the Measure

Figure 7: Definition of Population Included in the Measure

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CPC Core Measure Screenshots

Appendix A: Acronyms
Table 1: Acronyms
Acronym

Definition

CQM

Child Quality Measures

CPC

Consumer Assessment of Healthcare Providers and Systems® (CAHPS)
Health Plan Survey 5.0H - Child Version Including Medicaid and Children
with Chronic Conditions Supplemental Items (CPC)

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 2017 - Developmental Screening in the First
Three Years of Life (DEV) Core Measure PRA
Document
Version 1.0
08/25/2017

Document Number: 306-QSSI-MACPro-PRA-CQM2017-DEV-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) Screenshots.. 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
1.10

Measurement Specifications – Path 1 ............................................................. 1
Measurement Specifications – Path 2 ............................................................. 1
Data Source .................................................................................................... 1
Performance Measure - Path 1 ....................................................................... 2
Performance Measure - Path 2 ....................................................................... 2
Deviations from Measure Specifications – Screenshot 1 ................................ 3
Deviations from Measure Specifications – Screenshot 2 ................................ 3
Deviations from Measure Specifications – Screenshot 3 ................................ 4
Optional Measure Stratification – Screenshot 1 .............................................. 4
Optional Measure Stratification – Screenshot 2 .............................................. 5

Appendix A: Acronyms ................................................................................................. 6

List of Figures
Figure 1: Measurement Specifications – Path 1 ............................................................................................ 1
Figure 2: Measurement Specifications – Path 2 ............................................................................................ 1
Figure 3 : Data Source................................................................................................................................... 1
Figure 4: Performance Measure - Path 1....................................................................................................... 2
Figure 5: Performance Measure - Path 2....................................................................................................... 2
Figure 6: Deviations from Measure Specifications – Screenshot 1 ................................................................ 3
Figure 7 : Deviations from Measure Specifications – Screenshot 2 ............................................................... 3
Figure 8: Deviations from Measure Specifications – Screenshot 3 ................................................................ 4
Figure 9: Optional Measure Stratification – Screenshot 1.............................................................................. 4
Figure 10: Optional Measure Stratification – Screenshot 2............................................................................ 5

List of Tables
No table of figures entries found.

CQM 2017 - Developmental Screening in the First Three Years of Life (DEV) Core Measure PRA Document
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Measurement Specifications – Path 1

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

Measurement Specifications – Path 1

Figure 1: Measurement Specifications – Path 1

1.2

Measurement Specifications – Path 2

Figure 2: Measurement Specifications – Path 2

1.3

Data Source

Figure 3 : Data Source

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1.4

Performance Measure - Path 1

Performance Measure - Path 1

Figure 4: Performance Measure - Path 1

1.5

Performance Measure - Path 2

Figure 5: Performance Measure - Path 2

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1.6

Deviations from Measure Specifications – Screenshot 1

Deviations from Measure Specifications – Screenshot 1

Figure 6: Deviations from Measure Specifications – Screenshot 1

1.7

Deviations from Measure Specifications – Screenshot 2

Figure 7 : Deviations from Measure Specifications – Screenshot 2

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1.8

Deviations from Measure Specifications – Screenshot 3

Deviations from Measure Specifications – Screenshot 3

Figure 8: Deviations from Measure Specifications – Screenshot 3

1.9

Optional Measure Stratification – Screenshot 1

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

Figure 9: Optional Measure Stratification – Screenshot 1

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Optional Measure Stratification – Screenshot 2

1.10 Optional Measure Stratification – Screenshot 2

Figure 10: Optional Measure Stratification – Screenshot 2

CQM 2017 - Developmental Screening in the First Three Years of Life (DEV) Core Measure PRA Document
Version 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 2017 - Developmental Screening in the First Three Years of Life (DEV) Core Measure PRA Document
Version 1.0
6

08/25/2017

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

Medicaid and CHIP Program (MACPro)
CQM 2017 - Frequency of Ongoing Prenatal Care
(FPC) Core Measure PRA Document
Version 1.0
08/25/2017

Document Number: 266-QSSI-MACPro-PRA-CQM2017-FPC-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. Frequency of Ongoing Prenatal Care (FPC) 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
Performance Measure – Path 1 – Screenshot 1 ............................................. 2
Performance Measure – Path 1 – Screenshot 2 ............................................. 2
Performance Measure – Path 2 ...................................................................... 3
Deviations from Measure Specifications – Screenshot 1 ................................ 3
Deviations from Measure Specifications – Screenshot 2 ................................ 4
Deviations from Measure Specifications – Screenshot 3 ................................ 4
Deviations from Measure Specifications – Screenshot 4 ................................ 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 : Performance Measure – Path 1 – Screenshot 1 ............................................. 2
Figure 5: Performance Measure – Path 1 – Screenshot 2 .............................................. 2
Figure 6: Performance Measure – Path 2 ....................................................................... 3
Figure 7: Deviations from Measure Specifications – Screenshot 1 ................................. 3
Figure 8: Deviations from Measure Specifications – Screenshot 2 ................................. 4
Figure 9: Deviations from Measure Specifications – Screenshot 3 ................................. 4
Figure 10: Deviations from Measure Specifications – Screenshot 4 ............................... 5
Figure 11 : Optional Measure Stratification – Screenshot 1 ............................................ 5
Figure 12: Optional Measure Stratification – Screenshot 2 ............................................. 6

CQM 2017 - Frequency of Ongoing Prenatal Care (FPC) Core Measure PRA Document Version
1.0
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List of Tables

List of Tables
No table of figures entries found.

CQM 2017 - Frequency of Ongoing Prenatal Care (FPC) Core Measure PRA Document Version
1.0
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Measurement Specifications – Path 1

1. Frequency of Ongoing Prenatal Care (FPC)
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 2017 - Frequency of Ongoing Prenatal Care (FPC) Core Measure PRA Document Version
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1.4

Performance Measure – Path 1 – Screenshot 1

Performance Measure – Path 1 – Screenshot 1

Figure 4 : Performance Measure – Path 1 – Screenshot 1

1.5

Performance Measure – Path 1 – Screenshot 2

Figure 5: Performance Measure – Path 1 – Screenshot 2

CQM 2017 - Frequency of Ongoing Prenatal Care (FPC) Core Measure PRA Document Version
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1.6

Performance Measure – Path 2

Performance Measure – Path 2

Figure 6: Performance Measure – Path 2

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

Deviations from Measure Specifications – Screenshot 3

Figure 9: Deviations from Measure Specifications – Screenshot 3

CQM 2017 - Frequency of Ongoing Prenatal Care (FPC) Core Measure PRA Document Version
1.0
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Deviations from Measure Specifications – Screenshot 4

1.10 Deviations from Measure Specifications – Screenshot 4

Figure 10: Deviations from Measure Specifications – Screenshot 4

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

CQM 2017 - Frequency of Ongoing Prenatal Care (FPC) Core Measure PRA Document Version
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Optional Measure Stratification – Screenshot 2

1.12 Optional Measure Stratification – Screenshot 2

Figure 12: Optional Measure Stratification – Screenshot 2

CQM 2017 - Frequency of Ongoing Prenatal Care (FPC) 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 2017 - Frequency of Ongoing Prenatal Care (FPC) Core Measure PRA Document Version
1.0
7

08/25/2017

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

Medicaid and CHIP Program (MACPro)
CQM 2017 - Follow-Up After Hospitalization for
Mental Illness: Ages 6-20 (FUH) Core Measure
PRA Document
Version 1.0
08/28/2017

Document Number: 267-QSSI-MACPro-PRA-CQM2017-FUH-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)
Screenshots ............................................................................................................. 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9

Measurement Specifications – Path 1 ............................................................. 1
Measurement Specifications – Path 2 ............................................................. 1
Data Source .................................................................................................... 1
Performance Measure - Path 1 ....................................................................... 2
Performance Measure - Path 2 ....................................................................... 2
Deviations from Measure Specifications – Screenshot 1 ................................ 3
Deviations from Measure Specifications – Screenshot 2 ................................ 3
Optional Measure Stratification – Screenshot 1 .............................................. 4
Optional Measure Stratification – Screenshot 2 .............................................. 5

Appendix A: Acronyms ................................................................................................. 6

List of Figures
Figure 1: Measurement Specifications – Path 1 .............................................................. 1
Figure 2: Measurement Specifications – Path 2 .............................................................. 1
Figure 3 : Data Source .................................................................................................... 1
Figure 4: Performance Measure - Path 1 ........................................................................ 2
Figure 5: Performance Measure - Path 2 ........................................................................ 2
Figure 6: Deviations from Measure Specifications – Screenshot 1 ................................. 3
Figure 7 : Deviations from Measure Specifications – Screenshot 2 ................................ 3
Figure 8 : Optional Measure Stratification – Screenshot 1 .............................................. 4
Figure 9: Optional Measure Stratification – Screenshot 2 ............................................... 5

List of Tables
No table of figures entries found.

CQM 2017 - Follow-Up After Hospitalization for Mental Illness: Ages 6-20 (FUH) Core Measure PRA Document Version
1.0
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Measurement Specifications – Path 1

1. Follow-Up After Hospitalization for Mental Illness: Ages
6-20 (FUH) 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 2017 - Follow-Up After Hospitalization for Mental Illness: Ages 6-20 (FUH) Core Measure PRA Document Version
1.0
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1.4

Performance Measure - Path 1

Performance Measure - Path 1

Figure 4: Performance Measure - Path 1

1.5

Performance Measure - Path 2

Figure 5: Performance Measure - Path 2

CQM 2017 - Follow-Up After Hospitalization for Mental Illness: Ages 6-20 (FUH) Core Measure PRA Document Version
1.0
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1.6

Deviations from Measure Specifications – Screenshot 1

Deviations from Measure Specifications – Screenshot 1

Figure 6: Deviations from Measure Specifications – Screenshot 1

1.7

Deviations from Measure Specifications – Screenshot 2

Figure 7 : Deviations from Measure Specifications – Screenshot 2

CQM 2017 - Follow-Up After Hospitalization for Mental Illness: Ages 6-20 (FUH) Core Measure PRA Document Version
1.0
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1.8

Optional Measure Stratification – Screenshot 1

Optional Measure Stratification – Screenshot 1

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

Figure 8 : Optional Measure Stratification – Screenshot 1

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1.0
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1.9

Optional Measure Stratification – Screenshot 2

Optional Measure Stratification – Screenshot 2

Figure 9: Optional Measure Stratification – Screenshot 2

CQM 2017 - Follow-Up After Hospitalization for Mental Illness: Ages 6-20 (FUH) Core Measure PRA Document Version
1.0
5

08/28/2017

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 2017 - Follow-Up After Hospitalization for Mental Illness: Ages 6-20 (FUH) Core Measure PRA Document Version
1.0
6

08/28/2017

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

Medicaid and CHIP Program (MACPro)
CQM 2017 - Immunizations for Adolescents (IMA)
Core Measure PRA Document
Version 1.0
08/28/2017

Document Number: 268-QSSI-MACPro-PRA-CQM2017-IMA-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. Immunizations for Adolescents (IMA) 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
Performance Measure – Path 1 – Screenshot 1 ............................................. 2
Performance Measure – Path 1 – Screenshot 2 ............................................. 2
Performance Measure – Path 2 ...................................................................... 3
Deviations from Measure Specifications – Screenshot 1 ................................ 4
Deviations from Measure Specifications – Screenshot 2 ................................ 4
Deviations from Measure Specifications – Screenshot 3 ................................ 5
Deviations from Measure Specifications – Screenshot 4 ................................ 5
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: Performance Measure – Path 1 – Screenshot 1 .............................................. 2
Figure 5: Performance Measure – Path 1 – Screenshot 2 .............................................. 2
Figure 6: Performance Measure – Path 2 ....................................................................... 3
Figure 7: Deviations from Measure Specifications – Screenshot 1 ................................. 4
Figure 8: Deviations from Measure Specifications – Screenshot 2 ................................. 4
Figure 9 : Deviations from Measure Specifications – Screenshot 3 ................................ 5
Figure 10: Deviations from Measure Specifications – Screenshot 4 ............................... 5
Figure 11 : Optional Measure Stratification – Screenshot 1 ............................................ 6
Figure 12: Optional Measure Stratification – Screenshot 2 ............................................. 7

CQM 2017 - Immunizations for Adolescents (IMA) Core Measure PRA Document Version
1.0
i

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CMS XLC

List of Tables

List of Tables
No table of figures entries found.

CQM 2017 - Immunizations for Adolescents (IMA) Core Measure PRA Document Version
1.0
ii

08/28/2017

CMS XLC

Measurement Specifications – Path 1

1. Immunizations for Adolescents (IMA) 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 2017 - Immunizations for Adolescents (IMA) Core Measure PRA Document Version
1.0
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1.4

Performance Measure – Path 1 – Screenshot 1

Performance Measure – Path 1 – Screenshot 1

Figure 4: Performance Measure – Path 1 – Screenshot 1

1.5

Performance Measure – Path 1 – Screenshot 2

Figure 5: Performance Measure – Path 1 – Screenshot 2

CQM 2017 - Immunizations for Adolescents (IMA) Core Measure PRA Document Version
1.0
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1.6

Performance Measure – Path 2

Figure 6: Performance Measure – Path 2

CQM 2017 - Immunizations for Adolescents (IMA) Core Measure PRA Document Version
1.0
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1.7

Deviations from Measure Specifications – Screenshot 1

Deviations from Measure Specifications – Screenshot 1

Figure 7: Deviations from Measure Specifications – Screenshot 1

1.8

Deviations from Measure Specifications – Screenshot 2

Figure 8: Deviations from Measure Specifications – Screenshot 2

CQM 2017 - Immunizations for Adolescents (IMA) Core Measure PRA Document Version
1.0
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CMS XLC

1.9

Deviations from Measure Specifications – Screenshot 3

Deviations from Measure Specifications – Screenshot 3

Figure 9 : Deviations from Measure Specifications – Screenshot 3

1.10 Deviations from Measure Specifications – Screenshot 4

Figure 10: Deviations from Measure Specifications – Screenshot 4

CQM 2017 - Immunizations for Adolescents (IMA) Core Measure PRA Document Version
1.0
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CMS XLC

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

CQM 2017 - Immunizations for Adolescents (IMA) Core Measure PRA Document Version
1.0
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CMS XLC

Optional Measure Stratification – Screenshot 2

1.12 Optional Measure Stratification – Screenshot 2

Figure 12: Optional Measure Stratification – Screenshot 2

CQM 2017 - Immunizations for Adolescents (IMA) Core Measure PRA Document Version
1.0
7

08/28/2017

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 2017 - Immunizations for Adolescents (IMA) Core Measure PRA Document Version
1.0
8

08/28/2017

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

Medicaid and CHIP Program (MACPro)
CQM 2017 - Live Births Weighing Less Than 2,500
Grams (LBW) Core Measure PRA Document
Version 1.0
08/29/2017

Document Number: 302-QSSI-MACPro-PRA-CQM2017-LBW-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) Screenshots .................... 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7

Measurement Specifications – Path 1 ............................................................. 1
Measurement Specifications – Path 2 ............................................................. 1
Data Source .................................................................................................... 1
Performance Measure ..................................................................................... 2
Deviations from Measure Specifications ......................................................... 2
Optional Measure Stratification – Screenshot 1 .............................................. 3
Optional Measure Stratification – Screenshot 2 .............................................. 4

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

List of Figures
Figure 1: Measurement Specifications – Path 1 .............................................................. 1
Figure 2: Measurement Specifications – Path 2 .............................................................. 1
Figure 3 : Data Source .................................................................................................... 1
Figure 4: Performance Measure ...................................................................................... 2
Figure 5: Deviations from Measure Specifications .......................................................... 2
Figure 6: Optional Measure Stratification – Screenshot 1 ............................................... 3
Figure 7: Optional Measure Stratification – Screenshot 2 ............................................... 4

List of Tables
No table of figures entries found.

CQM 2017 - Live Births Weighing Less Than 2,500 Grams (LBW) Core Measure PRA Document
Version 1.0
i

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CMS XLC

Measurement Specifications – Path 1

1. Live Births Weighing Less Than 2,500 Grams (LBW)
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 2017 - Live Births Weighing Less Than 2,500 Grams (LBW) Core Measure PRA Document
Version 1.0
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1.4

Performance Measure

Performance Measure

Figure 4: Performance Measure

1.5

Deviations from Measure Specifications

Figure 5: Deviations from Measure Specifications

CQM 2017 - Live Births Weighing Less Than 2,500 Grams (LBW) Core Measure PRA Document
Version 1.0
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CMS XLC

1.6

Optional Measure Stratification – Screenshot 1

Optional Measure Stratification – Screenshot 1

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

Figure 6: Optional Measure Stratification – Screenshot 1

CQM 2017 - Live Births Weighing Less Than 2,500 Grams (LBW) Core Measure PRA Document
Version 1.0
3

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1.7

Optional Measure Stratification – Screenshot 2

Optional Measure Stratification – Screenshot 2

Figure 7: Optional Measure Stratification – Screenshot 2

CQM 2017 - Live Births Weighing Less Than 2,500 Grams (LBW) Core Measure PRA Document
Version 1.0
4

08/29/2017

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 2017 - Live Births Weighing Less Than 2,500 Grams (LBW) Core Measure PRA Document
Version 1.0
5

08/29/2017

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

Medicaid and CHIP Program (MACPro)
CQM 2017 - Medication Management for People
with Asthma (MMA) Core Measure PRA Document
Version 1.0
08/29/2017

Document Number: 273-QSSI-MACPro-PRA-CQM2017-MMA-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. Medication Management for People with Asthma (MMA) 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

Measurement Specifications – Path 1 ............................................................. 1
Measurement Specifications – Path 2 ............................................................. 1
Data Source .................................................................................................... 1
Performance Measure - Path 1 – Screenshot 1 .............................................. 2
Performance Measure - Path 1 – Screenshot 2 .............................................. 2
Performance Measure - Path 1 – Screenshot 3 .............................................. 3
Performance Measure - Path 2 – Screenshot 1 .............................................. 3
Performance Measure - Path 2 – Screenshot 2 .............................................. 4
Deviations from Measure Specifications – Screenshot 1 ................................ 4
Deviations from Measure Specifications – Screenshot 2 ................................ 5
Deviations from Measure Specifications – Screenshot 3 ................................ 5
Deviations from Measure Specifications – Screenshot 4 ................................ 6
Deviations from Measure Specifications – Screenshot 5 ................................ 6
Deviations from Measure Specifications – Screenshot 6 ................................ 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 .................................................................................................... 1
Figure 4: Performance Measure - Path 1 – Screenshot 1 ............................................... 2
Figure 5: Performance Measure - Path 1 – Screenshot 2 ............................................... 2
Figure 6: Performance Measure - Path 1 – Screenshot 3 ............................................... 3
Figure 7: Performance Measure - Path 2 – Screenshot 1 ............................................... 3
Figure 8: Performance Measure - Path 2 – Screenshot 2 ............................................... 4
Figure 9: Deviations from Measure Specifications – Screenshot 1 ................................. 4
Figure 10: Deviations from Measure Specifications – Screenshot 2 ............................... 5
Figure 11: Deviations from Measure Specifications – Screenshot 3 ............................... 5
Figure 12: Deviations from Measure Specifications – Screenshot 4 ............................... 6
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List of Tables

Figure 13: Deviations from Measure Specifications – Screenshot 5 ............................... 6
Figure 14 : Deviations from Measure Specifications – Screenshot 6 .............................. 7
Figure 15 : Optional Measure Stratification – Screenshot 1 ............................................ 7
Figure 16: Optional Measure Stratification – Screenshot 2 ............................................. 8

List of Tables
No table of figures entries found.

CQM 2017 - Medication Management for People with Asthma (MMA) Core Measure PRA Document Version
1.0
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Measurement Specifications – Path 1

1. Medication Management for People with Asthma
(MMA) Screenshots
1.1

Measurement Specifications – Path 1

Figure 1: Measurement Specifications – Path 1

1.2

Measurement Specifications – Path 2

Figure 2: Measurement Specifications – Path 2

1.3

Data Source

Figure 3 : Data Source

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1.4

Performance Measure - Path 1 – Screenshot 1

Performance Measure - Path 1 – Screenshot 1

Figure 4: Performance Measure - Path 1 – Screenshot 1

1.5

Performance Measure - Path 1 – Screenshot 2

Figure 5: Performance Measure - Path 1 – Screenshot 2

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1.6

Performance Measure - Path 1 – Screenshot 3

Performance Measure - Path 1 – Screenshot 3

Figure 6: Performance Measure - Path 1 – Screenshot 3

1.7

Performance Measure - Path 2 – Screenshot 1

Figure 7: Performance Measure - Path 2 – Screenshot 1

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1.8

Performance Measure - Path 2 – Screenshot 2

Performance Measure - Path 2 – Screenshot 2

Figure 8: Performance Measure - Path 2 – Screenshot 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 Deviations from Measure Specifications – Screenshot 3

Figure 11: Deviations from Measure Specifications – Screenshot 3

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Deviations from Measure Specifications – Screenshot 4

1.12 Deviations from Measure Specifications – Screenshot 4

Figure 12: Deviations from Measure Specifications – Screenshot 4

1.13 Deviations from Measure Specifications – Screenshot 5

Figure 13: Deviations from Measure Specifications – Screenshot 5

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Deviations from Measure Specifications – Screenshot 6

1.14 Deviations from Measure Specifications – Screenshot 6

Figure 14 : Deviations from Measure Specifications – Screenshot 6

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

Figure 15 : Optional Measure Stratification – Screenshot 1

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Optional Measure Stratification – Screenshot 2

1.16 Optional Measure Stratification – Screenshot 2

Figure 16: 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 2017 - Medication Management for People with Asthma (MMA) 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 2017 - PC-02: Cesarean Section (PC02) Core
Measure PRA Document
Version 1.0
08/30/2017

Document Number: 309-QSSI-MACPro-PRA-CQM2017-PC02-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

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

Measurement Specifications – Path 1 ............................................................. 1
Measurement Specifications – Path 2 ............................................................. 1
Data Source .................................................................................................... 1
Performance Measure ..................................................................................... 2
Deviations from Measure Specifications ......................................................... 2
Optional Measure Stratification – Screenshot 1 .............................................. 3
Optional Measure Stratification – Screenshot 2 .............................................. 4

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

List of Figures
Figure 1: Measurement Specifications – Path 1 .............................................................. 1
Figure 2: Measurement Specifications – Path 2 .............................................................. 1
Figure 3 : Data Source .................................................................................................... 1
Figure 4: Performance Measure ...................................................................................... 2
Figure 5: Deviations from Measure Specifications .......................................................... 2
Figure 6: Optional Measure Stratification – Screenshot 1 ............................................... 3
Figure 7: Optional Measure Stratification – Screenshot 2 ............................................... 4

List of Tables
No table of figures entries found.

CQM 2017 - PC-02: Cesarean Section (PC02) Core Measure PRA Document
Version 1.0
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Measurement Specifications – Path 1

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

Measurement Specifications – Path 1

Figure 1: Measurement Specifications – Path 1

1.2

Measurement Specifications – Path 2

Figure 2: Measurement Specifications – Path 2

1.3

Data Source

Figure 3 : Data Source

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1.4

Performance Measure

Performance Measure

Figure 4: Performance Measure

1.5

Deviations from Measure Specifications

Figure 5: Deviations from Measure Specifications

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Version 1.0
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1.6

Optional Measure Stratification – Screenshot 1

Optional Measure Stratification – Screenshot 1

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

Figure 6: Optional Measure Stratification – Screenshot 1

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1.7

Optional Measure Stratification – Screenshot 2

Optional Measure Stratification – Screenshot 2

Figure 7: Optional Measure Stratification – Screenshot 2

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Version 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 2017 - PC-02: Cesarean Section (PC02) Core Measure PRA Document
Version 1.0
5

08/30/2017

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

Medicaid and CHIP Program (MACPro)
CQM 2017 - PDENT-CH: Percentage of Eligibles
Who Received Preventive Dental Services Core
Measure PRA Document
Version 1.0
08/30/2017

Document Number: 313-QSSI-MACPro-PRA-CQM017-PDENT-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

Measurement Specifications ........................................................................... 1
Data Source .................................................................................................... 1
Performance Measure ..................................................................................... 1
Deviations from Measure Specification ........................................................... 2
Optional Measure Stratification ....................................................................... 2

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

List of Figures
Figure 1: Measurement Specifications ............................................................................ 1
Figure 2 : Data Source .................................................................................................... 1
Figure 3: Performance Measure ...................................................................................... 1
Figure 4: Deviations from Measure Specification ............................................................ 2
Figure 5: Optional Measure Stratification ........................................................................ 2

List of Tables
No table of figures entries found.

CQM 2017 - PDENT-CH: Percentage of Eligibles Who Received Preventive Dental Services Core Measure PRA Document
Version 1.0
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Measurement Specifications

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

Measurement Specifications

Figure 1: Measurement Specifications

1.2

Data Source

Figure 2 : Data Source

1.3

Performance Measure

Figure 3: Performance Measure

CQM 2017 - PDENT-CH: Percentage of Eligibles Who Received Preventive Dental Services Core Measure PRA Document
Version 1.0
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1.4

Deviations from Measure Specification

Deviations from Measure Specification

Figure 4: Deviations from Measure Specification

1.5

Optional Measure Stratification

Figure 5: Optional Measure Stratification

CQM 2017 - PDENT-CH: Percentage of Eligibles Who Received Preventive Dental Services Core Measure PRA Document
Version 1.0
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Optional Measure Stratification

Appendix A: Acronyms
Table 1: Acronyms
Acronym

Definition

CQM

Child Quality Measures

PRA

Paperwork Reduction Act of 1995

CQM 2017 - PDENT-CH: Percentage of Eligibles Who Received Preventive Dental Services Core Measure PRA Document
Version 1.0
3

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

Medicaid and CHIP Program (MACPro)
CQM 2017 - Prenatal and Postpartum Care:
Timeliness of Prenatal Care (PPC) Core Measure
PRA Document
Version 1.0
08/28/2017

Document Number: 269-QSSI-MACPro-PRA-CQM2017-PPC-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)
Screenshots ............................................................................................................. 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7

Measurement Specifications – Path 1 ............................................................. 1
Measurement Specifications – Path 2 ............................................................. 1
Data Source .................................................................................................... 1
Performance Measure ..................................................................................... 2
Deviations from Measure Specifications ......................................................... 2
Optional Measure Stratification – Screenshot 1 .............................................. 3
Optional Measure Stratification – Screenshot 2 .............................................. 4

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

List of Figures
Figure 1: Measurement Specifications – Path 1 .............................................................. 1
Figure 2: Measurement Specifications – Path 2 .............................................................. 1
Figure 3 : Data Source .................................................................................................... 1
Figure 4: Performance Measure - Path 1 ........................................................................ 2
Figure 5: Deviations from Measure Specifications .......................................................... 2
Figure 6: Optional Measure Stratification – Screenshot 1 ............................................... 3
Figure 7: Optional Measure Stratification – Screenshot 2 ............................................... 4

List of Tables
No table of figures entries found.

CQM 2017 - Prenatal and Postpartum Care: Timeliness of Prenatal Care (PPC) Core Measure PRA Document Version
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Measurement Specifications – Path 1

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

Measurement Specifications – Path 1

Figure 1: Measurement Specifications – Path 1

1.2

Measurement Specifications – Path 2

Figure 2: Measurement Specifications – Path 2

1.3

Data Source

Figure 3 : Data Source

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1.4

Performance Measure

Performance Measure

Figure 4: Performance Measure - Path 1

1.5

Deviations from Measure Specifications

Figure 5: Deviations from Measure Specifications

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1.6

Optional Measure Stratification – Screenshot 1

Optional Measure Stratification – Screenshot 1

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

Figure 6: Optional Measure Stratification – Screenshot 1

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1.7

Optional Measure Stratification – Screenshot 2

Optional Measure Stratification – Screenshot 2

Figure 7: 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 2017 - Prenatal and Postpartum Care: Timeliness of Prenatal Care (PPC) Core Measure PRA Document Version
1.0
5

08/28/2017

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

Medicaid and CHIP Program (MACPro)
CQM 2017 - Dental Sealants for 6-9 Year Old
Children at Elevated Caries Risk (SEAL) Core
Measure PRA Document
Version 1.0
08/30/2017

Document Number: 304-QSSI-MACPro-PRA-CQM2017-SEAL-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)
Screenshots ............................................................................................................. 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7

Measurement Specifications – Path 1 ............................................................. 1
Measurement Specifications – Path 2 ............................................................. 1
Data Source .................................................................................................... 1
Performance Measure ..................................................................................... 2
Deviations from Measure Specifications ......................................................... 2
Optional Measure Stratification – Screenshot 1 .............................................. 3
Optional Measure Stratification – Screenshot 2 .............................................. 4

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

List of Figures
Figure 1: Measurement Specifications – Path 1 .............................................................. 1
Figure 2: Measurement Specifications – Path 2 .............................................................. 1
Figure 3 : Data Source .................................................................................................... 1
Figure 4: Performance Measure ...................................................................................... 2
Figure 5: Deviations from Measure Specifications .......................................................... 2
Figure 6: Optional Measure Stratification – Screenshot 1 ............................................... 3
Figure 7: Optional Measure Stratification – Screenshot 2 ............................................... 4

List of Tables
No table of figures entries found.

CQM 2017 - Dental Sealants for 6-9 Year Old Children at Elevated Caries Risk (SEAL) Core Measure PRA Document
Version 1.0
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Measurement Specifications – Path 1

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

Measurement Specifications – Path 1

Figure 1: Measurement Specifications – Path 1

1.2

Measurement Specifications – Path 2

Figure 2: Measurement Specifications – Path 2

1.3

Data Source

Figure 3 : Data Source

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1.4

Performance Measure

Performance Measure

Figure 4: Performance Measure

1.5

Deviations from Measure Specifications

Figure 5: Deviations from Measure Specifications

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CMS XLC

1.6

Optional Measure Stratification – Screenshot 1

Optional Measure Stratification – Screenshot 1

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

Figure 6: Optional Measure Stratification – Screenshot 1

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Version 1.0
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CMS XLC

1.7

Optional Measure Stratification – Screenshot 2

Optional Measure Stratification – Screenshot 2

Figure 7: 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 2017 - Dental Sealants for 6-9 Year Old Children at Elevated Caries Risk (SEAL) Core Measure PRA Document
Version 1.0
5

08/30/2017

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

Medicaid and CHIP Program (MACPro)
CQM 2017 - Child and Adolescent Major
Depressive Disorder (MDD): Suicide Risk
Assessment (SRA) Core Measure PRA Document
Version 1.0
08/29/2017

Document Number: 280-QSSI-MACPro-PRA-CQM2017-SRA-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk
Assessment (SRA) Screenshots ............................................................................ 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7

Measurement Specifications – Path 1 ............................................................. 1
Measurement Specifications – Path 2 ............................................................. 1
Data Source .................................................................................................... 1
Performance Measure ..................................................................................... 2
Deviations from Measure Specifications ......................................................... 2
Optional Measure Stratification – Screenshot 1 .............................................. 3
Optional Measure Stratification – Screenshot 2 .............................................. 4

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

List of Figures
Figure 1: Measurement Specifications – Path 1 .............................................................. 1
Figure 2: Measurement Specifications – Path 2 .............................................................. 1
Figure 3 : Data Source .................................................................................................... 1
Figure 4: Performance Measure ...................................................................................... 2
Figure 6: Deviations from Measure Specifications .......................................................... 2
Figure 8 : Optional Measure Stratification – Screenshot 1 .............................................. 3
Figure 9: Optional Measure Stratification – Screenshot 2 ............................................... 4

List of Tables
No table of figures entries found.

CQM 2017 - Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk Assessment (SRA) Core Measure PRA Document Version
1.0
i
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CMS XLC

Measurement Specifications – Path 1

1. Child and Adolescent Major Depressive Disorder
(MDD): Suicide Risk Assessment (SRA) 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 2017 - Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk Assessment (SRA) Core Measure PRA Document Version
1.0
1
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CMS XLC

1.4

Performance Measure

Performance Measure

Figure 4: Performance Measure

1.5

Deviations from Measure Specifications

Figure 5: Deviations from Measure Specifications

CQM 2017 - Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk Assessment (SRA) Core Measure PRA Document Version
1.0
2
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CMS XLC

1.6

Optional Measure Stratification – Screenshot 1

Optional Measure Stratification – Screenshot 1

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

Figure 6: Optional Measure Stratification – Screenshot 1

CQM 2017 - Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk Assessment (SRA) Core Measure PRA Document Version
1.0
3
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CMS XLC

1.7

Optional Measure Stratification – Screenshot 2

Optional Measure Stratification – Screenshot 2

Figure 7: Optional Measure Stratification – Screenshot 2

CQM 2017 - Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk Assessment (SRA) Core Measure PRA Document Version
1.0
4
08/29/2017

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 2017 - Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk Assessment (SRA) Core Measure PRA Document Version
1.0
5
08/29/2017

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

Medicaid and CHIP Program (MACPro)
CQM 2017 - State-Specific Measures PRA
Document
Version 1.0
08/30/2017

Document Number: 315-QSSI-MACPro-PRA-CQM017-StateSpecific-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. State-Specific Measures Screenshots ................................................................... 1
1.1

Report Documents .......................................................................................... 1

Appendix A: Acronyms ................................................................................................. 2

List of Figures
Figure 1: Report Documents ........................................................................................... 1

List of Tables
No table of figures entries found.

CQM 2017 - State-Specific Measures PRA Document Version 1.0

i

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CMS XLC

Report Documents

1. State-Specific Measures Screenshots
1.1

Report Documents

Figure 1: Report Documents

CQM 2017 - State-Specific Measures PRA Document Version 1.0

1

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CMS XLC

Report Documents

Appendix A: Acronyms
Table 1: Acronyms
Acronym

Definition

CQM

Child Quality Measures

PRA

Paperwork Reduction Act of 1995

CQM 2017 - State-Specific Measures PRA Document Version 1.0

2

08/30/2017

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

Medicaid and CHIP Program (MACPro)
CQM 2017 - Well-Child Visits in the First 15
Months of Life (W15) Core Measure PRA
Document
Version 1.0
08/26/2017

Document Number: 270-QSSI-MACPro-PRA-CQM2017-W15-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) 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
Performance Measure - Path 1 – Screenshot 1 .............................................. 2
Performance Measure - Path 1 – Screenshot 2 .............................................. 2
Performance Measure - Path 2 – Screenshot 1 .............................................. 3
Performance Measure - Path 2 – Screenshot 2 .............................................. 3
Deviations from Measure Specifications – Screenshot 1 ................................ 4
Deviations from Measure Specifications – Screenshot 2 ................................ 4
Deviations from Measure Specifications – Screenshot 3 ................................ 5
Deviations from Measure Specifications – Screenshot 4 ................................ 5
Deviations from Measure Specifications – Screenshot 5 ................................ 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: Performance Measure - Path 1 – Screenshot 1 ............................................... 2
Figure 5: Performance Measure - Path 1 – Screenshot 2 ............................................... 2
Figure 6: Performance Measure - Path 2 – Screenshot 1 ............................................... 3
Figure 7: Performance Measure - Path 2 – Screenshot 2 ............................................... 3
Figure 8: Deviations from Measure Specifications – Screenshot 1 ................................. 4
Figure 9: Deviations from Measure Specifications – Screenshot 2 ................................. 4
Figure 10: Deviations from Measure Specifications – Screenshot 3 ............................... 5
Figure 11: Deviations from Measure Specifications – Screenshot 4 ............................... 5
Figure 12: Deviations from Measure Specifications – Screenshot 5 ............................... 6
Figure 13 : Optional Measure Stratification – Screenshot 1 ............................................ 6

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List of Tables

Figure 14: Optional Measure Stratification – Screenshot 2 ............................................. 7

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 (W15)
Screenshots
1.1

Measurement Specifications – Path 1

Figure 1: Measurement Specifications – Path 1

1.2

Measurement Specifications – Path 2

Figure 2: Measurement Specifications – Path 2

1.3

Data Source

Figure 3 : Data Source

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1.4

Performance Measure - Path 1 – Screenshot 1

Performance Measure - Path 1 – Screenshot 1

Figure 4: Performance Measure - Path 1 – Screenshot 1

1.5

Performance Measure - Path 1 – Screenshot 2

Figure 5: Performance Measure - Path 1 – Screenshot 2

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1.6

Performance Measure - Path 2 – Screenshot 1

Performance Measure - Path 2 – Screenshot 1

Figure 6: Performance Measure - Path 2 – Screenshot 1

1.7

Performance Measure - Path 2 – Screenshot 2

Figure 7: Performance Measure - Path 2 – Screenshot 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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Deviations from Measure Specifications – Screenshot 3

1.10 Deviations from Measure Specifications – Screenshot 3

Figure 10: Deviations from Measure Specifications – Screenshot 3

1.11 Deviations from Measure Specifications – Screenshot 4

Figure 11: Deviations from Measure Specifications – Screenshot 4

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Deviations from Measure Specifications – Screenshot 5

1.12 Deviations from Measure Specifications – Screenshot 5

Figure 12: Deviations from Measure Specifications – Screenshot 5

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

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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Services
CMS eXpedited Life Cycle (XLC)

Medicaid and CHIP Program (MACPro)
CQM 2017 - Well-Child Visits in the Third, Fourth,
Fifth, and Sixth Years of Life (W34) Core Measure
PRA Document
Version 1.0
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Document Number: 271-QSSI-MACPro-PRA-CQM2017-W34-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

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Table of Contents

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

Measurement Specifications – Path 1 ............................................................. 1
Measurement Specifications – Path 2 ............................................................. 1
Data Source .................................................................................................... 1
Performance Measure ..................................................................................... 2
Deviations from Measure Specifications ......................................................... 2
Optional Measure Stratification – Screenshot 1 .............................................. 3
Optional Measure Stratification – Screenshot 2 .............................................. 4

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

List of Figures
Figure 1: Measurement Specifications – Path 1 .............................................................. 1
Figure 2: Measurement Specifications – Path 2 .............................................................. 1
Figure 3 : Data Source .................................................................................................... 1
Figure 4: Performance Measure - Path 1 ........................................................................ 2
Figure 5: Deviations from Measure Specifications .......................................................... 2
Figure 6: Optional Measure Stratification – Screenshot 1 ............................................... 3
Figure 7: Optional Measure Stratification – Screenshot 2 ............................................... 4

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) Screenshots
1.1

Measurement Specifications – Path 1

Figure 1: Measurement Specifications – Path 1

1.2

Measurement Specifications – Path 2

Figure 2: Measurement Specifications – Path 2

1.3

Data Source

Figure 3 : Data Source

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1.4

Performance Measure

Performance Measure

Figure 4: Performance Measure - Path 1

1.5

Deviations from Measure Specifications

Figure 5: Deviations from Measure Specifications

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1.6

Optional Measure Stratification – Screenshot 1

Optional Measure Stratification – Screenshot 1

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

Figure 6: Optional Measure Stratification – Screenshot 1

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1.7

Optional Measure Stratification – Screenshot 2

Optional Measure Stratification – Screenshot 2

Figure 7: 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 2017 - WCC Core Measure PRA Document
Version 1.0
08/28/2017

Document Number: 272-QSSI-MACPro-PRA-CQM2017-WCC-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. WCC Screenshots .................................................................................................... 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9

Measurement Specifications – Path 1 ............................................................. 1
Measurement Specifications – Path 2 ............................................................. 1
Data Source .................................................................................................... 1
Performance Measure- Path 1 ........................................................................ 2
Performance Measure- Path 2 ........................................................................ 2
Deviations from Measure Specifications – Screenshot 1 ................................ 3
Deviations from Measure Specifications – Screenshot 2 ................................ 3
Optional Measure Stratification – Screenshot 1 .............................................. 4
Optional Measure Stratification – Screenshot 2 .............................................. 5

Appendix A: Acronyms ................................................................................................. 6

List of Figures
Figure 1: Measurement Specifications – Path 1 .............................................................. 1
Figure 2: Measurement Specifications – Path 2 .............................................................. 1
Figure 3 : Data Source .................................................................................................... 1
Figure 4: Performance Measure- Path 1 ......................................................................... 2
Figure 5: Performance Measure - Path 2 ........................................................................ 2
Figure 6: Deviations from Measure Specifications – Screenshot 1 ................................. 3
Figure 7: Deviations from Measure Specifications – Screenshot 2 ................................. 3
Figure 8 : Optional Measure Stratification – Screenshot 1 .............................................. 4
Figure 9: Optional Measure Stratification – Screenshot 2 ............................................... 5

List of Tables
No table of figures entries found.

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Measurement Specifications – Path 1

1. WCC Screenshots
1.1

Measurement Specifications – Path 1

Figure 1: Measurement Specifications – Path 1

1.2

Measurement Specifications – Path 2

Figure 2: Measurement Specifications – Path 2

1.3

Data Source

Figure 3 : Data Source

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1.4

Performance Measure- Path 1

Performance Measure- Path 1

Figure 4: Performance Measure- Path 1

1.5

Performance Measure- Path 2

Figure 5: Performance Measure - Path 2

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1.6

Deviations from Measure Specifications – Screenshot 1

Deviations from Measure Specifications – Screenshot 1

Figure 6: Deviations from Measure Specifications – Screenshot 1

1.7

Deviations from Measure Specifications – Screenshot 2

Figure 7: Deviations from Measure Specifications – Screenshot 2

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1.8

Optional Measure Stratification – Screenshot 1

Optional Measure Stratification – Screenshot 1

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

Figure 8 : Optional Measure Stratification – Screenshot 1

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1.9

Optional Measure Stratification – Screenshot 2

Optional Measure Stratification – Screenshot 2

Figure 9: 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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