Federal Register / Vol. 75, No. 250 / Thursday, December 30, 2010 / Notices 82397 

9300 for TDD Relay/1–800–877–8339 

for toll free. 

Jean H. Ellen, 

Chief Docket Clerk. 

[FR Doc. 2010–33038 Filed 12–28–10; 11:15 am] 

BILLING CODE 6735–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Office of the Secretary 

[CMS–2420–NC] 

Medicaid Program: Initial Core Set of 

Health Quality Measures for MedicaidEligible Adults 

AGENCY: Office of the Secretary, HHS. 

ACTION: Notice with comment period. 

SUMMARY: This notice identifies an 

initial core set of health quality 

measures recommended for Medicaideligible adults, as required by section 

2701 of the Affordable Care Act, for 

voluntary use by State programs 

administered under title XIX of the 

Social Security Act (the Act), health 

insurance issuers and managed care 

entities that enter into contracts with 

Medicaid, and providers of items and 

services under these programs. This 

notice also solicits comments on these 

initial measures, on facilitating the use 

of these measures by States and on 

identifying priority areas for measure 

enhancement and development. 

DATES: To be assured consideration, 

comments must be received at one of 

the addresses provided below, no later 

than 5 p.m. on March 1, 2011. 

ADDRESSES: Because of staff and 

resource limitations, we cannot accept 

comments by facsimile (FAX) 

transmission. 

You may submit comments in one of 

two ways (please choose only one of the 

ways listed): 

1. Electronic Mail. 

medicaidadultmeasures@ahrq.hhs.gov. 

2. Regular Mail. Agency for 

Healthcare Research and Quality, 

Attention: Nancy Wilson, Immediate 

Office of the Director, Room 3028, 540 

Gaither Road, Rockville, MD 20850. 

FOR FURTHER INFORMATION CONTACT: 

Nancy Wilson, M.D., M.P.H., 

Coordinator of the Advisory Council 

Subcommittee, at the Agency for 

Healthcare Research and Quality, 540 

Gaither Road, Rockville, MD 20850, 

(301) 427–1310. For press-related 

information, please contact Karen 

Migdail at (301) 427–1855. 

SUPPLEMENTARY INFORMATION: 

I. Background 

On March 23, 2010, President Obama 

signed into law the Patient Protection 

and Affordable Care Act (Affordable 

Care Act) (Pub. L. 111–148). Section 

2701 of the Affordable Care Act added 

new section 1139B to the Social 

Security Act (the Act); section 1139B(a) 

of the Act now mandates that the 

Secretary of Health and Human Services 

(HHS) identify and publish for public 

comment a recommended initial core 

set of health quality measures for 

Medicaid eligible adults. Section 

1139B(b) of the Act, as added by section 

2701 of the Affordable Care Act, 

requires that a recommended initial core 

set be published for public comment by 

January 1, 2011, and that an initial core 

set be published by January 1, 2012. 

In addition, the Affordable Care Act 

mandates that HHS should complete the 

following actions 

—By January 1, 2012: 

• Establish a Medicaid Quality 

Measurement Program to fund 

development, testing, and validation of 

emerging and innovative evidencebased measures. 

—By January 1, 2013: 

• Develop a standardized reporting 

format on the core set and procedures to 

encourage voluntary reporting by the 

States. 

—By January 1, 2014: 

• Annually publish recommended 

changes to the initial core set that shall 

reflect the results of the testing, 

validation, and consensus process for 

the development of adult health quality 

measures. 

—By September 30, 2014: 

• Collect, analyze, and make publicly 

available the information reported by 

the States as required in section 

1139B(d)(1) of the Act. 

Additionally, the statute requires the 

initial core set recommendation to 

consist of existing adult health quality 

measures that are in use under public 

and privately sponsored health care 

coverage arrangements or are part of 

reporting systems that measure both the 

presence and duration of health 

insurance coverage over time and that 

may be applicable to Medicaid-eligible 

adults. 

II. Method for Determining Proposed 

Initial Core Set of Adult Health Quality 

Measures 

The Affordable Care Act parallels the 

requirement under title IV of the 

Children’s Health Insurance Program 

Reauthorization Act (Pub. L. 111–3) to 

identify and publish a recommended 

initial core set of quality measures for 

children in Medicaid and the Children’s 

Health Insurance Program. A similar 

process was used to identify the 

proposed initial core set of adult health 

quality measures. To facilitate an 

evidence-based and transparent process 

for making recommendations, the 

National Advisory Council of the 

Agency for Healthcare Research and 

Quality (AHRQ) created a subcommittee 

(the Subcommittee) for identifying 

quality measures for Medicaid-eligible 

adults. The Subcommittee consisted of 

State Medicaid representatives, health 

care quality experts, and representatives 

of health professional organizations and 

associations. The Subcommittee held a 

public meeting October 18th and 19th 

and considered public comments. The 

Subcommittee’s advice was reported to 

the Chair of AHRQ’s National Advisory 

Council and considered further by the 

Centers for Medicare & Medicaid 

Services (CMS) and staff in the Office of 

the Secretary of HHS prior to this public 

posting. 

The initial core set was developed by 

reviewing measures from nationally 

recognized sources, including measures 

currently endorsed by the National 

Quality Forum (NQF), measures 

submitted by Medicaid medical 

directors, measures currently in use by 

CMS, and measures suggested by the 

Co-Chairs and members of the 

Subcommittee of AHRQ’s National 

Advisory Council. 

In prioritizing measures, the 

Subcommittee considered the needs of 

adults (ages 18 and older) enrolled in 

Medicaid. To help guide the discussion 

of priority health needs within the adult 

populations covered by Medicaid, the 

Subcommittee was divided into four 

workgroups—Maternal/Reproductive 

Health, Overall Adult Health, Complex 

Health Care Needs, and Mental Health 

and Substance Use. The workgroups 

considered potential measurement 

opportunities across the Institute of 

Medicine’s (IOM) eight domains of 

quality: Safe, timely, effective, efficient, 

access, patient and family centeredness, 

care coordination, and infrastructure 

capabilities for health care. The 

Subcommittee also considered how 

health care equity and value (also from 

the IOM) could be reflected in the initial 

measurement set. Ultimately, the 

Subcommittee used the following three 

criteria in voting on the recommended 

measures for the core set: 

• The scientific acceptability of 

measure properties. 

• Feasibility of use by Medicaid. 

• Importance to Medicaid programs. 

The Subcommittee also considered 

whether the measures were currently 

used in other Medicaid quality 


jlentini on DSKJ8SOYB1PROD with NOTICES
82398 Federal Register / Vol. 75, No. 250 / Thursday, December 30, 2010 / Notices 

measurement efforts (for example, three 

maternity care measures included in the 

initial core set of children’s quality 

measures, and measures designated for 

inclusion in the Medicare and Medicaid 

Electronic Health Record Incentive 

Payment Programs). The Subcommittee 

identified many measures that were 

cross-cutting and relevant to the entire 

adult Medicaid population. In the end, 

the Subcommittee identified a set of 51 

measures to recommend as the initial 

core set of adult quality measures. 

We are now soliciting public 

comments on the recommended initial 

core set of adult quality measures. 

Specifically, we seek comment on 

whether any measures should be added 

or deleted from the initial core set, the 

reporting burden, which measures may 

need further development, and the types 

of technical assistance and other 

resources States may need to implement 

these measures. We also are interested 

in feedback on how many measures are 

feasible and realistic for a State to 

collect and use in its monitoring of 

quality of care. We are trying to strike 

a balance between the need for State 

data to monitor and improve quality and 

an interest in minimizing the reporting 

burden on States and providers by 

aligning with other quality reporting 

and incentive initiatives. 

HHS will be making improvements 

and enhancements to the core set as a 

result of public comments on the initial 

recommended core measure set. To 

further these efforts, AHRQ and CMS 

are working to identify ways to align 

State reporting requirements with other 

HHS quality reporting initiatives and 

requirements; coordinate quality 

measurement efforts with payment 

reform strategies, health information 

technology, and electronic health record 

initiatives; and identify priority areas 

for the development of new measures. 

States will also receive technical 

assistance to facilitate implementation 

of the measures. The initial core set of 

adult quality measures, as required by 

the Affordable Care Act, will serve as 

the groundwork for creating a 

standardized approach to better 

understand the quality of care adults in 

Medicaid receive, improve how this 

care is measured, and create 

opportunities to impact health 

outcomes. 

III. The Draft Initial Core Set of Health 

Quality Measures for Medicaid-Eligible 

Adults 

The list of measures in the 

accompanying table of measures was 

developed on the basis of advice from 

the Subcommittee. For additional 

information, see the background paper 

at http://ahrq.hhs.gov/. 

Respondents commenting on the 

measurement set are encouraged to: 

• Specify which of the measures are 

being addressed. 

• Explain the reasoning behind their 

comment. 

In addition, we invite comments on 

ways to enhance the initial core set of 

measures so they can be implemented 

efficiently and accurately across all 

Medicaid programs, providers, and 

enrollees. 

IV. Collection of Information 

Requirements 

This document does not impose 

information collection and recordkeeping requirements. Consequently, it 

need not be reviewed by the Office of 

Management and Budget under the 

authority of the Paperwork Reduction 

Act of 1995 (44 U.S.C. Chapter 35). 

V. Regulatory Impact Statement 

In accordance with the provisions of 

Executive Order 12866, this notice was 

reviewed by the Office of Management 

and Budget. 

Authority: Sections XIX and XXI of the 

Social Security Act (42 U.S.C. 13206 through 

9a). 

Dated: November 17, 2010. 

Donald M. Berwick, 

Administrator, Centers for Medicare & 

Medicaid Services. 

Approved: December 20, 2010. 

Kathleen Sebelius, 

Secretary, Health and Human Services. 

Measures Recommended for Initial 

Core Set of Health Quality Measures for 

Medicaid-Eligible Adults 

This table of the recommended initial 

core measure set includes National 

Quality Forum (NQF) identifying 

numbers for measures that have been 

endorsed, provides the measure owners, 

and indicates those measures that have 

been designated for inclusion in the 

Medicare & Medicaid Electronic Health 

Record Incentive Payment Programs for 

eligible health care professionals and 

hospitals that adopt certified Electronic 

Health Record technology under the 

Final Rule published in the July 28, 

2010 Federal Register (75 FR 44314). 

Number NQF 

ID† Measure owner Measure name EHR ‡ 

Prevention & Health Promotion 

1 ........... 0039 .... NCQA ................................................ Flu Shots for Adults Ages 50–64 (Collected as part of HEDIS CAHPS 

Supplemental Survey).

2 ........... 0421 .... CMS ................................................... Adult Weight Screening and Follow up ......................................................... X 

3 ........... 0031 .... NCQA ................................................ Breast Cancer Screening .............................................................................. X 

4 ........... 0032 .... NCQA ................................................ Cervical Cancer Screening ............................................................................ X 

5 ........... NA ....... RAND ................................................. Alcohol Misuse: Screening, Brief Intervention, Referral for Treatment .........

6 ........... 0027 .... NCQA ................................................ Medical Assistance With Smoking and Tobacco Use Cessation ................. X 

7 ........... 0418 .... CMS ................................................... Screening for Clinical Depression and Followup Plan ..................................

8 ........... NA ....... NCQA ................................................ Plan All-Cause Readmission. 

9 ........... 0272 .... AHRQ ................................................ PQI 01: Diabetes, short-term complications ..................................................

10 ......... 0273 .... AHRQ ................................................ PQI 02: Perforated appendicitis. 

11 ......... 0274 .... AHRQ ................................................ PQI 03: Diabetes, long-term complications ...................................................

12 ......... 0275 .... AHRQ ................................................ PQI 05: Chronic obstructive pulmonary disease ...........................................

13 ......... 0276 .... AHRQ ................................................ PQI 07: Hypertension. 

14 ......... 0277 .... AHRQ ................................................ PQI 08: Congestive heart failure. ..................................................................

15 ......... 0280 .... AHRQ ................................................ PQI 10: Dehydration ......................................................................................

16 ......... 0279 .... AHRQ ................................................ PQI 11: Bacterial pneumonia ........................................................................

17 ......... 0281 .... AHRQ ................................................ PQI 12: Urinary Tract Infection Admission Rate ...........................................

18 ......... 0282 .... AHRQ ................................................ PQI 13: Angina without procedure. 

19 ......... 0638 .... AHRQ ................................................ PQI 14: Uncontrolled Diabetes Admission Rate ...........................................

20 ......... 0283 .... AHRQ ................................................ PQI 15: Adult asthma. 


jlentini on DSKJ8SOYB1PROD with NOTICES
Federal Register / Vol. 75, No. 250 / Thursday, December 30, 2010 / Notices 82399 

Number NQF 

ID† Measure owner Measure name EHR ‡ 

21 ......... 0285 .... AHRQ ................................................ PQI 16: Lower extremity amputations among patients with diabetes ...........

Management of Acute Conditions 

22 ......... 0052 .... NCQA ................................................ Use of Imaging Studies for Low Back Pain .................................................. X 

23 ......... 0640 .... TJC .................................................... HBIPS—2 Hours of physical restraint use. 

24 ......... 0576 .... NCQA ................................................ Followup After Hospitalization for Mental Illness ..........................................

25 ......... 0476 .... Providence St. Vincent Medical Center.Appropriate Use of Antenatal Steroids. 

26 ......... 0469 .... Hospital Corporation of America ....... Elective delivery prior to 39 completed weeks gestation ..............................

27 ......... 0648 .... AMA–PCPI ......................................... Timely Transmission of Transition Record (Inpatient Discharges to Home/ 

Self-Care or Any Other Site of Care).

28 ......... 0647 .... AMA–PCPI ......................................... Transition Record With Specified Elements Received by Discharged Patients (Inpatient Discharges to Home/Self-Care or Any Other Site of 

Care).

Management of Chronic Conditions 

29 ......... 0071 .... NCQA ................................................ Persistence of Beta-Blocker Treatment After a Heart Attack .......................

30 ......... 0018 .... NCQA ................................................ Controlling High Blood Pressure ................................................................... X 

31 ......... 0074 .... AMA–PCPI ......................................... Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL Cholesterol.X 

32 ......... 0075 .... NCQA ................................................ Comprehensive Ischemic Vascular Disease Care: Complete Lipid Profile 

and LDL–C Control Rates.

X 

33 ......... 0063 .... NCQA ................................................ Diabetes: Lipid profile. 

34 ......... 0057 .... NCQA ................................................ Comprehensive Diabetes Care: Hemoglobin A1c testing .............................

35 ......... 0036 .... NCQA ................................................ Use of Appropriate Medications for People With Asthma ............................. X 

36 ......... 0403 .... NCQA ................................................ HIV/AIDS: Medical visit. 

37 ......... 0105 .... NCQA ................................................ Antidepressant Medication Management ...................................................... X 

38 ......... NA ....... RAND ................................................. Bipolar I Disorder 2: Annual assessment of weight or BMI, glycemic control, and lipids.

39 ......... NA ....... RAND ................................................. Bipolar I Disorder C: Proportion of patients with bipolar I disorder treated 

with mood stabilizer medications during the course of bipolar I disorder 

treatment.

40 ......... NA ....... RAND ................................................. Schizophrenia 2: Annual assessment of weight/BMI, glycemic control, 

lipids.

41 ......... NA ....... RAND ................................................. Schizophrenia B: Proportion of schizophrenia patients with long-term utilization of antipsychotic medications.

42 ......... NA ....... RAND ................................................. Schizophrenia C: Proportion of selected schizophrenia patients with 

antipsychotic polypharmacy utilization.

43 ......... 0021 .... NCQA ................................................ Annual Monitoring for Patients on Persistent Medications ...........................

44 ......... 0541 .... PQA ................................................... Proportion of Days Covered (PDC): 5 Rates by Therapeutic Category .......

Family Experiences of Care 

45 ......... 0006 .... AHRQ ................................................ CAHPS Health Plan Survey v 4.0—Adult Questionnaire ..............................

46 ......... 0007 .... NCQA ................................................ CAHPS Health Plan Survey v 4.0H—NCQA Supplemental items for 

CAHPS 4.0 Adult Questionnaire.

Availability 

47 ......... NA ....... NCQA ................................................ Ambulatory Care: Outpatient and Emergency Department Visits .................

48 ......... NA ....... NCQA ................................................ Inpatient Utilization: General Hospital/Acute Care ........................................

49 ......... 0004 .... NCQA ................................................ Initiation and Engagement of Alcohol and Other Drug Dependence Treatment.X 

50 ......... NA ....... NCQA ................................................ Mental Health Utilization. 

51 ......... NA ....... NCQA ................................................ Prenatal and Postpartum Care: Postpartum Care Rate ...............................

† NQF ID National Quality Forum identification numbers are used for measures that are NQF-endorsed; otherwise, NA is used. 

‡EHR Measures with an ‘‘X’’ are included in the Medicare and Medicaid Electronic Health Record Incentive Payment Program and may be collected through electronic health records. Specifications for these measures are available from the Centers for Medicare & Medicaid Services 

Web site at: http://www.cms.gov/QualityMeasures/03_ElectronicSpecifications.asp#TopOfPage. 

[FR Doc. 2010–32978 Filed 12–29–10; 8:45 am] 

BILLING CODE 4120–01–P 


jlentini on DSKJ8SOYB1PROD with NOTICES