[Federal Register Volume 75, Number 250 (Thursday, December 30, 2010)]
[Notices]
[Pages 82397-82399]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-32978]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Office of the Secretary

[CMS-2420-NC]


Medicaid Program: Initial Core Set of Health Quality Measures for 
Medicaid-Eligible Adults

AGENCY: Office of the Secretary, HHS.

ACTION: Notice with comment period.

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SUMMARY: This notice identifies an initial core set of health quality 
measures recommended for Medicaid-eligible 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. <a href="/cdn-cgi/l/email-protection#365b53525f55575f525752435a425b5357454344534576575e4447185e5e4518515940"><span class="__cf_email__" data-cfemail="b0ddd5d4d9d3d1d9d4d1d4c5dcc4ddd5d1c3c5c2d5c3f0d1d8c2c19ed8d8c39ed7dfc6">[email protected]</span></a>.
    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:
    <bullet> Establish a Medicaid Quality Measurement Program to fund 
development, testing, and validation of emerging and innovative 
evidence-based measures.
--By January 1, 2013:
    <bullet> Develop a standardized reporting format on the core set 
and procedures to encourage voluntary reporting by the States.
--By January 1, 2014:
    <bullet> 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:
    <bullet> 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:
    <bullet> The scientific acceptability of measure properties.
    <bullet> Feasibility of use by Medicaid.
    <bullet> Importance to Medicaid programs.

The Subcommittee also considered whether the measures were currently 
used in other Medicaid quality

[[Page 82398]]

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:
    <bullet> Specify which of the measures are being addressed.
    <bullet> 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 record-
keeping 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).

------------------------------------------------------------------------
                 NQF                                               EHR
   Number    ID[dagger]   Measure owner       Measure name      [Dagger]
------------------------------------------------------------------------
                      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          X
                                           Screening and
                                           Follow up.
3..........  0031......  NCQA...........  Breast Cancer         X
                                           Screening.
4..........  0032......  NCQA...........  Cervical Cancer       X
                                           Screening.
5..........  NA........  RAND...........  Alcohol Misuse:       ........
                                           Screening, Brief
                                           Intervention,
                                           Referral for
                                           Treatment.
6..........  0027......  NCQA...........  Medical Assistance    X
                                           With Smoking and
                                           Tobacco Use
                                           Cessation.
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.

[[Page 82399]]

 
21.........  0285......  AHRQ...........  PQI 16: Lower         ........
                                           extremity
                                           amputations among
                                           patients with
                                           diabetes.
------------------------------------------------------------------------
                     Management of Acute Conditions
------------------------------------------------------------------------
22.........  0052......  NCQA...........  Use of Imaging        X
                                           Studies for Low
                                           Back Pain.
23.........  0640......  TJC............  HBIPS--2 Hours of     ........
                                           physical restraint
                                           use.
24.........  0576......  NCQA...........  Followup After        ........
                                           Hospitalization for
                                           Mental Illness.
25.........  0476......  Providence St.   Appropriate Use of    ........
                          Vincent          Antenatal Steroids.
                          Medical Center.
26.........  0469......  Hospital         Elective delivery     ........
                          Corporation of   prior to 39
                          America.         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      X
                                           Blood Pressure.
31.........  0074......  AMA-PCPI.......  Coronary Artery       X
                                           Disease (CAD): Drug
                                           Therapy for
                                           Lowering LDL
                                           Cholesterol.
32.........  0075......  NCQA...........  Comprehensive         X
                                           Ischemic Vascular
                                           Disease Care:
                                           Complete Lipid
                                           Profile and LDL-C
                                           Control Rates.
33.........  0063......  NCQA...........  Diabetes: Lipid       ........
                                           profile.
34.........  0057......  NCQA...........  Comprehensive         ........
                                           Diabetes Care:
                                           Hemoglobin A1c
                                           testing.
35.........  0036......  NCQA...........  Use of Appropriate    X
                                           Medications for
                                           People With Asthma.
36.........  0403......  NCQA...........  HIV/AIDS: Medical     ........
                                           visit.
37.........  0105......  NCQA...........  Antidepressant        X
                                           Medication
                                           Management.
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        X
                                           Engagement of
                                           Alcohol and Other
                                           Drug Dependence
                                           Treatment.
50.........  NA........  NCQA...........  Mental Health         ........
                                           Utilization.
51.........  NA........  NCQA...........  Prenatal and          ........
                                           Postpartum Care:
                                           Postpartum Care
                                           Rate.
------------------------------------------------------------------------
<SUP>[dagger]</SUP> NQF ID National Quality Forum identification numbers are used
  for measures that are NQF-endorsed; otherwise, NA is used.
<SUP>[Dagger]</SUP> 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


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