Measure Qualifications: Please note: This measure has been modified to remove consideration of the metropolitan or county area and instead will monitor the attributed DSRIP population. The following link(s) may be used to obtain additional information regarding the original measure specifications. This is provided without assurances: Measure Collection Description Setting of Care: Inpatient or Emergency Department Reporting Period: Annual; April Experience Period: 12 month period Baseline Period: CY 2017 Claim Type(s): 01, 14 01 – Inpatient Hospital 02 – Long Term Care 03 – Outpatient Hospital 04 – Physician 05 – Chiropractor 06 – Home Health 07 – Transportation 08 – Vision 09 – Supplies, DME 10 – Podiatry 11 – Dental 12 – Pharmacy 13 – EPDST/Healthstart 14 – Institutional Crossover 15 – Professional Crossover 16 – Lab 17 – Prosthetic and Orthotics 18 – Independent Clinic 19 – Psychologists 21 – Optometrists 22 – Mid Level Practitioner 23 – Hearing Aid Continuous Eligibility Period: No Risk Adjustment: No Sampling: No Continuous Eligibility/ Risk Adjustment/ Sampling Methodology: N/A DSRIP Incentive Impact Project Title: NA Project Code: NA Payment Method: NA Universal Measure: No Universal Code: NA Payment Method: NA Stage 1 Measure: Yes Code: NA Payment Method: P4R Measure: Adults’ Access to Preventive/Ambulatory Health Services DSRIP #: 105 Measure Description: The percentage of members 20 years and older who had an ambulatory or preventive care visit. Report 3 age range stratifications and the total, ages 20-44, 45-64 and 65+ years of age. Data Source: MMIS NQF #: Not Found Measure Steward: NCQA Measure Steward Version: 2017 Measure Calculation Description Numerator:
One or more ambulatory or preventive care visits (Appendix A 214 and Appendix A S1-10) during the measurement year. Denominator: Of the attributable New Jersey Low Income population, those patients ages 20 years or older as of December 31 of the measurement year. Result: The result is expressed as a percentage. Improvement Direction: Higher Measure Qualifications: The following link(s) may be used to obtain additional information regarding the original measure specification. This is provided without assurances: Measure Collection Description Setting of Care: Outpatient Reporting Period: Annual; April Experience Period: Calendar Year Baseline Period: CY 2014 Claim Type(s): 04, 18 01 – Inpatient Hospital 02 – Long Term Care 03 – Outpatient Hospital 04 – Physician 05 – Chiropractor 06 – Home Health 07 – Transportation 08 – Vision 09 – Supplies, DME 10 – Podiatry 11 – Dental 12 – Pharmacy 13 – EPDST/Healthstart 14 – Institutional Crossover 15 – Professional Crossover 16 – Lab 17 – Prosthetic and Orthotics 18 – Independent Clinic 19 – Psychologists 21 – Optometrists 22 – Mid Level Practitioner 23 – Hearing Aid Continuous Eligibility Period: Yes Risk Adjustment: No Sampling: No Continuous Eligibility/ Risk Adjustment/ Sampling Methodology: The patient is to be continuously enrolled for the measurement year with no more than a 45 day gap during the year. DSRIP Incentive Impact Project Title: NA Project Code: NA Payment Method: NA Universal Measure: NA Universal Code: NA Payment Method: NA Stage 1 Measure: Yes Code: NA Payment Method: P4R Measure: Annual Dental Visit DSRIP #: 106
Setting of Care: Outpatient Reporting Period: Annual; April Experience Period: Calendar Year Baseline Period: CY 2017 Claim Type(s): 11 01 – Inpatient Hospital 02 – Long Term Care 03 – Outpatient Hospital 04 – Physician 05 – Chiropractor 06 – Home Health 07 – Transportation 08 – Vision 09 – Supplies, DME 10 – Podiatry 11 – Dental 12 – Pharmacy 13 – EPDST/Healthstart 14 – Institutional Crossover 15 – Professional Crossover 16 – Lab 17 – Prosthetic and Orthotics 18 – Independent Clinic 19 – Psychologists 21 – Optometrists 22 – Mid Level Practitioner 23 – Hearing Aid Continuous Eligibility Period: Yes Risk Adjustment: No Sampling: No Continuous Eligibility/ Risk Adjustment/ Sampling Methodology: The patient is to be continuously enrolled for the measurement year with no more than a 45 day gap during the year. DSRIP Incentive Impact Project Title: NA Project Code: NA Payment Method: NA Universal Measure: NA Universal Code: NA Payment Method: NA Stage 1 Measure: Yes Code: NA Payment Method: P4R Measure: Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics DSRIP #: 107 Measure Description: The percentage of members 1–17 years of age who had a new prescription for an antipsychotic medication and had documentation of psychosocial care as first line treatment. Report 3 age stratifications and a total rate: 1 – 5 years 6 – 11 years 12 - 17 years Total Data Source: MMIS/PHARM NQF #: 2801 Measure Steward: NCQA Measure Steward Version: 2017 Measure Calculation Description Numerator: Documentation of psychosocial care (Appendix A S1-11) in the 121-day period from 90 days prior to the Index Prescription Start Date (IPSD) through 30 days after the IPSD. Exclusion(s):
Measure Collection Description Setting of Care: N/A Reporting Period: Annual; April Experience Period: 12 month period Baseline Period: CY 2018 Continuous Eligibility Period: No Risk Adjustment: No Sampling: No Continuous Eligibility/ Risk Adjustment/ Sampling Methodology: N/A DSRIP Incentive Impact Project Title: NA Project Code: NA Payment Method: NA Universal Measure: No Universal Code: NA Payment Method: NA Stage 1 Measure: Yes Code: NA Payment Method: P4R Measure: Potentially Avoidable Emergency Room Visits DSRIP #: 108 Measure Description: This measure is used to assess the number of emergency room visits that were potentially avoidable, defined as ER visits that could have been prevented or managed with better ambulatory care, per 1,000. Data Source: MMIS NQF #: N/A Measure Steward: 3M Measure Steward Version: TBD Measure Calculation Description Numerator: All emergency room visits that were potentially avoidable and could been prevented or managed with better ambulatory care. These specifications were developed by 3M and are proprietary. Further details are forthcoming. Denominator: Of the hospital’s attributable New Jersey Low Income population, those patients who visited the Emergency Room in the measurement year. Result: The result is expressed as a rate. The rate will be expressed as the number of admits per 1,000 in each attributable population per hospital.