[Federal Register Volume 74, Number 248 (Tuesday, December 29, 2009)]
[Notices]
[Pages 68846-68849]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-30802]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Office of the Secretary
[CMS-2474-NC]
Medicaid and CHIP Programs; Initial Core Set of Children's
Healthcare Quality Measures for Voluntary Use by Medicaid and CHIP
Programs
AGENCY: Office of the Secretary, HHS.
ACTION: Notice with comment period.
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SUMMARY: This notice identifies and solicits public comments on the
initial, recommended core set of children's health care quality
measures for voluntary use by State programs administered under titles
XIX and XXI of the Social Security Act, health insurance issuers and
managed care entities that enter into contracts with Medicaid and
Children's Health Insurance Programs, and providers of items and
services under these programs, in accordance with the Children's Health
Insurance Program Reauthorization Act of 2009 (Pub. L. 111-3). This
notice also discusses steps already underway to facilitate the
programs' voluntary use of the children's health care quality measures.
In addition, this notice solicits comments on how the steps might be
enhanced, and recommendations for additional steps to facilitate use of
the measures.
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, 2010.
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. [email protected].
2. Regular Mail. Agency for Healthcare Research and Quality,
Attention: Office of Extramural Research, Education, and Priority
Populations--Public Comment, CHIPRA Core Measures, 540 Gaither Rd.,
Rockville, MD 20850.
Please note that all submissions may be posted without change to
http://www.AHRQ.gov, including any personal information provided.
FOR FURTHER INFORMATION CONTACT: [email protected].
SUPPLEMENTARY INFORMATION:
I. Background
On February 4, 2009, the Congress enacted the Children's Health
Insurance Program Reauthorization Act (CHIPRA) of 2009 (Pub. L. 111-3).
Section 401(a) of the legislation amended the Social Security Act (the
Act), to establish section 1139A (42 U.S.C. 1320b-9a). This section
requires the Secretary to identify and publish for general comment an
initial, recommended core set of child health quality measures for use
by State programs administered under titles XIX and XXI of the Act,
health insurance issuers and managed care entities that enter into
contracts with such programs, and providers of items and services under
such programs. The statute requires that the
[[Page 68847]]
Secretary identify and publish these measures by January 1, 2010. The
Secretary delegated this task to the Centers for Medicare & Medicaid
Services (CMS). A ``Memorandum of Understanding'' was signed with the
Agency for Healthcare Research and Quality (AHRQ), by which CMS and
AHRQ would collaborate to make recommendations for the initial core set
of children's health care quality measures to be posted for public
comment. The initial core set is intended to be used voluntarily by
Medicaid and the Children's Health Insurance Program (CHIP).
The initial core set of children's health care quality measures for
voluntary use by Medicaid and CHIP programs was developed in
consultation with organizations representing the stakeholder categories
set out at section 1139A(b)(3) of the Act (including States; health
care providers specializing in pediatric health and dentistry; health
care providers that furnish primary health care to children and
families who live in urban and rural medically underserved communities
or who are members of distinct population sub-groups at heightened risk
for poor health outcomes; national organizations representing children
and families; individuals and organizations with health care quality
measurement expertise; and other organizations involved in the
advancement of evidence-based measures of health care).
Measures for consideration for the initial core set were compiled
from ``existing quality of care measures for children that are in use
under public and privately sponsored health care coverage arrangements,
or that are part of reporting systems that measure both the presence
and duration of health insurance coverage over time'' as required by
section 1139A(a)(2) of the Act.
The statute requires that the initial core set of child health
quality measures include the following:
1. The duration of children's health insurance coverage over a 12-
month time period.
2. The availability and effectiveness of a full range of preventive
services, treatments, and services for acute conditions, including
services to promote healthy birth, prevent and treat premature birth,
and detect the presence or risk of physical or mental conditions that
could adversely affect growth and development; and treatments to
correct or ameliorate the effects of physical and mental conditions,
including chronic conditions in infants, young children, school-age
children, and adolescents.
3. The availability of care in a range of ambulatory and inpatient
health care settings in which such care is furnished.
4. The types of measures that, taken together, can be used to
estimate the overall national quality of health care for children,
including children with special needs, and to perform comparative
analyses of pediatric health care quality and racial, ethnic, and
socioeconomic disparities in child health and health care for children.
To help facilitate an evidence-informed and transparent process for
making recommendations, AHRQ's National Advisory Council on Healthcare
Research and Quality created a Subcommittee on Children's Healthcare
Quality Measures for Medicaid and CHIP programs (the ``Subcommittee'').
The Subcommittee held public meetings, and considered public comments
and measure nominations throughout their deliberations. Subcommittee
members were provided with standard definitions, criteria, and
objective information to facilitate scoring of measures for validity,
feasibility, and importance over several iterations of measure
consideration. The Subcommittee's recommendations were reported to the
Chair of AHRQ's National Advisory Council on Healthcare Research and
Quality and subsequently considered further by Medicaid and CHIP
officials, as well as staff in the Office of the Secretary of the
Department of Health and Human Services (HHS) prior to this public
posting. Extensive details regarding the process, the measures
recommended, and other considerations regarding the initial core set
can be found at http://www.ahrq.gov/chip/corebackgrnd.htm. We are now
soliciting additional comments from the public to help determine which
measures should remain in the core set, which measures may need further
development to enhance their validity and feasibility, and the nature
of technical assistance and other resources required before State
Medicaid and CHIP programs and health care providers can be expected to
implement and report on these measures. In submitting comments, it is
important to consider the kinds of activities already under way at HHS
to facilitate making the measures more feasible and valid for use by
the States for reporting across all Medicaid and CHIP programs (for
example, managed care, fee-for-service and enrollees).
HHS will be making improvements and enhancements to the core set of
measures as a result of the following:
Public comment on the initial, recommended core measure
set.
Products developed by a pediatric quality measures program
of grants and contracts to begin in 2010 (section 1139A(b) of the Act).
Products stimulated by CMS's CHIPRA Quality Demonstration
Grants, including evaluation and experimentation with the measures and
development of an electronic health record format for children's health
care (section 1139A(d) of the Act).
Other advancements and improvements to children's health
care quality measures (such as annual quality reporting as required
under section 1139A(a)(4) of the Act).
Section 1139A(b)(5) of the Act directs that an improved, evidence-
based core measure set is to be available by January 1, 2013, to be
feasible for use by a broad range of providers, payers, and programs,
both public and private (42 U.S.C. 1320b-9a).
To further these efforts, AHRQ and CMS are currently working to
continue or implement the following initiatives:
1. Establishing methodologies to create measure specifications that
are applicable to all Medicaid and CHIP enrollees, and suitable for
identifying disparities in quality by race, ethnicity, socioeconomic
status, and special health care needs status, as required by CHIPRA.
2. Providing technical assistance to States to facilitate
implementation of the initial, recommended core measure set.
3. Using a public process for the pediatric quality measures grants
and contracts program to build on priorities identified during the 2009
identification of the initial, recommended core set. Priority topics
already identified include quality measures for: mental health and
substance abuse services for children, other specialty services,
inpatient care, duration of enrollment and coverage, medical home and
other integrated health care delivery mechanisms, and availability of
services.
4. Considering ways to align State reporting requirements across
CHIPRA provisions, with Early and Periodic Screening, Diagnostic and
Treatment Services (EPSDT) via CMS 416 reporting, and with annual
reporting requirements for CHIP.
5. Coordinating quality measurement efforts with payment reform
strategies, health information technology and electronic health record
initiatives, and
6. Working with States to identify the best formats for sharing
Medicaid and CHIP quality measurement data, including when and how
state reports should be made publicly available.
7. Continuing to work with States and national stakeholders to
develop
[[Page 68848]]
national intervention strategies for improving health care quality and
outcomes for children (for example, Medicaid Transformation Grants and
the CHIPRA Quality Demonstration Grants).
8. Continuing development and implementation of the Federal-State
National Quality Framework in alignment with CHIPRA initiatives for
improving the quality of care for children.
9. Due to the concurrent CHIPRA and American Recovery and
Reinvestment Act (ARRA) HIT implementation activities, CMS will align
the two programs and strive to create efficiencies for States and
pediatric providers, where applicable, by prioritizing consistency in
measure selection for pediatric providers.
II. Categories of the Initial, Recommended Core Set of Children's
Healthcare Quality Measures
The basic categories of the initial, recommended core set of
children's health care quality measures are set forth below. For full
specifications of each measure and summaries of the rationales behind
each recommended measure, see the background paper for this Federal
Register notice at http://www.ahrq.gov/chip/corebackgrnd.htm. Measures
that have received National Quality Forum (NQF) endorsement are
indicated with the relevant number.
Measures Recommended for Initial Core Set of Children's Healthcare
Quality for Voluntary Reporting by Medicaid and CHIP Programs, Measure
Labels by Legislative Category
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Legislative measure topic/Subtopic/
Measure number Current measure label
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PREVENTION AND HEALTH PROMOTION
Prenatal/Perinatal
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1................................. Frequency of ongoing prenatal care.
2................................. Timeliness of prenatal care--the
percentage of deliveries that
received a prenatal care visit as a
member of the organization in the
first trimester or within 42 days
of enrollment in the organization.
3................................. Percent of live births weighing less
than 2,500 grams.
4................................. Cesarean Rate for low-risk first
birth women [NQF 0471].
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Immunizations
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5................................. Childhood immunization status [NQF
0038].
6................................. Immunizations for adolescents.
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Screening
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7................................. BMI documentation 2-18 year olds
[NQF 0024].
8................................. Screening using standardized
screening tools for potential
delays in social and emotional
development--Assuring Better Child
Health and Development (ABCD)
initiative measures.
9................................. Chlamydia screening for women [NQF
0033].
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Well-child Care Visits (WCV)
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10................................ WCVs in the first 15 months of life.
11................................ WCVs in the third, fourth, fifth and
sixth years of life.
12................................ WCV for 12-21 yrs of age--with PCP
or OB-GYN.
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Dental
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13................................ Total eligibles receiving preventive
dental services (EPSDT measure Line
12B).
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MANAGEMENT OF ACUTE CONDITIONS
Upper Respiratory--Appropriate Use of Antibiotics
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14................................ Appropriate testing for children
with pharyngitis [NQF 0002].
15................................ Otitis Media with Effusion--
avoidance of inappropriate use of
systemic antimicrobials--ages 2-12.
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Dental
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16................................ Total EPSDT eligibles who received
dental treatment services (EPSDT
CMS Form 416, Line 12C).
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Emergency Department
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17................................ Emergency Department (ED)
Utilization--Average number of ED
visits per member per reporting
period.
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Inpatient Safety
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18................................ Pediatric catheter-associated blood
stream infection rates (PICU and
NICU) [NQF 0139].
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MANAGEMENT OF CHRONIC CONDITIONS
Asthma
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19................................ Annual number of asthma patients (>=
1 year old) with >= 1 asthma
related ER visit (S/AL Medicaid
Program).
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[[Page 68849]]
ADHD
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20................................ Follow-up care for children
prescribed attention-deficit/
hyperactivity disorder (ADHD)
medication (Continuation and
Maintenance Phase) [NQF 108].
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Mental Health
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21................................ Follow up after hospitalization for
mental illness.
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Diabetes
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22................................ Annual hemoglobin A1C testing (all
children and adolescents diagnosed
with diabetes).
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FAMILY EXPERIENCES OF CARE
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23................................ CAHPS[supreg] Health Plan Survey
4.0, Child Version including
Medicaid and Children with Chronic
Conditions supplemental items.
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AVAILABILITY
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24................................ Children and adolescents' access to
primary care practitioners (PCP),
by age and total.
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Comments on the measures themselves are encouraged to:
Specify which of the measures are being addressed with
each comment.
Explain views and reasoning clearly.
In addition, comments are invited on the AHRQ and CMS plans to
enhance the initial, recommended core measure set so that they can be
collected most efficiently and accurately across all Medicaid and CHIP
programs, providers, and enrollees.
We strongly encourage comments to be as succinct as possible (250
words or less recommended, with additional supporting data allowed).
III. 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. 35).
IV. Regulatory Impact Analysis
As this notice does not meet the significance criteria of Executive
Order 12866, it was not reviewed by the Office of Management and
Budget.
Authority: Section XIX and XXI of the Social Security Act (42
U.S.C. 13206 through 9a)
(Catalog of Federal Domestic Assistance Program No. 93.778, Medical
Assistance Program)
Dated: December 22, 2009.
Kathleen Sebelius,
Secretary.
[FR Doc. E9-30802 Filed 12-28-09; 8:45 am]
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