HHSC UNIFORM MANAGED CARE MANUAL Quality Challenge Award Performance Indicators

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HHSC Uniform Managed Care MANUAL
HHSC UNIFORM MANAGED CARE MANUAL
6.2.6
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EFFECTIVE DATE
Quality Challenge Award Performance Indicators
June 5, 2014
Version 2.1
DOCUMENT HISTORY LOG
STATUS1
DOCUMENT
REVISION2
EFFECTIVE
DATE
DESCRIPTION3
Baseline
1.0
June 1, 2010
Initial version Uniform Managed Care Manual Chapter 6.2.6, “Quality
Challenge Award Performance Indicators.”
Revision
1.1
December 30, 2010
Chapter 6.2.6 is modified to add indicators for calendar year 2011.
Revision 2.0 applies to contracts issued as a result of HHSC RFP numbers
529-12-0002, 529-08-0001, and 529-10-0020.
Revision
2.0
March 1, 2012
Chapter 6.2.6 is revised to include new measures for March through
December of Calendar Year 2012. HHSC will not apply the Quality
Challenge Award to performance from January 1, 2012 to February 29,
2012.
Chapter 6.2.6 is revised to include new measures for January through
December of Calendar Year 2013.
Revision
2.1
June 5, 2014
For Calendar Year 2013, Measures 1, 2, 5, 6, 7, and 9 are modified to
remove measurement against the state mean.
For Calendar Year 2012, Measure 1 will be run as a hybrid.
1
2
3
Status should be represented as “Baseline” for initial issuances, “Revision” for changes to the Baseline version, and “Cancellation” for withdrawn versions
Revisions should be numbered according to the version of the issuance and sequential numbering of the revision—e.g., “1.2” refers to the first version of the document and the
second revision.
Brief description of the changes to the document made in the revision.
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EFFECTIVE DATE
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Quality Challenge Award Performance Indicators
Version 2.1
Quality Challenge Award Performance Indicators
(Reported by Program and MCO)
Calendar Year 2013 Added by Version
2.0 and modified by Version 2.1
Calendar Year 2013 for STAR, CHIP, and STAR+PLUS1
2
Measure
Data Collection
Period
Data Collection Method / Methodology
2. Weight Assessment and
Counseling for Nutrition and
Physical Activity for
Children/Adolescents
(WCC)
3. Member using Inpatient
Services for ACSC (AHRQ1
Jan ‘13- Dec’13
Jan ‘13- Dec’13
4
STAR+
PLUS
STAR
CHIP


N/A
This is a HEDIS measure and the HEDIS technical
®
specifications are followed. Refer to HEDIS Technical
Specifications Manual. This measure is collected by the EQRO
and reported on the Annual Quality of Care Report.


N\A
Pediatric Quality Indicators (PDIs) for child enrollees


N/A
®
1. Appropriate Testing for
Children with Pharyngitis 218years(CWP)
3
®
This is a HEDIS measure and the HEDIS technical
®
specifications are followed. Refer to HEDIS Technical
Specifications Manual. This measure is collected by the EQRO
and reported on the Annual Quality of Care Report.
®
®
(1) Asthma
NOTE: An asterisk () indicates this measure is part of the Quality Challenge Award for the identified Program. Each Program’s measures are
equally weighted. For any quality indicators that yield response rates deemed by HHSC to be too low for statistically valid comparisons, HHSC will
reapportion points across the remaining measures. If the MCO serves more than one Service Area in a Program, then HHSC will average
performance results for all Service Areas by program. Refer to the applicable managed care contract for additional information concerning the
Quality Challenge Award.
2
For all performance indicators, if changes are made to the national set measures, the specifications for the measurement year will be used.
3
For all performance indicators, if changes are made to the national set measures, the specifications for the measurement year will be used.
4
The Performance Indicators do not apply to the CHIP Perinatal Program.
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6.2.6
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EFFECTIVE DATE
Quality Challenge Award Performance Indicators
June 5, 2014
Version 2.1
Calendar Year 2013 for STAR, CHIP, and STAR+PLUS1
2
Measure
Pediatric Quality Indicators
(PDI)
Data Collection
Period
Jan ‘13- Dec’13
Data Collection Method / Methodology
3
4
STAR+
PLUS
STAR
CHIP
N/A
N/A



N/A
(2) Diabetes Short-Term Complications
(3) Gastroenteritis
(4) Perforated Appendix
(5) Urinary Tract Infection
(The age eligibility for these measures is 17 years old and
younger.)
Prevention Quality Indicators (PQIs) for adult enrollees
4. Member using inpatient
services for ACSC (AHRQPrevention Quality
Indicators (PQIs)
Jan ‘13- Dec’13
(1) Diabetes Short-Term Complications
(2) Perforated Appendix
(3) Diabetes Long-Term Complications
(4) Chronic Obstructive Pulmonary Disease
(5) Low Birth Weight
(6) Hypertension
(7) Congestive Heart Failure
(8) Dehydration
(9) Bacterial Pneumonia
(10) Urinary Tract Infection
(11) Angina without Procedure
(12) Uncontrolled Diabetes
(13) Adult Asthma
(14) Rate of Lower Extremity Amputation among Patients
with Diabetes.
(For these measures, adults are those individuals ages 18 or
older)
5. Follow-up Care for Children
Prescribed ADHD
Jan ‘13- Dec’13
®
®
This is a HEDIS measure and the HEDIS technical
®
specifications are followed. Refer to HEDIS Technical
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EFFECTIVE DATE
Quality Challenge Award Performance Indicators
June 5, 2014
Version 2.1
Calendar Year 2013 for STAR, CHIP, and STAR+PLUS1
2
Measure
Data Collection
Period
Medication ( ADD): Initiation
Phase
Data Collection Method / Methodology
STAR+
PLUS
CHIP
N/A
N/A

®
Jan ‘13- Dec’13
This is a HEDIS measure and the HEDIS technical
®
specifications are followed. Refer to HEDIS Technical
Specifications Manual. This measure is collected by the EQRO
and reported on the Annual Quality of Care Report.
Jan ‘13- Dec’13
This is a HEDIS measure and the HEDIS technical
®
specifications are followed. Refer to HEDIS Technical
Specifications Manual. This measure is collected by the EQRO
and reported on the Annual Quality of Care Report.
N/A
N/A

Jan ‘13- Dec’13
Results from the four quarterly CDS Utilization reports
submitted by the MCO will be averaged to identify the
percentage achieved compared to Calendar year 2012
N/A
N/A

Jan ‘13- Dec’13
This is a HEDIS measure and the HEDIS technical
®
specifications are followed. Refer to HEDIS Technical
Specifications Manual. This measure is collected by the EQRO
and reported on the Annual Quality of Care Report.
N/A
N/A

®
7. Adult BMI Assessment
(ABA)
4
STAR
Specifications Manual. This measure is collected by the EQRO
and reported on the Annual Quality of Care Report.
®
6. Antidepressant Medication
Management (AMM)
3
®
8. 0.5% Increase in Members
utilizing Consumer Directed
Services


1915 (b)Primary Home
Care(PHC)
1915 (c)Personal
Attendant Services
(PAS)
®
9. Diabetic Eye Exam
®
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6.2.6
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EFFECTIVE DATE
June 5, 2014
Quality Challenge Award Performance Indicators
Version 2.1
Calendar Year 2012 Added by Version
2.0 and modified by Version 2.1
Quality Challenge Award Performance Indicators
(Calculated by Service Area, by Program)
Calendar Year 2012 for STAR, CHIP, and STAR+PLUS5
Measure6
Data Collection
Period
Data Collection Method / Methodology7
STAR
CHIP8




STAR+
PLUS
National Committee for Quality Assurance (NCQA) HEDIS
measures for Medicaid health plans will be used. This measure
will be run as a hybrid.
Prenatal/Postpartum Care
(PPC) [Timeliness/Postpartum
Visits]
Mar ‘12– Dec ‘12
Ambulatory Care (AMB)
Mar‘12– Dec ‘12
5
This measure is collected by the EQRO and reported on the
Annual Quality of Care Report. For the purposes of the Quality
Challenge Award, MCO performance is ranked relative to each
other. Risk adjustment methodologies, including but not
limited to, geographic and illness severity adjustors may be
applied to the Quality Challenge Ranking.
®
®
This is a HEDIS 13 measure and the HEDIS technical
®
specifications are followed. Refer to HEDIS Technical

NOTE: An asterisk () indicates this measure is part of the Quality Challenge Award for the identified Program. Each Program’s measures are
equally weighted. For any quality indicators that yield response rates deemed by HHSC to be too low for statistically valid comparisons, HHSC will
reapportion points across the remaining measures. If the MCO serves more than one Service Area in a Program, then HHSC will average
performance results for all Service Areas by program. Refer to the applicable managed care contract for additional information concerning the
Quality Challenge Award.
6
For all performance indicators, if changes are made to the national set measures, the specifications for the measurement year will be used.
7
For all performance indicators, if changes are made to the national set measures, the specifications for the measurement year will be used.
8
The Performance Indicators do not apply to the CHIP Perinatal Program.
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6.2.6
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EFFECTIVE DATE
Quality Challenge Award Performance Indicators
June 5, 2014
Version 2.1
Calendar Year 2012 for STAR, CHIP, and STAR+PLUS5
Measure6

Outpatient Visits

ED Visits
Data Collection
Period
Mar ‘12– Dec ‘12
Data Collection Method / Methodology7
Inpatient Utilization –General
Hospital/acute Care
0.5% Increase in Members
utilizing Consumer Directed
Services

1915 (b)Primary Home
Care(PHC)

1915 (c)Personal Attendant
Services (PAS)
Mar ‘12– Nov ‘12
CHIP8
STAR+
PLUS



Specifications Manual for Ambulatory Care: [AMB]. This
measure is collected by the EQRO and reported on the Annual
Quality of Care Report. For the purposes of the Quality
Challenge Award, MCO performance is ranked relative to each
other. Risk adjustment methodologies, including but not
limited to, geographic and illness severity adjustors may be
applied to the Quality Challenge Ranking.
®
Mar ‘12– Dec ‘12
STAR
®
This is a HEDIS 13 measure and the HEDIS technical
®
specifications are followed. Refer to HEDIS Technical
Specifications Manual for Inpatient Utilization (IPU). This
measure is collected by the EQRO and reported on the Annual
Quality of Care Report. For the purposes of the Quality
Challenge Award, MCO performance is ranked relative to each
other. Risk adjustment methodologies, including but not
limited to, geographic and illness severity adjustors may be
applied to the Quality Challenge Ranking.
Results from the three quarterly CDS Utilization reports
submitted by the MCO will be averaged to identify the
percentage achieved compared to Calendar Year 2011.

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6.2.6
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EFFECTIVE DATE
June 5, 2014
Quality Challenge Award Performance Indicators
Version 2.1
Quality Challenge Award Performance Indicators
(Calculated by Service Area, by Program)
Calendar Year 2011
Added by Version 1.1
Calendar Year 2011 for STAR, CHIP, and STAR+PLUS9
Measure10
Data Collection
Period
Data Collection Method / Methodology11
STAR
CHIP12
STAR+
PLUS
Children’s preventive health
®
Newborns receive 6 or more
well-child visits in first 15
months of life
Jan. ‘11– Dec ‘11
9
This is a HEDIS® 12 measure and the HEDIS technical
®
specifications are followed. Refer to HEDIS Technical
Specifications Manual for Well-Child Visits in the First 15
Months of Life. This measure is collected by the External
Quality Review Organization (EQRO) and reported on the
Annual Quality of Care Report. The rating will be measured
against the state mean reported in the Quality of Care Report.

NOTE: An asterisk () indicates this measure is part of the Quality Challenge Award for the identified Program. Each Program’s measures are
equally weighted. For any quality indicators that yield response rates deemed by HHSC to be too low for statistically valid comparisons, HHSC will
reapportion points across the remaining measures. If the MCO serves more than one Service Area in a Program, then HHSC will average
performance results for all Service Areas by program. Refer to the applicable managed care contract for additional information concerning the
Quality Challenge Award.
10
For all performance indicators, if changes are made to the national set measures, the specifications for the measurement year will be used.
11
For all performance indicators, if changes are made to the national set measures, the specifications for the measurement year will be used.
12
The Performance Indicators do not apply to the CHIP Perinatal Program.
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6.2.6
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EFFECTIVE DATE
Quality Challenge Award Performance Indicators
June 5, 2014
Version 2.1
Measure10
Children receive well-child visits
rd
th
th
th
in their 3 , 4 , 5 , and 6 years
of life
Data Collection
Period
Data Collection Method / Methodology11
STAR
CHIP12




®
Jan. ‘11– Dec ‘11
This is a HEDIS® 12 measure and the HEDIS technical
®
specifications are followed. Refer to HEDIS Technical
Specifications Manual for Well-Child Visits in the Third, Fourth,
Fifth, and Sixth Years of Life. This measure is collected by the
EQRO and reported on the Annual Quality of Care Report.
The rating will be measured against the state mean reported in
the Quality of Care Report.
®
Adolescents receive well-child
visits
Jan. ‘11– Dec ‘11
This is a HEDIS® 12 measure and the HEDIS technical
®
specifications are followed. Refer to HEDIS Technical
Specifications Manual for Adolescent Well-Care Visits. This
measure is collected by the EQRO and reported on the Annual
Quality of Care Report. The rating will be measured against
the state mean reported in the Quality of Care Report.
Women’s preventive and maternal health
®
Adult female members (age 18
and older) receive cervical
cancer screening
Jan. ‘11– Dec ‘11
This is a HEDIS® 12 measure and the HEDIS technical
®
specifications are followed. Refer to HEDIS Technical
Specifications Manual for Cervical Cancer Screening. This
measure is collected by the EQRO and reported on the Annual
Quality of Care Report. The rating will be measured against
the state mean reported in the Quality of Care Report.
Jan. ‘11– Dec ‘11
This is a HEDIS® 12 measure and the HEDIS technical
®
specifications are followed. Refer to HEDIS Technical
Specifications Manual for Prenatal and Postpartum Care. This
measure is collected by the EQRO and reported on the Annual
Quality of Care Report. The rating will be measured against
the state mean reported in the Quality of Care Report.

®
Pregnant women receive
prenatal care

STAR+
PLUS
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EFFECTIVE DATE
Quality Challenge Award Performance Indicators
June 5, 2014
Version 2.1
Measure10
Data Collection
Period
Data Collection Method / Methodology11
STAR
CHIP12
STAR+
PLUS
®
New mothers receive
postpartum care
Jan. ‘11– Dec ‘11
This is a HEDIS® 12 measure and the HEDIS technical
®
specifications are followed. Refer to HEDIS Technical
Specifications Manual for Prenatal and Postpartum Care. This
measure is collected by the EQRO and reported on the Annual
Quality of Care Report. The rating will be measured against
the state mean reported in the Quality of Care Report.
Jan. ‘11– Dec ‘11
HEDIS® Use of Appropriate Medications for People with
Asthma. This is a HEDIS® 12 Measure and the HEDIS®
Technical Specifications are followed. This measure is
collected by the EQRO and reported on the Annual Quality of
Care Report. The rating will be measured against the state
mean reported in the Quality of Care Report.

Jan. ‘11– Dec ‘11
HEDIS® Use of Appropriate Medications for People with
®
Asthma This is a HEDIS® 12 measure and the HEDIS
Technical Specifications are followed. This measure is
collected by the EQRO and reported on the Annual Quality of
Care Report. The rating will be measured against the state
mean reported in the Quality of Care Report.

Jan. ‘11– Dec ’11
This is a HEDIS® 12 measure and the HEDIS technical
®
specifications are followed. Refer to HEDIS Technical
Specifications Manual for Comprehensive Diabetes Care. This
measure is collected by the EQRO and reported on the Annual
Quality of Care Report. The rating will be measured against

Asthma
Children with asthma (ages 5
through 11 ) receive appropriate
medication
People with asthma (ages 12
through 50) receive appropriate
medication
Diabetes (age 18 and older)
®
Members with diabetes (age 18
and older) are HbA1c controlled

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EFFECTIVE DATE
Quality Challenge Award Performance Indicators
June 5, 2014
Version 2.1
Measure10
Data Collection
Period
Data Collection Method / Methodology11
STAR
CHIP12
STAR+
PLUS
the state mean reported in the Quality of Care Report.
High blood pressure
Members with high blood
pressure (age 18 and older)
have high blood pressure
controlled
®
Jan. ‘11– Dec ‘11
This is a HEDIS® 12 measure and the HEDIS technical
®
specifications are followed. Refer to HEDIS Technical
Specifications Manual for Controlling High Blood Pressure.
This measure is collected by the EQRO and reported on the
Annual Quality of Care Report. The rating will be measured
against the state mean reported in the Quality of Care Report.

Use of Ambulatory Care Sensitive Conditions
(ACSCs) in an inpatient setting
®
This is not a HEDIS 12 measure. Indicators developed for
the Agency for Healthcare Research and Quality (AHRQ) will
be use to evaluate the performance of MCOs related to
inpatient admissions for various ACSCs. Specifically, two sets
of indicators will be used in the analysis:
Members use inpatient services
for ACSCs (PDI/PQI)
Jan. ‘11– Dec ‘11
Prevention Quality Indicators (PQIs) for adult enrollees
(1) Diabetes Short-Term Complications
(2) Perforated Appendix
(3) Diabetes Long-Term Complications
(4) Chronic Obstructive Pulmonary Disease
(5) Low Birth Weight
(6) Hypertension
(7) Congestive Heart Failure
(8) Dehydration
(9) Bacterial Pneumonia
(10) Urinary Tract Infection
(11) Angina without Procedure



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6.2.6
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EFFECTIVE DATE
Quality Challenge Award Performance Indicators
June 5, 2014
Version 2.1
Measure10
Data Collection
Period
Data Collection Method / Methodology11
STAR
CHIP12
STAR+
PLUS



(12) Uncontrolled Diabetes
(13) Adult Asthma
(14) Rate of Lower Extremity Amputation among
Patients with Diabetes.
(For these measures, adults are those individuals ages 18 or
older.)
Pediatric Quality Indicators (PDIs) for child enrollees
(1) Asthma
(2) Diabetes Short-Term Complications
(3) Gastroenteritis
(4) Perforated Appendix
(5) Urinary Tract Infection
(The age eligibility for these measures is 17 years old and
younger.)
The rating will be measured against the state mean reported in
the Quality of Care Report.
®
Ambulatory Care: ED use
Jan. ‘11– Dec ‘11
This is a HEDIS 12 measure for Ambulatory Care ED visits.
This measure is collected by the EQRO and reported on the
Annual Quality of Care Report. Refer to Technical
Specification for the Annual Quality of Care Report prepared
by the EQRO. The rating will be measured against the state
mean reported in the Quality of Care Report.
Use of Consumer Directed Services (CDS) Option
3% increase in Members
utilizing Consumer Directed
Services option for Personal
Attendant Services (PAS) or
Jan. ‘11– Dec ‘11
Results from the four quarterly CDS Utilization reports
submitted by the MCO will be averaged to identify the
percentage achieved in SFY 2011.

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EFFECTIVE DATE
Quality Challenge Award Performance Indicators
June 5, 2014
Version 2.1
Measure10
Data Collection
Period
Data Collection Method / Methodology11
STAR
CHIP12
STAR+
PLUS
Respite care
Rate of Members Referred and Enrolled in Money
Follows the Person (MFP) Program
38% of individuals residing in a
nursing facility who are referred
to the community through
Money Follows the Person are
enrolled in the 1915(c)
STAR+PLUS Waiver (SPW).
3% of total enrollments in 1915
STAR+PLUS Waiver (SPW) are
individuals who were referred to
the SPW using the MFP/MFPD
Program
Jan. ‘11– Dec ‘11
Results from the four quarterly Money Follows the Person
/Money Follows the Person Demonstration (MFP/MFPD)
Utilization reports submitted by the MCO will be used to
identify the percentage achieved in SFY 2011. The numerator
will be the number of nursing facility (NF) residents who are
enrolled into SPW via the MFP/MFPD program. The
denominator will be the number of NF residents who are
referred to SPW via the MFP/MFPD program.

Jan. ‘11– Dec ‘11
Results from the four quarterly MFP/MFPD Utilization reports
submitted by the MCO will be used to identify the percentage
achieved in SFY 2011. The numerator will be the number of
consumers who are enrolled into SPW via the MFP/MFPD
program. The denominator will be the number of consumers
enrolled in the 1915(c) STAR+PLUS Waiver.

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EFFECTIVE DATE
June 5, 2014
Quality Challenge Award Performance Indicators
Version 2.1
Quality Challenge Award Performance Indicators
(Calculated by Service Area, by Program)
State Fiscal Year (SFY) 2010 for STAR, CHIP, and STAR+PLUS13
Measure
Data Collection
Period
Data Collection Method / Methodology
STAR
CHIP14
STAR+
PLUS
Children’s preventive health
®
Newborns receive 6 or more
well-child visits in first 15
months of life
Sept ’08 – Aug ’09
This is a HEDIS® 10 measure and the HEDIS technical
®
specifications are followed. Refer to HEDIS Technical
Specifications Manual for Well-Child Visits in the First 15
Months of Life. This measure is collected by the External
Quality Review Organization (EQRO) and reported on the
Annual Quality of Care Report. The rating will be measured
against the state mean reported in the Quality of Care Report.
13

NOTE: An asterisk () indicates this measure is part of the Quality Challenge Award for the identified Program. Each Program’s
measures are equally weighted. For any quality indicators that yield response rates deemed by HHSC to be too low for statistically
valid comparisons, HHSC will reapportion points across the remaining measures. If the MCO serves more than one Service Area in
a Program, then HHSC will average performance results for all Service Areas by program. Refer to the applicable managed care
contract for additional information concerning the Quality Challenge Award.
14
The Performance Indicators do not apply to the CHIP Perinatal Program.
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6.2.6
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EFFECTIVE DATE
Quality Challenge Award Performance Indicators
June 5, 2014
Version 2.1
Measure
Data Collection
Period
Data Collection Method / Methodology
STAR
CHIP14




®
Children receive well-child visits
rd
th
th
th
in their 3 , 4 , 5 , and 6 years
of life
Sept ’08 – Aug ‘09
This is a HEDIS® 10 measure and the HEDIS technical
®
specifications are followed. Refer to HEDIS Technical
Specifications Manual for Well-Child Visits in the Third, Fourth,
Fifth, and Sixth Years of Life. This measure is collected by the
EQRO and reported on the Annual Quality of Care Report.
The rating will be measured against the state mean reported in
the Quality of Care Report.
Sept ’08 – Aug ‘09
This is a HEDIS® 10 measure and the HEDIS technical
®
specifications are followed. Refer to HEDIS Technical
Specifications Manual for Adolescent Well-Care Visits. This
measure is collected by the EQRO and reported on the Annual
Quality of Care Report. The rating will be measured against
the state mean reported in the Quality of Care Report.
®
Adolescents receive well-child
visits
Women’s preventive and maternal health
®
Adult female members receive
cervical cancer screening
Sept ’08 – Aug ‘09
This is a HEDIS® 10 measure and the HEDIS technical
®
specifications are followed. Refer to HEDIS Technical
Specifications Manual for Cervical Cancer Screening. This
measure is collected by the EQRO and reported on the Annual
Quality of Care Report. The rating will be measured against
the state mean reported in the Quality of Care Report.
Sept ’08 – Aug ‘09
This is a HEDIS® 10 measure and the HEDIS technical
®
specifications are followed. Refer to HEDIS Technical
Specifications Manual for Prenatal and Postpartum Care. This
measure is collected by the EQRO and reported on the Annual
Quality of Care Report. The rating will be measured against
the state mean reported in the Quality of Care Report.

®
Pregnant women receive
prenatal care

STAR+
PLUS
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EFFECTIVE DATE
Quality Challenge Award Performance Indicators
June 5, 2014
Version 2.1
Measure
Data Collection
Period
Data Collection Method / Methodology
STAR
CHIP14
STAR+
PLUS
®
New mothers receive
postpartum care
Sept ’08 – Aug ‘09
This is a HEDIS® 10 measure and the HEDIS technical
®
specifications are followed. Refer to HEDIS Technical
Specifications Manual for Prenatal and Postpartum Care. This
measure is collected by the EQRO and reported on the Annual
Quality of Care Report. The rating will be measured against
the state mean reported in the Quality of Care Report.
Sept ’08 – Aug ’09
HEDIS® Use of Appropriate Medications for People with
Asthma This is a HEDIS® Measure and the HEDIS® Technical
Specifications are followed. This measure is collected by the
EQRO and reported on the Annual Quality of Care Report.
The rating will be measured against the state mean reported in
the Quality of Care Report.

Sept ’08 – Aug ‘09
HEDIS® Use of Appropriate Medications for People with
®
Asthma This is a HEDIS® 10 measure and the HEDIS
Technical Specifications are followed. This measure is
collected by the EQRO and reported on the Annual Quality of
Care Report. The rating will be measured against the state
mean reported in the Quality of Care Report.

Sept ’08 – Aug ‘09
This is a HEDIS® 10 measure and the HEDIS technical
®
specifications are followed. Refer to HEDIS Technical
Specifications Manual for Comprehensive Diabetes Care. This
measure is collected by the EQRO and reported on the Annual
Quality of Care Report. The rating will be measured against

Asthma
Children with asthma (ages 5
through11) receive appropriate
medication
Children with asthma (ages12
through 17) receive appropriate
medication
Diabetes (age 18 and older)
®
Members with diabetes (age 18
and older) are HBa1c tested

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6.2.6
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EFFECTIVE DATE
Quality Challenge Award Performance Indicators
June 5, 2014
Version 2.1
Measure
Data Collection
Period
Data Collection Method / Methodology
STAR
CHIP14
STAR+
PLUS
the state mean reported in the Quality of Care Report.
High blood pressure
Members with high blood
pressure (age 18 and older)
have high blood pressure
controlled
®
Sept ’08 – Aug ‘09
This is a HEDIS® 10 measure and the HEDIS technical
®
specifications are followed. Refer to HEDIS Technical
Specifications Manual for Controlling High Blood Pressure.
This measure is collected by the EQRO and reported on the
Annual Quality of Care Report. The rating will be measured
against the state mean reported in the Quality of Care Report.

Use of Ambulatory Care Sensitive Conditions
(ACSCs) in an inpatient setting
®
This is not a HEDIS measure. Indicators developed for the
Agency for Healthcare Research and Quality (AHRQ) will be
use to evaluate the performance of MCOs related to inpatient
admissions for various ACSCs. Specifically, two sets of
indicators will be used in the analysis:
Members use inpatient services
for ACSCs
Sept ’08 – Aug ‘09
Prevention Quality Indicators (PQIs) for adult enrollees
(1) Diabetes Short-Term Complications
(2) Perforated Appendix
(3) Diabetes Long-Term Complications
(4) Chronic Obstructive Pulmonary Disease
(5) Low Birth Weight
(6) Hypertension
(7) Congestive Heart Failure
(8) Dehydration
(9) Bacterial Pneumonia
(10) Urinary Tract Infection
(11) Angina without Procedure



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6.2.6
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EFFECTIVE DATE
Quality Challenge Award Performance Indicators
June 5, 2014
Version 2.1
Measure
Data Collection
Period
Data Collection Method / Methodology
STAR
CHIP14
STAR+
PLUS



(12) Uncontrolled Diabetes
(13) Adult Asthma
(14) Rate of Lower Extremity Amputation among Patients with
Diabetes.
(For these measures, adults are those individuals ages 18 or
older.)
Pediatric Quality Indicators (PQIs) for child enrollees
(1) Asthma
(2) Diabetes Short-Term Complications
(3) Gastroenteritis
(4) Perforated Appendix
(5) Urinary Tract Infection
(The age eligibility for these measures is 17 years old and
younger.)
The rating will be measured against the state mean reported in
the Quality of Care Report.
®
% of ER services for ACSCs
Sept ’08 – Aug ‘09
This is not a HEDIS measure. This measure is collected by
the EQRO and reported on the Annual Quality of Care Report.
Refer to Technical Specification for the Annual Quality of Care
Report prepared by the EQRO. The rating will be measured
against the state mean reported in the Quality of Care Report.
Use of Consumer Directed Services (CDS) Option
3% increase in Members
utilizing Consumer Directed
Services option for Personal
Attendant Services (PAS) or
Respite care
Sept ’08 – Aug ’09
Results from the four quarterly CDS Utilization reports
submitted by the HMO will be averaged to identify the
percentage achieved in SFY 2009.

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6.2.6
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EFFECTIVE DATE
Quality Challenge Award Performance Indicators
June 5, 2014
Version 2.1
Measure
Data Collection
Period
Data Collection Method / Methodology
STAR
CHIP14
STAR+
PLUS
Rate of Members Referred and Enrolled in Money
Follows the Person (MFP) Program
38% of individuals residing in a
nursing facility who are referred
to the community through
Money Follows the Person are
enrolled in the 1915(c)
STAR+PLUS Waiver.
3% of total enrollments in 1915
STAR+PLUS Waiver (SPW) are
individuals who were referred to
the SPW using the MFP/MFPD
Program
Sept ’08 – Aug ‘09
Results from the four quarterly Money Follows the Person
/Money Follows the Person Demonstration (MFP/MFPD)
Utilization reports submitted by the HMO will be averaged to
identify the percentage achieved in SFY 2009.

Sept ’08 – Aug ‘09
Results from the four quarterly MFP/MFPD Utilization reports
submitted by the HMO will be averaged to identify the
percentage achieved in SFY 2009.
