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Welcome to the Health Homes Quality MeasureCMS10434 OMB 09381188
Federal Fiscal Year *
2013
Request Technical Assistance
View Implementation Guide
The Health Homes provision, authorized by section 2703 of the Affordable Care Act (section 1945 of the Social Security Act), provides an opportunity to build a personcentered care delivery model that focuses on improving outcomes and disease management for beneficiaries with chronic conditions. The Health Homes core set of quality measures will be used to evaluate care across all state Health Homes programs. Specifically, section 2703 requires Health Homes providers to report health care quality measures in order to receive payment. The recommended Health Homes core set will require reporting at the Health Homes provider level which the state will collect and aggregate at the Health Homes program level.
Choose State Plan Amendment (SPA)*
CONVERTED Oregon Health Home Services in process
Provide responses to the Administrative Questions and Cost Data here.
Core Measures
Measure Status
Adult Body Mass Index (BMI) Assessment (ABA) Not Started
Screening for Clinical Depression and FollowUp Plan (CDF) Not Started
Plan AllCause Readmission Rate (PCR) Not Started
FollowUp After Hospitalization for Mental Illness (FUH) Not Started
Controlling High Blood Pressure (CBP) Not Started
Care Transition Timely Transmission of Transtition Record (CTR) Not Started
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (IET) Not Started
Prevention Quality Indicator (PQI) 92: Chronic Condition Composite Not Started
Manage Health Home State Specific Goals and Measures Not Started
19 of 9
Utilization Measures
Measure Status
Ambulatory Care Emergency Department Visits (AMB) Not Started
Inpatient Utilization (IU) Not Started
Nursing Facility Utilization (NFU) Not Started
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PRA Disclosure Statement According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 09381188. The time required to complete this information collection is estimated to average 40 hours per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C42605, Baltimore, Maryland 212441850.
Request State POC Review
10/1/2015 Annual Report Admin Screen
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Adult Body Mass Index (BMI) Assessment (ABA)Health Homes Quality Measure OR 2013
Request Technical Assistance Clear View All Responses
Are you reporting on this measure? *YesNo
View Implementation Guide
Please explain why you are not reporting on the measureSelect all that apply (must select at least one)
Service not covered
Population not covered Portion of population not covered *Entire population not coveredPartial population not covered
Data not available Explain why data not availableSelect all that apply (must select at least one)
Budget Constraints
Staff Constraints
Data Inconsistencies/Accuracy
*Please explain
Data not submitted by Providers to State
Data source not easily accessible
Reason Select all that apply
Requires medical record review
Requires data linkage, which does not currentlyexist
* Other
Information not collected
Reason Select all that apply
Not collected by provider (hospital/health plan)
* Other
Other
*Please explain
Small sample size (less than 30) Enter specific sample size *
Continuous enrollment requirement not met due to start date of SPA
Other Explain other reason why data not reported *
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10/1/2015 Annual Report Admin Screen
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Report Documents
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Saved Documents
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Would you like to validate the core measure data at this time?
Yes No(Note: While the measure does not need to be validated at this time in order to proceed, each measure must be validated for the measure to be marked as ‘complete’ andbefore the report can be submitted to CMS).
Note: If validation fails, errors will appear in red above.
10/1/2015 Annual Report Admin Screen
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Adult Body Mass Index (BMI) Assessment (ABA)Health Homes Quality Measure OR 2013
Request Technical Assistance Clear View All Responses
Are you reporting on this measure? *YesNo
View Implementation Guide
Please explain why you are not reporting on the measureSelect all that apply (must select at least one)
Service not covered
Population not covered Portion of population not covered *Entire population not coveredPartial population not covered
*Explain thepartial population
not covered
Data not available Explain why data not availableSelect all that apply (must select at least one)
Budget Constraints
Staff Constraints
Data Inconsistencies/Accuracy
*Please explain
Data not submitted by Providers to State
Data source not easily accessible
Reason Select all that apply
Requires medical record review
Requires data linkage, which does not currentlyexist
* Other
Information not collected
Reason Select all that apply
Not collected by provider (hospital/health plan)
* Other
Other
*Please explain
Small sample size (less than 30) Enter specific sample size *
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Continuous enrollment requirement not met due to start date of SPA
Other Explain other reason why data not reported *
Report Documents
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Saved Documents
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Would you like to validate the core measure data at this time?
Yes No(Note: While the measure does not need to be validated at this time in order to proceed, each measure must be validated for the measure to be marked as ‘complete’ andbefore the report can be submitted to CMS).
Note: If validation fails, errors will appear in red above.
10/1/2015 Annual Report Admin Screen
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Adult Body Mass Index (BMI) Assessment (ABA)Health Homes Quality Measure OR 2013
Request Technical Assistance Clear View All Responses
Are you reporting on this measure? *YesNo
View Implementation Guide
Measurement Specification
+/
NCQA: National Committee for Quality AssuranceOther
Specify version of HEDIS used *
2011
HEDIS: Healthcare Effectiveness Data and Information Set
Data Source
+/
Administrative Data From where is the Administrative Data coming?Must select one or more
Medicaid Management Information System (MMIS)
Other
*Specify
Character count: 0/2000
Hybrid (Administrative and Medical Records Data) From where is the Administrative Data coming?Must select one or more
Medicaid Management Information System (MMIS)
Other
*Specify
Character count: 0/2000
From where is the Medical Records coming?Must select only one
Electronic Health Record (EHR) DataPaperBoth (EHR and Paper)
Other Specify *
Character count: 0/2000
Date Range
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+/
Please define the date range for the reporting period based on the “From” time period as the month and year that corresponds to the beginning period in which utilization took place and please report the “To” time period as the month and year that corresponds to the end period in which utilization took place. Do not report the year in which data were collected from the measure, or the version of HEDIS® used to calculate the measure, both of which may be different from the period corresponding to the utilization of services.
Start Date
January
Month
2000
Year
End Date
February
Month
2014
Year
Definition of Population Included in the Measure
+/
Definition of Denominator
Select all that apply
Denominator includes Medicaid population
Denominator includes Medicare and Medicaid DuallyEligible population
Other Specify *
Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure?
YesNo
Definition of Numerator
Health Home enrollees for whom BMI was documented (Table ABA.B) during the measurement year or the year prior to the measurement year.
*States that report using a oneyear lookback period should include only BMI during the measurement year.
Deviations from Measure Specifications
+/
Did your calculation of the measure deviate from the measure specification in any way? *YesNo
Please select and explain the deviation(s)
Age Range: 1864
Numerator Explain *
Denominator Explain *
Explain *
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Other Explain *
Age Range: 6574
Numerator Explain *
Denominator Explain *
Other Explain *
Age Range: Total
Numerator Explain *
Denominator Explain *
Other Explain *
Performance Measure
+/
The percentage of Medicaid enrollees ages 18 to 74 who had an outpatient visit and whose body mass index (BMI) was documented during the measurement year or the year prior to the measurement year.
Age Range: 1864
Please explain why data was not entered for this numerator/denominator/rate set*
10/1/2015 Annual Report Admin Screen
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Character count: 0/2000
Age Range: 6574
Please explain why data was not entered for this numerator/denominator/rate set*
Character count: 0/2000
The option "Denominator includes Medicare and Medicaid DuallyEligible population" was selected in the "Definition of Population included in theMeasure" section; however, no data were reported for the population age 65 and older. Are data available for population age 65 and over? *
YesNo
Age Range: Total
Please explain why data was not entered for this numerator/denominator/rate set*
Character count: 0/2000
Additional Notes/Comments on Measure
Character count: 0/2000
Optional Measure Stratification
+/
If this measure is also reported by additional classifications/subcategories, e.g. racial, ethnic, gender, language, disability status, or geography, complete the following as applicable.
Check all that apply
Race (NonHispanic)
White
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Black or African American
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
10/1/2015 Annual Report Admin Screen
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0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
American Indian or Alaska Native
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Asian
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Native Hawaiian or Other Pacific Islander
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Please define the otherrace *
jhlhhjDelete OtherRace
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
+ Additional Race(s)
10/1/2015 Annual Report Admin Screen
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Ethnicity
Hispanic or Latino
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Not Hispanic or Latino
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Please define the otherethnicity *
hjkhjDelete OtherEthnicity
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
+ Additional Ethnicity(ies)
Sex
Male
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Female
10/1/2015 Annual Report Admin Screen
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Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Disability Status
SSI
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
NonSSI
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Please define the otherdisabilitystatus *
ghjghjDelete OtherDisabilityStatus
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
+ Additional Disability Status(es)
Primary Spoken Language
English
Classification/Subcategory Numerator Denominator Rate
10/1/2015 Annual Report Admin Screen
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Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Spanish
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Please define the otherlanguage *
uuyhiDelete OtherLanguage
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
+ Additional Primary Spoken Language(s)
Geography
Urban
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Rural
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 Clear
10/1/2015 Annual Report Admin Screen
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0 0 0 Row
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Please define the othergeographicalregion *
dfhydfhdDelete OtherGeographicalRegion
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
+ Additional Geographical Region(s)
Final Comments (Optional)
+/
Please enter any summary comments
Report Documents
+/
Saved Documents
Maximum documents that can be uploaded for this report: 84Maximum file size : 2MBValid file extensions : pdf; ppt; doc; docx; xlsx; xls; pptx
Name Description Date Created Updated By Size Type
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Delete Document(s) Save Documents
Would you like to validate the core measure data at this time?
Yes No(Note: While the measure does not need to be validated at this time in order to proceed, each measure must be validated for the measure to be marked as ‘complete’ andbefore the report can be submitted to CMS).
Note: If validation fails, errors will appear in red above.
10/1/2015 Annual Report Admin Screen
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10/1/2015 Annual Report Admin Screen
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Adult Body Mass Index (BMI) Assessment (ABA)Health Homes Quality Measure OR 2013
Request Technical Assistance Clear View All Responses
Are you reporting on this measure? *YesNo
View Implementation Guide
Measurement Specification
+/
NCQA: National Committee for Quality AssuranceOther
Specify version of HEDIS used *
2011
HEDIS: Healthcare Effectiveness Data and Information Set
Data Source
+/
Administrative Data From where is the Administrative Data coming?Must select one or more
Medicaid Management Information System (MMIS)
Other
*Specify
Character count: 0/2000
Hybrid (Administrative and Medical Records Data) From where is the Administrative Data coming?Must select one or more
Medicaid Management Information System (MMIS)
Other
*Specify
Character count: 0/2000
From where is the Medical Records coming?Must select only one
Electronic Health Record (EHR) DataPaperBoth (EHR and Paper)
Other Specify *
Character count: 0/2000
Date Range
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+/
Please define the date range for the reporting period based on the “From” time period as the month and year that corresponds to the beginning period in which utilization took place and please report the “To” time period as the month and year that corresponds to the end period in which utilization took place. Do not report the year in which data were collected from the measure, or the version of HEDIS® used to calculate the measure, both of which may be different from the period corresponding to the utilization of services.
Start Date
January
Month
2000
Year
End Date
February
Month
2014
Year
Definition of Population Included in the Measure
+/
Definition of Denominator
Select all that apply
Denominator includes Medicaid population
Denominator includes Medicare and Medicaid DuallyEligible population
Other Specify *
Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure?
YesNo
Definition of Numerator
Health Home enrollees for whom BMI was documented (Table ABA.B) during the measurement year or the year prior to the measurement year.
*States that report using a oneyear lookback period should include only BMI during the measurement year.
Deviations from Measure Specifications
+/
Did your calculation of the measure deviate from the measure specification in any way? *YesNo
Please select and explain the deviation(s)
Age Range: 1864
Numerator Explain *
Denominator Explain *
Explain *
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Other Explain *
Age Range: 6574
Numerator Explain *
Denominator Explain *
Other Explain *
Age Range: Total
Numerator Explain *
Denominator Explain *
Other Explain *
Performance Measure
+/
The percentage of Medicaid enrollees ages 18 to 74 who had an outpatient visit and whose body mass index (BMI) was documented during the measurement year or the year prior to the measurement year.
Age Range: 1864
Numerator Denominator Rate
0 0 0
Age Range: 6574
10/1/2015 Annual Report Admin Screen
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Numerator Denominator Rate
0 0 0
Age Range: Total
Numerator Denominator Rate
0 0 0
Additional Notes/Comments on Measure
Character count: 0/2000
Optional Measure Stratification
+/
If this measure is also reported by additional classifications/subcategories, e.g. racial, ethnic, gender, language, disability status, or geography, complete the following as applicable.
Check all that apply
Race (NonHispanic)
White
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Black or African American
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
American Indian or Alaska Native
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
Clear
10/1/2015 Annual Report Admin Screen
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0 0 0 Row
+ Additional/Alternative Classification/Subcategory
Asian
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Native Hawaiian or Other Pacific Islander
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Please define the otherrace *
jhlhhjDelete OtherRace
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
+ Additional Race(s)
Ethnicity
Hispanic or Latino
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
10/1/2015 Annual Report Admin Screen
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+ Additional/Alternative Classification/Subcategory
Not Hispanic or Latino
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Please define the otherethnicity *
hjkhjDelete OtherEthnicity
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
+ Additional Ethnicity(ies)
Sex
Male
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Female
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Disability Status
10/1/2015 Annual Report Admin Screen
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SSI
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
NonSSI
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Please define the otherdisabilitystatus *
ghjghjDelete OtherDisabilityStatus
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
+ Additional Disability Status(es)
Primary Spoken Language
English
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Spanish
Classification/Subcategory Numerator Denominator Rate
10/1/2015 Annual Report Admin Screen
https://gmacbistest.appiancloud.com/suite/tempo/actions/item/koBbrxGjzbwMkxqSHyoHpJkcjOxmGT3DHmQaINTV3NeeDIHK_H5ECSeQ7hrSgJ2DL6JGeR… 8/9
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Please define the otherlanguage *
uuyhiDelete OtherLanguage
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
+ Additional Primary Spoken Language(s)
Geography
Urban
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Rural
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Please define the othergeographicalregion *
dfhydfhdDelete OtherGeographicalRegion
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
10/1/2015 Annual Report Admin Screen
https://gmacbistest.appiancloud.com/suite/tempo/actions/item/koBbrxGjzbwMkxqSHyoHpJkcjOxmGT3DHmQaINTV3NeeDIHK_H5ECSeQ7hrSgJ2DL6JGeR… 9/9
Cancel Save Go to Admin Screen
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
+ Additional Geographical Region(s)
Final Comments (Optional)
+/
Please enter any summary comments
Report Documents
+/
Saved Documents
Maximum documents that can be uploaded for this report: 84Maximum file size : 2MBValid file extensions : pdf; ppt; doc; docx; xlsx; xls; pptx
Name Description Date Created Updated By Size Type
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Would you like to validate the core measure data at this time?
Yes No(Note: While the measure does not need to be validated at this time in order to proceed, each measure must be validated for the measure to be marked as ‘complete’ andbefore the report can be submitted to CMS).
Note: If validation fails, errors will appear in red above.
10/1/2015 Annual Report Admin Screen
https://gmacbistest.appiancloud.com/suite/tempo/actions/item/koBbrxGjzbwMkxqSHyoHpJkcjOxmGT3DHmQaINTV3NeeDIHK_H5ECSeQ7hrSgJ2DL6JGeR… 1/8
Adult Body Mass Index (BMI) Assessment (ABA)Health Homes Quality Measure OR 2013
Request Technical Assistance Clear View All Responses
Are you reporting on this measure? *YesNo
View Implementation Guide
Measurement Specification
+/
NCQA: National Committee for Quality AssuranceOther
Specify version of HEDIS used *
2011
HEDIS: Healthcare Effectiveness Data and Information Set
Data Source
+/
Administrative Data From where is the Administrative Data coming?Must select one or more
Medicaid Management Information System (MMIS)
Other
*Specify
Character count: 0/2000
Hybrid (Administrative and Medical Records Data) From where is the Administrative Data coming?Must select one or more
Medicaid Management Information System (MMIS)
Other
*Specify
Character count: 0/2000
From where is the Medical Records coming?Must select only one
Electronic Health Record (EHR) DataPaperBoth (EHR and Paper)
Other Specify *
Character count: 0/2000
Date Range
https://gmacbistest.appiancloud.com/suite/rest/a/content/latest/ikBbrxGjzbwMkxqSHetHJN9ZaTrTOVVI86PTvug5X9rK0uL1B3z4J0SXw/o
10/1/2015 Annual Report Admin Screen
https://gmacbistest.appiancloud.com/suite/tempo/actions/item/koBbrxGjzbwMkxqSHyoHpJkcjOxmGT3DHmQaINTV3NeeDIHK_H5ECSeQ7hrSgJ2DL6JGeR… 2/8
+/
Please define the date range for the reporting period based on the “From” time period as the month and year that corresponds to the beginning period in which utilization took place and please report the “To” time period as the month and year that corresponds to the end period in which utilization took place. Do not report the year in which data were collected from the measure, or the version of HEDIS® used to calculate the measure, both of which may be different from the period corresponding to the utilization of services.
Start Date
January
Month
2000
Year
End Date
February
Month
2014
Year
Definition of Population Included in the Measure
+/
Definition of Denominator
Select all that apply
Denominator includes Medicaid population
Denominator includes Medicare and Medicaid DuallyEligible population
Other Specify *
Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure?
YesNo
Definition of Numerator
Health Home enrollees for whom BMI was documented (Table ABA.B) during the measurement year or the year prior to the measurement year.
*States that report using a oneyear lookback period should include only BMI during the measurement year.
Deviations from Measure Specifications
+/
Did your calculation of the measure deviate from the measure specification in any way? *YesNo
Performance Measure
+/
The percentage of Medicaid enrollees ages 18 to 74 who had an outpatient visit and whose body mass index (BMI) was documented during the measurement year or the year prior to the measurement year.
Age Range: 1864
Numerator Denominator Rate
0 0 0
Age Range: 6574
Numerator Denominator Rate
0 0 0
10/1/2015 Annual Report Admin Screen
https://gmacbistest.appiancloud.com/suite/tempo/actions/item/koBbrxGjzbwMkxqSHyoHpJkcjOxmGT3DHmQaINTV3NeeDIHK_H5ECSeQ7hrSgJ2DL6JGeR… 3/8
Age Range: Total
Numerator Denominator Rate
0 0 0
Additional Notes/Comments on Measure
Character count: 0/2000
Optional Measure Stratification
+/
If this measure is also reported by additional classifications/subcategories, e.g. racial, ethnic, gender, language, disability status, or geography, complete the following as applicable.
Check all that apply
Race (NonHispanic)
White
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Black or African American
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
American Indian or Alaska Native
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
10/1/2015 Annual Report Admin Screen
https://gmacbistest.appiancloud.com/suite/tempo/actions/item/koBbrxGjzbwMkxqSHyoHpJkcjOxmGT3DHmQaINTV3NeeDIHK_H5ECSeQ7hrSgJ2DL6JGeR… 4/8
Asian
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Native Hawaiian or Other Pacific Islander
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Please define the otherrace *
jhlhhjDelete OtherRace
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
+ Additional Race(s)
Ethnicity
Hispanic or Latino
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Not Hispanic or Latino
Classification/Subcategory Numerator Denominator Rate
10/1/2015 Annual Report Admin Screen
https://gmacbistest.appiancloud.com/suite/tempo/actions/item/koBbrxGjzbwMkxqSHyoHpJkcjOxmGT3DHmQaINTV3NeeDIHK_H5ECSeQ7hrSgJ2DL6JGeR… 5/8
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Please define the otherethnicity *
hjkhjDelete OtherEthnicity
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
+ Additional Ethnicity(ies)
Sex
Male
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Female
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Disability Status
SSI
Classification/Subcategory Numerator Denominator Rate
Age Range: 18640 0 0 Clear
10/1/2015 Annual Report Admin Screen
https://gmacbistest.appiancloud.com/suite/tempo/actions/item/koBbrxGjzbwMkxqSHyoHpJkcjOxmGT3DHmQaINTV3NeeDIHK_H5ECSeQ7hrSgJ2DL6JGeR… 6/8
Row
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
NonSSI
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Please define the otherdisabilitystatus *
ghjghjDelete OtherDisabilityStatus
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
+ Additional Disability Status(es)
Primary Spoken Language
English
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Spanish
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
0 0 0 Clear
10/1/2015 Annual Report Admin Screen
https://gmacbistest.appiancloud.com/suite/tempo/actions/item/koBbrxGjzbwMkxqSHyoHpJkcjOxmGT3DHmQaINTV3NeeDIHK_H5ECSeQ7hrSgJ2DL6JGeR… 7/8
Age Range: 6574 Row
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Please define the otherlanguage *
uuyhiDelete OtherLanguage
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
+ Additional Primary Spoken Language(s)
Geography
Urban
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Rural
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Please define the othergeographicalregion *
dfhydfhdDelete OtherGeographicalRegion
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
10/1/2015 Annual Report Admin Screen
https://gmacbistest.appiancloud.com/suite/tempo/actions/item/koBbrxGjzbwMkxqSHyoHpJkcjOxmGT3DHmQaINTV3NeeDIHK_H5ECSeQ7hrSgJ2DL6JGeR… 8/8
Cancel Save Go to Admin Screen
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
+ Additional Geographical Region(s)
Final Comments (Optional)
+/
Please enter any summary comments
Report Documents
+/
Saved Documents
Maximum documents that can be uploaded for this report: 84Maximum file size : 2MBValid file extensions : pdf; ppt; doc; docx; xlsx; xls; pptx
Name Description Date Created Updated By Size Type
No items available
No file chosenChoose File
Delete Document(s) Save Documents
Would you like to validate the core measure data at this time?
Yes No(Note: While the measure does not need to be validated at this time in order to proceed, each measure must be validated for the measure to be marked as ‘complete’ andbefore the report can be submitted to CMS).
Note: If validation fails, errors will appear in red above.
10/1/2015 Annual Report Admin Screen
https://gmacbistest.appiancloud.com/suite/tempo/actions/item/koBbrxGjzbwMkxqSHyoHpJkcjOxmGT3DHmQaINTV3NeeDIHK_H5ECSeQ7hrSgJ2DL6JGeR… 1/9
Adult Body Mass Index (BMI) Assessment (ABA)Health Homes Quality Measure OR 2013
Request Technical Assistance Clear View All Responses
Are you reporting on this measure? *YesNo
View Implementation Guide
Measurement Specification
+/
NCQA: National Committee for Quality AssuranceOther
Specify version of HEDIS used *
2011
HEDIS: Healthcare Effectiveness Data and Information Set
Data Source
+/
Administrative Data From where is the Administrative Data coming?Must select one or more
Medicaid Management Information System (MMIS)
Other
*Specify
Character count: 0/2000
Hybrid (Administrative and Medical Records Data) From where is the Administrative Data coming?Must select one or more
Medicaid Management Information System (MMIS)
Other
*Specify
Character count: 0/2000
From where is the Medical Records coming?Must select only one
Electronic Health Record (EHR) DataPaperBoth (EHR and Paper)
Other Specify *
Character count: 0/2000
Date Range
https://gmacbistest.appiancloud.com/suite/rest/a/content/latest/ikBbrxGjzbwMkxqSHetHJN9ZaTrTOVVI86PTvug5X9rK0uL1B3z4J0SXw/o
10/1/2015 Annual Report Admin Screen
https://gmacbistest.appiancloud.com/suite/tempo/actions/item/koBbrxGjzbwMkxqSHyoHpJkcjOxmGT3DHmQaINTV3NeeDIHK_H5ECSeQ7hrSgJ2DL6JGeR… 2/9
+/
Please define the date range for the reporting period based on the “From” time period as the month and year that corresponds to the beginning period in which utilization took place and please report the “To” time period as the month and year that corresponds to the end period in which utilization took place. Do not report the year in which data were collected from the measure, or the version of HEDIS® used to calculate the measure, both of which may be different from the period corresponding to the utilization of services.
Start Date
January
Month
2000
Year
End Date
February
Month
2014
Year
Definition of Population Included in the Measure
+/
Definition of Denominator
Select all that apply
Denominator includes Medicaid population
Denominator includes Medicare and Medicaid DuallyEligible population
Other Specify *
Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure?
YesNo
Explain which populations are excluded and why *
What is the sample size? *
What is the measureeligible population? *
Definition of Numerator
Health Home enrollees for whom BMI was documented (Table ABA.B) during the measurement year or the year prior to the measurement year.
*States that report using a oneyear lookback period should include only BMI during the measurement year.
Deviations from Measure Specifications
+/
Did your calculation of the measure deviate from the measure specification in any way? *YesNo
Performance Measure
+/
The percentage of Medicaid enrollees ages 18 to 74 who had an outpatient visit and whose body mass index (BMI) was documented during the measurement year or the year prior to the measurement year.
Age Range: 1864
10/1/2015 Annual Report Admin Screen
https://gmacbistest.appiancloud.com/suite/tempo/actions/item/koBbrxGjzbwMkxqSHyoHpJkcjOxmGT3DHmQaINTV3NeeDIHK_H5ECSeQ7hrSgJ2DL6JGeR… 3/9
Numerator Denominator Rate
0 0 0
Age Range: 6574
Numerator Denominator Rate
0 0 0
Age Range: Total
Numerator Denominator Rate
0 0 0
Additional Notes/Comments on Measure
Character count: 0/2000
Optional Measure Stratification
+/
If this measure is also reported by additional classifications/subcategories, e.g. racial, ethnic, gender, language, disability status, or geography, complete the following as applicable.
Check all that apply
Race (NonHispanic)
White
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Black or African American
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
American Indian or Alaska Native
Classification/Subcategory Numerator Denominator Rate
10/1/2015 Annual Report Admin Screen
https://gmacbistest.appiancloud.com/suite/tempo/actions/item/koBbrxGjzbwMkxqSHyoHpJkcjOxmGT3DHmQaINTV3NeeDIHK_H5ECSeQ7hrSgJ2DL6JGeR… 4/9
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Asian
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Native Hawaiian or Other Pacific Islander
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Please define the otherrace *
jhlhhjDelete OtherRace
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
+ Additional Race(s)
Ethnicity
Hispanic or Latino
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
0 0 0 Clear
10/1/2015 Annual Report Admin Screen
https://gmacbistest.appiancloud.com/suite/tempo/actions/item/koBbrxGjzbwMkxqSHyoHpJkcjOxmGT3DHmQaINTV3NeeDIHK_H5ECSeQ7hrSgJ2DL6JGeR… 5/9
Age Range: 6574 Row
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Not Hispanic or Latino
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Please define the otherethnicity *
hjkhjDelete OtherEthnicity
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
+ Additional Ethnicity(ies)
Sex
Male
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Female
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
Clear
10/1/2015 Annual Report Admin Screen
https://gmacbistest.appiancloud.com/suite/tempo/actions/item/koBbrxGjzbwMkxqSHyoHpJkcjOxmGT3DHmQaINTV3NeeDIHK_H5ECSeQ7hrSgJ2DL6JGeR… 6/9
0 0 0 Row
+ Additional/Alternative Classification/Subcategory
Disability Status
SSI
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
NonSSI
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Please define the otherdisabilitystatus *
ghjghjDelete OtherDisabilityStatus
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
+ Additional Disability Status(es)
Primary Spoken Language
English
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 Clear
10/1/2015 Annual Report Admin Screen
https://gmacbistest.appiancloud.com/suite/tempo/actions/item/koBbrxGjzbwMkxqSHyoHpJkcjOxmGT3DHmQaINTV3NeeDIHK_H5ECSeQ7hrSgJ2DL6JGeR… 7/9
Row
+ Additional/Alternative Classification/Subcategory
Spanish
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Please define the otherlanguage *
uuyhiDelete OtherLanguage
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
+ Additional Primary Spoken Language(s)
Geography
Urban
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Rural
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
10/1/2015 Annual Report Admin Screen
https://gmacbistest.appiancloud.com/suite/tempo/actions/item/koBbrxGjzbwMkxqSHyoHpJkcjOxmGT3DHmQaINTV3NeeDIHK_H5ECSeQ7hrSgJ2DL6JGeR… 8/9
Cancel Save Go to Admin Screen
+ Additional/Alternative Classification/Subcategory
Please define the othergeographicalregion *
dfhydfhdDelete OtherGeographicalRegion
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
+ Additional Geographical Region(s)
Final Comments (Optional)
+/
Please enter any summary comments
Report Documents
+/
Saved Documents
Maximum documents that can be uploaded for this report: 84Maximum file size : 2MBValid file extensions : pdf; ppt; doc; docx; xlsx; xls; pptx
Name Description Date Created Updated By Size Type
No items available
No file chosenChoose File
Delete Document(s) Save Documents
Would you like to validate the core measure data at this time?
Yes No(Note: While the measure does not need to be validated at this time in order to proceed, each measure must be validated for the measure to be marked as ‘complete’ andbefore the report can be submitted to CMS).
Note: If validation fails, errors will appear in red above.
10/1/2015 Annual Report Admin Screen
https://gmacbistest.appiancloud.com/suite/tempo/actions/item/koBbrxGjzbwMkxqSHyoHpJkcjOxmGT3DHmQaINTV3NeeDIHK_H5ECSeQ7hrSgJ2DL6JGeR… 9/9
10/1/2015 Annual Report Admin Screen
https://gmacbistest.appiancloud.com/suite/tempo/actions/item/koBbrxGjzbwMkxqSHyoHpJkcjOxmGT3DHmQaINTV3NeeDIHK_H5ECSeQ7hrSgJ2DL6JGeR… 1/8
Adult Body Mass Index (BMI) Assessment (ABA)Health Homes Quality Measure OR 2013
Request Technical Assistance Clear View All Responses
Are you reporting on this measure? *YesNo
View Implementation Guide
Measurement Specification
+/
NCQA: National Committee for Quality AssuranceOther
Explain *
Data Source
+/
Administrative Data From where is the Administrative Data coming?Must select one or more
Medicaid Management Information System (MMIS)
Other
*Specify
Character count: 0/2000
Hybrid (Administrative and Medical Records Data) From where is the Administrative Data coming?Must select one or more
Medicaid Management Information System (MMIS)
Other
*Specify
Character count: 0/2000
From where is the Medical Records coming?Must select only one
Electronic Health Record (EHR) DataPaperBoth (EHR and Paper)
Other Specify *
Character count: 0/2000
Date Range
https://gmacbistest.appiancloud.com/suite/rest/a/content/latest/ikBbrxGjzbwMkxqSHetHJN9ZaTrTOVVI86PTvug5X9rK0uL1B3z4J0SXw/o
10/1/2015 Annual Report Admin Screen
https://gmacbistest.appiancloud.com/suite/tempo/actions/item/koBbrxGjzbwMkxqSHyoHpJkcjOxmGT3DHmQaINTV3NeeDIHK_H5ECSeQ7hrSgJ2DL6JGeR… 2/8
Date Range
+/
Please define the date range for the reporting period based on the “From” time period as the month and year that corresponds to the beginning period in which utilization took place and please report the “To” time period as the month and year that corresponds to the end period in which utilization took place. Do not report the year in which data were collected from the measure, or the version of HEDIS® used to calculate the measure, both of which may be different from the period corresponding to the utilization of services.
Start Date
January
Month
2000
Year
End Date
February
Month
2014
Year
Definition of Population Included in the Measure
+/
Definition of Denominator
Select all that apply
Denominator includes Medicaid population
Denominator includes Medicare and Medicaid DuallyEligible population
Other Specify *
Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure?
YesNo
Explain which populations are excluded and why *
What is the sample size? *
What is the measureeligible population? *
Definition of Numerator
Health Home enrollees for whom BMI was documented (Table ABA.B) during the measurement year or the year prior to the measurement year.
*States that report using a oneyear lookback period should include only BMI during the measurement year.
Deviations from Measure Specifications
+/
Did your calculation of the measure deviate from the measure specification in any way? *YesNo
Other Performance Measure
+/
Please describe the other methodology used *
10/1/2015 Annual Report Admin Screen
https://gmacbistest.appiancloud.com/suite/tempo/actions/item/koBbrxGjzbwMkxqSHyoHpJkcjOxmGT3DHmQaINTV3NeeDIHK_H5ECSeQ7hrSgJ2DL6JGeR… 3/8
Please describe the rate (e.g.,1864) Numerator Denominator Rate
No items available
+ Additional/Other Rate(s)
Additional Notes/Comments on Measure
Optional Measure Stratification
+/
If this measure is also reported by additional classifications/subcategories, e.g. racial, ethnic, gender, language, disability status, or geography, complete the following as applicable.
Check all that apply
Race (NonHispanic)
White
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Black or African American
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
American Indian or Alaska Native
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
10/1/2015 Annual Report Admin Screen
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Asian
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Native Hawaiian or Other Pacific Islander
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Please define the otherrace *
jhlhhjDelete OtherRace
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
+ Additional Race(s)
Ethnicity
Hispanic or Latino
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Not Hispanic or Latino
Classification/Subcategory Numerator Denominator Rate
10/1/2015 Annual Report Admin Screen
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Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Please define the otherethnicity *
hjkhjDelete OtherEthnicity
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
+ Additional Ethnicity(ies)
Sex
Male
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Female
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Disability Status
SSI
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 Clear
10/1/2015 Annual Report Admin Screen
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0 0 0 Row
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
NonSSI
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Please define the otherdisabilitystatus *
ghjghjDelete OtherDisabilityStatus
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
+ Additional Disability Status(es)
Primary Spoken Language
English
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Spanish
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Clear
10/1/2015 Annual Report Admin Screen
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Age Range: 6574 0 0 0 Row
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Please define the otherlanguage *
uuyhiDelete OtherLanguage
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
+ Additional Primary Spoken Language(s)
Geography
Urban
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Rural
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Please define the othergeographicalregion *
dfhydfhdDelete OtherGeographicalRegion
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 6574 0 0 0 ClearRow
10/1/2015 Annual Report Admin Screen
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Cancel Save Go to Admin Screen
0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
+ Additional Geographical Region(s)
Final Comments (Optional)
+/
Please enter any summary comments
Report Documents
+/
Saved Documents
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Would you like to validate the core measure data at this time?
Yes No(Note: While the measure does not need to be validated at this time in order to proceed, each measure must be validated for the measure to be marked as ‘complete’ andbefore the report can be submitted to CMS).
Note: If validation fails, errors will appear in red above.
10/1/2015 Annual Report Admin Screen
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Ambulatory Care Emergency Department Visits (AMB)Health Homes Quality Measure OR 2013
Request Technical Assistance Clear View All Responses
Are you reporting on this measure? *YesNo
View Implementation Guide
Measurement Specification
+/
NCQA: National Committee for Quality AssuranceOther
Specify version of HEDIS used *
Select Year
HEDIS: Healthcare Effectiveness Data and Information Set
Data Source
+/
Administrative Data Only From where is the Administrative Data coming?Must select one or more
Medicaid Management Information System (MMIS)
Other
*Specify
Character count: 0/2000
Other
Date Range
+/
Please define the date range for the reporting period based on the “From” time period as the month and year that corresponds to the beginning period in which utilization took place and please report the “To” time period as the month and year that corresponds to the end period in which utilization took place. Do not report the year in which data were collected from the measure, or the version of HEDIS® used to calculate the measure, both of which may be different from the period corresponding to the utilization of services.
Start Date
Select Month
Month
Select Year
Year
End Date
Select Month
Month
Select Year
Year
Definition of Population Included in the Measure
+/
Definition of Denominator
Select all that apply
Denominator includes Medicaid population
Denominator includes Medicare and Medicaid DuallyEligible population
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Other Specify *
Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure?
YesNo
Definition of Numerator
The total number of emergency department visits for Health Home enrollees that Medicaid (or Medicare for Dual Eligible beneficiaries) paid for, or expects to pay for, during the measurement year.
Each visit that does not result in an inpatient stay is counted once, regardless of the intensity of duration of the visit. Emergency department visits that result in an inpatient stay are not included.
Deviations from Measure Specifications
+/
Did your calculation of the measure deviate from the measure specification in any way? *YesNo
Please select and explain the deviation(s)
Age Range: 017
Numerator Explain *
Denominator Explain *
Other Explain *
Age Range: 1864
Numerator Explain *
Denominator Explain *
Other Explain *
10/1/2015 Annual Report Admin Screen
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Age Range: 65 and older
Numerator Explain *
Denominator Explain *
Other Explain *
Age Range: Total
Numerator Explain *
Denominator Explain *
Other Explain *
Performance Measure
+/
The rate of emergency department (ED) visits per 1,000 enrollee months among Health Home enrollees.
Age Range: 017
ED Visits Enrollee Months Visits per 1,000 Enrollee Months
0 0 0
Age Range: 1864
ED Visits Enrollee Months Visits per 1,000 Enrollee Months
10/1/2015 Annual Report Admin Screen
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0 0 0
Age Range: 65 and older
ED Visits Enrollee Months Visits per 1,000 Enrollee Months
0 0 0
Age Range: Total
ED Visits Enrollee Months Visits per 1,000 Enrollee Months
0 0 0
Additional Notes/Comments on Measure
Character count: 0/2000
Optional Measure Stratification
+/
If this measure is also reported by additional classifications/subcategories, e.g. racial, ethnic, gender, language, disability status, or geography, complete the following as applicable.
Check all that apply
Race (NonHispanic)
White
Classification/Subcategory Numerator Denominator Rate
Age Range: 017 0 0 0 ClearRow
Age Range: 1864 0 0 0 ClearRow
Age Range: 65 and older 0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Black or African American
Classification/Subcategory Numerator Denominator Rate
Age Range: 017 0 0 0 ClearRow
Age Range: 1864 0 0 0 ClearRow
Age Range: 65 and older 0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
American Indian or Alaska Native
Classification/Subcategory Numerator Denominator Rate
Age Range: 017 0 0 0 ClearRow
10/1/2015 Annual Report Admin Screen
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Age Range: 1864 0 0 0 ClearRow
Age Range: 65 and older 0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Asian
Classification/Subcategory Numerator Denominator Rate
Age Range: 017 0 0 0 ClearRow
Age Range: 1864 0 0 0 ClearRow
Age Range: 65 and older 0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Native Hawaiian or Other Pacific Islander
Classification/Subcategory Numerator Denominator Rate
Age Range: 017 0 0 0 ClearRow
Age Range: 1864 0 0 0 ClearRow
Age Range: 65 and older 0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
+ Additional Race(s)
Ethnicity
Hispanic or Latino
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 65 and older 0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Not Hispanic or Latino
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 65 and older 0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
+ Additional Ethnicity(ies)
Sex
10/1/2015 Annual Report Admin Screen
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Male
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 65 and older 0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Female
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 65 and older 0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Disability Status
SSI
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 65 and older 0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
NonSSI
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 65 and older 0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
+ Additional Disability Status(es)
Primary Spoken Language
English
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 65 and older 0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Spanish
Classification/Subcategory Numerator Denominator Rate
10/1/2015 Annual Report Admin Screen
https://gmacbistest.appiancloud.com/suite/tempo/records/type/UE0S6w/item/iwBbrxGjzbwMkxqSBHfH_J9Pcd60YZZ7GCjdMDpP2i3NDDyhURVsEjXcpksIA/… 7/8
Age Range: 1864 0 0 0 ClearRow
Age Range: 65 and older 0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
+ Additional Primary Spoken Language(s)
Geography
Urban
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 65 and older 0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Rural
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 65 and older 0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
+ Additional Geographical Region(s)
Final Comments (Optional)
+/
Please enter any summary comments
Report Documents
+/
Saved Documents
Maximum documents that can be uploaded for this report: 84Maximum file size : 2MBValid file extensions : pdf; ppt; doc; docx; xlsx; xls; pptx
Name Description Date Created Updated By Size Type
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No file chosenChoose File
10/1/2015 Annual Report Admin Screen
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Would you like to validate the core measure data at this time?
Yes No(Note: While the measure does not need to be validated at this time in order to proceed, each measure must be validated for the measure to be marked as ‘complete’ andbefore the report can be submitted to CMS).
Warning: Any field containing more than 4000 characters will be truncated when saved.
10/1/2015 Annual Report Admin Screen
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Ambulatory Care Emergency Department Visits (AMB)Health Homes Quality Measure OR 2013
Request Technical Assistance Clear View All Responses
Are you reporting on this measure? *YesNo
View Implementation Guide
Measurement Specification
+/
NCQA: National Committee for Quality AssuranceOther
Explain *
Data Source
+/
Administrative Data Only From where is the Administrative Data coming?Must select one or more
Medicaid Management Information System (MMIS)
Other
*Specify
Character count: 0/2000
Other
Date Range
+/
Please define the date range for the reporting period based on the “From” time period as the month and year that corresponds to the beginning period in which utilization took place and please report the “To” time period as the month and year that corresponds to the end period in which utilization took place. Do not report the year in which data were collected from the measure, or the version of HEDIS® used to calculate the measure, both of which may be different from the period corresponding to the utilization of services.
Start Date
Select Month
Month
Select Year
Year
End Date
Select Month
Month
Select Year
Year
Definition of Population Included in the Measure
+/
Definition of Denominator
Select all that apply
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10/1/2015 Annual Report Admin Screen
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Denominator includes Medicaid population
Denominator includes Medicare and Medicaid DuallyEligible population
Other Specify *
Does this denominator represent your total measure eligible population as defined by the Technical Specifications for this measure?
YesNo
Definition of Numerator
The total number of emergency department visits for Health Home enrollees that Medicaid (or Medicare for Dual Eligible beneficiaries) paid for, or expects to pay for, during the measurement year.
Each visit that does not result in an inpatient stay is counted once, regardless of the intensity of duration of the visit. Emergency department visits that result in an inpatient stay are not included.
Deviations from Measure Specifications
+/
Did your calculation of the measure deviate from the measure specification in any way? *YesNo
Please select and explain the deviation(s)
Age Range: 017
Numerator Explain *
Denominator Explain *
Other Explain *
Age Range: 1864
Numerator Explain *
Denominator Explain *
10/1/2015 Annual Report Admin Screen
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Other Explain *
Age Range: 65 and older
Numerator Explain *
Denominator Explain *
Other Explain *
Age Range: Total
Numerator Explain *
Denominator Explain *
Other Explain *
Other Performance Measure
+/
Please describe the other methodology used *
Please describe the rate (e.g.,1864) Numerator Denominator Rate
0 0 0 ClearRow
10/1/2015 Annual Report Admin Screen
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+ Additional/Other Rate(s)
Additional Notes/Comments on Measure
Optional Measure Stratification
+/
If this measure is also reported by additional classifications/subcategories, e.g. racial, ethnic, gender, language, disability status, or geography, complete the following as applicable.
Check all that apply
Race (NonHispanic)
White
Classification/Subcategory Numerator Denominator Rate
Age Range: 017 0 0 0 ClearRow
Age Range: 1864 0 0 0 ClearRow
Age Range: 65 and older 0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Black or African American
Classification/Subcategory Numerator Denominator Rate
Age Range: 017 0 0 0 ClearRow
Age Range: 1864 0 0 0 ClearRow
Age Range: 65 and older 0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
American Indian or Alaska Native
Classification/Subcategory Numerator Denominator Rate
Age Range: 017 0 0 0 ClearRow
Age Range: 1864 0 0 0 ClearRow
Age Range: 65 and older 0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Asian
Classification/Subcategory Numerator Denominator Rate
Age Range: 017 0 Clear
10/1/2015 Annual Report Admin Screen
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0 0 Row
Age Range: 1864 0 0 0 ClearRow
Age Range: 65 and older 0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Native Hawaiian or Other Pacific Islander
Classification/Subcategory Numerator Denominator Rate
Age Range: 017 0 0 0 ClearRow
Age Range: 1864 0 0 0 ClearRow
Age Range: 65 and older 0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
+ Additional Race(s)
Ethnicity
Hispanic or Latino
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 65 and older 0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
Not Hispanic or Latino
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 65 and older 0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
+ Additional Ethnicity(ies)
Sex
Male
Classification/Subcategory Numerator Denominator Rate
Age Range: 1864 0 0 0 ClearRow
Age Range: 65 and older 0 0 0 ClearRow
+ Additional/Alternative Classification/Subcategory
10/1/2015 Annual Report Admin Screen
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