Quality Measures by Topic
Jump to topic
Access to Care and Treatment | Behavioral Health Care | Behavioral Health Care - Adults | Behavioral Health Care - Children | Behavioral Health Care - Older Adults | Behavioral Health Care - Special Needs Population | Care Coordination | Care Management | CMS Medicaid Adult Core Set - Standard Medicaid | CMS Medicaid Child Core Set | Dental Organization Operations | Dental Provider Network Management | Diabetes Health Care - Adults | Grievances and Appeals | Health Services Management - Standard Medicaid | HEDIS Acute and Chronic Care Measures | HEDIS Behavioral Health Care Measures | HEDIS Preventive Care Measures | Hospital Inpatient and Outpatient Care | Hospital Inpatient and Outpatient Care - Adults | Hospital Inpatient and Outpatient Care - Children | Hospital Inpatient and Outpatient Care - Older Adults | Hospital Inpatient and Outpatient Care - Special Needs Population | Long Term Community Based Care | Long Term Community Based Care - Adults | Long Term Community Based Care - Children | Member Experience of Care - Children | Member Services | Network Adequacy | Non-Emergent Medical Transportation (NEMT) | Pharmacy | Pharmacy - Adults | Pharmacy - Children | Provider Network Management | Provider Services | Substance Use Disorder Care▲ Back to top
Access to Care and Treatment
- Dental Service, Equipment and Supply Service Authorization Timely Determination Rate: New Routine Requests
- Dental Service, Equipment and Supply Service Authorization Timely Determination Rate: Post-Delivery Requests
- Dental Service, Equipment and Supply Service Authorization Timely Determination Rate: Urgent Requests
- Family and Friends Program NEMT Legs for Adult Dental Services
- Member Dental Appeals Received
- Member Dental Grievances Received
- Member Dental Services Authorized within 72 Hours Following a Reversed Appeal
- Requests for Assistance Accessing Dentists by County
- Requests for Assistance Accessing Oral Surgeons by County
- Resolution of All Member Dental Appeals within 45 Calendar Days
- Resolution of Expedited Member Dental Appeals within 72 Hours
- Resolution of Extended Standard Member Dental Appeals within 45 Calendar Days
- Resolution of Member Dental Appeals by Disposition Type
- Resolution of Standard Member Dental Appeals within 30 Calendar Days
- Results of Scheduled NEMT Legs for Adult Dental Services by Outcome
- Scheduled NEMT Legs Delivered On Time for Adult Dental Services
- Timely Processing of All Member Dental Grievances
▲ Back to top
Behavioral Health Care
- Adherence to Antipsychotic Medications for Individuals With Schizophrenia (SAA)
- Community Hospital Discharges for Mental Health-Related Conditions - Follow-up Visit within 30 Days of Discharge
- Community Hospital Discharges for Mental Health-Related Conditions - Follow-up Visit within 7 Days of Discharge
- Community Hospital or APRT Readmissions for Mental Health Conditions at 180 Days
- Community Hospital or APRT Readmissions for Mental Health Conditions at 30 Days
- Community Hospital Readmissions for Mental Health-Related Conditions within 180 Days of Discharge
- Community Hospital Readmissions for Mental Health-Related Conditions within 30 Days of Discharge
- Concurrent Use of Opioids and Benzodiazepines (CUOB, CMS Adult Core Set)
- Diabetes Care for People with Serious Mental Illness - HA1c Testing Poor Control (>9%) (HPCMI, CMS Adult Core Set)
- Diabetes Monitoring for People With Diabetes and Schizophrenia (SMD)
- Engagement of Alcohol Abuse or Dependence Treatment (IET)
- Engagement of Alcohol and Other Drug Abuse or Dependence Treatment (IET)
- Engagement of Opioid Abuse or Dependence Treatment (IET)
- Engagement of Other Drug Abuse or Dependence Treatment (IET)
- Follow-up After Emergency Department Visit for Mental Illness (FUM) Within 30 days by Age
- Follow-up After Emergency Department Visit for Mental Illness (FUM) Within 7 days by Age
- Initiation of Alcohol Abuse or Dependence Treatment (IET)
- Initiation of Alcohol and Other Drug Abuse or Dependence Treatment (IET)
- Initiation of Opioid Abuse or Dependence Treatment (IET)
- Initiation of Other Drug Abuse or Dependence Treatment (IET)
- NH Hospital Discharges - Discharge Plan Provided to Aftercare Provider within 7 Calendar Days of Member Discharge
- NH Hospital Discharges - Follow-up Visit within 30 Days of Discharge
- NH Hospital Discharges - MCO Contacts and Contact Attempts
- NH Hospital Discharges - New CMHC Patient Had Intake Appointment with CMHC within 7 Calendar Days of Discharge
- Readmissions for Mental Health Conditions within 30 Days
- Readmissions to NH Hospital within 30 Days
- Risk of Continued Opioid Use (COU) >= 15 Days by Age
- Risk of Continued Opioid Use (COU) >= 30 Days by Age
- Screening for Depression and Follow-Up Plan (CDF, CMS Adult and Child Core Set)
- Use of Opioids at High Dosage (HDO)
- Use of Opioids from Multiple Providers (UOP): Multiple Pharmacies
- Use of Opioids from Multiple Providers (UOP): Multiple Prescribers
- Use of Opioids from Multiple Providers (UOP): Multiple Prescribers and Multiple Pharmacies
▲ Back to top
Behavioral Health Care - Adults
- Community Hospital Discharges for Mental Health-Related Conditions - Follow-up Visit within 7 Days of Discharge
- Community Hospital Readmissions for Mental Health-Related Conditions within 180 Days of Discharge
▲ Back to top
Behavioral Health Care - Children
- Community Hospital Discharges for Mental Health-Related Conditions - Follow-up Visit within 7 Days of Discharge
- Community Hospital Readmissions for Mental Health-Related Conditions within 180 Days of Discharge
- Community Hospital Readmissions for Mental Health-Related Conditions within 30 Days of Discharge
- Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM) - Blood Glucose and Cholesterol Testing
- Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM) - Blood Glucose Testing
- Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM) - Cholesterol Testing
▲ Back to top
Behavioral Health Care - Older Adults
▲ Back to top
Behavioral Health Care - Special Needs Population
▲ Back to top
Care Coordination
▲ Back to top
Care Management
▲ Back to top
CMS Medicaid Adult Core Set - Standard Medicaid
- Asthma in Younger Adults Admission Rate (PQI15, CMS Adult Core Set)
- Chronic Obstructive Pulmonary Disease (COPD) or Asthma in Older Adults Admission Rate (PQI05, CMS Adult Core Set)
- Colorectal Cancer Screening (COL, CMS Adult Core Set)
- Concurrent Use of Opioids and Benzodiazepines (CUOB, CMS Adult Core Set)
- Contraceptive Care – All Women : Long-Acting Reversible Method of Contraception (LARC) (CCW, CMS Adult and Child Core Set)
- Contraceptive Care – All Women - Most Effective or Moderately Effective Contraception (CCW, CMS Adult and Child Core Set)
- Contraceptive Care – Postpartum Women: Long-Acting Reversible Method of Contraception (LARC) – 3 days (CCP, CMS Adult and Child Core Sets)
- Contraceptive Care – Postpartum Women: Long-Acting Reversible Method of Contraception (LARC) – 90 days (CCP, CMS Adult and Child Core Sets)
- Contraceptive Care – Postpartum Women: Most or Moderately Effective Contraception – 3 Days by Age Group (CCP, CMS Adult and Child Core Sets)
- Contraceptive Care – Postpartum Women: Most or Moderately Effective Contraception – 90 days by Age Group (CCP, CMS Adult and Child Core Sets)
- Diabetes Care for People with Serious Mental Illness - HA1c Testing Poor Control (>9%) (HPCMI, CMS Adult Core Set)
- Diabetes Short-Term Complications Admission Rate (PQI01,CMS Adult Core Set)
- Heart Failure Admission Rate (PQI08, CMS Adult Core Set)
- Medical Assistance with Smoking and Tobacco Use Cessation: Advising Smokers and Tobacco Users to Quit (MSC, CMS Adult Core Set)
- Medical Assistance with Smoking and Tobacco Use Cessation: Discussing Cessation Medications (MSC, CMS Adult Core Set)
- Medical Assistance with Smoking and Tobacco Use Cessation: Discussing Cessation Strategies (MSC, CMS Adult Core Set)
- Screening for Depression and Follow-Up Plan (CDF, CMS Adult and Child Core Set)
▲ Back to top
CMS Medicaid Child Core Set
- Contraceptive Care – All Women : Long-Acting Reversible Method of Contraception (LARC) (CCW, CMS Adult and Child Core Set)
- Contraceptive Care – All Women - Most Effective or Moderately Effective Contraception (CCW, CMS Adult and Child Core Set)
- Contraceptive Care – Postpartum Women: Long-Acting Reversible Method of Contraception (LARC) – 3 days (CCP, CMS Adult and Child Core Sets)
- Contraceptive Care – Postpartum Women: Long-Acting Reversible Method of Contraception (LARC) – 90 days (CCP, CMS Adult and Child Core Sets)
- Contraceptive Care – Postpartum Women: Most or Moderately Effective Contraception – 3 Days by Age Group (CCP, CMS Adult and Child Core Sets)
- Contraceptive Care – Postpartum Women: Most or Moderately Effective Contraception – 90 days by Age Group (CCP, CMS Adult and Child Core Sets)
- Developmental Screening in the First Three Years of Life (DEV, CMS Child Core Set)
▲ Back to top
Dental Organization Operations
- Dental Claims Quality Assurance: Dental Claims Financial Accuracy
- Dental Claims Quality Assurance: Dental Claims Payment Accuracy
- Dental Claims Quality Assurance: Dental Claims Processing Accuracy
- Dental Member Communications: Calls Abandoned
- Dental Member Communications: Calls Returned by the Next Business Day
- Dental Member Communications: Reasons for Telephone Inquiries
- Dental Member Communications: Speed to Answer Within 30 Seconds
- Dental Provider Communications: Calls Abandoned
- Dental Provider Communications: Calls Returned by Next Business Day
- Dental Provider Communications: Reasons for Telephone Inquiries
- Dental Provider Communications: Speed to Answer within 30 Seconds
- Family and Friends Program NEMT Legs for Adult Dental Services
- Interest on Late Paid Dental Claims
- Results of Scheduled NEMT Legs for Adult Dental Services by Outcome
- Scheduled NEMT Legs Delivered On Time for Adult Dental Services
- Timely Processing of All Clean Dental Claims: Ninety Days of Receipt
- Timely Processing of All Clean Dental Claims: Thirty Days of Receipt
▲ Back to top
Dental Provider Network Management
▲ Back to top
Diabetes Health Care - Adults
▲ Back to top
Grievances and Appeals
- Member Appeals Received
- Member Grievances Received
- Resolution of All Appeals within 45 Calendar Days
- Resolution of Appeals by Disposition Type
- Resolution of Expedited Appeals within 72 Hours
- Resolution of Extended Standard Appeals within 44 Calendar Days
- Resolution of Provider Appeals within 30 Calendar Days
- Resolution of Standard Appeals within 30 Calendar Days
- Services Authorized within 72 Hours Following a Reversed Appeal
- Timely Processing of Grievances
▲ Back to top
Health Services Management - Standard Medicaid
- Medical Service, Equipment and Supply Post-Delivery Service Authorization Timely Determination Rate
- Medical Service, Equipment and Supply Service Authorization Timely Determination Rate: New Routine Requests
- Medical Service, Equipment and Supply Service Authorization Timely Determination Rate: Urgent Requests
- Pharmacy Service Authorization Timely Determination Rate
- Service Authorization Denials for Waiver & Non-HCBC Waiver Populations
- Service Authorizations: Physical, Occupational & Speech Therapy Service Authorization Denials by Waiver & Non-HCBC Waiver Populations
▲ Back to top
HEDIS Acute and Chronic Care Measures
- Blood Pressure Control (<140/90) (BPD)
- Comprehensive Diabetes Care (CDC, Hybrid Specification): Medical Attention for Nephropathy
- Eye Exam for Patients With Diabetes (EED)
- Hemoglobin A1c Control for Patients with Diabetes: HbA1c Poor Control (>9.0%) (HBD)
- Kidney Health Evaluation for Patients With Diabetes (KED)
- Lead Screening (LSC)
- Medication Management for People With Asthma (MMA): Medication Compliance 50%
- Medication Management for People With Asthma (MMA): Medication Compliance 75%
▲ Back to top
HEDIS Behavioral Health Care Measures
- Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM) - Blood Glucose and Cholesterol Testing
- Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM) - Blood Glucose Testing
▲ Back to top
HEDIS Preventive Care Measures
▲ Back to top
Hospital Inpatient and Outpatient Care
- Community Hospital Readmissions for Mental Health-Related Conditions within 180 Days of Discharge
- Community Hospital Readmissions for Mental Health-Related Conditions within 30 Days of Discharge
▲ Back to top
Hospital Inpatient and Outpatient Care - Adults
- Community Hospital Readmissions for Mental Health-Related Conditions within 180 Days of Discharge
- Community Hospital Readmissions for Mental Health-Related Conditions within 30 Days of Discharge
▲ Back to top
Hospital Inpatient and Outpatient Care - Children
▲ Back to top
Hospital Inpatient and Outpatient Care - Older Adults
▲ Back to top
Hospital Inpatient and Outpatient Care - Special Needs Population
▲ Back to top
Long Term Community Based Care
▲ Back to top
Long Term Community Based Care - Adults
▲ Back to top
Long Term Community Based Care - Children
▲ Back to top
Member Experience of Care - Children
- Getting Care Quickly: Days to Get Appointment For Check-up or Routine Care (CAHPS® - Child)
- Getting Care Quickly: Days to Get Appointment When Care Needed Right Away (CAHPS® - Child)
- Number of Specialists Child Talked To (CAHPS® - Child)
- Number of Visits with Personal Doctor (CAHPS® - Child)
▲ Back to top
Member Services
- Family and Friends Program NEMT Legs
- Member Communications: Calls Abandoned
- Member Communications: Calls Returned by the Next Business Day
- Member Communications: Reasons for Telephone Inquiries
- Member Communications: Speed to Answer Within 30 Seconds
- NEMT Legs Delivered by Covered Medical Service
- NEMT Request Authorization Approvals by Mode of Transportation
- Requests for Assistance Accessing MCO Designated Primary Care Providers by County
- Requests for Assistance Accessing non-MCO Designated Physician/APRN Specialists by County
- Results of Scheduled NEMT Legs by Outcome
- Timeliness of Scheduled and Delivered NEMT Legs
▲ Back to top
Network Adequacy
▲ Back to top
Non-Emergent Medical Transportation (NEMT)
- Family and Friends Program NEMT Legs
- NEMT Legs Delivered by Covered Medical Service
- NEMT Request Authorization Approvals by Mode of Transportation
▲ Back to top
Pharmacy
- Pharmacy Utilization Management: Generic Drug Substitution
- Pharmacy Utilization Management: Generic Drug Utilization
- Pharmacy Utilization Management: Generic Drug Utilization Adjusted for Preferred PDL Brands
- Polypharmacy Monitoring: Adults with 5 or More Prescriptions for 60 Consecutive Days
- Polypharmacy Monitoring: Children with 4 or More Prescriptions for 60 Consecutive Days
- Safety Monitoring - Opioid Prescriptions Meeting NH DHHS Morphine Equivalent Dosage Prior Authorization Compliance
▲ Back to top
Pharmacy - Adults
▲ Back to top
Pharmacy - Children
▲ Back to top
Provider Network Management
▲ Back to top
Provider Services
- Average Pharmacy Claim Processing Time
- NEMT Claims Quality Assurance: Claims Processing Accuracy
- NEMT Timely Claims Processing
- Professional and Facility Medical Claim Processing Results
- Provider Communications: Calls Abandoned
- Provider Communications: Calls Returned by Next Business Day
- Provider Communications: Reasons for Telephone Inquiries
- Provider Communications: Speed to Answer within 30 Seconds
- Timely Processing of All Clean Provider Claims: Ninety Days of Receipt
- Timely Processing of All Clean Provider Claims: Thirty Days of Receipt
- Timely Processing of Electronic Provider Claims: Fifteen Days of Receipt
- Timely Processing of Non-Electronic Provider Claims: Thirty Days of Receipt
▲ Back to top