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Quality Measures by Topic
Care Management Program
Preventive Care
Acute and Chronic Care
Behavioral Health Care
Children
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Step 1: Select your measure(s).
Filter Measures by One or More Topics
Include uncategorized
Behavioral Health Care
Behavioral Health Care - Adults
Behavioral Health Care - Children
Behavioral Health Care - Older Adults
Behavioral Health Care - Special Needs Population
Beneficiary Demographics - Standard Medicaid
Cardiovascular Health Care - Adults
Care Coordination
Care Coordination - Children
CMS Medicaid Adult Core Set - NH Health Protection Program
CMS Medicaid Adult Core Set - Standard Medicaid
CMS Medicaid Child Core Set
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 - NH Health Protection Program Members
Hospital Inpatient and Outpatient Care - Older Adults
Hospital Inpatient and Outpatient Care - Special Needs Population
Immunizations - Children
Long Term Community Based Care
Long Term Community Based Care - Adults
Long Term Community Based Care - Children
Member Experience of Care - Adults
Member Experience of Care - Children
Member Services
Network Adequacy
Non-Emergent Medical Transportation (NEMT)
Office and Clinic Care
Office and Clinic Care - Adults
Office and Clinic Care - Children
Office and Clinic Care - NH Health Protection Program Members
Office and Clinic Care - Older Adults
Office and Clinic Care - Special Needs Population
Pharmacy
Pharmacy - Adults
Pharmacy - Children
Pharmacy - Older Adults
Provider Services
Respiratory Health Care
Respiratory Health Care - Adults
Respiratory Health Care - Children
Screenings - Adults
Screenings - Children
Substance Use Disorder Care
Substance Use Disorder Care - Adults
Substance Use Disorder Care - NH Health Protection Program Members
Well Care - Children
Measures
*
Adherence to Antipsychotic Medications for Individuals With Schizophrenia (SAA)
Adolescent Well-Care Visits (AWC, Hybrid Specification)
Adult BMI Assessment (ABA, Hybrid Specification)
Adult CAHPS®: Aware Can Make a Complaint To Health Plan About Care or Services Received or Decisions Made
Adult CAHPS®: Customer Service Provided Information or Help: Usually or Always
Adult CAHPS®: Customer Service Treated Member with Courtesy and Respect: Usually or Always
Adult CAHPS®: Days to Get Appointment For Check-up or Routine Care
A. Same Day
B. 1 Day
C. 2 to 3 Days
D. 4 to 7 Days
E. 8 to 14 Days
F. 15 to 30 Days
G. More than 30 Days
Adult CAHPS®: Days to Get Appointment When Care Needed Right Away
A. Same Day
B. 1 Day
C. 2 - 3 Days
D. 4 - 7 Days
E. More than 7 Days
Adult CAHPS®: Doctor or Other Health Provider Talked About What Member Thought was Best for Themselves When Discussing Medicine
Adult CAHPS®: Doctor or Other Health Provider Talked With Member About Reasons Member Might Want to Take a Medicine
Adult CAHPS®: Doctor or Other Health Provider Talked with Member About Reasons Member Might Not Want to Take a Medicine
Adult CAHPS®: Doctor or Other Health Provider Talked with Member about Specific Things the Member Could do to Prevent Illness
Adult CAHPS®: Ease In Getting Care, Tests, and Treatment: Usually or Always
Adult CAHPS®: Ease in Getting Special Medical Equipment: Usually or Always
Adult CAHPS®: Ease in Getting Treatment or Counseling: Usually or Always
Adult CAHPS®: Feel Comfortable Speaking To Doctor or Other Health Provider About Personal or Family Problems with Alcohol or Other Drugs
Adult CAHPS®: Flu Vaccinations for Adults Ages 18 - 64 (FVA)
Adult CAHPS®: Getting Appointment to See Specialist as Soon as Needed: Usually or Always
Adult CAHPS®: Getting Needed Care Right Away - Usually or Always
Adult CAHPS®: Getting Needed Care from a Doctor's Office or Clinic During Evenings, Weekends, or Holidays - Usually or Always
Adult CAHPS®: Getting Routine or Check-up Appointments as Soon as They Were Needed: Usually or Always
Adult CAHPS®: Heath Plan Forms Easy to Fill Out: Usually or Always
Adult CAHPS®: In The Last 6 Months, Needed Treatment or Counseling For An Alcohol or Drug Problem But Didn’t Get It
Adult CAHPS®: Member Got Care from a Doctor or Other Health Provider Besides Their Personal Doctor
Adult CAHPS®: Member Rating of Overall Health - Very Good or Excellent
Adult CAHPS®: Member Rating of Overall Mental or Emotional Health - Very Good or Excellent
Adult CAHPS®: Members Reporting a Condition or Problem Lasting at Least 3 months for which They Received Health Care 3 or More Times in the Last 6 Months.
Adult CAHPS®: Number of Specialists Seen
A. None
B. One
C. Two
D. Three
E. Four
F. Five or More Specialists
Adult CAHPS®: Number of Visits to Personal Doctor
A. None
B. One
C. Two
D. Three
E. Four
F. Five to Nine
G. Ten or More
Adult CAHPS®: Percent of Adults Reporting Now Needing or Taking Medicine Prescribed by a Doctor
Adult CAHPS®: Percent of Adults Reporting a Condition or Problem Lasting at Least 3 months for which They Need or Take Medicine Prescribed by a Doctor.
Adult CAHPS®: Personal Doctor Explained Things in a Way That Was Easy to Understand: Usually or Always
Adult CAHPS®: Personal Doctor Listened Carefully: Usually or Always
Adult CAHPS®: Personal Doctor Provided Help Needed to Manage Care Among Different Providers and Services - Usually or Always
Adult CAHPS®: Personal Doctor Showed Respect: Usually or Always
Adult CAHPS®: Personal Doctor Spent Enough time with Member: Usually or Always
Adult CAHPS®: Personal Doctor Up-to-Date about Care from other Doctors or Health Providers: Usually or Always
Adult CAHPS®: Provider had Medical Records About Care - Usually or Always
Adult CAHPS®: Rating of Health Care - 8, 9 or 10
Adult CAHPS®: Rating of Health Plan: 8, 9, or 10
Adult CAHPS®: Rating of Personal Doctor - 8, 9 or 10
Adult CAHPS®: Rating of Specialist Seen Most Often - 8, 9 or 10
Adult CAHPS®: Reason Why Did Not Get the Treatment or Counseling for an Alcohol or Drug Problem Needed
A. Couldn’t Afford the Cost
B: Concerned Neighbors or Community Might Have a Negative Opinion
C. Concerned Getting Treatment Might Have a Negative Effect on Job
D. Health Insurance Does Not Cover Treatment or Counseling For an Alcohol or Drug Problem
E. Health Insurance Does Not Pay Enough
F. Did Not Know Where to Go to Get Services
G. Concerned about Confidentiality
H. Concerned You Might Be Committed to a Psychiatric Hospital or Might Have to Take Medicine
I. Other Reason
Adult CAHPS®: Written Materials or Internet Provide Information Needed about How Health Plan Works: Usually or Always
Adults’ Access to Preventive/Ambulatory Health Services (AAP)
A: Age 20-44 Years
B: Age 45-64 Years
C. Age 65+ Years
Ambulatory Care (AMB): Total Medicaid
Emergency Department Visits
A. Age <1
B. Age 1-9 Years
C. Age 10-19 Years
D. Age 20-44 Years
E. Age 45-64 Years
F. Age 65-74 Years
G. Age 75-84 Years
H. Age 85+ Years
I. Age Unknown
Outpatient Visits
A. Age <1
B. Age 1-9 Years
C. Age 10-19 Years
D. Age 20-44 Years
E. Age 45-64 Years
F. Age 65-74 Years
G. Age 75-84 Years
H. Age 85+ Years
I. Age Unknown
Annual Monitoring for Members on Angiotensin Converting Enzyme inhibitors (ACE) or Agiotensin Receptor Blockers (MPM): Ace Inhibitors or ARBs
Adults
All Other Adults
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Special Needs Adult
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Older Adults
All Older Adults
Not Receiving Waiver, CMHC or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Annual Monitoring for Members on Angiotensin Converting Enzyme inhibitors (ACE) or Agiotensin Receptor Blockers (MPM): Diuretics
Adults
All Other Adults
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Special Needs Adult
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Older Adults
All Older Adults
Not Receiving Waiver, CMHC or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Annual Monitoring for Members on Digoxin (MPM, CMS Adult Core Set)
A. Age 18-64 Years
Annual Monitoring for Patients on Persistent Medications (MPM): ACE Inhibitors or ARBs
Annual Monitoring for Patients on Persistent Medications (MPM): Diuretics
Antidepressant Medication Management (AMM): Effective Acute Phase Treatment
Antidepressant Medication Management (AMM): Effective Acute Phase Treatment
Adults
All Other Adults
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Special Needs Adult
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Older Adults
All Older Adults
Not Receiving Waiver, CMHC or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Antidepressant Medication Management (AMM): Effective Continuation Phase Treatment
Adults
All Other Adults
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Special Needs Adult
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Older Adults
All Older Adults
Not Receiving Waiver, CMHC or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Antidepressant Medication Management (AMM): Effective Continuation Phase Treatment
Appeals Elevated to State Fair Hearing
A. Upheld
B. Reversed by Plan
C. Withdrawn
D. Dismissed
E. Resolved by Settlement
Appeals by Reason Type
A. Denial or Limited Authorization
B. Reduction, Suspension, or Termination of Previously Authorized Service
C. Denial of Payment
D. Failure to Provide Timely Service
E. Untimely Service Authorization
F. Failure of MCO to Act Within NH DHHS Contract Timeframes
G. Other
Appropriate Testing for Children With Pharyngitis (CWP)
Appropriate Treatment for Children With Upper Respiratory Infection (URI)
Asthma Medication Ratio (AMR)
A. Age 5 to 11 Years
B. Age 12 to 18 Years
C. Age 19 to 50 Years
D. Age 51 to 64 Years
Asthma in Younger Adults Admission Rate per 100,000 Enrollee Months (PQI15, CMS Adult Core Set)
Average Pharmacy Claim Processing Time
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis (AAB)
Breast Cancer Screening (BCS)
Adults
All Other Adults
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Special Needs Adult
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Older Adults
All Older Adults
Not Receiving Waiver, CMHC or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Breast Cancer Screening (BCS)
Cardiovascular Monitoring for People With Cardiovascular Disease and Schizophrenia (SMC)
Cervical Cancer Screening (CCS, Hybrid Specification)
Child CAHPS®: Care Coordination for More than One Kind of Health Care Provider or Service
Child CAHPS®: Caregiver Aware of Health Plan Complaint Process
Child CAHPS®: Child Able to Talk with Doctors about His or Her Health Care
Child CAHPS®: Child Got Care from a Doctor or Other Health Provider Besides Their Personal Doctor
Child CAHPS®: Child Limited or Prevented in Ability to do Things Most Children of Same Age Can Do
Child CAHPS®: Child Needs/Gets Special Therapy (e.g., Physical, Occupational, or Speech)
Child CAHPS®: Child Needs/Uses More Health Care than Usual for Children of Same Age
Child CAHPS®: Child Needs/Uses Prescribed Medicine Due Health Condition
Child CAHPS®: Child has Emotional, Developmental, or Behavioral Problem for which they Need/Get Treatment or Counseling
Child CAHPS®: Child's Health Plan, Doctor's Office, or Clinic Helped Get Prescription Medicines for Child
Child CAHPS®: Child's Health Plan, Doctor's Office, or Clinic Helped Get Special Medical Equipment or Devices for Child
Child CAHPS®: Child's Health Plan, Doctor's Office, or Clinic Helped Get Special Therapy for Child
Child CAHPS®: Child's Health Plan, Doctor's Office, or Clinic Helped Get Treatment or Counseling for Child
Child CAHPS®: Child's Personal Doctor Understands How Health Conditions Affect Child's Day-to-Day Life
Child CAHPS®: Child's Personal Doctor Understands How Health Conditions Affect Child's Family's Day-to-Day Life
Child CAHPS®: Customer Service Provided Information or Help: Usually or Always
Child CAHPS®: Customer Service Treated Caregiver with Courtesy and Respect: Usually or Always
Child CAHPS®: Days to Get Appointment For Check-up or Routine Care
A. Same Day
B. 1 Day
C. 2 to 3 Days
D. 4 to 7 Days
E. 8 to 14 Days
F. 15 to 30 Days
G. More than 30 Days
Child CAHPS®: Days to Get Appointment When Care Needed Right Away
A. Same Day
B. 1 Day
C. 2 - 3 Days
D. 4 - 7 Days
E. More than 7 Days
Child CAHPS®: Doctor/Other Health Provider Talked About What Caregiver Thought was Best for Child When Discussing Medicine
Child CAHPS®: Doctor/Other Health Provider Talked With Caregiver About Reasons Caregiver Might Want Child to Take Medicine
Child CAHPS®: Doctor/Other Health Provider Talked with Caregiver About Reasons Caregiver Might Not Want Child to Take Medicine
Child CAHPS®: Doctor/Other Health Provider Talked with Caregiver about Specific Things Caregiver Could do to Prevent Illness for Child
Child CAHPS®: Ease In Getting Care, Tests, and Treatment- Usually or Always
Child CAHPS®: Ease in Getting Prescription Medicines for Child - Usually or Always
Child CAHPS®: Ease in Getting Special Medical Equipment or Devices for their Child - Usually or Always
Child CAHPS®: Ease in Getting Special Therapy for their Child - Usually or Always
Child CAHPS®: Ease in Getting Treatment or Counseling for their Child - Usually or Always
Child CAHPS®: Getting Appointment to See Specialist as Soon as Needed: Usually or Always
Child CAHPS®: Getting Needed Care Right Away - Usually or Always
Child CAHPS®: Getting Needed Care from a Doctor's Office or Clinic During Evenings, Weekends, or Holidays - Usually or Always
Child CAHPS®: Getting Questions Answered by Child's Doctors or Other Health Providers - Usually or Always
Child CAHPS®: Getting Routine or Check-up Appointments as Soon as They Were Needed: Usually or Always
Child CAHPS®: Got Help Needed From Child's Doctors or Other Health Providers to Contact Child's School or Daycare
Child CAHPS®: Heath Plan Forms Easy to Fill Out: Usually or Always
Child CAHPS®: Member Rating of Overall Health - Very Good or Excellent
Child CAHPS®: Member Rating of Overall Mental or Emotional Health - Very Good or Excellent
Child CAHPS®: Needed Child's Doctors or Other Health Providers to Contact Child's School or Daycare
Child CAHPS®: Number of Specialists Seen
A. None
B. One
C. Two
D. Three
E. Four
F. Five or More Specialists
Child CAHPS®: Number of Visits to Personal Doctor
A. None
B. One
C. Two
D. Three
E. Four
F. Five to Nine
G. Ten or More
Child CAHPS®: Personal Doctor Explained Things in a Way That Was Easy for Child to Understand: Usually or Always
Child CAHPS®: Personal Doctor Explained Things in a Way That Was Easy to Understand: Usually or Always
Child CAHPS®: Personal Doctor Had Medical Records or Other Information About Child's Care - Usually or Always
Child CAHPS®: Personal Doctor Listened Carefully: Usually or Always
Child CAHPS®: Personal Doctor Showed Respect: Usually or Always
Child CAHPS®: Personal Doctor Spent Enough time with Child: Usually or Always
Child CAHPS®: Personal Doctor Talked with Caregiver about How Child is Feeling, Growing, or Behaving
Child CAHPS®: Personal Doctor Up-to-Date about Child's Care from other Doctors or Health Providers: Usually or Always
Child CAHPS®: Rating of Health Care - 8, 9 or 10
Child CAHPS®: Rating of Health Plan: 8, 9, or 10
Child CAHPS®: Rating of Personal Doctor - 8, 9 or 10
Child CAHPS®: Rating of Specialist Seen Most Often - 8, 9 or 10
Child CAHPS®: Satisfaction with Help Received to Coordinate Child's Care - Satisfied or Very Satisfied
Childhood Immunization Status (CIS, Hybrid Specification): Combination 10
Childhood Immunization Status (CIS, Hybrid Specification): Combination 2
Childhood Immunization Status (CIS, Hybrid Specification): Combination 3
Childhood Immunization Status (CIS, Hybrid Specification): Combination 4
Childhood Immunization Status (CIS, Hybrid Specification): Combination 5
Childhood Immunization Status (CIS, Hybrid Specification): Combination 6
Childhood Immunization Status (CIS, Hybrid Specification): Combination 7
Childhood Immunization Status (CIS, Hybrid Specification): Combination 8
Childhood Immunization Status (CIS, Hybrid Specification): Combination 9
Children and Adolescents’ Access to Primary Care Practitioners (CAP): A. Age 12-24 Months
Children and Adolescents’ Access to Primary Care Practitioners (CAP): B. Age 25 Months - 6 Years
Children and Adolescents’ Access to Primary Care Practitioners (CAP): C. Age 7-11 Years
Children and Adolescents’ Access to Primary Care Practitioners (CAP): D. Age 12-19 Years
Chlamydia Screening in Women (CHL, Administrative Specification)
A. Age 16-20 Years
B. Age 21-24 Years
Chronic Obstructive Pulmonary Disease (COPD) or Asthma in Older Adults Admission Rate per 100,000 Enrollee Months (PQI05, CMS Adult Core Set)
A. Age 40-64 Years
B. Age 65 and Older
Claims Quality Assurance: Claims Processing Accuracy
Community Hospital Discharges for Mental Health-Related Conditions - Follow-up Visit within 30 Days of Discharge
Adults
All Other Adults
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Special Needs Adult
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Children
Children With Severe Disabilities (HC-CSD, SSI, SMS)
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
DCYF Involved Child
Not Receiving Waiver, CMHC or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Other Child
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Other Special Needs Child
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Older Adults
All Older Adults
Not Receiving Waiver, CMHC or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Community Hospital Discharges for Mental Health-Related Conditions - Follow-up Visit within 7 Days of Discharge
Adults
All Other Adults
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Special Needs Adult
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Children
Children With Severe Disabilities (HC-CSD, SSI, SMS)
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
DCYF Involved Child
Not Receiving Waiver, CMHC or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Other Child
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Other Special Needs Child
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Older Adults
All Older Adults
Not Receiving Waiver, CMHC or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Community Hospital Readmissions for Mental Health-Related Conditions within 180 Days of Discharge
Adults
All Other Adults
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Special Needs Adult
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Children
Children With Severe Disabilities (HC-CSD, SSI, SMS)
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
DCYF Involved Child
Not Receiving Waiver, CMHC or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Other Child
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Other Special Needs Child
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Older Adults
All Older Adults
Not Receiving Waiver, CMHC or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Community Hospital Readmissions for Mental Health-Related Conditions within 30 Days of Discharge
Adults
All Other Adults
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Special Needs Adult
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Children
Children With Severe Disabilities (HC-CSD, SSI, SMS)
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
DCYF Involved Child
Not Receiving Waiver, CMHC or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Other Child
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Other Special Needs Child
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Older Adults
All Older Adults
Not Receiving Waiver, CMHC or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Completion of an Annual Comprehensive Medication Review in Prior Twelve Months for Polypharmacy Members
A. Ages 19-64
B. Ages 65+
Complex Diagnostic Radiology Authorization Timely (2 Day) Determination Rate: Routine Requests
Comprehensive Diabetes Care (CDC): Blood Pressure Control (<140/90 mm Hg)
Comprehensive Diabetes Care (CDC): Medical Attention for Nephropathy
Comprehensive Diabetes Care (CDC, Hybrid Specification): Blood Pressure Controlled <140/90 mm Hg
Comprehensive Diabetes Care (CDC, Hybrid Specification): Eye Exam
Comprehensive Diabetes Care (CDC, Hybrid Specification): HbA1c Control (<8.0%)
Comprehensive Diabetes Care (CDC, Hybrid Specification): HbA1c Poor Control (>9.0%)
Comprehensive Diabetes Care (CDC, Hybrid Specification): HbA1c Testing
Comprehensive Diabetes Care (CDC, Hybrid Specification): Medical Attention for Nephropathy
Comprehensive Diabetes Care: People with Serious Mental Illness - HA1c Testing Poor Control (>9%) (HPCMI, CMS Adult Core Set)
A. Age 18-64 Years
B. Age 65-75 Years
Concurrent Use of Opioids and Benzodiazepines (CUOB, CMS Adult Core Set)
A. Age 18 to 64 Years
B. Age 65 and Older
Contraceptive Care – All Women (CCW, CMS Adult Core Set): Long-Acting Reversible Method of Contraception (LARC)
A. Age 15 to 20 Years
B. Age 21 to 44 Year
Contraceptive Care – All Women (CCW, CMS Adult and Child Core Set) - Most Effective or Moderately Effective Contraception
A. Age 15 to 20 Years
B. Age 21 to 44 Years
Contraceptive Care – Postpartum Women: Long-Acting Reversible Method of Contraception (LARC) – 3 days (CCP, CMS Adult and Child Core Sets)
A. Age 15–20
B. Age 21–44
Contraceptive Care – Postpartum Women: Long-Acting Reversible Method of Contraception (LARC) – 60 days (CCP, CMS Adult and Child Core Sets)
A. Age 15–20
B. Age 21–44
Contraceptive Care – Postpartum Women: Most or Moderately Effective Contraception – 3 Days by Age Group (CCP, CMS Adult and Child Core Sets)
A. Age 15–20
B. Age 21–44
Contraceptive Care – Postpartum Women: Most or Moderately Effective Contraception – 60 days by Age Group (CCP, CMS Adult and Child Core Sets)
A. Age 15–20
B. Age 21–44
Controlling High Blood Pressure (CBP)
Developmental Screening in the First Three Years of Life (DEV, CMS Child Core Set)
A. Children who turned 1 year of age
B. Children who turned 2 years of age
C. Children who turned 3 years of age
Diabetes Monitoring for People With Diabetes and Schizophrenia (SMD)
Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications (SSD)
Diabetes Short-Term Complications Admission Rate per 100,000 Enrollee Months (PQI01,CMS Adult Core Set)
A. Age 18-64 Years
B. Age 65 and Older
Disease-Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis (ART)
Emergency Department Visits - Mental Health Conditions
Adults
All Other Adults
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Special Needs Adult
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Children
Children With Severe Disabilities (HC-CSD, SSI, SMS)
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
DCYF Involved Child
Not Receiving Waiver, CMHC or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Other Child
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Other Special Needs Child
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Older Adults
All Older Adults
Not Receiving Waiver, CMHC or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Emergency Department Visits - Physical Health Conditions
Adults
All Other Adults
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Special Needs Adult
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Children
Children With Severe Disabilities (HC-CSD, SSI, SMS)
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
DCYF Involved Child
Not Receiving Waiver, CMHC or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Other Child
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Other Special Needs Child
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Older Adults
All Older Adults
Not Receiving Waiver, CMHC or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Emergency Department Visits - Potentially Treatable in Primary Care
Adults
All Other Adults
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Special Needs Adult
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Children
Children With Severe Disabilities (HC-CSD, SSI, SMS)
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
DCYF Involved Child
Not Receiving Waiver, CMHC or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Other Child
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Other Special Needs Child
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Older Adults
All Older Adults
Not Receiving Waiver, CMHC or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Emergency Department Visits - Substance Use Disorder and Substance Misuse Related Conditions
Adults
All Other Adults
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Special Needs Adult
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Children
Children With Severe Disabilities (HC-CSD, SSI, SMS)
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
DCYF Involved Child
Not Receiving Waiver, CMHC or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Other Child
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Other Special Needs Child
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Older Adults
All Older Adults
Not Receiving Waiver, CMHC or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Engagement of Alcohol & Other Drug Dependence Treatment (IET) by Subpopulation
Adults
All Other Adults
Not Receiving Waiver, CMHC, Or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services (Waiver or Nursing Home)
Medicaid Primary
Medicare Primary
Other Primary
Special Needs Adult
Not Receiving Waiver, CMHC, Or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services (Waiver or Nursing Home)
Medicaid Primary
Medicare Primary
Other Primary
Children
Children With Severe Disabilities (HC-CSD, SSI, SMS)
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services (Waiver or Nursing Home)
Medicaid Primary
Medicare Primary
Other Primary
DCYF Involved Child
Not Receiving Waiver, CMHC or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services (Waiver or Nursing Home)
Medicaid Primary
Medicare Primary
Other Primary
Other Child
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services (Waiver or Nursing Home)
Medicaid Primary
Medicare Primary
Other Primary
Other Special Needs Child
Not Receiving Waiver, CMHC, Or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services (Waiver or Nursing Home)
Medicaid Primary
Medicare Primary
Other Primary
Older Adults
All Older Adults
Not Receiving Waiver, CMHC or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services (Waiver or Nursing Home)
Medicaid Primary
Medicare Primary
Other Primary
Engagement of Alcohol Abuse or Dependence Treatment (IET)
A. Ages 13-17
B. Age 18+
Engagement of Alcohol and Other Drug Abuse or Dependence Treatment (IET)
A. Age 13-17 Years
B. Age 18+ Years
Engagement of Opioid Abuse or Dependence Treatment (IET)
A. Ages 13-17
B. Age 18+
Engagement of Other Drug Abuse or Dependence Treatment (IET)
A. Ages 13-17
B. Age 18+
Follow Up Care for Children Prescribed ADHD Medication by Subpopulation-Initiation Phase
Children
Children With Severe Disabilities (HC-CSD, SSI, SMS)
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
DCYF Involved Child
Not Receiving Waiver, CMHC or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Other Child
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Other Special Needs Child
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Follow Up Care for Children Prescribed ADHD Medication by Subpopulation-Initiation Phase
Children
Children With Severe Disabilities (HC-CSD, SSI, SMS)
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
DCYF Involved Child
Not Receiving Waiver, CMHC or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Other Child
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Other Special Needs Child
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Follow-Up After Hospitalization for Mental Illness (FUH): 30-Day Follow-Up
Follow-Up After Hospitalization for Mental Illness (FUH): 7-Day Follow-Up
Follow-Up Care for Children Prescribed ADHD Medication (ADD): Continuation and Maintenance Phase
Follow-Up Care for Children Prescribed ADHD Medication (ADD): Initiation Phase
Follow-up After Emergency Department Visit for Alcohol and Other Drug Dependence (FUA) within 30 days.
Follow-up After Emergency Department Visit for Alcohol and Other Drug Dependence (FUA) within 30 days: A. Age 13 to 17 Years.
Follow-up After Emergency Department Visit for Alcohol and Other Drug Dependence (FUA) within 30 days: B. Age 18 + Years.
Follow-up After Emergency Department Visit for Alcohol and Other Drug Dependence (FUA) within 7 days.
Follow-up After Emergency Department Visit for Alcohol and Other Drug Dependence (FUA) within 7 days: A. Age 13 to 17 Years.
Follow-up After Emergency Department Visit for Alcohol and Other Drug Dependence (FUA) within 7 days: B. Age 18 + Years.
Follow-up After Emergency Department Visit for Mental Illness (FUM) within 30 days.
Follow-up After Emergency Department Visit for Mental Illness (FUM) within 7 days.
Frequency of Ongoing Prenatal Care (FPC, Hybrid Specification): 81+ Percent
Frequent Emergency Department Use
Adults
All Other Adults
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Special Needs Adult
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Children
Children With Severe Disabilities (HC-CSD, SSI, SMS)
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
DCYF Involved Child
Not Receiving Waiver, CMHC or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Other Child
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Other Special Needs Child
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Older Adults
All Older Adults
Not Receiving Waiver, CMHC or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Grievance Dispositions Made Within 45 Calendar Days
Health Risk Assessment Completion Percentage
Health Risk Assessment Completion for Higher Risk Populations
Health Risk Assessment Quarterly Completions
Heart Failure Admission Rate per 100,000 Enrollee Months (PQI08, CMS Adult Core Set)
A. Age 18-64 Years
B. Age 65 and Older
Immunizations for Adolescents (IMA, Hybrid Specification): Combination 1
Immunizations for Adolescents (IMA, Hybrid Specification): Combination 2
Immunizations for Adolescents (IMA, Hybrid Specification): Human Papillomavirus
Immunizations for Adolescents (IMA, Hybrid Specification): Meningococcal Vaccine
Immunizations for Adolescents (IMA, Hybrid Specification): Tdap/Td Vaccine
Initiation of Alcohol & Other Drug Dependence Treatment (IET) by Subpopulation
Adults
All Other Adults
Not Receiving Waiver, CMHC, Or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services (Waiver or Nursing Home)
Medicaid Primary
Medicare Primary
Other Primary
Special Needs Adult
Not Receiving Waiver, CMHC, Or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services (Waiver or Nursing Home)
Medicaid Primary
Medicare Primary
Other Primary
Children
Children With Severe Disabilities (HC-CSD, SSI, SMS)
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services (Waiver or Nursing Home)
Medicaid Primary
Medicare Primary
Other Primary
DCYF Involved Child
Not Receiving Waiver, CMHC or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services (Waiver or Nursing Home)
Medicaid Primary
Medicare Primary
Other Primary
Other Child
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services (Waiver or Nursing Home)
Medicaid Primary
Medicare Primary
Other Primary
Other Special Needs Child
Not Receiving Waiver, CMHC, Or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services (Waiver or Nursing Home)
Medicaid Primary
Medicare Primary
Other Primary
Older Adults
All Older Adults
Not Receiving Waiver, CMHC or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services (Waiver or Nursing Home)
Medicaid Primary
Medicare Primary
Other Primary
Initiation of Alcohol Abuse or Dependence Treatment (IET)
A. Ages 13-17
B. Age 18+
Initiation of Alcohol and Other Drug Abuse or Dependence Treatment (IET)
A. Age 13-17 Years
B. Age 18+ Years
Initiation of Opioid Abuse or Dependence Treatment (IET)
A. Ages 13-17
B. Age 18+
Initiation of Other Drug Abuse or Dependence Treatment (IET)
A. Ages 13-17
B. Age 18+
Inpatient Hospital Utilization - All Conditions, Excluding Maternity and Newborns
Adults
All Other Adults
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Special Needs Adult
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Children
Children With Severe Disabilities (HC-CSD, SSI, SMS)
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
DCYF Involved Child
Not Receiving Waiver, CMHC or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Other Child
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Other Special Needs Child
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Older Adults
All Older Adults
Not Receiving Waiver, CMHC or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Inpatient Hospital Utilization - Ambulatory Care Sensitive Conditions
Adults
All Other Adults
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Special Needs Adult
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Older Adults
All Older Adults
Not Receiving Waiver, CMHC or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Interest Paid on Late Paid Claims
Lead Screening
Medical Assistance with Smoking and Tobacco Use Cessation: Advising Smokers and Tobacco Users to Quit (MSC, CMS Adult Core Set)
A. Age 18-64 Years
Medical Assistance with Smoking and Tobacco Use Cessation: Discussing Cessation Medications (MSC, CMS Adult Core Set)
A. Age 18-64 Years
Medical Assistance with Smoking and Tobacco Use Cessation: Discussing Cessation Strategies (MSC, CMS Adult Core Set)
A. Age 18-64 Years
Medical Service, Equipment and Supply Post-Delivery Service Authorization Timely (30 Day) Determination Rate
Medical Service, Equipment and Supply Service Authorization Timely (14 Day) Determination Rate: New Routine Requests
Medical Service, Equipment and Supply Service Authorization Timely Determination Rate: Urgent Requests
Medication Management for People With Asthma (MMA): Medication Compliance 50%
A. Age 5 to 11 Years
B. Age 12 to 18 Years
C. Age 19 to 50 Years
D. Age 51 to 64 Years
Medication Management for People With Asthma (MMA): Medication Compliance 75%
A. Age 5 to 11 Years
B. Age 12 to 18 Years
C. Age 19 to 50 Years
D. Age 51 to 64 Years
Member Appeals Received
Member Communications: Calls Abandoned
A. Main Health Plan
B. Pharmacy Benefit Manager (PBM)
C. Non-Emergent Transportation (NEMT) Manager
D. Behavioral Health Manager
E. Vision Manager
Member Communications: New Member Welcome Calls
A. Welcome Call Successfully Completed
B. Call not Successfully Completed with 3 Attempts Made
C. Call Not Successfully Completed With Less Than 3 Attempts Made
D. Insufficient Member Data for Successful Call Completion
E. Call Not Successfully Completed for Other Reason
Member Communications: Reasons for Telephone Inquiries
A. Benefit Question Non-RX
B. Rx-Question
C. Billing Issue
D. Finding / Changing a PCP
E. Finding a Specialist
F. Complaints About Health Plan
G. Enrollment Status
H. Material Request
I. Information / Demographic Update
J. Giveaways
K. Other
L. NEMT Inquiry
Member Communications: Speed to Answer Within 30 Seconds
A. Main Health Plan
B. Pharmacy Benefit Manager (PBM)
C. Non-Emergent Transportation (NEMT) Manager
D. Behavioral Health Manager
E. Vision Manager
Member Communications: Voice Mails Returned by Next Business Day
A. Main Health Plan
B. Pharmacy Benefit Manager (PBM)
C. Non-Emergent Transportation (NEMT) Manager
D. Behavioral Health Manager
E. Vision Manager
Member Communications: Warm Transfers to NH DHHS
A. DHHS Temporary Medicaid Call Center
B. DHHS Medicaid Call Center
C. DHHS Central Processing Unit
D. DHHS Other
Member Grievances Received
Member Non-Emergent Medical Transportation Grievance Dispositions Resolved Within 30 Calendar Days
Member Non-Emergent Medical Transportation Grievances
Member Requests for Assistance Accessing MCO Designated Primary Care Providers per Average Members by County
A. Belknap County
B. Carroll County
C. Cheshire County
D. Coos County
E. Grafton County
F. Hillsborough County
G. Merrimack County
H. Rockingham County
I. Strafford County
J. Sullivan County
K. Non-NH/Unknown Counties
Member Requests for Assistance Accessing Other Providers (non-Physician/APRN) per Average Members by County
A. Belknap County
B. Carroll County
C. Cheshire County
D. Coos County
E. Grafton County
F. Hillsborough County
G. Merrimack County
H. Rockingham County
I. Strafford County
J. Sullivan County
K. Non-NH/Unknown Counties
Member Requests for Assistance Accessing Physician/APRN Specialists (non-MCO Designated Primary Care) Providers per Average Members by County
A. Belknap County
B. Carroll County
C. Cheshire County
D. Coos County
E. Grafton County
F. Hillsborough County
G. Merrimack County
H. Rockingham County
I. Strafford County
J. Sullivan County
K. Non-NH/Unknown Counties
Members Receiving Care Management Services
Adults
All Other Adults
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Special Needs Adult
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Children
Children With Severe Disabilities (HC-CSD, SSI, SMS)
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
DCYF Involved Child
Not Receiving Waiver, CMHC or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Other Child
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Other Special Needs Child
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Older Adults
All Older Adults
Not Receiving Waiver, CMHC or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM)
A. Age 1-5 Years
B. Age 6-11 Years
C. Age 12-17 Years
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
Adults
All Other Adults
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Special Needs Adult
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Children
Children With Severe Disabilities (HC-CSD, SSI, SMS)
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
DCYF Involved Child
Not Receiving Waiver, CMHC or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Other Child
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Other Special Needs Child
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Older Adults
All Older Adults
Not Receiving Waiver, CMHC or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
NH Hospital Discharges - Follow-up Visit within 7 Days of Discharge
Adults
All Other Adults
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Special Needs Adult
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Children
Children With Severe Disabilities (HC-CSD, SSI, SMS)
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
DCYF Involved Child
Not Receiving Waiver, CMHC or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Other Child
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Other Special Needs Child
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Older Adults
All Older Adults
Not Receiving Waiver, CMHC or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
NH Hospital Discharges - MCO Contacts and Contact Attempts
NH Hospital Discharges - New CMHC Patient Had an Intake Appointment with a CMHC Within 7 Calendar Days of Discharge
NH Hospital Discharges - Unsuccessful in Contacting Members within 3 Business Days of Discharge - By Reason
A: The Plan Failed to Make an Attempt to Contact Member
B. Insufficient Data for Successful Contact: Plan Outreached To Member's Providers for Contact Information
C. Insufficient Data for Successful Contact: Plan Did Not Outreach To Member's Providers for Contact Information
D. Member Did Not Answer Call
E. Member Refused to Communicate with Plan
F. Discharged to Location where Unreachable
G. Member Contacted After Three Days
H. Other Reason
New Member Health Needs Assessment - MCO Successfully Completed HNA
A. Within 30 Days for Pregnant Women, and Adults/Children with Special Health Care Needs
B. Within 90 Days for All Other Members
New Member Health Needs Assessment – Best Effort to Conduct a Health Needs Assessment
A. Within 30 Days for Pregnant Women, and Adults/Children with Special Health Care Needs
B. Within 90 Days for All Other Members
Non-Emergent Medical Transportation - Contracted Transportation & Wheelchair Van Provider Scheduled and Delivered Trips - Timeliness
A. Delivered On-Time
B. Delivered Late
Non-Emergent Medical Transportation Calls That Were Abandoned
Non-Emergent Medical Transportation Claims Quality Assurance: Claims Processing Accuracy
Non-Emergent Medical Transportation Contracted Transportation & Wheelchair Van Provider Scheduled Trip Member Cancellations by Reason for Member Cancellation for Contracted Providers
A. Appointment changed or cancelled
B. Member Found Other Transportation
C. Member Illness
D. Other Reason
Non-Emergent Medical Transportation Contracted Transportation & Wheelchair Van Provider Scheduled Trip Results by Outcome
A. Member Cancelled or Rescheduled
B. Transportation Provider Cancelled or Rescheduled
C. Member No Show
D. Transportation Provider No Show
E. Other Reason Trip Wasn't Made
F. Delivered
G. Unknown if Trip Occurred
Non-Emergent Medical Transportation Hold Status of Less Than 4 Minutes
Non-Emergent Medical Transportation Request Authorization Approvals by Mode of Transportation
A. Contracted Transportation Provider (Non-Wheelchair Van)
B. Volunteer Driver
C. Member
D. Public Transportation
E. Wheelchair Van
F. Other
Non-Emergent Medical Transportation Requests Delivered by Mode of Transportation
A. Contracted Transportation Provider (Non-Wheelchair Van)
B. Volunteer Driver
C. Member
D. Public Transportation
E. Wheelchair Van
F. Other
Non-Emergent Medical Transportation Requests Delivered by Type of Medical Service
A. Hospital
B. Medical Provider
C. Mental Health Provider
D. Dentist
E. Pharmacy
F. Methadone Treatment
G. Other
Non-Emergent Medical Transportation Scheduled Trips Assigned Within the Advanced Notice Period
Non-Emergent Medical Transportation Speed to Answer Within 90 Seconds
Non-Emergent Medical Transportation Timely Claims Processing
Non-Emergent Transportation Speed to Answer Within 30 Seconds
Non-Recommended Cervical Cancer Screening in Adolescent Females (NCS)
Persistence of Beta-Blocker Treatment After a Heart Attack (PBH)
Pharmacotherapy Management of COPD Exacerbation (PCE): Bronchodilator
Adults
All Other Adults
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Special Needs Adult
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Older Adults
All Older Adults
Not Receiving Waiver, CMHC or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Pharmacotherapy Management of COPD Exacerbation (PCE): Bronchodilator
Pharmacotherapy Management of COPD Exacerbation (PCE): Systemic Corticosteroid
Pharmacotherapy Management of COPD Exacerbation (PCE): Systemic Corticosteroid
Adults
All Other Adults
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Special Needs Adult
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Older Adults
All Older Adults
Not Receiving Waiver, CMHC or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Pharmacy Prior Authorizations Requests By Behavioral Health and Non-Behavioral Health Therapeutic Drug Classes
Pharmacy Prior Authorizations Requests By Select Therapeutic Drug Class and Outcome: A. Behavioral Health Medications
A-1: Approved
A-2: Denied
A-3: Pending
Pharmacy Prior Authorizations Requests By Select Therapeutic Drug Class and Outcome: B. Non-Behavioral Health Medications
B-1: Approved
B-2: Denied
B-3: Pending
Pharmacy Service Authorization Timely Determination Rate
Pharmacy Utilization Management: Generic Drug Substitution
Pharmacy Utilization Management: Generic Drug Utilization
Pharmacy Utilization Management: Generic Drug Utilization Adjusted for Preferred PDL Brands
Physician/APRN/Clinic Visits
Adults
All Other Adults
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Special Needs Adult
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Children
Children With Severe Disabilities (HC-CSD, SSI, SMS)
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
DCYF Involved Child
Not Receiving Waiver, CMHC or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Other Child
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Other Special Needs Child
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Older Adults
All Older Adults
Not Receiving Waiver, CMHC or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Polypharmacy Members Offered Annual Comprehensive Medication Review
A. Age 0-17 Years
B. Age 18-64 Years
C. Age 65 Years and Older
Polypharmacy Members Who Completed Annual Comprehensive Medication Review
A. Age 0-17 Years
B. Age 18-64 Years
C. Age 65 Years and Older
Prenatal and Postpartum Care (PPC, Hybrid Specification): Postpartum Care
Prenatal and Postpartum Care (PPC, Hybrid Specification): Timeliness of Prenatal Care
Private Duty Nursing: Authorized Hours for Adults Delivered and Billed by Month
A. Day/Evening Hours
B. Night/Weekend Hours
C. Intensive Care (Ventilator Dependent) Hours
D. Unbilled Hours
Private Duty Nursing: Authorized Hours for Adults Delivered and Billed by Quarter
A. Day/Evening Hours
B. Night/Weekend Hours
C. Intensive Care (Ventilator Dependent) Hours
D. Unbilled Hours
Private Duty Nursing: Authorized Hours for Children Delivered and Billed by Month
A. Day/Evening Hours
B. Night/Weekend Hours
C. Intensive Care (Ventilator Dependent) Hours
D. Unbilled Hours
Private Duty Nursing: Authorized Hours for Children Delivered and Billed by Quarter
A. Day/Evening Hours
B. Night/Weekend Hours
C. Intensive Care (Ventilator Dependent) Hours
D. Unbilled Hours
Professional and Facility Medical Claim Processing Results
A. Paid
B. Suspended
C. Denied
Proportion of Days Covered (PDC) - Adherence to Non-Warfarin Oral Anticoagulants
Proportion of Days Covered - Adherence to Long-Acting Inhaled Bronchodilator Agents in COPD Patients (PDC-COPD)
Proportion of Days Covered - Adherence to Non-Infused Disease Modifying Agents Used to Treat Multiple Sclerosis (PDC-MS)
Proportion of Days Covered - Antiretroviral Medications (PDC-ARV)
Proportion of Days Covered - Beta-Blockers (PDC-BB)
Proportion of Days Covered - Biguanides (PDC-BG)
Proportion of Days Covered - Calcium Channel Blockers (PDC-CCB)
Proportion of Days Covered - DPP-4 Inhibitors (PDC-DPP)
Proportion of Days Covered - Diabetes All Class Rate (PDC-DR)
Proportion of Days Covered - Renin Angiotensin System Antagonists (PDC-RASA)
Proportion of Days Covered - Statins (PDC-STA)
Proportion of Days Covered - Sulfonylureas (PDC-SFU)
Proportion of Days Covered - Thiazolidinediones (PDC-TZD)
Provider Communications: Calls Abandoned
A. Main Health Plan
B. Pharmacy Benefit Manager (PBM)
C. Non-Emergent Transportation (NEMT) Manager
D. Behavioral Health Manager
E. Vision Manager
Provider Communications: Mean Call Time
A. Main Health Plan
B. Pharmacy Benefit Manager (PBM)
C. Non-Emergent Transportation (NEMT) Manager.
D. Behavioral Health Manager
E. Vision Manager
Provider Communications: Speed to Answer Within 30 Seconds
A. Main Health Plan
B. Pharmacy Benefit Manager (PBM)
C. Non-Emergent Transportation (NEMT) Manager
D. Behavioral Health Manager
E. Vision Manager
Provider Communications: Reasons for Telephone Inquiries
A. Verifying Member Eligibility
B. Billing/Payment
C. Service Authorization
D. Change of Address, Name, Contact Info., etc.
E. Changing Service Mix Offered by Provider
F. Changing Panel Size
G. Voluntary Termination
H. Enrollment/Credentialing
I. Complaints About Health Plan
J. Other
Provider Communications: Voice Mails Returned by Next Business Day
A. Main Health Plan
B. Pharmacy Benefit Manager (PBM)
C. Non-Emergent Transportation (NEMT) Manager
D. Behavioral Health Manager
E. Vision Manager
Quality Assessment: Referral to Case Management for All Newborns With a Diagnosis of Neonatal Abstinence Syndrome
Readmissions to NH Hospital within 180 Days of Discharge
Adults
All Other Adults
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Special Needs Adult
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Children
Children With Severe Disabilities (HC-CSD, SSI, SMS)
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
DCYF Involved Child
Not Receiving Waiver, CMHC or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Other Child
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Other Special Needs Child
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Older Adults
All Older Adults
Not Receiving Waiver, CMHC or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Readmissions to NH Hospital within 30 Days of Discharge
Adults
All Other Adults
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Special Needs Adult
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Children
Children With Severe Disabilities (HC-CSD, SSI, SMS)
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
DCYF Involved Child
Not Receiving Waiver, CMHC or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Other Child
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Other Special Needs Child
Not Receiving Waiver, CMHC, or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Older Adults
All Older Adults
Not Receiving Waiver, CMHC or Nursing Home Services
Medicaid Primary
Medicare Primary
Other Primary
Receiving CMHC Services But Not Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Receiving LTC Services-Waiver or Nursing Home
Medicaid Primary
Medicare Primary
Other Primary
Resolution of All Appeals Within 45 Calendar Days
Resolution of Appeals by Disposition Type
A. Member Abandoned Appeal
B. Appeal Upheld
C. Appeal Reversed
Resolution of Expedited Appeals Within 72 Hours
Resolution of Extended Standard Appeals Within 44 Calendar Days
Resolution of Standard Appeals Within 30 Calendar Days
