Hi everybody, I’m Caroline Margiotta from Mathematica. We want to tell you about some
changes to the Child, Adult, and Health Home Core Sets for FFY 2020. Please note that the
FFY 2020 reporting cycle generally covers utilization occurring in calendar year 2019.
Also, the FFY 2020 resource manuals contain the technical specifications for the measures
I’ll be talking about. You can find links to the resource manuals toward the end of this
slide deck. As you can see on this slide, four measures were added to one or more Core Sets
for FFY 2020. First, Metabolic Monitoring for Children and Adolescents on Antipsychotics,
or APM, was added to the Child Core Set. This measure assesses the percentage of children
ages 1-17 who had two or more antipsychotics prescriptions and had blood glucose testing,
cholesterol testing, or both types of testing. The measure is calculated using the Administrative
method. Use of Pharmacotherapy for Opioid Use Disorder or OUD was added to both
the Adult and Health Home Core Sets. This measure shows the percentage of beneficiaries
with an opioid use disorder who filled a prescription or were administered a medication
for the disorder during the measurement year. This measure includes five rates. There are
separate rates for use of four types of drugs: buprenorphine, oral naltrexone, long-lasting
injectable naltrexone, or methadone. There is a total rate that shows use of any of these four
medications. The measure is also calculated using the Administrative method. The National
Core Indicators In-Person Survey, which we refer to as NCIDDS, was added to the
Adult Core Set. These indicators describe beneficiaries' experience and self-reported
outcomes of long-term services and support for individuals with intellectual and developmental
disabilities and their families. Follow-up After Emergency Department Visit for Alcohol and
Other Drug Abuse or Dependence, or FUA, was added to the Health Home Core Set.
This measure is already in the Adult Core Set for beneficiaries age 18 and older. The measure
shows the percentage of emergency department visits for Health Home enrollees age 13 and older
with the diagnosis of alcohol or other drug abuse or dependence who had a follow-up visit for AOD
abuse or dependence. We also wanted to let you know that two indicators were added to the
Weight Assessment and Counseling for Nutrition and Physical Activity for Children and
Adolescents measure in the Child Core Set. These indicators are related to Counseling for
Nutrition and Counseling for Physical Activity. Those states will now be reporting three
indicators for this measure. And finally, three measures were retired from the Child Core Set
and two measures were retired from the Adult Core Set. In the interest of time, I won’t review
each of these measures. For more information about all of these changes, please see the
CMCS Informational Bulletin. The links are at the bottom of this slide.
Now we’d like to review some updates to existing core set measures that were made by the
measure steward. For the APP measure in the Child Core Set, the measure steward updated
the reported age groups. The rates for ages 1-5 and 6-11 were combined into one rate for ages
1-11 for FFY 2020. The measure steward made several changes to the Prenatal and Postpartum
Care measures. The Timeliness of Prenatal Care measure is in the Child Core Set and the
Postpartum Care measure is in the Adult Core Set. First, the time frame for the denominator
for both measures changed. For FFY 2020, the denominator includes live births occurring
between October 8th of the year prior to the measurement year and October 7th of the
measurement year. In addition, the numerator for both measures changed. For the Timeliness of
Prenatal Care measure, the numerator now includes prenatal care visits occurring before the
Medicaid or CHIP enrollment start date. And for the numerator for the Postpartum Care measure,
now includes postpartum visits occurring on or between 7 and 84 days after delivery. Finally, for
both measures, the continuous enrollment requirement was changed to 60 days after
delivery. For the SAA measure, the rate for ages 19-64 was replaced with the rate for age 18
and older.
For the Cervical Cancer Screening, or CCS measure, in the Adult Core Set, the measure
steward revised the numerator criteria for women ages 30-64. Now the numerator counts women
ages 30-64 who had cervical high-risk HPV testing alone or in conjunction with cervical
cytology within the last five years. For the Screening for Depression and Follow-Up Plan,
or CDF measure, in the Child, Adult, and Health Home Core Sets, we added several clarifications
and examples to the specifications in response to TA questions from states. First, the specification
was clarified that enrollees with an active diagnosis of depression or bipolar disorder are
excluded from the measure. This is because the intent of the measure is to promote screening of
patients who were never previously diagnosed with depression or bipolar disorder.
The specifications also clarify that an active diagnosis starts prior to the encounter but may
not have an end date. In addition, the specifications clarify that if a recommended
follow-up includes an additional screening, it must occur on the same encounter of the initial positive
screen. An additional screen alone is not considered a follow-up plan. The FFY 2020
specifications also include examples of follow-up plans that meet numerator criteria. Next, I will tell
you about updates the measure steward made to the Plan All-Cause Readmissions, or PCR,
measure in the Adult and Health Home Core Set. First, the definitions of the index hospital stays
and 30-day readmission event now include observation stays. Another change is the addition
of a new category of outlier beneficiaries. Outlier beneficiaries are defined as those with four or
more index hospital stays during the measurement year-- from January 1st to
December 1st. Outlier beneficiaries should be excluded from the existing risk adjusted
readmission rates, which are defined in the specifications. Three new data fields were added
to the measure to capture the outlier beneficiaries. These are the counted
beneficiaries in the Medicaid population, the counted outlier beneficiaries, and the outlier rate.
Finally, for several measures, the measure steward added exclusions for beneficiaries with
advanced illness and modified the value sets. The applies to Breast Cancer Screenings,
Controlling High Blood Pressure, Comprehensive Diabetes Care Hemoglobin A1C
Poor Control, Diabetes Care for People with Serious Mental Illness Hemoglobin A1C Poor
Control, and Adherence to Anti-Psychotic Medications for Individuals With Schizophrenia.
On this slide, we summarize changes to the Live Births Weighing Less than 2,500 Grams, or
LBW, measure in the Child Core Set for FFY 2020. This past spring, CMS piloted calculating
the LBW measure using vital records data submitted by states and compiled by the National
Center for Health Statistics in CDC WONDER. For FFY 2020 reporting, states can choose to
calculate and report the measure using Core Set specifications in MACPro or request that CMS
use the rate calculated from CDC WONDER data. States that choose to have CMS calculate
the rate using CDC WONDER data will have an opportunity to preview the rate in the spring.
The flow chart on this slide illustrates how to report the LBW measure in MACPro. If your
state did not calculate the measure or did not use core set specifications, please select “no” for
“Are you reporting on this measure” and select “State requests that CMS calculate and report
this measure using CDC WONDER for FFY 2020 reporting." If your state calculated the
measure using Core Set specifications, the state can either choose to report the state-calculated
rate in MACPro or use the CMS calculated rate. If the state wishes to report the state-calculated
rate, the state should select “yes” for “Are you reporting on this measure?” and then proceed
with reporting. Otherwise, if the state wishes to use the CMS calculated rate, the state should
select “no” for “Are you reporting on this measure” and then select “State requests that
CMS calculate and report this measure using CDC WONDER for FFY 2020 reporting.”
As we noted earlier, the National Core Indicators, or NCI measure, is new to the Adult Core Set.
The NCI provides information on beneficiaries’ experience and self-reported outcomes of long-
term services and supports for individuals with intellectual and developmental disabilities and
their families. We’d like to emphasize that many states already conduct the NCI surveys through
their Developmental Disabilities agencies, and they submit data to the NCI National Team.
For FFY 2020, CMS will report state-level results using data collected earlier this year and submit it
to the NCI National Team. States do not need to report rates for this measure in MACPro but will
be asked to respond to a few questions including whether the state collected this measure and
whether data were submitted to the NCI National Team using the Online Data Entry System,
ODESA. States wishing to provide additional notes or comments on a measure may also do
so in the MACPro system. For more information about the NCI survey, as well as a list of
participating states, please click on the link for the NCI website. In the near future, we will be
providing more information about CMS’ plan for reporting the NCI measure for FFY 2020.
CMS acknowledges the challenges the COVID-19 pandemic may pose for FFY 2020
Core Set reporting. For FFY 2020, states may document COVID-related impacts on Core Set
reporting through new Reason for Not Reporting category-- Limitations with data collection,
reporting, or accuracy due to the COVID-19 pandemic. State selecting this category should
use the associated text box in MACPro to describe the reasons for not being able to report
the measure.
CMS recognizes that social distancing makes it inadvisable to do onsite medical chart reviews
required for the Hybrid method. While reporting of the Core Sets is voluntary, CMS encourages
states to continue reporting measures that they have reported in the past if they are able to do so.
This slide provides guidance on reporting measures that include the Hybrid method as an
option. CMS encourages states to review the quality and completeness of data collected using
the Hybrid method. If a state determines that it will not be able to report high-quality data using
this method as a result of challenges from the COVID-19 pandemic, CMS encourages the
state to consider calculating the measure using the Administrative method or electronic health
records where permitted by the measure technical specifications. If the state chooses to
report measures using the Hybrid method for FFY 2020, the state should note if the FFY 2020
rate is worse than the FFY 2019 rate due to low chart retrieval. Then, the state should indicate in
MACPro whether the state would prefer to use the FFY 2019 rate instead. In this case, CMS
encourages states to report the FFY 2020 rate in the performance measure section and the chart
retrieval rate, if available, in the “Additional Notes/Comments on Measure” section in
MACPro. If an alternate method is not feasible and prior year data are not available, states
should report to CMS that they were unable to report the measure due to challenges with data
collection as a result of the COVID-19 pandemic.
The flow chart on this slide illustrates how to report measure with the hybrid option in MACPro.
In summary, for measures collected using the Hybrid method, states can indicate in MACPro if
they prefer to use FFY 2019 data because the pandemic affected their ability to conduct chart
retrieval. States are still asked to report their FFY 2020 rates in MACPro even if choosing to
use FFY 2019 data for public reporting.
Now, I would like to pass it over to Mira who will walk us through CMS’ data quality priorities for
FFY 2020.