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["Directed Payment Program (DPP) Measure Specifications for State Fiscal Year (SFY) 2022"]
["File Version & Publication Date","v7.0 August 9, 2022"]
["File Description","This file includes detailed instructions for the approved measures to be reported for state fiscal year (SFY) 2022 directed payment program(s) (DPP) operated by the Texas Health and Human Services Commission (HHSC), as approved by the Center for Medicare and Medicaid Services (CMS). "]
["File Version Updates","The proposed SFY 2022 DPP measures and measure specifications were first published in January 2021 as v1.1, and the CMS-approved SFY 2022 measures and measure specifications were first published in December 2021 (as v2.0) for DPP BHHS and in April 2022 (as v4.0) for CHIRP, TIPPS, and RAPPs. \n\nHHSC will continue to release file version updates on an as needed basis. Please refer to the DPP-specific \"Quality\" webpage for the most up-to-date file version: https://www.hhs.texas.gov/services/health/medicaid-chip/provider-information/medicaid-chip-directed-payment-programs."]
["Contact","dppquality@hhs.texas.gov"]
[]
["Prog Component Eligibility Reqs SFY22"]
["Tab Overview","The Component Eligibility tab identifies the Program Component Eligibility Requirements, including Minimum Volume Requirements and Provider Class Requirements, for provider eligibility to participate in a given program component or module of the DPP. The program component eligibility requirements have been developed by HHSC for program reporting purposes. More information about the program components in a given DPP are detailed in the respective DPP Requirements documents."]
[]
["Attribution Methodology SFY22"]
["Tab Overview","This tab outlines the steps to identify the specific population that should be included in the denominator and numerator of participating provider-reported measures for each DPP: \nStep 1: Determine the DPP attributed population\nStep 2: Determine the measure-specific denominator population \nStep 3: Stratify the measure-specific denominator population by payer type. \n\nThe attribution methodology has been developed by HHSC for DPP program reporting purposes. "]
[]
["Measure Specifications SFY22"]
["Tab Overview","This tab lists all the measures included in each program component/module of a DPP and the corresponding measure specifications such as denominator and numerator inclusion and exclusion criteria. Measure specifications are developed by a measure steward external to HHSC, unless otherwise noted under the \"Measure Steward\" field. For each measure, the measure steward, the measure specifications source, and the publicly accessible link to the measure specifications source are included.\n\nThis tab also outlines helpful reporting information including the data measurement period for a given reporting period and the reporting payer type stratification for each measure as required by HHSC for program reporting purposes. Definitions of fields included in this tab are further described below. "]
["Field","Definition"]
["Final Measure ID","The DPP-specific alphanumeric identifier designated to an individual measure"]
["DPP Shorthand","The DPP-specific program name abbreviation"]
["Program Component","The DPP-specific program component or module. More information about the program components in a given DPP are detailed in the respective DPP Requirements documents found on the HHSC DPP webpages."]
["Measure Name","The name of the measure"]
["Measure Type","“Structure Measure”, “Process Measure”, \"Outcome (Intermediate) Measure\", and “Outcome Measure” are measure type classifications commonly used in health care quality measurement. “Structure Measures” are a type of measure that helps provide a sense of a health care organization’s capacity, infrastructure, and strategy for delivering evidence-based best practices for high quality care. “Process Measures” are a type of measure that helps indicate what a health care organization does to maintain or improve health, often reflecting generally accepted recommendations for clinical practice. \"Outcome (Intermediate) Measures\" are a type of measure that helps assess the change produced by a healthcare intervention that leads to a long-term outcome. “Outcome Measures” are a type of measure that helps reflect the impact of the health care service or intervention on the health status of patients. https://www.ahrq.gov/talkingquality/measures/types.html; https://www.cms.gov/files/document/blueprint-glossary-and-acronyms.pdf"]
["Blank Field (intentionally left blank)"]
["Reporting Period 1 - Data Measurement Period","The start and end dates for data measurement of the measures reported during the Reporting Period 1"]
["Reporting Period 1 - Reporting Requirements","The reporting requirements for the Reporting Period 1, e.g., may be described either as \"Status Update Only\" or \"Numeric Data Reporting & Status Update\""]
["Blank Field (intentionally left blank)"]
["Reporting Period 2 - Data Measurement Period","The start and end dates for data measurement of the measures reported during the Reporting Period 2"]
["Reporting Period 2 - Reporting Requirements","The reporting requirements for the Reporting Period 2, e.g., may be described either as \"Status Update Only\" or \"Numeric Data Reporting & Status Update\""]
["Blank Field (intentionally left blank)"]
["Required Reporting Payer Types","The payer type stratifications to meet DPP reporting requirements. Depending on the measure, one or more payer type stratifications may be required. More information about the required reporting payer type stratifications are detailed in Step 3 of the Attribution Methodology as well as in the respective DPP Requirements documents found on the respective HHSC DPP webpages."]
["Blank Field (intentionally left blank)"]
["Blank Field (intentionally left blank)"]
["Blank Field (intentionally left blank)"]
["Blank Field (intentionally left blank)"]
["Blank Field (intentionally left blank)"]
["NQF ID","The numeric identifier assigned by the National Quality Forum (NQF) to a measure. Please note this is not a field listing the measure's current NQF Endorsement Status. Please note measures with an NQF ID may be endorsed, not endorsed, or no longer endorsed by NQF and not all measures have an NQF ID."]
["Measure Steward","The organization responsible for development and maintenance of the data specifications for the measure and often the inclusion of clinical guidelines or recommendations related to the measure and endorsement of the measure."]
["Measure Specs Source","The source for publicly accessing the measure specifications. The version information for the publicly accessible measure specifications are included in parentheses."]
["Link to Measure Specs Source","The weblink to the publicly available measure specifications source. Please note when HHSC includes any \"HHSC Program Specific Modifications\" to a measure, these HHSC program-specific modifications will not be found in the original measure specifications source. "]
["Measure Description","Brief description of the measure. This field is taken from the measure steward's measure specifications as identified in the measure specifications source."]
["Eligible Physician Specialties and Other Clinicians","For certain outpatient-based measures, HHSC has outlined which physician specialties and other clinicians are eligible for denominator inclusion, as described in Step 2 of the Attribution Methodology. The listing of eligible physician specialties and other clinicians is adapted from those identified for the CMS Medicare Merit-based Incentive Payment System (MIPS) program. \n\nAs described in Step 2 of the Attribution Methodology, please refer to the most recent NUCC Health Care Provider Taxonomy Code Set (https://taxonomy.nucc.org/) for the definitions and taxonomy codes for physician specialties, subspecialties, and other clinicians, as defined by the National Uniform Claim Committee (NUCC)."]
["Unit of Measurement","The unit of measurement for the denominator (e.g., individual or encounter) determines the payer type stratification methodology."]
["Denominator Description","The description of the defined denominator population, from which eligible numerator cases will ultimately be identified. This field is taken from the measure steward's measure specifications as identified in the publicly available measure specifications source."]
["Denominator Inclusions","The detailed denominator inclusion criteria for defining what qualifies into the denominator population. This field is taken from the measure steward's measure specifications as identified in the publicly available measure specifications source. Not all measure stewards provide detailed denominator inclusion criteria for a measure."]
["Denominator Exclusions","The detailed denominator exclusion criteria for defining what should be removed from the denominator population. Some measure specifications may state \"denominator exclusions\" as \"denominator exceptions\", which should all be removed from the denominator population. This field is taken from the measure steward's measure specifications as identified in the publicly available measure specifications source. Not all measure stewards provide detailed denominator exclusion criteria for a measure."]
["Numerator Description","The description of the eligible cases that meet the measure's objective for measurement. Numerator cases must be derived from the denominator population. This field is taken from the measure steward's measure specifications as identified in the publicly available measure specifications source."]
["Numerator Inclusion (Performance Met) ","The detailed numerator inclusion criteria for defining what qualifies as meeting the measure's objective for measurement. This field is taken from the measure steward's measure specifications as identified in the publicly available measure specifications source. Not all measure stewards provide detailed numerator inclusion criteria for a measure."]
["Numerator Exclusion (Performance Not Met) ","The detailed numerator exclusion criteria for defining what does not qualify as meeting the measure's objective for measurement. This field is taken from the measure steward's measure specifications as identified in the publicly available measure specifications source. Not all measure stewards provide detailed numerator exclusion criteria for a measure."]
["HHSC Program Specific Modifications","For DPP-specific reporting purposes, any modifications made by HHSC to the measure steward's measure specifications will be indicated in this field."]
["Measure Steward Additional Information","If applicable, any additional information from the measure steward that is helpful to undersatnding the measure specifications will be included in this field. This field is taken from the measure steward's measure specifications as identified in the measure specifications source. "]
["Blank Field (intentionally left blank)"]
["Blank Field (intentionally left blank)"]
["Blank Field (intentionally left blank)"]
["Performance Directionality","The performance directionality of a measure can be \"positive\" (i.e., better performance on the measure is demonstrated by a higher rate), \"negative\" (i.e., better performance on the measure is demonstrated by a lower rate), or \"N/A\" (i.e., the measure does not have a numeric performance calculation)."]
["Public Notes","These notes are helpful reminders about any denominator and/or numerator specifications or reporting information unique to a given measure."]
[]
["Additional DPP Reporting Info"]
["Tab Overview","This tab includes helpful additional information relevant to DPP reporting including guidance concerning allowable data sources and sampling methodology. The rules on allowable data sources and sampling methodology, including minimum sample size requirements, have been developed by HHSC for program reporting purposes. "]
[]
["Specs Viewer SFY22"]
["Tab Overview","A printer friendly version of the measure specifications and attribution methodology. Can be used to print specifications for individual measures by selecting Measure ID in cell E2."]
[]
["Change Log"]
["Tab Overview","The proposed SFY 2022 DPP measures and measure specifications were first published in January 2021 as v1.1. When the next file version is published, the Change Log tab will include the changes made to this file since v1.1, and highlighted yellow cells will represent the most recently published changes."]

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["Directed Payment Program (DPP) Information",null,"Program Component Eligibility Requirements"]
["DPP Shorthand","Program Component (Module) Information","Provider Class Eligibility Requirements","Minimum Volume Requirements"]
["TIPPS","T1 - Uniform dollar increase paid on a monthly basis","Physician Practice Groups affiliated with a Health-Related Institution (HRI)","N/a"]
["TIPPS","T1 - Uniform dollar increase paid on a monthly basis","Physician Practice Groups affiliated with a hospital receiving the Indirect Medical Education add-on (IME)"]
["TIPPS","T2 - Uniform rate enhancement paid semiannually","Physician Practice Groups affiliated with a Health-Related Institution (HRI)",">=30 Medicaid Managed Care patients (includes STAR, STAR+PLUS, and STAR Kids) in CY2021 in at least 50 percent of the measures in the program component"]
["TIPPS","T2 - Uniform rate enhancement paid semiannually","Physician Practice Groups affiliated with a hospital receiving the Indirect Medical Education add-on (IME)"]
["TIPPS","T3 - Rate enhancement for certain outpatient services","Physician Practice Groups affiliated with a Health-Related Institution (HRI)",">=30 Medicaid Managed Care patients (includes STAR, STAR+PLUS, and STAR Kids) in CY2021 in at least 50 percent of the measures in the program component"]
["TIPPS","T3 - Rate enhancement for certain outpatient services","Physician Practice Groups affiliated with a hospital receiving the Indirect Medical Education add-on (IME)"]
["TIPPS","T3 - Rate enhancement for certain outpatient services","Other Physician Practice Groups that are not HRI or IME "]
["CHIRP","C1 (UHRIP) - UHRIP rate enhancement","Children’s Hospitals","N/a"]
["CHIRP","C1 (UHRIP) - UHRIP rate enhancement","Rural Hospitals"]
["CHIRP","C1 (UHRIP) - UHRIP rate enhancement","State-owned Hospitals that are not Institutions for Mental Diseases (IMDs)"]
["CHIRP","C1 (UHRIP) - UHRIP rate enhancement","Urban Hospitals"]
["CHIRP","C1 (UHRIP) - UHRIP rate enhancement","Non-state-owned IMDs"]
["CHIRP","C1 (UHRIP) - UHRIP rate enhancement","State-owned IMDs"]
["CHIRP","C2 (ACIA Maternal Care) - ACIA rate enhancement","Children’s Hospitals",">=30 Medicaid Managed Care patients (includes STAR and STAR+PLUS) live births in CY2020 or CY2019"]
["CHIRP","C2 (ACIA Maternal Care) - ACIA rate enhancement","State-owned Hospitals that are not Institutions for Mental Diseases (IMDs)"]
["CHIRP","C2 (ACIA Maternal Care) - ACIA rate enhancement","Urban Hospitals"]
["CHIRP","C2 (ACIA Hospital Safety) - ACIA rate enhancement","State-owned Hospitals that are not Institutions for Mental Diseases (IMDs)",">=1 Medicaid Managed Care patients (includes STAR and STAR+PLUS) in CY2020 for at least one of the measures in the program component module. "]
["CHIRP","C2 (ACIA Hospital Safety) - ACIA rate enhancement","Urban Hospitals"]
["CHIRP","C2 (ACIA Pediatric) - ACIA rate enhancement","Children's Hospitals",">=1 Medicaid Managed Care patients (includes STAR and STAR+PLUS) in CY2020 for at least one of the measures in the program component module. "]
["CHIRP","C2 (ACIA Psychiatric Care Transitions) - ACIA rate enhancement","Children's Hospitals",">=30 Medicaid Managed Care (includes STAR and STAR+PLUS) Psychiatric Discharges in CY2020 or CY2019\n\nPsychiatric discharges include revenue codes: \n114 Private medical or general-psychiatric\n124 Semi-private 2 bed (medical or general)-psychiatric\n134 Semi-private 3 and 4 beds-psychiatric\n144 Private (deluxe)-psychiatric\n204 Intensive care-psychiatric\n1001 Behavioral health accommodations - residential treatment - psychiatric"]
["CHIRP","C2 (ACIA Psychiatric Care Transitions) - ACIA rate enhancement","State-owned Hospitals that are not Institutions for Mental Diseases (IMDs)"]
["CHIRP","C2 (ACIA Psychiatric Care Transitions) - ACIA rate enhancement","Urban Hospitals"]
["CHIRP","C2 (ACIA Psychiatric Care Transitions) - ACIA rate enhancement","Non-state-owned IMDs"]
["CHIRP","C2 (ACIA Psychiatric Care Transitions) - ACIA rate enhancement","State-owned IMDs"]
["CHIRP","C2 (ACIA Care Transitions) - ACIA rate enhancement","State-owned Hospitals that are not Institutions for Mental Diseases (IMDs)",">=30 Medicaid Managed Care (includes STAR and STAR+PLUS) Non-Psychiatric Discharges in CY2020 or CY2019"]
["CHIRP","C2 (ACIA Care Transitions) - ACIA rate enhancement","Urban Hospitals"]
["CHIRP","C2 (ACIA Rural Hospitals Best Practices) - ACIA rate enhancement","Rural Hospitals",">=1 Medicaid Managed Care patient (includes STAR and STAR+PLUS) in CY2020 for at least one of the measures in the program component module. "]
["DPP BHS","B1 - Dollar increase","Community Mental Health Centers (CMHCs)","N/a"]
["DPP BHS","B2 - Percent increase","Community Mental Health Centers (CMHCs)","N/a"]
["RAPPS","R1 - Dollar increase","Rural Health Clinics (RHCs)","N/a"]
["RAPPS","R2 - Percent rate increase","Rural Health Clinics (RHCs)","N/a"]

{"sheet":"Attribution Methodology SFY22","index":2,"n_rows":20,"n_cols":12,"rows_kept":20,"cut":false,"hidden":false,"merged":[[0,0,3,2]]}
["In each Directed Payment Program (DPP), the attribution methodology for reporting quality measures is determined by the following process:"]
[]
[]
[]
["Directed Payment Program (DPP) Information",null,null,"Step 1: Determine the DPP attributed population for process and outcome measures",null,null,null,null,"Step 2: Determine the measure-specific denominator population","Step 3: Stratify the measure-specific denominator population by payer type"]
["DPP Shorthand","DPP Name","Program Component (Module)","Attributed Population Definition","Attributed Population Inclusion Criteria","Primary Care Service - HCPCS Codes","Preventive Care Service - Value Sets","Ambulatory Encounter - Value Sets","Measure-Specific Denominator Population Definition","Reporting Payer Types*","Payer Type Assignment Methodology","Allowable Exclusion(s)"]
["TIPPS","Texas Incentives for Physician and Professional Services","T1","N/a","N/a","N/a","N/a","N/a","N/a","N/a","N/a","N/a"]
["TIPPS","Texas Incentives for Physician and Professional Services","T2","Using a retrospective attribution methodology, the TIPPS attributed population includes the individuals that a participating Physician Practice Group, as approved in the enrollment application, is accountable for under the TIPPS program, as defined by the Attributed Population Inclusion Criteria. ","The Physician Practice’s Group’s attributed population includes any individual that meets at least one of the criteria below:\na) One primary care service or preventive service provided during the measurement period; OR\nb) One ambulatory encounter during the measurement period; OR\nc) One prenatal or postnatal visit during the measurement period","99201–99205: New patient, office, or other outpatient visit\n99211–99215: Established patient, office, or other outpatient visit\n99304–99306: New patient, nursing facility care\n99307–99310: Established patient, nursing facility care\n99315–99316: Established patient, discharge day management service\n99318: Established patient, other nursing facility service\n99324–99328: New patient, domiciliary or rest home visit\n99334–99337: Established patient, domiciliary or rest home visit\n99339–99340: Established patient, physician supervision of patient (patient not present) in home, domiciliary, or rest home\n99341–99345: New patient, home visit\n99347–99350: Established patient, home visit","Encounter, Performed: Annual Wellness Visit:  2.16.840.1.113883.3.526.2.1363\nEncounter, Performed: Preventive Care - Initial Office Visit 0 to 17: 2.16.840.1.113883.3.464.1003.101.12.1022.\nEncounter, Performed: Preventive Care - Established Office Visit 0 to 17: 2.16.840.1.113883.3.464.1003.101.12.1024\nEncounter, Performed: Preventive Care - Initial Office Visit, 18 and Up: 2.16.840.1.113883.3.464.1003.101.12.1023\nEncounter, Performed: Preventive Care - Established Office Visit, 18 and Up: 2.16.840.1.113883.3.464.1003.101.12.1025 \nEncounter, Performed: Preventive Care Services - Individual Counseling: 2.16.840.1.113883.3.464.1003.101.12.1026","Encounter, Performed: Office Visit: 2.16.840.1.113883.3.464.1003.101.12.1001\nEncounter, Performed: Face-to-Face Interaction: 2.16.840.1.113883.3.464.1003.101.12.1048\nEncounter, Performed: Ophthalmological Services: 2.16.840.1.113883.3.526.3.1285\nEncounter, Performed: Outpatient Consultation: 2.16.840.1.113883.3.464.1003.101.12.1008\nEncounter, Performed: Psych Visit - Psychotherapy: 2.16.840.1.113883.3.526.3.1496\nEncounter, Performed: Ambulatory/ED Visit: 2.16.840.1.113883.3.464.1003.101.12.1061\nEncounter, Performed: Psych Visit - Diagnostic Evaluation: 2.16.840.1.113883.3.526.3.1492\nEncounter, Performed: Psychoanalysis: 2.16.840.1.113883.3.526.3.1141\nEncounter, Performed: Occupational Therapy Evaluation: 2.16.840.1.113883.3.526.3.1011\nProcedure, Performed: Hemodialysis: 2.16.840.1.113883.3.526.3.1083\nProcedure, Performed: Peritoneal Dialysis: 2.16.840.1.113883.3.526.3.1084\nEncounter, Performed: Health & Behavioral Assessment - Individual: 2.16.840.1.113883.3.526.3.1020\nEncounter, Performed: Health and Behavioral Assessment - Initial: 2.16.840.1.113883.3.526.3.1245\nEncounter, Performed: Health and Behavioral Assessment, Reassessment: 2.16.840.1.113883.3.526.3.1529\n*Encounter, Performed: Preventive Care Services - Other: 2.16.840.1.113883.3.464.1003.101.12.1030 \nEncounter, Performed: Speech and Hearing Evaluation: 2.16.840.1.113883.3.526.3.1530\nEncounter, Performed: Outpatient Encounters for Preventive Care: 2.16.840.1.113762.1.4.1047.9\n*NOTE: “Preventive Care Services – Other” value set includes codes that have been replaced by 96160 and 96161 in TX Health Steps. For TIPPS reporting purposes, 96160 and 96161 should be included as ambulatory encounters.","The measure-specific denominator population (Step 2) includes the individuals or encounters from the TIPPS attributed population (Step 1) that meet all criteria under the \"Eligible Physician Specialties and Other Clinicians\", \"Denominator Inclusions\", and \"Denominator Exclusions\" as applicable for each quality measure, as defined in the TIPPS Measure Specifications. \n\nPhysician groups may refer to the most recent NUCC Health Care Provider Taxonomy Code Set (https://taxonomy.nucc.org/) for the definitions and taxonomy codes for physician specialties, physician subspecialties, and other clinicians, as defined by the National Uniform Claim Committee (NUCC). The NUCC provider taxonomy definitions and codes for physician subspecialties that are nested within an eligible physician specialty may be included if these subspecialists perform the quality actions described in the measure based on the services provided and the measure specific-denominator coding. Nurse Practitioners and Physician Assistants, as defined by NUCC, practicing under the listed eligible physician specialties or practicing equivalent services may also be included.","*Measures must be stratified by the required reporting payer types unless otherwise specified under \"Required Reporting Payer Type Stratification\" in the \"Measure Specifications SFY22\" tab. For example, some measures may only require reporting by one of more of the following reporting payer types below. \n\n• Medicaid Managed Care** (includes STAR, STAR+PLUS, and STAR Kids)\n• Other Medicaid (includes other Medicaid Managed Care programs and Medicaid Fee-For-Service (FFS))\n• Uninsured (includes No insurance; County-based or other public medical assistance)\n• All Payer (includes Medicaid Managed Care, Other Medicaid, Uninsured, and all other payer types such as CHIP, Medicare, Medicare/Medicaid Dual Eligibles, and Commercial Insurance)\n\n**In the reporting template, providers will indicate whether the provider's system can report the required reporting payer type of “Medicaid Managed Care\" as outlined above to include STAR, STAR+PLUS, and STAR Kids. If provider's system cannot report “Medicaid Managed Care\" as outlined above, then the provider may alternatively report the “Medicaid Managed Care” payer type as \"Medicaid\" (includes all Medicaid Managed Care programs and Medicaid FFS). This alternative will only be available during Year 1 of the DPP. As a result of using this alternative, the required reporting payer types would be as shown below:  \n• Medicaid (includes all Medicaid Managed Care programs and Medicaid FFS)\n• Uninsured (includes No insurance; County-based or other public medical assistance)\n• All Payer (includes Medicaid, Uninsured, and all other payer types such as CHIP, Medicare, Medicare/Medicaid Dual Eligibles, and Commercial Insurance)","The payer type assignment methodology depends on the unit of measurement (e.g., “Individual” or “Encounter”) of the measure-specific denominator (Step 2), as defined in the TIPPS Measure Specifications. \n\n1. Individual: A unit of measurement is an “individual” if a person can only be counted once in the denominator in a given measurement period. Payer type will be determined either by the most recent payer type on record for the individual at the end of the measurement period OR as any individual with a Medicaid-enrolled service at any point in the measurement period, even if their most recent payer type of record is not Medicaid. The same assignment methodology for determining Medicaid must be applied consistently across the measurement period.\n\n2. Encounter: A unit of measurement is an “encounter” if a person can be counted in the denominator more than once in a given measurement period. Payer type will be determined by the payer type on record for the qualifying encounter (visit or admission).","Encounters with an individual incarcerated in a state or federal facility during the measurement period"]
["TIPPS","Texas Incentives for Physician and Professional Services","T3","Using a retrospective attribution methodology, the TIPPS attributed population includes the individuals that a participating Physician Practice Group, as approved in the enrollment application, is accountable for under the TIPPS program, as defined by the Attributed Population Inclusion Criteria. ","The Physician Practice’s Group’s attributed population includes any individual that meets at least one of the criteria below:\na) One primary care service or preventive service provided during the measurement period; OR\nb) One ambulatory encounter during the measurement period; OR\nc) One prenatal or postnatal visit during the measurement period","99201–99205: New patient, office, or other outpatient visit\n99211–99215: Established patient, office, or other outpatient visit\n99304–99306: New patient, nursing facility care\n99307–99310: Established patient, nursing facility care\n99315–99316: Established patient, discharge day management service\n99318: Established patient, other nursing facility service\n99324–99328: New patient, domiciliary or rest home visit\n99334–99337: Established patient, domiciliary or rest home visit\n99339–99340: Established patient, physician supervision of patient (patient not present) in home, domiciliary, or rest home\n99341–99345: New patient, home visit\n99347–99350: Established patient, home visit","Encounter, Performed: Annual Wellness Visit:  2.16.840.1.113883.3.526.2.1363\nEncounter, Performed: Preventive Care - Initial Office Visit 0 to 17: 2.16.840.1.113883.3.464.1003.101.12.1022.\nEncounter, Performed: Preventive Care - Established Office Visit 0 to 17: 2.16.840.1.113883.3.464.1003.101.12.1024\nEncounter, Performed: Preventive Care - Initial Office Visit, 18 and Up: 2.16.840.1.113883.3.464.1003.101.12.1023\nEncounter, Performed: Preventive Care - Established Office Visit, 18 and Up: 2.16.840.1.113883.3.464.1003.101.12.1025 \nEncounter, Performed: Preventive Care Services - Individual Counseling: 2.16.840.1.113883.3.464.1003.101.12.1026","Encounter, Performed: Office Visit: 2.16.840.1.113883.3.464.1003.101.12.1001\nEncounter, Performed: Face-to-Face Interaction: 2.16.840.1.113883.3.464.1003.101.12.1048\nEncounter, Performed: Ophthalmological Services: 2.16.840.1.113883.3.526.3.1285\nEncounter, Performed: Outpatient Consultation: 2.16.840.1.113883.3.464.1003.101.12.1008\nEncounter, Performed: Psych Visit - Psychotherapy: 2.16.840.1.113883.3.526.3.1496\nEncounter, Performed: Ambulatory/ED Visit: 2.16.840.1.113883.3.464.1003.101.12.1061\nEncounter, Performed: Psych Visit - Diagnostic Evaluation: 2.16.840.1.113883.3.526.3.1492\nEncounter, Performed: Psychoanalysis: 2.16.840.1.113883.3.526.3.1141\nEncounter, Performed: Occupational Therapy Evaluation: 2.16.840.1.113883.3.526.3.1011\nProcedure, Performed: Hemodialysis: 2.16.840.1.113883.3.526.3.1083\nProcedure, Performed: Peritoneal Dialysis: 2.16.840.1.113883.3.526.3.1084\nEncounter, Performed: Health & Behavioral Assessment - Individual: 2.16.840.1.113883.3.526.3.1020\nEncounter, Performed: Health and Behavioral Assessment - Initial: 2.16.840.1.113883.3.526.3.1245\nEncounter, Performed: Health and Behavioral Assessment, Reassessment: 2.16.840.1.113883.3.526.3.1529\n*Encounter, Performed: Preventive Care Services - Other: 2.16.840.1.113883.3.464.1003.101.12.1030 \nEncounter, Performed: Speech and Hearing Evaluation: 2.16.840.1.113883.3.526.3.1530\nEncounter, Performed: Outpatient Encounters for Preventive Care: 2.16.840.1.113762.1.4.1047.9\n*NOTE: “Preventive Care Services – Other” value set includes codes that have been replaced by 96160 and 96161 in TX Health Steps. For TIPPS reporting purposes, 96160 and 96161 should be included as ambulatory encounters.","The measure-specific denominator population (Step 2) includes the individuals or encounters from the TIPPS attributed population (Step 1) that meet all criteria under the \"Eligible Physician Specialties and Other Clinicians\", \"Denominator Inclusions\", and \"Denominator Exclusions\" as applicable for each quality measure, as defined in the TIPPS Measure Specifications. \n\nPhysician groups may refer to the most recent NUCC Health Care Provider Taxonomy Code Set (https://taxonomy.nucc.org/) for the definitions and taxonomy codes for physician specialties, physician subspecialties, and other clinicians, as defined by the National Uniform Claim Committee (NUCC). The NUCC provider taxonomy definitions and codes for physician subspecialties that are nested within an eligible physician specialty may be included if these subspecialists perform the quality actions described in the measure based on the services provided and the measure specific-denominator coding. Nurse Practitioners and Physician Assistants, as defined by NUCC, practicing under the listed eligible physician specialties or practicing equivalent services may also be included.","*Measures must be stratified by the required reporting payer types unless otherwise specified under \"Required Reporting Payer Type Stratification\" in the \"Measure Specifications SFY22\" tab. For example, some measures may only require reporting by one of more of the following reporting payer types below. \n\n• Medicaid Managed Care** (includes STAR, STAR+PLUS, and STAR Kids)\n• Other Medicaid (includes other Medicaid Managed Care programs and Medicaid Fee-For-Service (FFS))\n• Uninsured (includes No insurance; County-based or other public medical assistance)\n• All Payer (includes Medicaid Managed Care, Other Medicaid, Uninsured, and all other payer types such as CHIP, Medicare, Medicare/Medicaid Dual Eligibles, and Commercial Insurance)\n\n**In the reporting template, providers will indicate whether the provider's system can report the required reporting payer type of “Medicaid Managed Care\" as outlined above to include STAR, STAR+PLUS, and STAR Kids. If provider's system cannot report “Medicaid Managed Care\" as outlined above, then the provider may alternatively report the “Medicaid Managed Care” payer type as \"Medicaid\" (includes all Medicaid Managed Care programs and Medicaid FFS). This alternative will only be available during Year 1 of the DPP. As a result of using this alternative, the required reporting payer types would be as shown below:  \n• Medicaid (includes all Medicaid Managed Care programs and Medicaid FFS)\n• Uninsured (includes No insurance; County-based or other public medical assistance)\n• All Payer (includes Medicaid, Uninsured, and all other payer types such as CHIP, Medicare, Medicare/Medicaid Dual Eligibles, and Commercial Insurance)","The payer type assignment methodology depends on the unit of measurement (e.g., “Individual” or “Encounter”) of the measure-specific denominator (Step 2), as defined in the TIPPS Measure Specifications. \n\n1. Individual: A unit of measurement is an “individual” if a person can only be counted once in the denominator in a given measurement period. Payer type will be determined either by the most recent payer type on record for the individual at the end of the measurement period OR as any individual with a Medicaid-enrolled service at any point in the measurement period, even if their most recent payer type of record is not Medicaid. The same assignment methodology for determining Medicaid must be applied consistently across the measurement period.\n\n2. Encounter: A unit of measurement is an “encounter” if a person can be counted in the denominator more than once in a given measurement period. Payer type will be determined by the payer type on record for the qualifying encounter (visit or admission).","Encounters with an individual incarcerated in a state or federal facility during the measurement period"]
["CHIRP","Comprehensive Hospital Increased Reimbursement Program","C1 (UHRIP)","Using a retrospective attribution methodology, the CHIRP attributed population includes the individuals that a participating Hospital, as approved in the enrollment application, is accountable for under CHIRP, as defined by the Attributed Population Inclusion Criteria. ","The Hospital’s attributed population includes any individual that meets the criteria below:\na) One encounter during the measurement period","N/a","N/a","N/a","The measure-specific denominator population (Step 2) includes the individuals or encounters from the CHIRP attributed population (Step 1) that meet all criteria under the \"Eligible Physician Specialties and Other Clinicians\", \"Denominator Inclusions\", and \"Denominator Exclusions\" as applicable for each quality measure, as defined in the CHIRP Measure Specifications. \n\nHospitals may refer to the most recent NUCC Health Care Provider Taxonomy Code Set (https://taxonomy.nucc.org/) for the definitions and taxonomy codes for physician specialties, physician subspecialties, and other clinicians, as defined by the National Uniform Claim Committee (NUCC). The NUCC provider taxonomy definitions and codes for physician subspecialties that are nested within an eligible physician specialty may be included if these subspecialists perform the quality actions described in the measure based on the services provided and the measure specific-denominator coding. Nurse Practitioners and Physician Assistants, as defined by NUCC, practicing under the listed eligible physician specialties or practicing equivalent services may also be included.","*Measures must be stratified by the required reporting payer types unless otherwise specified under \"Required Reporting Payer Type Stratification\" in the \"Measure Specifications SFY22\" tab. For example, some measures may only require reporting by one of more of the following reporting payer types below. \n\n• Medicaid Managed Care** (includes STAR and STAR+PLUS)\n• Other Medicaid (includes other Medicaid Managed Care programs and Medicaid Fee-For-Service (FFS))\n• Uninsured (includes No insurance; County-based or other public medical assistance)\n• All Payer (includes Medicaid Managed Care, Other Medicaid, Uninsured, and all other payer types such as CHIP, Medicare, Medicare/Medicaid Dual Eligibles, and Commercial Insurance)\n\n**In the reporting template, providers will indicate whether the provider's system can report the required reporting payer type of “Medicaid Managed Care\" as outlined above to include STAR and STAR+PLUS. If provider's system cannot report “Medicaid Managed Care\" as outlined above, then the provider may alternatively report the “Medicaid Managed Care” payer type as \"Medicaid\" (includes all Medicaid Managed Care programs and Medicaid FFS). This alternative will only be available during Year 1 of the DPP. As a result of using this alternative, the required reporting payer types would be as shown below:  \n• Medicaid (includes all Medicaid Managed Care programs and Medicaid FFS)\n• Uninsured (includes No insurance; County-based or other public medical assistance)\n• All Payer (includes Medicaid, Uninsured, and all other payer types such as CHIP, Medicare, Medicare/Medicaid Dual Eligibles, and Commercial Insurance)","The payer type assignment methodology depends on the unit of measurement (e.g., “Individual” or “Encounter”) of the measure-specific denominator (Step 2), as defined in the CHIRP Measure Specifications. \n\n1. Individual: A unit of measurement is an “individual” if a person can only be counted once in the denominator in a given measurement period. Payer type will be determined either by the most recent payer type on record for the individual at the end of the measurement period OR as any individual with a Medicaid-enrolled service at any point in the measurement period, even if their most recent payer type of record is not Medicaid. The same assignment methodology for determining Medicaid must be applied consistently across the measurement period.\n\n2. Encounter: A unit of measurement is an “encounter” if a person can be counted in the denominator more than once in a given measurement period. Payer type will be determined by the payer type on record for the qualifying encounter (visit or admission).","N/a"]
["CHIRP","Comprehensive Hospital Increased Reimbursement Program","C2 (ACIA Maternal Care)","Using a retrospective attribution methodology, the CHIRP attributed population includes the individuals that a participating Hospital, as approved in the enrollment application, is accountable for under CHIRP, as defined by the Attributed Population Inclusion Criteria. ","The Hospital’s attributed population includes any individual that meets at least one of the criteria below:\na) One delivery during the measurement period","N/a","N/a","N/a","The measure-specific denominator population (Step 2) includes the individuals or encounters from the CHIRP attributed population (Step 1) that meet all criteria under the \"Denominator Inclusions\" and \"Denominator Exclusions\" as applicable for each quality measure as defined in the CHIRP Measure Specifications.","*Measures must be stratified by the required reporting payer types unless otherwise specified under \"Required Reporting Payer Type Stratification\" in the \"Measure Specifications SFY22\" tab. For example, some measures may only require reporting by one of more of the following reporting payer types below. \n\n• Medicaid Managed Care** (includes STAR and STAR+PLUS)\n• Other Medicaid (includes other Medicaid Managed Care programs and Medicaid Fee-For-Service (FFS))\n• Uninsured (includes No insurance; County-based or other public medical assistance)\n• All Payer (includes Medicaid Managed Care, Other Medicaid, Uninsured, and all other payer types such as CHIP, Medicare, Medicare/Medicaid Dual Eligibles, and Commercial Insurance)\n\n**In the reporting template, providers will indicate whether the provider's system can report the required reporting payer type of “Medicaid Managed Care\" as outlined above to include STAR and STAR+PLUS. If provider's system cannot report “Medicaid Managed Care\" as outlined above, then the provider may alternatively report the “Medicaid Managed Care” payer type as \"Medicaid\" (includes all Medicaid Managed Care programs and Medicaid FFS). This alternative will only be available during Year 1 of the DPP. As a result of using this alternative, the required reporting payer types would be as shown below:  \n• Medicaid (includes all Medicaid Managed Care programs and Medicaid FFS)\n• Uninsured (includes No insurance; County-based or other public medical assistance)\n• All Payer (includes Medicaid, Uninsured, and all other payer types such as CHIP, Medicare, Medicare/Medicaid Dual Eligibles, and Commercial Insurance)","The payer type assignment methodology depends on the unit of measurement (e.g., “Individual” or “Encounter”) of the measure-specific denominator (Step 2), as defined in the CHIRP Measure Specifications. \n\n1. Individual: A unit of measurement is an “individual” if a person can only be counted once in the denominator in a given measurement period. Payer type will be determined either by the most recent payer type on record for the individual at the end of the measurement period OR as any individual with a Medicaid-enrolled service at any point in the measurement period, even if their most recent payer type of record is not Medicaid. The same assignment methodology for determining Medicaid must be applied consistently across the measurement period.\n\n2. Encounter: A unit of measurement is an “encounter” if a person can be counted in the denominator more than once in a given measurement period. Payer type will be determined by the payer type on record for the qualifying encounter (visit or admission).","N/a"]
["CHIRP","Comprehensive Hospital Increased Reimbursement Program","C2 (ACIA Hospital Safety)","Using a retrospective attribution methodology, the CHIRP attributed population includes the individuals that a participating Hospital, as approved in the enrollment application, is accountable for under CHIRP, as defined by the Attributed Population Inclusion Criteria. ","The Hospital’s attributed population includes any individual that meets the criteria below:\na) One encounter during the measurement period","N/a","N/a","N/a","The measure-specific denominator population (Step 2) includes the individuals or encounters from the CHIRP attributed population (Step 1) that meet all criteria under the \"Denominator Inclusions\" and \"Denominator Exclusions\" as applicable for each quality measure as defined in the CHIRP Measure Specifications.","*Measures must be stratified by the required reporting payer types unless otherwise specified under \"Required Reporting Payer Type Stratification\" in the \"Measure Specifications SFY22\" tab. For example, some measures may only require reporting by one of more of the following reporting payer types below. \n\n• Medicaid Managed Care** (includes STAR and STAR+PLUS)\n• Other Medicaid (includes other Medicaid Managed Care programs and Medicaid Fee-For-Service (FFS))\n• Uninsured (includes No insurance; County-based or other public medical assistance)\n• All Payer (includes Medicaid Managed Care, Other Medicaid, Uninsured, and all other payer types such as CHIP, Medicare, Medicare/Medicaid Dual Eligibles, and Commercial Insurance)\n\n**In the reporting template, providers will indicate whether the provider's system can report the required reporting payer type of “Medicaid Managed Care\" as outlined above to include STAR and STAR+PLUS. If provider's system cannot report “Medicaid Managed Care\" as outlined above, then the provider may alternatively report the “Medicaid Managed Care” payer type as \"Medicaid\" (includes all Medicaid Managed Care programs and Medicaid FFS). This alternative will only be available during Year 1 of the DPP. As a result of using this alternative, the required reporting payer types would be as shown below:  \n• Medicaid (includes all Medicaid Managed Care programs and Medicaid FFS)\n• Uninsured (includes No insurance; County-based or other public medical assistance)\n• All Payer (includes Medicaid, Uninsured, and all other payer types such as CHIP, Medicare, Medicare/Medicaid Dual Eligibles, and Commercial Insurance)","Hospital Safety Measures are not stratified by payer type but reported as \"All payer\".","N/a"]
["CHIRP","Comprehensive Hospital Increased Reimbursement Program","C2 (ACIA Pediatric)","Using a retrospective attribution methodology, the CHIRP attributed population includes the individuals that a participating Hospital, as approved in the enrollment application, is accountable for under CHIRP, as defined by the Attributed Population Inclusion Criteria. ","The Hospital’s attributed population includes any individual that meets the criteria below:\na) One encounter during the measurement period","N/a","N/a","N/a","The measure-specific denominator population (Step 2) includes the individuals or encounters from the CHIRP attributed population (Step 1) that meet all criteria under the \"Denominator Inclusions\" and \"Denominator Exclusions\" as applicable for each quality measure as defined in the CHIRP Measure Specifications.","*Measures must be stratified by the required reporting payer types unless otherwise specified under \"Required Reporting Payer Type Stratification\" in the \"Measure Specifications SFY22\" tab. For example, some measures may only require reporting by one of more of the following reporting payer types below. \n\n• Medicaid Managed Care** (includes STAR and STAR+PLUS)\n• Other Medicaid (includes other Medicaid Managed Care programs and Medicaid Fee-For-Service (FFS))\n• Uninsured (includes No insurance; County-based or other public medical assistance)\n• All Payer (includes Medicaid Managed Care, Other Medicaid, Uninsured, and all other payer types such as CHIP, Medicare, Medicare/Medicaid Dual Eligibles, and Commercial Insurance)\n\n**In the reporting template, providers will indicate whether the provider's system can report the required reporting payer type of “Medicaid Managed Care\" as outlined above to include STAR and STAR+PLUS. If provider's system cannot report “Medicaid Managed Care\" as outlined above, then the provider may alternatively report the “Medicaid Managed Care” payer type as \"Medicaid\" (includes all Medicaid Managed Care programs and Medicaid FFS). This alternative will only be available during Year 1 of the DPP. As a result of using this alternative, the required reporting payer types would be as shown below:  \n• Medicaid (includes all Medicaid Managed Care programs and Medicaid FFS)\n• Uninsured (includes No insurance; County-based or other public medical assistance)\n• All Payer (includes Medicaid, Uninsured, and all other payer types such as CHIP, Medicare, Medicare/Medicaid Dual Eligibles, and Commercial Insurance)","Only C2-116: Engagement in Integrated Behavioral Health is stratified by payer type. See \"Reporting Payer Types\".\n\nPediatric hospital safety measures (C2-111; C2-112; C2-113; C2-114; C2-115) are not stratified by payer type but reported as \"All payer\".","N/a"]
["CHIRP","Comprehensive Hospital Increased Reimbursement Program","C2 (ACIA Psychiatric Care Transitions)","N/a","N/a","N/a","N/a","N/a","N/a","N/a","N/a","N/a"]
["CHIRP","Comprehensive Hospital Increased Reimbursement Program","C2 (ACIA Care Transitions)","N/a","N/a","N/a","N/a","N/a","N/a","N/a","N/a","N/a"]
["CHIRP","Comprehensive Hospital Increased Reimbursement Program","C2 (ACIA Rural Hospital Best Practices)","Using a retrospective attribution methodology, the CHIRP attributed population includes the individuals that a participating Hospital, as approved in the enrollment application, is accountable for under CHIRP, as defined by the Attributed Population Inclusion Criteria. ","The Hospital’s attributed population includes any individual that meets the criteria below:\na) One encounter during the measurement period","N/a","N/a","N/a","The measure-specific denominator population (Step 2) includes the individuals or encounters from the CHIRP attributed population (Step 1) that meet all criteria under the \"Eligible Physician Specialties and Other Clinicians\", \"Denominator Inclusions\", and \"Denominator Exclusions\" as applicable for each quality measure, as defined in the CHIRP Measure Specifications. \n\nHospitals may refer to the most recent NUCC Health Care Provider Taxonomy Code Set (https://taxonomy.nucc.org/) for the definitions and taxonomy codes for physician specialties, physician subspecialties, and other clinicians, as defined by the National Uniform Claim Committee (NUCC). The NUCC provider taxonomy definitions and codes for physician subspecialties that are nested within an eligible physician specialty may be included if these subspecialists perform the quality actions described in the measure based on the services provided and the measure specific-denominator coding. Nurse Practitioners and Physician Assistants, as defined by NUCC, practicing under the listed eligible physician specialties or practicing equivalent services may also be included.","*Measures must be stratified by the required reporting payer types unless otherwise specified under \"Required Reporting Payer Type Stratification\" in the \"Measure Specifications SFY22\" tab. For example, some measures may only require reporting by one of more of the following reporting payer types below. \n\n• Medicaid Managed Care** (includes STAR and STAR+PLUS)\n• Other Medicaid (includes other Medicaid Managed Care programs and Medicaid Fee-For-Service (FFS))\n• Uninsured (includes No insurance; County-based or other public medical assistance)\n• All Payer (includes Medicaid Managed Care, Other Medicaid, Uninsured, and all other payer types such as CHIP, Medicare, Medicare/Medicaid Dual Eligibles, and Commercial Insurance)\n\n**In the reporting template, providers will indicate whether the provider's system can report the required reporting payer type of “Medicaid Managed Care\" as outlined above to include STAR and STAR+PLUS. If provider's system cannot report “Medicaid Managed Care\" as outlined above, then the provider may alternatively report the “Medicaid Managed Care” payer type as \"Medicaid\" (includes all Medicaid Managed Care programs and Medicaid FFS). This alternative will only be available during Year 1 of the DPP. As a result of using this alternative, the required reporting payer types would be as shown below:  \n• Medicaid (includes all Medicaid Managed Care programs and Medicaid FFS)\n• Uninsured (includes No insurance; County-based or other public medical assistance)\n• All Payer (includes Medicaid, Uninsured, and all other payer types such as CHIP, Medicare, Medicare/Medicaid Dual Eligibles, and Commercial Insurance)","The payer type assignment methodology depends on the unit of measurement (e.g., “Individual” or “Encounter”) of the measure-specific denominator (Step 2), as defined in the CHIRP Measure Specifications. \n\n1. Individual: A unit of measurement is an “individual” if a person can only be counted once in the denominator in a given measurement period. Payer type will be determined either by the most recent payer type on record for the individual at the end of the measurement period OR as any individual with a Medicaid-enrolled service at any point in the measurement period, even if their most recent payer type of record is not Medicaid. The same assignment methodology for determining Medicaid must be applied consistently across the measurement period.\n\n2. Encounter: A unit of measurement is an “encounter” if a person can be counted in the denominator more than once in a given measurement period. Payer type will be determined by the payer type on record for the qualifying encounter (visit or admission).","N/a"]
["DPP BHS","Directed Payment Program for Behavioral Health Services","B1","N/a","N/a","N/a","N/a","N/a","N/a","N/a","N/a","N/a"]
["DPP BHS","Directed Payment Program for Behavioral Health Services","B2","Using a retrospective attribution methodology, the DPP BHS attributed population includes the individuals that a participating behavioral health provider, as approved in the enrollment application, is accountable for under the DPP BHS, as defined by the Attributed Population Inclusion Criteria.","The participating behavioral health provider's attributed population includes any individual that meets the criterion below:\na) One encounter with the provider during the measurement period","n/a","n/a","n/a","The measure-specific denominator population (Step 2) includes the individuals or encounters from the DPP BHS attributed population (Step 1) that meet all criteria under the \"Eligible Physician Specialties and Other Clinicians\", \"Denominator Inclusions\", and \"Denominator Exclusions\" as applicable for each quality measure, as defined in the DPP BHS Measure Specifications. \n\nProviders may refer to the most recent NUCC Health Care Provider Taxonomy Code Set (https://taxonomy.nucc.org/) for the definitions and taxonomy codes for physician specialties, physician subspecialties, and other clinicians, as defined by the National Uniform Claim Committee (NUCC). The NUCC provider taxonomy definitions and codes for physician subspecialties that are nested within an eligible physician specialty may be included if these subspecialists perform the quality actions described in the measure based on the services provided and the measure specific-denominator coding. Nurse Practitioners and Physician Assistants, as defined by NUCC, practicing under the listed eligible physician specialties or practicing equivalent services may also be included.","*Measures must be stratified by the required reporting payer types unless otherwise specified under \"Required Reporting Payer Type Stratification\" in the \"Measure Specifications SFY22\" tab. For example, some measures may only require reporting by one of more of the following reporting payer types below. \n\n• Medicaid Managed Care** (includes STAR, STAR+PLUS, and STAR Kids)\n• Other Medicaid (includes other Medicaid Managed Care programs and Medicaid Fee-For-Service (FFS))\n• Uninsured (includes No insurance; County-based or other public medical assistance)\n• All Payer (includes Medicaid Managed Care, Other Medicaid, Uninsured, and all other payer types such as CHIP, Medicare, Medicare/Medicaid Dual Eligibles, and Commercial Insurance)\n\n**In the reporting template, providers will indicate whether the provider's system can report the required reporting payer type of “Medicaid Managed Care\" as outlined above to include STAR, STAR+PLUS, and STAR Kids. If provider's system cannot report “Medicaid Managed Care\" as outlined above, then the provider may alternatively report the “Medicaid Managed Care” payer type as \"Medicaid\" (includes all Medicaid Managed Care programs and Medicaid FFS). This alternative will only be available during Year 1 of the DPP. As a result of using this alternative, the required reporting payer types would be as shown below:  \n• Medicaid (includes all Medicaid Managed Care programs and Medicaid FFS)\n• Uninsured (includes No insurance; County-based or other public medical assistance)\n• All Payer (includes Medicaid, Uninsured, and all other payer types such as CHIP, Medicare, Medicare/Medicaid Dual Eligibles, and Commercial Insurance)","The payer type assignment methodology depends on the unit of measurement (e.g., “Individual” or “Encounter”) of the measure-specific denominator (Step 2), as defined in the DPP BHS Measure Specifications. \n\n1. Individual: A unit of measurement is an “individual” if a person can only be counted once in the denominator in a given measurement period. Payer type will be determined either by the most recent payer type on record for the individual at the end of the measurement period OR as any individual with a Medicaid-enrolled service at any point in the measurement period, even if their most recent payer type of record is not Medicaid. The same assignment methodology for determining Medicaid must be applied consistently across the measurement period.\n\n2. Encounter: A unit of measurement is an “encounter” if a person can be counted in the denominator more than once in a given measurement period. Payer type will be determined by the payer type on record for the qualifying encounter (visit or admission).","Encounters with an individual incarcerated in a state or federal facility during the measurement period"]
["RAPPS","Rural Access to Primary and Preventive Services","R1","N/a","N/a","N/a","N/a","N/a","N/a","N/a","N/a","N/a"]
["RAPPS","Rural Access to Primary and Preventive Services","R2","Using a retrospective attribution methodology, the RAPPS attributed population includes the individuals that a participating Rural Health Clinic (RHC), as approved in the enrollment application, is accountable for under the RAPPS program, as defined by the Attributed Population Inclusion Criteria.","The RHC’s attributed population includes any individual that meets the criterion below:\na) One encounter with the RHC during the measurement period","N/a","N/a","N/a","The measure-specific denominator population (Step 2) includes the individuals or encounters from the RAPPS attributed population (Step 1) that meet all criteria under the \"Eligible Physician Specialties and Other Clinicians\", \"Denominator Inclusions\", and \"Denominator Exclusions\" as applicable for each quality measure, as defined in the RAPPS Measure Specifications. \n\nProviders may refer to the most recent NUCC Health Care Provider Taxonomy Code Set (https://taxonomy.nucc.org/) for the definitions and taxonomy codes for physician specialties, physician subspecialties, and other clinicians, as defined by the National Uniform Claim Committee (NUCC). The NUCC provider taxonomy definitions and codes for physician subspecialties that are nested within an eligible physician specialty may be included if these subspecialists perform the quality actions described in the measure based on the services provided and the measure specific-denominator coding. Nurse Practitioners and Physician Assistants, as defined by NUCC, practicing under the listed eligible physician specialties or practicing equivalent services may also be included.","*Measures must be stratified by the required reporting payer types unless otherwise specified under \"Required Reporting Payer Type Stratification\" in the \"Measure Specifications SFY22\" tab. For example, some measures may only require reporting by one of more of the following reporting payer types below. \n\n• Medicaid Managed Care** (includes STAR, STAR+PLUS, and STAR Kids)\n• Other Medicaid (includes other Medicaid Managed Care programs and Medicaid Fee-For-Service (FFS))\n• Uninsured (includes No insurance; County-based or other public medical assistance)\n• All Payer (includes Medicaid Managed Care, Other Medicaid, Uninsured, and all other payer types such as CHIP, Medicare, Medicare/Medicaid Dual Eligibles, and Commercial Insurance)\n\n**In the reporting template, providers will indicate whether the provider's system can report the required reporting payer type of “Medicaid Managed Care\" as outlined above to include STAR, STAR+PLUS, and STAR Kids. If provider's system cannot report “Medicaid Managed Care\" as outlined above, then the provider may alternatively report the “Medicaid Managed Care” payer type as \"Medicaid\" (includes all Medicaid Managed Care programs and Medicaid FFS). This alternative will only be available during Year 1 of the DPP. As a result of using this alternative, the required reporting payer types would be as shown below:  \n• Medicaid (includes all Medicaid Managed Care programs and Medicaid FFS)\n• Uninsured (includes No insurance; County-based or other public medical assistance)\n• All Payer (includes Medicaid, Uninsured, and all other payer types such as CHIP, Medicare, Medicare/Medicaid Dual Eligibles, and Commercial Insurance)","The payer type assignment methodology depends on the unit of measurement (e.g., “Individual” or “Encounter”) of the measure-specific denominator (Step 2), as defined in the RAPPS Measure Specifications. \n\n1. Individual: A unit of measurement is an “individual” if a person can only be counted once in the denominator in a given measurement period. Payer type will be determined either by the most recent payer type on record for the individual at the end of the measurement period OR as any individual with a Medicaid-enrolled service at any point in the measurement period, even if their most recent payer type of record is not Medicaid. The same assignment methodology for determining Medicaid must be applied consistently across the measurement period.\n\n2. Encounter: A unit of measurement is an “encounter” if a person can be counted in the denominator more than once in a given measurement period. Payer type will be determined by the payer type on record for the qualifying encounter (visit or admission).","Encounters with an individual incarcerated in a state or federal facility during the measurement period"]

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["Final Measure ID","DPP Shorthand","Program Component (Module)","Measure Name","Measure Type","Blank Field (intentionally left blank)","Reporting Period 1 - Data Measurement Period","Reporting Period 1 - Reporting Requirements","Blank Field (intentionally left blank)2","Reporting Period 2 - Data Measurement Period","Reporting Period 2 -  Reporting Requirements","Blank Field (intentionally left blank)3","Required Reporting Payer Types","Blank Field (intentionally left blank)4","Blank Field (intentionally left blank)5","Blank Field (intentionally left blank)6","Blank Field (intentionally left blank)7","Blank Field (intentionally left blank)8","NQF ID","Measure Steward","Measure Specs Source","Link to Measure Specs Source","Measure Description","Eligible Physician Specialties and Other Clinicians","Denominator Unit of Measurement","Denominator Description","Denominator Inclusions","Denominator Exclusions","Numerator Description","Numerator Inclusion (Performance Met) ","Numerator Exclusion (Performance Not Met) ","HHSC Program Specific Modifications","Measure Steward Additional Information","Blank Field (intentionally left blank)9","Blank Field (intentionally left blank)10","Blank Field (intentionally left blank)11","Performance Directionality","Blank Field (intentionally left blank)12","Blank Field (intentionally left blank)13","Blank Field (intentionally left blank)14","Blank Field (intentionally left blank)15","Blank Field (intentionally left blank)16","Blank Field (intentionally left blank)17","Blank Field (intentionally left blank)18","Public Notes"]
["T1-101","TIPPS","T1","Care team includes personnel in a care coordination role not requiring clinical licensure","Structure",null,"NA","Status Update Only",null,"NA","NA",null,"NA",null,null,null,null,null,"NA","NA","NA","NA","Reporting of care team composition, number of encounters performed by personnel in a care coordination role not requiring clinical licensure (e.g., community health workers, promotor(a)s, any social workers that are not a licensed clinical social worker, patient navigators, and medical assistants that perform care coordination)","NA","NA",null,null,null,null,null,null,null,null,null,null,null,"N/A",null,null,null,null,null,null,null,"A care coordination role typically involves functions or responsibilities to review a client’s care plan to proactively confirm that any needed appointments, specialty services, labs, tests, and community resources are being coordinated and completed. Examples of personnel not requiring clinical licensure AND who may be performing a care coordination role typically include community health workers, promotor(a)s, any social workers that are not a licensed clinical social worker, patient navigators, and medical assistants."]
["T1-105","TIPPS","T1","Health Information Exchange (HIE) Participation","Structure",null,"NA","Status Update Only",null,"NA","NA",null,"NA",null,null,null,null,null,"NA","NA","NA","NA","Reporting on status with enrollment in a public HIE","NA","NA",null,null,null,null,null,null,null,null,null,null,null,"N/A"]
["T1-106","TIPPS","T1","Patient-Centered Medical Home (PCMH) Accreditation or Recognition Status","Structure",null,"NA","Status Update Only",null,"NA","NA",null,"NA",null,null,null,null,null,"NA","NA","NA","NA","Reporting PCMH accreditation or recognition status or steps to obtain accreditation or recognition","NA","NA",null,null,null,null,null,null,null,null,null,null,null,"N/A"]
["T1-107","TIPPS","T1","Same-day, walk-in, or after-hours appointments in the outpatient setting","Structure",null,"NA","Status Update Only",null,"NA","NA",null,"NA",null,null,null,null,null,"NA","NA","NA","NA","Reporting of availability of same-day, walk-in, or after-hours appointments","NA","NA",null,null,null,null,null,null,null,null,null,null,null,"N/A"]
["T1-108","TIPPS","T1","Pre-visit planning and/or standing order protocols","Structure",null,"NA","Status Update Only",null,"NA","NA",null,"NA",null,null,null,null,null,"NA","NA","NA","NA","Reporting of processes in place for pre-visit planning and/or standing order protocols ","NA","NA",null,null,null,null,null,null,null,null,null,null,null,"N/A"]
["T1-109","TIPPS","T1","Patient education focused on disease self-management","Structure",null,"NA","Status Update Only",null,"NA","NA",null,"NA",null,null,null,null,null,"NA","NA","NA","NA","Reporting of availability of self-management education, number of patients with completed education/classes","NA","NA",null,null,null,null,null,null,null,null,null,null,null,"N/A"]
["T1-110","TIPPS","T1","Identification of pregnant women at-risk for Hypertension, Preeclampsia, or Eclampsia; treatment based on best practices; and follow-up with postpartum women diagnosed with Hypertension, Preeclampsia, or Eclampsia ","Structure",null,"NA","Status Update Only",null,"NA","NA",null,"NA",null,null,null,null,null,"NA","NA","NA","NA","Reporting of processes in place to Identify, treat, and provide follow-up for pregnant women at-risk for Hypertension, Preeclampsia, or Eclampsia","NA","NA",null,null,null,null,null,null,null,null,null,null,null,"N/A"]
["T1-111","TIPPS","T1","Telehealth to provide virtual medical appointments and/or consultations for specialty services, including both physical health and behavioral health services","Structure",null,"NA","Status Update Only",null,"NA","NA",null,"NA",null,null,null,null,null,"NA","NA","NA","NA","Reporting of availability of telehealth for specialty services and in what setting","NA","NA",null,null,null,null,null,null,null,null,null,null,null,"N/A"]
["T2-103","TIPPS","T2","Preventive Care and Screening: Influenza Immunization","Process",null,"01/01/21 - 12/31/21","Numeric Data Reporting & Status Update Only",null,"NA","NA",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"0041","AMA-PCPI","eCQM - CMS147v10","https://ecqi.healthit.gov/ecqm/ep/2021/cms147v10","Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization","Allergy & Immunology; Family Medicine; Internal Medicine; Obstetrics & Gynecology; Otolaryngology; Pediatrics; Preventive Medicine","Individuals","Initial population: All patients aged 6 months and older\nInitial population and seen for a visit during the measurement period, and seen for a visit between October 1 and March 31\n*For DPP reporting purposes, report denominator as individuals with encounters that fall within the measurement period, e.g., for CY2021, the denominator would include encounters from January 2021 - March 2021 and October 2021 - December 2021 (See \"Program Specific Modifications\" cell).","Initial Population\nexists ( [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n    where Global.\"CalendarAgeInMonthsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) >= 6)\n  and ( exists \"Qualifying Encounter During Measurement Period\"\n      or exists \"Hemodialysis During Measurement Period\"\n      or exists \"Peritoneal Dialysis During Measurement Period\")\n \n\"Initial Population\"\n  and ( exists \"Encounter During Influenza Season\"\n      or exists \"Hemodialysis During Influenza Season\"\n      or exists \"Peritoneal Dialysis During Influenza Season\")\n\n[\"Encounter, Performed\": \"Encounter-Influenza\"] FluEncounter\n  where FluEncounter.relevantPeriod starts during \"Influenza Season\"\n\n[\"Procedure, Performed\": \"Hemodialysis\"] FluSeasonHemodialysis\n  where FluSeasonHemodialysis.relevantPeriod overlaps \"Influenza Season\"\n\n[\"Procedure, Performed\": \"Peritoneal Dialysis\"] PeritonealDialysis\n  where PeritonealDialysis.relevantPeriod overlaps \"Measurement Period\"","Documentation of medical reason(s) for not receiving influenza immunization (e.g., patient allergy, other medical reasons).\nDocumentation of patient reason(s) for not receiving influenza immunization (e.g., patient declined, other patient reasons).\nDocumentation of system reason(s) for not receiving influenza immunization (e.g., vaccine not available, other system reasons).\n\nDenominator Exceptions\nexists \"Medical Patient or System Reason for Not Performing Influenza Vaccination\"\n  or exists \"Medical Patient or System Reason for Not Administering Influenza Vaccine\"\n  or exists \"Diagnosis of Allergy to Egg\"\n  or exists \"Egg Substance Allergy\"\n  or exists \"Diagnosis of Allergy to Influenza Vaccine\"\n  or exists \"Diagnosis of Intolerance to Influenza Vaccine\"\n  or exists \"Intolerance of Influenza Vaccination Procedure\"\n  or exists \"Allergy or Intolerance to Influenza Vaccine","Patients who received an influenza immunization OR who reported previous receipt of an influenza immunization","exists \"Influenza Vaccination Procedure\"\n  or exists \"Influenza Immunization Administered\"\n  or exists \"Influenza Vaccine Previously Received\"\n*For DPP reporting purposes, report numerator as individuals who received an influenza immunization OR who reported previous receipt of an influenza immunization within the measurement period, e.g., for denominator encounters in January 2021 – March 2021, the numerator would include influenza immunization received in August 2020 - March 2021, and for denominator encounters in October 2021 - December 2021, the numerator would include influenza immunization received in August 2021 - December 2021. An Individual with multiple eligible encounters during the data measurement period only has to have the numerator met once to be counted as Numerator Performance Met. (See \"Program Specific Modifications\" cell and please note the measure steward's definition of \"Previous Receipt\" in the \"Additional Information\" cell.)","None","For DPP reporting purposes, report denominator as individuals with encounters that fall within the measurement period, e.g., for CY2021, the denominator would include encounters from January 2021 - March 2021 and October 2021 - December 2021. \n \nFor DPP reporting purposes, report numerator as individuals who received an influenza immunization OR who reported previous receipt of an influenza immunization within the measurement period, e.g., for denominator encounters in January 2021 – March 2021, the numerator would include influenza immunization received in August 2020 - March 2021, and for denominator encounters in October 2021 - December 2021, the numerator would include influenza immunization received in August 2021 - December 2021. An Individual with multiple eligible encounters during the data measurement period only has to have the numerator met once to be counted as Numerator Performance Met. \n\nPlease note the measure steward's definition of \"Previous Receipt\" (see the \"Additional Information\" cell).","Definitions: \nPrevious Receipt - receipt of the current season's influenza immunization from another provider OR from same provider prior to the visit to which the measure is applied (typically, prior vaccination would include influenza vaccine given since August 1st)",null,null,null,"Positive"]
["T2-104","TIPPS","T2","Preventive Care & Screening: Tobacco Use: Screening & Cessation Intervention","Process",null,"01/01/21 - 12/31/21","Numeric Data Reporting & Status Update Only",null,"NA","NA",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"0028","PCPI","eCQM - CMS138v9","https://ecqi.healthit.gov/ecqm/ep/2021/cms138v9","Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 12 months AND who received tobacco cessation intervention if identified as a tobacco user\n\nOnly one rate is reported:\nPercentage of patients aged 18 years and older who were screened for tobacco use one or more times within 12 months AND who received tobacco cessation intervention if identified as a tobacco user","Allergy & Immunology; Dermatology; Family Medicine; Internal Medicine; Obstetrics & Gynecology; Ophthalmology; Orthopaedic Surgery; Otolaryngology; Physical Medicine & Rehabilitation; Plastic Surgery; Pediatrics (Optional); Preventive Medicine; Psychiatry & Neurology; Neurosurgical Surgery; Surgery; Thoracic Surgery; Urology; Audiologist; Occupational Therapist; Physical Therapist; Podiatrist; Social Worker; Speech Language Pathologist; Urgent Care","Individuals","All patients aged 18 years and older seen for at least two visits or at least one preventive visit during the measurement period","\"Initial Population\"\n\nexists ( [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n    where Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) >= 18)\n  and ( Count(\"Office Based Visit During Measurement Period\")>= 2\n      or exists \"Preventive Visit During Measurement Period\")","Documentation of medical reason(s) for not screening for tobacco use OR for not providing tobacco cessation intervention for patients identified as tobacco users (e.g., limited life expectancy, other medical reason)\n\nexists \"Medical Reason for Not Screening for Tobacco Use\"\n  or exists \"Medical Reason for Not Counseling Tobacco User\"\n  or exists \"Medical Reason for Not Ordering Tobacco Cessation Pharmacotherapy\"\n  or \"Has Limited Life Expectancy\"\n\n[\"Assessment, Not Performed\": \"Tobacco Use Screening\"] NoTobaccoUseScreening\n  where NoTobaccoUseScreening.authorDatetime during \"Measurement Period\"\n    and NoTobaccoUseScreening.negationRationale in \"Medical Reason\"\n\nor [\"Intervention, Not Performed\": \"Tobacco Use Cessation Counseling\"] NoTobaccoCessationCounseling\n  where NoTobaccoCessationCounseling.authorDatetime during \"Measurement Period\"\n    and NoTobaccoCessationCounseling.negationRationale in \"Medical Reason\"\n\nor [\"Medication, Not Ordered\": \"Tobacco Use Cessation Pharmacotherapy\"] NoCessationPharmacotherapyOrdered\n  where NoCessationPharmacotherapyOrdered.authorDatetime during \"Measurement Period\"\n    and NoCessationPharmacotherapyOrdered.negationRationale in \"Medical Reason\"\n\nor exists ( [\"Diagnosis\": \"Limited Life Expectancy\"] LimitedLifeExpectancy\n    where LimitedLifeExpectancy.prevalencePeriod overlaps after \"Measurement Period\")","Patients who were screened for tobacco use at least once within 12 months AND who received tobacco cessation intervention if identified as a tobacco user","Criteria 3\n\"Most Recent Tobacco Use Screening Indicates Tobacco Non User\" is not null\n  or ( \"Most Recent Tobacco Use Screening Indicates Tobacco User\" is not null\n      and ( exists \"Tobacco Cessation Counseling Given\"\n          or exists \"Tobacco Cessation Pharmacotherapy Ordered\"\n          or exists \"Active Pharmacotherapy for Tobacco Cessation\"))\n\n(Last([\"Assessment, Performed\": \"Tobacco Use Screening\"] TobaccoUseScreening\n    where TobaccoUseScreening.relevantDatetime during \"Measurement Period\"\n    sort by relevantDatetime)) MostRecentTobaccoUseScreening\n  where MostRecentTobaccoUseScreening.result in \"Tobacco Non-User\"\n \n(Last([\"Assessment, Performed\": \"Tobacco Use Screening\"] TobaccoUseScreening\n    where TobaccoUseScreening.relevantDatetime during \"Measurement Period\"\n    sort by relevantDatetime)) MostRecentTobaccoUseScreening\n  where MostRecentTobaccoUseScreening.result in \"Tobacco User\"\n\n[\"Intervention, Performed\": \"Tobacco Use Cessation Counseling\"] TobaccoCessationCounseling\n  where TobaccoCessationCounseling.relevantDatetime during \"Measurement Period\"\n\n[\"Medication, Order\": \"Tobacco Use Cessation Pharmacotherapy\"] CessationPharmacotherapyOrdered\n  where CessationPharmacotherapyOrdered.authorDatetime during \"Measurement Period\"\n\n[\"Medication, Active\": \"Tobacco Use Cessation Pharmacotherapy\"] TakingCessationPharmacotherapy\n  where TakingCessationPharmacotherapy.relevantPeriod overlaps after \"Measurement Period\"","None","Only one rate, rate 3, is reported, using criteria 3. ","Definitions:\nTobacco Use - Includes any type of tobacco\nTobacco Cessation Intervention - Includes brief counseling (3 minutes or less), and/or pharmacotherapy -- Note: Concepts aligned with brief counseling (e.g., minimal and intensive advice/counseling interventions conducted both in person and over the phone) are included in the value set for the numerator. Other concepts such as written self-help materials (e.g., brochures, pamphlets) and complementary/alternative therapies are not included in the value set and do not qualify for the numerator. Brief counseling also may be of longer duration or be performed more frequently, as evidence shows there is a dose-response relationship between the intensity of counseling provided (either length or frequency) and tobacco cessation rates (U.S. Preventive Services Task Force, 2015).\n\n\nGuidance: \nThe requirement of two or more visits is to establish that the eligible professional or eligible clinician has an existing relationship with the patient for certain types of encounters. \n\nTo satisfy the intent of this measure, a patient must have at least one tobacco use screening during the 12-month period. If a patient has multiple tobacco use screenings during the 12-month period, only the most recent screening, which has a documented status of tobacco user or tobacco non-user, will be used to satisfy the measure requirements.\n\nIf a patient uses any type of tobacco (i.e., smokes or uses smokeless tobacco), the expectation is that they should receive tobacco cessation intervention: either counseling and/or pharmacotherapy.\n\nAs noted above in a recommendation statement from the USPSTF, the current evidence is insufficient to recommend electronic nicotine delivery systems (ENDS) including electronic cigarettes for tobacco cessation. Additionally, ENDS are not currently classified as tobacco in the recent evidence review to support the update of the USPSTF recommendation given that the devices do not burn or use tobacco leaves. In light of the current lack of evidence, the measure does not currently capture e-cigarette usage as either tobacco use or a cessation aid.\n\nIf tobacco use status of a patient is unknown, the patient does not meet the screening component required to be counted in the numerator and should be considered a measure failure. Instances where tobacco use status of \"unknown\" is recorded include: 1) the patient was not screened; or 2) the patient was screened and the patient (or caregiver) was unable to provide a definitive answer. If the patient does not meet the screening component of the numerator but has an allowable medical exception, then the patient should be removed from the denominator of the measure and reported as a valid exception.\n\nIn order to promote a team-based approach to patient care, the tobacco cessation intervention can be performed by another healthcare provider; therefore, the tobacco use screening and tobacco cessation intervention do not need to be performed by the same provider or clinician.   \n\nThe medical reason exception may be applied to either the screening data element OR to any of the applicable tobacco cessation intervention data elements (counseling and/or pharmacotherapy) included in the measure. \n\nIf a patient has a diagnosis of limited life expectancy, that patient has a valid denominator exception for not being screened for tobacco use or for not receiving tobacco use cessation intervention (counseling and/or pharmacotherapy) if identified as a tobacco user.\n\nThis measure contains three reporting rates which aim to identify patients who were screened for tobacco use (rate/population 1), patients who were identified as tobacco users and who received tobacco cessation intervention (rate/population 2), and a comprehensive look at the overall performance on tobacco screening and cessation intervention (rate/population 3). By separating this measure into various reporting rates, the eligible professional or eligible clinician will be able to better ascertain where gaps in performance exist, and identify opportunities for improvement. The overall rate (rate/population 3) can be utilized to compare performance to published versions of this measure prior to the 2018 performance year, when the measure had a single performance rate. \n \nThis eCQM is a patient-based measure.\n\nThis version of the eCQM uses QDM version 5.5.  Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.",null,null,null,"Positive",null,null,null,null,null,null,null,"Measure is a screening rate. Both positive and negative screens should be included if they meet the numerator inclusion criteria. "]
["T2-112","TIPPS","T2","Cervical Cancer Screening","Process",null,"01/01/21 - 12/31/21","Numeric Data Reporting & Status Update Only",null,"NA","NA",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"0032","NCQA","eCQM - CMS124v9","https://ecqi.healthit.gov/ecqm/ep/2021/cms124v9","Percentage of women 21-64 years of age who were screened for cervical cancer using either of the following criteria:\n-Women age 21-64 who had cervical cytology performed within the last 3 years\n-Women age 30-64 who had cervical human papillomavirus (HPV) testing performed within the last 5 years","Family Medicine; Internal Medicine; Obstetrics & Gynecology","Individuals","Women 23-64 years of age with a visit during the measurement period","\"Initial Population\"\n\nexists ( [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n    where Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) in Interval[23, 64))\n  and exists ( [\"Patient Characteristic Sex\": \"Female\"] )\n  and exists \"Qualifying Encounters\"\n\n( [\"Encounter, Performed\": \"Office Visit\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services - Established Office Visit, 18 and Up\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services-Initial Office Visit, 18 and Up\"]\n  union [\"Encounter, Performed\": \"Home Healthcare Services\"] ) ValidEncounter\n  where ValidEncounter.relevantPeriod during \"Measurement Period\"","Women who had a hysterectomy with no residual cervix or a congenital absence of cervix.\nExclude patients whose hospice care overlaps the measurement period.\n\nHospice. \"Has Hospice\"\n  or exists \"Absence of Cervix\"\n\nexists ( [\"Encounter, Performed\": \"Encounter Inpatient\"] DischargeHospice\n    where ( DischargeHospice.dischargeDisposition ~ \"Discharge to home for hospice care (procedure)\"\n        or DischargeHospice.dischargeDisposition ~ \"Discharge to healthcare facility for hospice care (procedure)\")\n      and DischargeHospice.relevantPeriod ends during \"Measurement Period\")\n  or exists ( [\"Intervention, Order\": \"Hospice care ambulatory\"] HospiceOrder\n      where HospiceOrder.authorDatetime during \"Measurement Period\")\n  or exists ( [\"Intervention, Performed\": \"Hospice care ambulatory\"] HospicePerformed\n      where HospicePerformed.relevantPeriod overlaps \"Measurement Period\")\n\n( [\"Procedure, Performed\": \"Hysterectomy with No Residual Cervix\"] NoCervixProcedure\n    where NoCervixProcedure.relevantPeriod ends on or before \n    end of \"Measurement Period\")\n  union ( [\"Diagnosis\": \"Congenital absence of cervix (disorder)\"] NoCervixDiagnosis\n      where NoCervixDiagnosis.prevalencePeriod starts on or before \n      end of \"Measurement Period\")","Women with one or more screenings for cervical cancer. Appropriate screenings are defined by any one of the following criteria:\n-Cervical cytology performed during the measurement period or the two years prior to the measurement period for women who are at least 21 years old at the time of the test\n-Cervical human papillomavirus (HPV) testing performed during the measurement period or the four years prior to the measurement period for women who are 30 years or older at the time of the test","exists \"Cervical Cytology Within 3 Years\"\n  or exists \"HPV Test Within 5 Years for Women Age 30 and Older\"\n\n[\"Laboratory Test, Performed\": \"Pap Test\"] CervicalCytology\n  where CervicalCytology.relevantDatetime 3 years or less on or before \n  end of \"Measurement Period\"\n    and CervicalCytology.result is not null\n\n[\"Laboratory Test, Performed\": \"HPV Test\"] HPVTest\n  with [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n    such that Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, HPVTest.relevantDatetime ) >= 30\n  where HPVTest.relevantDatetime 5 years or less on or before \n  end of \"Measurement Period\"\n    and HPVTest.result is not null","None",null,"Guidance: \nTo ensure the measure is only looking for a cervical cytology test only after a woman turns 21 years of age, the youngest age in the initial population is 23.\n\nPatient self-report for procedures as well as diagnostic studies should be recorded in 'Procedure, Performed' template or 'Diagnostic Study, Performed' template in QRDA-1.\n\nThis eCQM is a patient-based measure.\n\nThis version of the eCQM uses QDM version 5.5.  Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.",null,null,null,"Positive"]
["T2-113","TIPPS","T2","Childhood Immunization Status","Process",null,"01/01/21 - 12/31/21","Numeric Data Reporting & Status Update Only",null,"NA","NA",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"0038","NCQA","eCQM - CMS117v9","https://ecqi.healthit.gov/ecqm/ep/2021/cms117v9","Percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV), one measles, mumps and rubella (MMR); three or four H influenza type B (Hib); three hepatitis B (Hep B); one chicken pox (VZV); four pneumococcal conjugate (PCV); one hepatitis A (Hep A); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday","Family Medicine; Pediatrics","Individuals","Children who turn 2 years of age during the measurement period and who have a visit during the measurement period","\"Initial Population\"\n\nexists ( [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n    where Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) >= 1\n      and Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, \n      end of \"Measurement Period\" ) = 2)\n  and exists ( \"Qualifying Encounter\" )\n\n( [\"Encounter, Performed\": \"Office Visit\"]\n  union [\"Encounter, Performed\": \"Home Healthcare Services\"]\n  union [\"Encounter, Performed\": \"Preventive Care, Established Office Visit, 0 to 17\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services, Initial Office Visit, 0 to 17\"] ) ValidEncounter\n  where ValidEncounter.relevantPeriod during \"Measurement Period\"","Exclude patients whose hospice care overlaps the measurement period\n\nHospice. \"Has Hospice\"\nexists ( [\"Encounter, Performed\": \"Encounter Inpatient\"] DischargeHospice\n    where ( DischargeHospice.dischargeDisposition ~ \"Discharge to home for hospice care (procedure)\"\n        or DischargeHospice.dischargeDisposition ~ \"Discharge to healthcare facility for hospice care (procedure)\")\n      and DischargeHospice.relevantPeriod ends during \"Measurement Period\")\n  or exists ( [\"Intervention, Order\": \"Hospice care ambulatory\"] HospiceOrder\n      where HospiceOrder.authorDatetime during \"Measurement Period\")\n  or exists ( [\"Intervention, Performed\": \"Hospice care ambulatory\"] HospicePerformed\n      where HospicePerformed.relevantPeriod overlaps \"Measurement Period\")","Children who have evidence showing they received recommended vaccines, had documented history of the illness, had a seropositive test result, or had an allergic reaction to the vaccine by their second birthday","( exists ( \"Four DTaP Vaccinations\" )\n    or exists ( \"DTaP Numerator Inclusion Conditions\" ))\n  and ( exists ( \"Three Polio Vaccinations\" )\n      or exists ( \"Polio Numerator Inclusion Conditions\" ))\n  and ( exists ( \"One MMR Vaccination\" )\n      or exists ( \"MMR Numerator Inclusion Conditions\" )\n      or ( exists ( \"Measles Indicators\" )\n          and exists ( \"Mumps Indicators\" )\n          and exists ( \"Rubella Indicators\" )))\n  and ( \"Has Appropriate Number of Hib Immunizations\"\n      or exists ( \"Hib Numerator Inclusion Conditions\" ))\n  and ( exists ( \"Three Hepatitis B Vaccinations\" )\n      or exists ( \"Hepatitis B Numerator Inclusion Conditions\" ))\n  and ( exists ( \"One Chicken Pox Vaccination\" )\n      or exists ( \"Varicella Zoster Numerator Inclusion Conditions\" ))\n  and ( exists ( \"Four Pneumococcal Conjugate Vaccinations\" )\n      or exists ( \"Pneumococcal Conjugate Numerator Inclusion Conditions\" ))\n  and ( exists ( \"One Hepatitis A Vaccinations\" )\n      or exists ( \"Hepatitis A Numerator Inclusion Conditions\" ))\n  and ( \"Has Appropriate Number of Rotavirus Immunizations\"\n      or exists ( \"Rotavirus Numerator Inclusion Conditions\" ))\n  and ( exists ( \"Two Influenza Vaccinations\" )\n      or exists ( \"Influenza Numerator Inclusion Conditions\" ))\n\nfrom\n  \"DTaP Immunizations or Procedures\" DTaPVaccination1,\n  \"DTaP Immunizations or Procedures\" DTaPVaccination2,\n  \"DTaP Immunizations or Procedures\" DTaPVaccination3,\n  \"DTaP Immunizations or Procedures\" DTaPVaccination4\n  where DTaPVaccination2.relevantDatetime 1 day or more after day of DTaPVaccination1.relevantDatetime\n    and DTaPVaccination3.relevantDatetime 1 day or more after day of DTaPVaccination2.relevantDatetime\n    and DTaPVaccination4.relevantDatetime 1 day or more after day of DTaPVaccination3.relevantDatetime\n  return DTaPVaccination1\n\n( [\"Diagnosis\": \"Anaphylactic Reaction to DTaP Vaccine\"]\n  union [\"Diagnosis\": \"Encephalopathy due to Childhood Vaccination\"] ) DTaPConditions\n  where ( start of DTaPConditions.prevalencePeriod during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])\n\nfrom\n  \"Polio Immunizations or Procedures\" PolioVaccination1,\n  \"Polio Immunizations or Procedures\" PolioVaccination2,\n  \"Polio Immunizations or Procedures\" PolioVaccination3\n  where PolioVaccination2.relevantDatetime 1 day or more after day of PolioVaccination1.relevantDatetime\n    and PolioVaccination3.relevantDatetime 1 day or more after day of PolioVaccination2.relevantDatetime\n  return PolioVaccination1\n\n( [\"Diagnosis\": \"Poliomyelitis vaccine adverse reaction (disorder)\"]\n  union [\"Diagnosis\": \"Streptomycin adverse reaction (disorder)\"]\n  union [\"Diagnosis\": \"Polymyxin B adverse reaction (disorder)\"]\n  union [\"Diagnosis\": \"Neomycin adverse reaction (disorder)\"] ) PolioConditions\n  where ( start of PolioConditions.prevalencePeriod during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])\n\n( ( [\"Immunization, Administered\": \"Measles, Mumps and Rubella (MMR) Vaccine\"]\n    union [\"Procedure, Performed\": \"Measles, Mumps and Rubella (MMR) Vaccine Administered\"] ) MMRVaccination\n    where MMRVaccination.relevantDatetime during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])\n\n( [\"Diagnosis\": \"Disorders of the Immune System\"]\n  union [\"Diagnosis\": \"HIV\"]\n  union [\"Diagnosis\": \"Malignant Neoplasm of Lymphatic and Hematopoietic Tissue\"]\n  union [\"Diagnosis\": \"Neomycin adverse reaction (disorder)\"] ) MMRConditions\n  where ( start of MMRConditions.prevalencePeriod during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])\n\n( ( [\"Laboratory Test, Performed\": \"Measles Antibody Test (IgG Antibody Titer)\"] MeaslesTiter\n    where MeaslesTiter.result >= 1.10)\n  union ( [\"Laboratory Test, Performed\": \"Measles Antibody Test (IgG Antibody presence)\"] MeaslesIgGPresence\n      where MeaslesIgGPresence.result as Code in \"Positive Finding”)\n  union ( [\"Diagnosis\": \"Measles\"] MeaslesDiagnosis\n      return \"Laboratory Test, Performed\" { relevantDatetime: start of MeaslesDiagnosis.prevalencePeriod }) ) Measles\n  where ( Measles.relevantDatetime during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])\n\n( ( [\"Laboratory Test, Performed\": \"Mumps Antibody Test (IgG Antibody Titer)\"] MumpsTiter\n    where MumpsTiter.result >= 1.10)\n  union ( [\"Laboratory Test, Performed\": \"Mumps Antibody Test (IgG Antibody presence)\"] MumpsIgGPresence\n      where MumpsIgGPresence.result as Code in \"Positive Finding\")\n  union ( [\"Diagnosis\": \"Mumps\"] MumpsDiagnosis\n      return \"Laboratory Test, Performed\" { relevantDatetime: start of MumpsDiagnosis.prevalencePeriod }) ) Mumps\n  where ( Mumps.relevantDatetime during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])\n\n( ( [\"Laboratory Test, Performed\": \"Rubella Antibody Test (IgG Antibody Titer)\"] RubellaTiter\n    where RubellaTiter.result >= 1.10)\n  union ( [\"Laboratory Test, Performed\": \"Rubella Antibody Test (IgG Antibody presence)\"] RubellaIgGPresence\n      where RubellaIgGPresence.result as Code in \"Positive Finding\")\n  union ( [\"Diagnosis\": \"Rubella\"] RubellaDiagnosis\n      return \"Laboratory Test, Performed\" { relevantDatetime: start of RubellaDiagnosis.prevalencePeriod }) ) Rubella\n  where ( Rubella.relevantDatetime during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])\n\nexists ( \"All Hib Vaccinations\" HibImmunization //union of 3 and 4 dose immunizations\n//4 dose test\n    let has_4_dose: Count(\"Hib 4 Dose Immunizations or Procedures\")> 0\n    where ( has_4_dose //if pt had at least one 4 dose code\n        and Count(distinct(\"All Hib Vaccinations\" HibVaccinations\n              return HibVaccinations.relevantDatetime)\n        )>= 4 //pt must have 4 regimens (e.g., 3,3,4,4 or 4,3,4,4))\n      or ( has_4_dose is false //if pt did not have at least one 4 dose code\n          and Count(distinct(\"All Hib Vaccinations\" HibVaccinations\n                return HibVaccinations.relevantDatetime))>= 3 //pt must have 3 regimens of 3 dose codes))\n\n[\"Diagnosis\": \"Anaphylaxis due to Haemophilus influenzae type b vaccine (disorder)\"] HibReaction\n  where ( start of HibReaction.prevalencePeriod during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])\n\nfrom\n  \"Hepatitis B Immunizations or Procedures\" HepatitisBVaccination1,\n  \"Hepatitis B Immunizations or Procedures\" HepatitisBVaccination2,\n  \"Hepatitis B Immunizations or Procedures\" HepatitisBVaccination3\n  where HepatitisBVaccination2.relevantDatetime 1 day or more after day of HepatitisBVaccination1.relevantDatetime\n    and HepatitisBVaccination3.relevantDatetime 1 day or more after day of HepatitisBVaccination2.relevantDatetime\n  return HepatitisBVaccination1\n \n( ( [\"Laboratory Test, Performed\": \"Anti Hepatitis B Virus Surface Ab\"] HepatitisBAntigenTest\n    where HepatitisBAntigenTest.result as Code in \"Positive Finding\" )\n  union ( [\"Diagnosis\": \"Anaphylaxis due to Hepatitis B vaccine (disorder)\"] HepatitisBReaction\n      return \"Laboratory Test, Performed\" { relevantDatetime: start of HepatitisBReaction.prevalencePeriod } )\n  union ( [\"Diagnosis\": \"Anaphylactic Reaction to Common Baker's Yeast\"] YeastReaction\n      return \"Laboratory Test, Performed\" { relevantDatetime: start of YeastReaction.prevalencePeriod } )\n  union ( [\"Diagnosis\": \"Hepatitis B\"] HepatitisBDiagnosis\n      return \"Laboratory Test, Performed\" { relevantDatetime: start of HepatitisBDiagnosis.prevalencePeriod } ) ) HepBConditions\n where ( HepBConditions.relevantDatetime during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])\n\n( ( [\"Immunization, Administered\": \"Varicella Zoster Vaccine (VZV)\"]\n    union [\"Procedure, Performed\": \"Varicella Zoster Vaccine (VZV) Administered\"] ) ChickenPoxVaccination\n    where ChickenPoxVaccination.relevantDatetime during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])\n\n( ( [\"Laboratory Test, Performed\": \"Varicella Zoster Antibody Test (IgG Antibody Titer)\"] ChickenPoxTiter\n    where ChickenPoxTiter.result >= 1.10)\n  union ( [\"Laboratory Test, Performed\": \"Varicella Zoster Antibody Test (IgG Antibody Presence)\"] ChickenPoxIgGPresence\n      where ChickenPoxIgGPresence.result as Code in \"Positive Finding\")\n  union ( [\"Diagnosis\": \"Disorders of the Immune System\"] ImmuneDisorder\n      return \"Laboratory Test, Performed\" { relevantDatetime: start of ImmuneDisorder.prevalencePeriod })\n  union ( [\"Diagnosis\": \"HIV\"] HIV\n      return \"Laboratory Test, Performed\" { relevantDatetime: start of HIV.prevalencePeriod })\n  union ( [\"Diagnosis\": \"Malignant Neoplasm of Lymphatic and Hematopoietic Tissue\"] LymphaticMalignantNeoplasm\n      return \"Laboratory Test, Performed\" { relevantDatetime: start of LymphaticMalignantNeoplasm.prevalencePeriod })\n  union ( [\"Diagnosis\": \"Neomycin adverse reaction (disorder)\"] NeomycinReaction\n      return \"Laboratory Test, Performed\" { relevantDatetime: start of NeomycinReaction.prevalencePeriod })\n  union ( [\"Diagnosis\": \"Varicella Zoster\"] VaricellaZoster\n      return \"Laboratory Test, Performed\" { relevantDatetime: start of VaricellaZoster.prevalencePeriod }) ) VaricellaZosterConditions\n  where ( VaricellaZosterConditions.relevantDatetime during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])\n\nfrom\n  \"Pneumococcal Conjugate Immunizations or Procedures\" PneumococcalVaccination1,\n  \"Pneumococcal Conjugate Immunizations or Procedures\" PneumococcalVaccination2,\n  \"Pneumococcal Conjugate Immunizations or Procedures\" PneumococcalVaccination3,\n  \"Pneumococcal Conjugate Immunizations or Procedures\" PneumococcalVaccination4\n  where PneumococcalVaccination2.relevantDatetime 1 day or more after day of PneumococcalVaccination1.relevantDatetime\n    and PneumococcalVaccination3.relevantDatetime 1 day or more after day of PneumococcalVaccination2.relevantDatetime\n    and PneumococcalVaccination4.relevantDatetime 1 day or more after day of PneumococcalVaccination3.relevantDatetime\n  return PneumococcalVaccination1\n \n[\"Diagnosis\": \"Pneumococcal vaccine adverse reaction (disorder)\"] PneumococcalReaction\n  where ( start of PneumococcalReaction.prevalencePeriod during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])\n\n( ( [\"Immunization, Administered\": \"Hepatitis A Vaccine\"]\n    union [\"Procedure, Performed\": \"Hepatitis A Vaccine Administered\"] ) HepatitisAVaccination\n    where HepatitisAVaccination.relevantDatetime during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])\n\n( ( [\"Laboratory Test, Performed\": \"Anti Hepatitis A IgG Antigen Test\"] HepatitisAAntigenTest\n    where HepatitisAAntigenTest.result as Code in \"Positive Finding\")\n  union ( [\"Diagnosis\": \"Anaphylactic Reaction to Hepatitis A Vaccine\"] HepatitisAReaction\n      return \"Laboratory Test, Performed\" { relevantDatetime: start of HepatitisAReaction.prevalencePeriod })\n  union ( [\"Diagnosis\": \"Hepatitis A\"] HepatitisADiagnosis\n      return \"Laboratory Test, Performed\" { relevantDatetime: start of HepatitisADiagnosis.prevalencePeriod }) ) HepatitisAConditions\n  where ( HepatitisAConditions.relevantDatetime during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])\n\nexists ( \"All Rotavirus Vaccinations\" RotavirusImmunization\n    let has_3_dose: Count(\"Rotavirus 3 Dose Immunizations or Procedures\")> 0\n    where ( has_3_dose\n        and Count(distinct(\"All Rotavirus Vaccinations\" RotavirusVaccinations\n              return RotavirusVaccinations.relevantDatetime))>= 3)\n      or ( has_3_dose is false\n          and Count(distinct(\"All Rotavirus Vaccinations\" RotavirusVaccinations\n                return RotavirusVaccinations.relevantDatetime))>= 2))\n\n( ( [\"Diagnosis\": \"Anaphylaxis due to rotavirus vaccine (disorder)\"]\n    union [\"Diagnosis\": \"Severe Combined Immunodeficiency\"]\n    union [\"Diagnosis\": \"Intussusception\"] ) RotavirusConditions\n    where ( start of RotavirusConditions.prevalencePeriod during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years]))\n\nfrom\n  \"Influenza Immunizations or Procedures\" FluVaccination1,\n  \"Influenza Immunizations or Procedures\" FluVaccination2\n  where FluVaccination2.relevantDatetime 1 day or more after day of FluVaccination1.relevantDatetime\n  return FluVaccination1\n\n( [\"Diagnosis\": \"Influenza virus vaccine adverse reaction (disorder)\"]\n  union [\"Diagnosis\": \"Malignant Neoplasm of Lymphatic and Hematopoietic Tissue\"]\n  union [\"Diagnosis\": \"Neomycin adverse reaction (disorder)\"]\n  union [\"Diagnosis\": \"HIV\"]\n  union [\"Diagnosis\": \"Disorders of the Immune System\"] ) InfluenzaConditions\n  where ( start of InfluenzaConditions.prevalencePeriod during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])","None",null,"Definitions:\nRecommended vaccines: Vaccines and the schedule of vaccines as recommended by the Advisory Committee on Immunization Practices (ACIP) for children two years of age. The measure may differ slightly from the ACIP recommendations because the measure focuses on immunizations that are appropriate by age 2. Also, there may be small differences when there are shortages for a particular vaccine.\n\nFor the MMR, hepatitis B, VZV and hepatitis A vaccines, numerator inclusion criteria include: evidence of receipt of the recommended vaccine; documented history of the illness; or, a seropositive test result for the antigen. For the DTaP, IPV, Hib, pneumococcal, rotavirus, and influenza vaccines, numerator inclusion criteria include only evidence of receipt of the recommended vaccine. \n\nPatients may be included in the numerator for a particular antigen if they had an anaphylactic reaction to the vaccine. Patients may be included in the numerator for the DTaP vaccine if they have encephalopathy. Patients may be included in the numerator for the IPV vaccine if they have had an anaphylactic reaction to streptomycin, polymyxin B, or neomycin. Patients may be included in the numerator for the influenza, MMR, or varicella vaccines if they have cancer of lymphoreticular or histiocytic tissue, multiple myeloma, leukemia, have had an anaphylactic reaction to neomycin, have immunodeficiency, or have HIV. Patients may be included in the numerator for the hepatitis B vaccine if they have had an anaphylactic reaction to common baker's yeast.\nThe measure allows a grace period by measuring compliance with these recommendations between birth and age two.\nThis eCQM is a patient-based measure.\nThis version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.\n\nRecommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States 2019 (Centers for Disease Control and Prevention, 2019)\n\nHepatitis B (HepB)\n\"(minimum age: birth)\nBirth dose (monovalent HepB vaccine only)\n-- Mother is HBsAg-negative: 1 dose within 24 hours of birth for all medically stable infants ?2,000 grams. Infants <2,000 grams: administer 1 dose at chronological age 1 month or hospital discharge.\n-- Mother is HBsAg-positive:\n- Administer HepB vaccine and 0.5 mL of hepatitis B immune globulin (HBIG) (at separate anatomic sites) within 12 hours of birth, regardless of birth weight. For infants <2,000 grams, administer 3 additional doses of vaccine (total of 4 doses) beginning at age 1 month.\n- Test for HBsAg and anti-HBs at age 9–12 months. If HepB series is delayed, test 1–2 months after final dose.\n-- Mother’s HBsAg status is unknown:\n- Administer HepB vaccine within 12 hours of birth, regardless of birth weight.\n- For infants <2,000 grams, administer 0.5 mL of HBIG in addition to HepB vaccine within 12 hours of birth. Administer 3 additional doses of vaccine (total of 4 doses) beginning at age 1 month.\n- Determine mother’s HBsAg status as soon as possible. If mother is HBsAg-positive, administer 0.5 mL of HBIG to infants ?2,000 grams as soon as possible, but no later than 7 days of age.\nRoutine series\n-- 3-dose series at 0, 1–2, 6–18 months (use monovalent HepB vaccine for doses administered before age 6 weeks)\n-- Infants who did not receive a birth dose should begin the series as soon as feasible (see Table 2).\n-- Administration of 4 doses is permitted when a combination vaccine containing HepB is used after the birth dose.\n-- Minimum age for the final (3rd or 4th ) dose: 24 weeks\n-- Minimum intervals: dose 1 to dose 2: 4 weeks / dose 2 to\ndose 3: 8 weeks / dose 1 to dose 3: 16 weeks (when 4 doses are administered, substitute \"dose 4\" for \"dose 3\" in these calculations) \"\n\nDiphtheria, tetanus, acellular pertussis vaccinations (DTap)\n\"(minimum age: 6 weeks [4 years for Kinrix or Quadracel])\nRoutine vaccination\n-- 5-dose series at 2, 4, 6, 15–18 months, 4–6 years\n- Prospectively: Dose 4 may be given as early as age 12 months if at least 6 months have elapsed since dose 3.\n- Retrospectively: A 4th dose that was inadvertently given as early as 12 months may be counted if at least 4 months have elapsed since dose 3.\"\n\nHaemophilus influenzae type b (Hib)\n\"(minimum age: 6 weeks)\nRoutine vaccination\n-- ActHIB, Hiberix, or Pentacel: 4-dose series at 2, 4, 6, 12–15 months\n-- PedvaxHIB: 3-dose series at 2, 4, 12–15 months\"\n\nPoliovirus (inactivated) (IPV)\n\" (minimum age: 6 weeks)\nRoutine vaccination\n-- 4-dose series at ages 2, 4, 6–18 months, 4–6 years; administer the final dose on or after the 4th birthday and at least 6 months after the previous dose.\n-- 4 or more doses of IPV can be administered before the 4th birthday when a combination vaccine containing IPV is used. However, a dose is still recommended after the 4th birthday and at least 6 months after the previous dose.\"\n\nMeasles, mumps, and rubella (MMR)\n\"(minimum age: 12 months for routine vaccination)\nRoutine vaccination\n-- 2-dose series at 12–15 months, 4–6 years\n Dose 2 may be administered as early as 4 weeks after dose 1\"\n\nPneumococcal\n\"(minimum age: 6 weeks [PCV13], 2 years [PPSV23])\nRoutine vaccination with PCV13\n-- 4-dose series at 2, 4, 6, 12–15 months\"\n\nVaricella (VAR) \n\"(minimum age: 12 months)\nRoutine vaccination\n-- 2-dose series: 12–15 months, 4–6 years\n-- Dose 2 may be administered as early as 3 months after dose 1 (a dose administered after a 4-week interval may be counted).\"\n\nHepatitis A (HepA)\n\"(minimum age: 12 months for routine vaccination)\nRoutine vaccination\n-- 2-dose series (Havrix 6–12 months apart or Vaqta 6–18 months apart, minimum interval 6 months); a series begun before the 2nd birthday should be completed even if the child turns 2 before the second dose is administered.\"\n\nRotavirus (RV) \n\"(minimum age: 6 weeks)\nRoutine vaccination\n-- Rotarix: 2-dose series at 2 and 4 months.\n-- RotaTeq: 3-dose series at 2, 4, and 6 months.\nIf any dose in the series is either RotaTeq or unknown, default to 3-dose series.\"\n\nInfluenza (inactivated)  influenza vaccine (IIV) \n\"(minimum age: 6 months [IIV], 2 years [LAIV  ], 18 years [RIV])\nRoutine vaccination\n-- 1 dose any influenza vaccine appropriate for age and health status annually (2 doses separated by at least 4 weeks for children 6 months–8 years who did not receive at least 2 doses of influenza vaccine before July 1, 2018)\"",null,null,null,"Positive"]
["T2-114","TIPPS","T2","Immunization for Adolescents","Process",null,"01/01/21 - 12/31/21","Numeric Data Reporting & Status Update Only",null,"NA","NA",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,1407,"NCQA","CMS MIPS #394 2020","https://qpp-cm-prod-content.s3.amazonaws.com/uploads/786/2020+CQM+Specifications+and+Supporting+Docs.zip","The percentage of adolescents 13 years of age who had the recommended immunizations by their 13th birthday. \nOnly one rate is reported: All patients who are compliant for Meningococcal, Tdap and HPV during the specified timeframes","Family Medicine; Pediatrics","Individuals","Adolescents who turn 13 years of age during the measurement period ","Patients who turn 13 years of age during the measurement period\n\nAND\n\nPatient encounter during the performance period (CPT or HCPCS): 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0402","Meningococcal, Tdap and/or HPV vaccine contraindicated OR patient allergic to the meningococcal, Tdap, and/or HPV vaccine\n\nOR\n\nEncephalopathy due to Tdap vaccine\n\nOR\n\nPatients who use hospice services any time during the measurement period: G9761","All patients who are numerator compliant for Meningococcal, Tdap and HPV during the specified timeframes","Patient had one dose of meningococcal vaccine (serogroups A, C, W, Y) on or between the patient’s 11th and 13th birthdays (G9414) \nAND\nPatient had one tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap) on or between the patient’s 10th and 13th birthdays (G9416) \nAND\nPatient had at least two HPV vaccines (with at least 146 days between the two) OR three HPV vaccines on or between the patient’s 9th and 13th birthdays (G9762)\n","Patient did not have one dose of meningococcal vaccine on or between the patient’s 11th and 13th birthdays (G9415) \nOR\nPatient did not have one tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap) on or between the patient’s 10th and 13th birthdays (G9417) \nOR\nPatient did not have at least two HPV vaccines (with at least 146 days between the two) OR three HPV vaccines on or between the patient’s 9th and 13th birthdays (G9763)","Under CMS MIPS specifications, measure is reported as 4 rates but only one rate is reported in TIPPS (criteria 4: adolescents who are numerator compliant for Rates 1, 2 and 3).",null,null,null,null,"Positive"]
["T2-115","TIPPS","T2","Preventive Care and Screening: Screening for Depression and Follow-Up Plan","Process",null,"01/01/21 - 12/31/21","Numeric Data Reporting & Status Update Only",null,"NA","NA",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"0418","CMS","eCQM - CMS2v10","https://ecqi.healthit.gov/ecqm/ep/2021/cms002v10","Percentage of patients aged 12 years and older screened for depression on the date of the encounter or up to 14 days prior to the date of the encounter using an age-appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the eligible encounter","Family Medicine; Internal Medicine; Orthopedic Surgery; Pediatrics; Preventive Medicine; Psychiatry & Neurology; Audiologist; Occupational Therapist; Physical Therapist; Social Worker","Individuals","All patients aged 12 years and older at the beginning of the measurement period with at least one eligible encounter during the measurement period","\"Initial Population\"\n\n\"Patient Age 12 Years or Older at Start of Measurement Period\"\n  and exists ( \"Qualifying Encounter During Measurement Period\" )\n\nexists [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n  where Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) >= 12\n\n( [\"Encounter, Performed\": \"Encounter to Screen for Depression\"]\n  union [\"Encounter, Performed\": \"Physical Therapy Evaluation\"] ) ValidEncounter\n  where ValidEncounter.relevantPeriod during \"Measurement Period\"","Patient Reason(s)\nPatient refuses to participate \nOR\nMedical Reason(s) \nDocumentation of medical reason for not screening patient for depression (e.g., cognitive, functional, or motivational limitations that may impact accuracy of results; patient is in an urgent or emergent situation where time is of the essence and to delay treatment would jeopardize the patient's health status)\n\nPatients who have been diagnosed with depression or with bipolar disorder\nexists \"History of Bipolar or Depression Diagnosis Before Qualifying Encounter\"\n\n( [\"Diagnosis\": \"Bipolar Diagnosis\"]\n  union [\"Diagnosis\": \"Depression Diagnosis\"] ) DiagnosisBipolarorDepression\n  with \"Qualifying Encounter During Measurement Period\" QualifyingEncounter\n    such that DiagnosisBipolarorDepression.prevalencePeriod starts before QualifyingEncounter.relevantPeriod\n\nDenominator Exceptions\n( exists \"Medical or Patient Reason for Not Screening Adolescent for Depression\"\n    and not \"Has Adolescent Depression Screening\")\n  or ( exists \"Medical or Patient Reason for Not Screening Adult for Depression\"\n      and not \"Has Adult Depression Screening\")\n\n[\"Assessment, Not Performed\": \"Adolescent depression screening assessment\"] NoAdolescentScreen\n  with \"Qualifying Encounter During Measurement Period\" QualifyingEncounter\n    such that NoAdolescentScreen.authorDatetime during QualifyingEncounter.relevantPeriod\n  where ( NoAdolescentScreen.negationRationale in \"Patient Declined\"\n      or NoAdolescentScreen.negationRationale in \"Medical Reason\")\n\nand not exists ( [\"Assessment, Performed\": \"Adolescent depression screening assessment\"] AdolescentScreening\n    with \"Qualifying Encounter During Measurement Period\" QualifyingEncounter\n      such that AdolescentScreening.relevantDatetime 14 days or less on or before day of start of QualifyingEncounter.relevantPeriod\n        and AdolescentScreening.result is not null)\n\nor [\"Assessment, Not Performed\": \"Adult depression screening assessment\"] NoAdultScreen\n  with \"Qualifying Encounter During Measurement Period\" QualifyingEncounter\n    such that NoAdultScreen.authorDatetime during QualifyingEncounter.relevantPeriod\n  where ( NoAdultScreen.negationRationale in \"Patient Declined\"\n      or NoAdultScreen.negationRationale in \"Medical Reason\")\n\nand not exists ( [\"Assessment, Performed\": \"Adult depression screening assessment\"] AdultScreening\n    with \"Qualifying Encounter During Measurement Period\" QualifyingEncounter\n      such that AdultScreening.relevantDatetime 14 days or less on or before day of start of QualifyingEncounter.relevantPeriod\n        and AdultScreening.result is not null)","Patients screened for depression on the date of the encounter or up to 14 days prior to the date of the encounter using an age-appropriate standardized tool AND if positive, a follow-up plan is documented on the date of the eligible encounter","( \"Patient Age 12 to 16 Years at Start of Measurement Period\"\n    and ( \"Has Most Recent Adolescent Screening Negative\"\n        or exists \"Most Recent Adolescent Screening Positive and Follow Up Provided\"))\n  or ( \"Patient Age 17 Years at Start of Measurement Period\"\n      and ( \"Has Most Recent Adolescent Screening Negative\"\n          or exists \"Most Recent Adolescent Screening Positive and Follow Up Provided\"\n          or \"Has Most Recent Adult Screening Negative\"\n          or exists \"Most Recent Adult Depression Screening Positive and Follow Up Provided\"))\n  or ( \"Patient Age 18 Years or Older at Start of Measurement Period\"\n      and ( \"Has Most Recent Adult Screening Negative\"\n          or exists \"Most Recent Adult Depression Screening Positive and Follow Up Provided\"))\n \nexists [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n  where Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) < 17\n\nand ( \"Most Recent Adolescent Depression Screening\" AdolescentScreen\n    where AdolescentScreen.result in \"Negative Depression Screening\") is not null\n\nor from\n  \"Most Recent Adolescent Depression Screening\" LastAdolescentScreen,\n  \"Follow Up For Positive Adolescent Depression Screening\" FollowUpPositiveAdolescentScreen,\n  \"Qualifying Encounter During Measurement Period\" QualifyingEncounter\n  where LastAdolescentScreen.relevantDatetime 14 days or less on or before day of start of QualifyingEncounter.relevantPeriod\n    and LastAdolescentScreen.result in \"Positive Depression Screening\"\n    and ( FollowUpPositiveAdolescentScreen.authorDatetime same day as \n      end of QualifyingEncounter.relevantPeriod\n        or FollowUpPositiveAdolescentScreen.relevantDatetime same day as \n        end of QualifyingEncounter.relevantPeriod)\n\nor exists [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n  where Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) = 17\n\nand ( \"Most Recent Adolescent Depression Screening\" AdolescentScreen\n    where AdolescentScreen.result in \"Negative Depression Screening\") is not null\n\nor from\n  \"Most Recent Adolescent Depression Screening\" LastAdolescentScreen,\n  \"Follow Up For Positive Adolescent Depression Screening\" FollowUpPositiveAdolescentScreen,\n  \"Qualifying Encounter During Measurement Period\" QualifyingEncounter\n  where LastAdolescentScreen.relevantDatetime 14 days or less on or before day of start of QualifyingEncounter.relevantPeriod\n    and LastAdolescentScreen.result in \"Positive Depression Screening\"\n    and ( FollowUpPositiveAdolescentScreen.authorDatetime same day as \n      end of QualifyingEncounter.relevantPeriod\n        or FollowUpPositiveAdolescentScreen.relevantDatetime same day as \n        end of QualifyingEncounter.relevantPeriod)\n\nor ( \"Most Recent Adult Depression Screening\" AdultScreen\n    where AdultScreen.result in \"Negative Depression Screening\") is not null\n\nand from\n  \"Most Recent Adult Depression Screening\" LastAdultScreen,\n  \"Follow Up for Positive Adult Depression Screening\" FollowUpPositiveAdultScreen,\n  \"Qualifying Encounter During Measurement Period\" QualifyingEncounter\n  where LastAdultScreen.relevantDatetime 14 days or less on or before day of start of QualifyingEncounter.relevantPeriod\n    and LastAdultScreen.result in \"Positive Depression Screening\"\n    and ( FollowUpPositiveAdultScreen.authorDatetime same day as \n      end of QualifyingEncounter.relevantPeriod\n        or FollowUpPositiveAdultScreen.relevantDatetime same day as \n        end of QualifyingEncounter.relevantPeriod)\n\nor exists [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n  where Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) >= 18\n\nand ( \"Most Recent Adult Depression Screening\" AdultScreen\n    where AdultScreen.result in \"Negative Depression Screening\") is not null\n\nor from\n  \"Most Recent Adult Depression Screening\" LastAdultScreen,\n  \"Follow Up for Positive Adult Depression Screening\" FollowUpPositiveAdultScreen,\n  \"Qualifying Encounter During Measurement Period\" QualifyingEncounter\n  where LastAdultScreen.relevantDatetime 14 days or less on or before day of start of QualifyingEncounter.relevantPeriod\n    and LastAdultScreen.result in \"Positive Depression Screening\"\n    and ( FollowUpPositiveAdultScreen.authorDatetime same day as \n      end of QualifyingEncounter.relevantPeriod\n        or FollowUpPositiveAdultScreen.relevantDatetime same day as \n        end of QualifyingEncounter.relevantPeriod)","None",null,"Definitions:\n\t\nScreening:\nCompletion of a clinical or diagnostic tool used to identify people at risk of developing or having a certain disease or condition, even in the absence of symptoms.  \n\nStandardized Depression Screening Tool: A normalized and validated depression screening tool developed for the patient population in which it is being utilized.\n\nExamples of standardized depression screening tools include but are not limited to: \n*  Adolescent Screening Tools (12-17 years) \n   *  Patient Health Questionnaire for Adolescents (PHQ-A)\n   *  Beck Depression Inventory-Primary Care Version (BDI-PC)\n   *  Mood Feeling Questionnaire (MFQ)\n   *  Center for Epidemiologic Studies Depression Scale (CES-D)\n   *  Patient Health Questionnaire (PHQ-9)\n   *  Pediatric Symptom Checklist (PSC-17)\n   *  PRIME MD-PHQ2 \n*  Adult Screening Tools (18 years and older) \n   *  Patient Health Questionnaire (PHQ9)\n   *  Beck Depression Inventory (BDI or BDI-II)\n   *  Center for Epidemiologic Studies Depression Scale (CES-D)\n   *  Depression Scale (DEPS)\n   *  Duke Anxiety-Depression Scale (DADS)\n   *  Geriatric Depression Scale (GDS)\n   *  Cornell Scale for Depression in Dementia (CSDD)\n   *  PRIME MD-PHQ2 \n   *  Hamilton Rating Scale for Depression (HAM-D)\n   *  Quick Inventory of Depressive Symptomatology Self-Report (QID-SR)\n   *  Computerized Adaptive Testing Depression Inventory (CAT-DI)\n   *  Computerized Adaptive Diagnostic Screener (CAD-MDD)\n* Perinatal Screening Tools\n   *  Edinburgh Postnatal Depression Scale\n   *  Postpartum Depression Screening Scale\n   *  Patient Health Questionnaire 9 (PHQ-9)\n   *  Beck Depression Inventory\n   *  Beck Depression Inventory-II\n   *  Center for Epidemiologic Studies Depression Scale\n   *  Zung Self-rating Depression Scale\n   \nFollow-Up Plan: \nDocumented follow-up for a positive depression screening must include one or more of the following:\n *  Referral to a practitioner who is qualified to diagnose and treat depression\n *  Pharmacological interventions\n *  Other interventions or follow-up for the diagnosis or treatment of depression\n\n\n\nGuidance\t\nA depression screen is completed on the date of the encounter or up to 14 days prior to the date of the encounter using an age-appropriate standardized depression screening tool AND if positive, a follow-up plan must be documented on the date of the encounter, such as referral to a practitioner who is qualified to treat depression, pharmacological interventions or other interventions for the treatment of depression.\n\nThis eCQM is a patient-based measure. Depression screening is required once per measurement period, not at all encounters.\n\nThe intent of the measure is to screen for depression in patients who have never had a diagnosis of depression or bipolar disorder prior to the eligible encounter used to evaluate the numerator. Patients who have ever been diagnosed with depression or bipolar disorder will be excluded from the measure.\n\nScreening Tools:\n *  An age-appropriate, standardized, and validated depression screening tool must be used for numerator compliance.\n *  The name of the age-appropriate standardized depression screening tool utilized must be documented in the medical record.\n *  The depression screening must be reviewed and addressed in the office of the provider, filing the code, on the date of the encounter. Positive pre-screening results indicating a patient is at high risk for self-harm should receive more urgent intervention as determined by the provider practice.\n *  The screening should occur during a qualifying encounter or up to 14 days prior to the date of the qualifying encounter.\n *  The measure assesses the most recent depression screening completed either during the eligible encounter or within the 14 days prior to that encounter. Therefore, a clinician would not be able to complete another screening at the time of the encounter to count towards a follow-up, because that would serve as the most recent screening. In order to satisfy the follow-up requirement for a patient screening positively, the eligible clinician would need to provide one of the aforementioned follow-up actions, which does not include use of a standardized depression screening tool.\n\nFollow-Up Plan:\n\nThe follow-up plan must be related to a positive depression screening, for example: \"Patient referred for psychiatric evaluation due to positive depression screening.\"\n\nExamples of a follow-up plan include but are not limited to: \n *  Referral to a practitioner or program for further evaluation for depression, for example, referral to a psychiatrist, psychologist, social worker, mental health counselor, or other mental health service such as family or group therapy, support group, depression management program, or other service for treatment of depression\n *  Other interventions designed to treat depression such as behavioral health evaluation, psychotherapy, pharmacological interventions, or additional treatment options\n\nShould a patient screen positive for depression, a clinician should opt to complete a suicide risk assessment when appropriate and based on individual patient characteristics. However, for the purposes of this measure, a suicide risk assessment or additional screening using a standardized tool will not qualify as a follow-up plan.\n\nThis version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.",null,null,null,"Positive",null,null,null,null,null,null,null,"Measure is a screening rate. Both positive and negative screens should be included if they meet the numerator inclusion criteria. "]
["T2-116","TIPPS","T2","Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Testing","Process",null,"01/01/21 - 12/31/21","Numeric Data Reporting & Status Update Only",null,"NA","NA",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"0057","NCQA","CMIT (CMS Measures Inventory Tool)","https://cmit.cms.gov/CMIT_public/ViewMeasure?MeasureId=2838#tab1","Percentage of patients ages 18 to 75 with diabetes (type 1 and type 2) who had a hemoglobin A1c (HbA1c) test.","Family Medicine; Internal Medicine; Pediatrics (Optional); Preventive Medicine; Dietician, Registered","Individuals","Ages 18 to 75 as of December 31 of the measurement year with diabetes (type 1 and type 2).",{"$cut":{"chars":32459,"head":"Ages 18 to 75 as of December 31 of the measurement year. \n\nThere are two ways to identify patients with diabetes: by claim/encounter data and by pharmacy data. The provider must use both methods to identify the eligible population, but a patient only needs to be identified by one method to be included in the measure. Patients may be identified as having diabetes during the measurement year or the year prior to the measurement year. \n\nClaim/encounter data. Patients who met any of the following criteria during the measurement year or year prior to the measurement year (count services that occur over both years): \n- At least two outpatient visits (Outpatient Value Set), observation visits (Observation Value Set), ED Visits (ED Value Set), or nonacute inpatient encounters (Nonacute Inpatient Value Set) on different dates of service, with a diagnosis of diabetes (Diabetes Value Set). Visit type need not be the same for the two visits. \n- At least one acute inpatient encounter (Acute Inpatient Value Set) with a diagnosis of diabetes (Diabetes Value Set).\n\nPharmacy data. Patients who were dispensed insulin or oral hypoglycemics/antihyperglycemics on an ambulatory basis during the measurement year or year prior to the measurement year (Diabetes Medications List available at http://www.ncqa.org/hedis-quality-measurement/hedis-measures/hedis-2018).\n\nDiabetes Value Set: \n[E10.10] Type 1 diabetes mellitus with ketoacidosis without coma\n[E10.11] Type 1 diabetes mellitus with ketoacidosis with coma\n[E10.21] Type 1 diabetes mellitus with diabetic nephropathy\n[E10.22] Type 1 diabetes mellitus with diabetic chronic kidney disease\n[E10.29] Type 1 diabetes mellitus with other diabetic kidney complication\n[E10.311] Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edema\n[E10.319] Type 1 diabetes mellitus with unspecified diabetic retinopathy without macular edema\n[E10.321] Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema\n[E10.3211] Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye\n[E10.3212] Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye\n[E10.3213] Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral\n[E10.3219] Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye\n[E10.329] Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema\n[E10.3291] Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye\n[E10.3292] Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye\n[E10.3293] Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral\n[E10.3299] Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye\n[E10.331] Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema\n[E10.3311] Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye\n[E10.3312] Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye\n[E10.3313] Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral\n[E10.3319] Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye\n[E10.339] Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema\n[E10.3391] Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye\n[E10.3392] Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye\n[E10.3393] Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral"}},{"$cut":{"chars":24867,"head":"Exclusions: Patients who do not have a diagnosis of diabetes (Diabetes Value Set), in any setting, during the measurement year or year prior to the measurement year and who had a diagnosis of gestational diabetes or steroid-induced diabetes (Diabetes Exclusions Value Set), in any setting, during the measurement year or the year prior to the measurement year. If the patient was included in this measure based on claim or encounter data, as described in the event/diagnosis criteria, the optional exclusions do not apply because the patient had a diagnosis of diabetes\n\nDiabetes Exclusions Value Set:\n[E08.00] Diabetes mellitus due to underlying condition with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC)\n[E08.01] Diabetes mellitus due to underlying condition with hyperosmolarity with coma\n[E08.10] Diabetes mellitus due to underlying condition with ketoacidosis without coma\n[E08.11] Diabetes mellitus due to underlying condition with ketoacidosis with coma\n[E08.21] Diabetes mellitus due to underlying condition with diabetic nephropathy\n[E08.22] Diabetes mellitus due to underlying condition with diabetic chronic kidney disease\n[E08.29] Diabetes mellitus due to underlying condition with other diabetic kidney complication\n[E08.311] Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema\n[E08.319] Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy without macular edema\n[E08.321] Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema\n[E08.3211] Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, right eye\n[E08.3212] Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, left eye\n[E08.3213] Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, bilateral\n[E08.3219] Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye\n[E08.329] Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema\n[E08.3291] Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, right eye\n[E08.3292] Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, left eye\n[E08.3293] Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, bilateral\n[E08.3299] Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye\n[E08.331] Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema\n[E08.3311] Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, right eye\n[E08.3312] Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, left eye\n[E08.3313] Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, bilateral\n[E08.3319] Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye\n[E08.339] Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema\n[E08.3391] Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, right eye\n[E08.3392] Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, left eye\n[E08.3393] Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, bilateral\n[E08.3399] Di"}},"An HbA1c test (HbA1c Tests Value Set) performed during the measurement year, as identified by claim/encounter or automated laboratory data. ","HbA1c Test Value Set: \n\nCPT: \n83036\n83037 \n\nLOINC: \n17856-6 Hemoglobin A1c/Hemoglobin.total in Blood by HPLC\n4548-4 Hemoglobin A1c/Hemoglobin.total in Blood\n4549-2 Hemoglobin A1c/Hemoglobin.total in Blood by Electrophoresis \n\nSNOMED CT US Edition:\n43396009 Hemoglobin A1c measurement (procedure) \n313835008 Hemoglobin A1c measurement aligned to the Diabetes Control and Complications Trial (procedure) \n",null,"For TIPPS reporting purposes, the word \"beneficiary\" or \"member\" has been replaced with \"patient,\" and the word \"State\" has been replaced with \"provider\". ","The last publicly available measure specifications for T2-114 were available through the Medicaid Adult Core Set 2019 measure specifications; however the measure has since been retired form the Medicaid Adult Core Set. As a HEDIS measure, the measure specifications are not publicly available without licensed purchase; in the absence of publicly available measure specifications for T2-114, a link to CMIT (CMS Measures Inventory Tool) is instead provided as the measure specifications source. Value sets adapted from Medicaid Adult Core Set 2020 Adult HEDIS codes.",null,null,null,"Positive"]
["T2-117","TIPPS","T2","Tobacco Use and Help with Quitting Among Adolescents","Process",null,"01/01/21 - 12/31/21","Numeric Data Reporting & Status Update Only",null,"NA","NA",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"2803","NCQA","CMS MIPS #402 2020","https://qpp-cm-prod-content.s3.amazonaws.com/uploads/786/2020+CQM+Specifications+and+Supporting+Docs.zip","The percentage of adolescents 12 to 20 years of age with a primary care visit during the measurement year for whom tobacco use status was documented and received help with quitting if identified as a tobacco user","Allergy & Immunology;  Dermatology; Family Medicine; Internal Medicine; Obstetrics & Gynecology; Orthopaedic Surgery; Otolaryngology; Pediatrics; Physicial Medicine & Rehabilitation; Preventive Medicine; Psychiatry & Neurology; Surgery; Thoracic Surgery; Social Worker; Urgent Care","Individuals","All patients aged 12-20 years with a visit during the measurement period","Patients aged 12-20 years on date of encounter\n\nAND\n\nPatient encounter during the performance period (CPT or HCPCS): 90791, 90792, 90832, 90834, 90837, 90839, 90845, 92002, 92004, 92012, 92014, 96156, 96158, 97165, 97166, 97167, 97168, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99406, 99407, G0438, G0439, 99383, 99384, 99385, 99393, 99394, 99395",null,"Patients who were screened for tobacco use at least once within 18 months (during the measurement period or the six months prior to the measurement period) AND who received tobacco cessation counseling intervention if identified as a tobacco user","Patient documented as tobacco user AND received tobacco cessation intervention (must include at least one of the following: advice given to quit smoking or tobacco use, counseling on the benefits of quitting smoking or tobacco use, assistance with or referral to external smoking or tobacco cessation support programs, or current enrollment in smoking or tobacco use cessation program) if identified as a tobacco user (G9458)\n\nOR\n\nCurrently a tobacco non-user (G9459)","Tobacco assessment OR tobacco cessation intervention not performed, reason not given (G9460)","Providers should include Texas Health Steps medical checkup codes 99383, 99384, 99385, 99393, 99394, 99395. ",null,null,null,null,"Positive"]
["T2-118","TIPPS","T2","Chlamydia Screening in Women","Process",null,"01/01/21 - 12/31/21","Numeric Data Reporting & Status Update Only",null,"NA","NA",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"0033","NCQA","eCQM - CMS153v9","https://ecqi.healthit.gov/ecqm/ep/2021/cms153v9","Percentage of women 16-24 years of age who were identified as sexually active and who had at least one test for chlamydia during the measurement period","Family Medicine; Obstetrics & Gynecology; Pediatrics","Individuals","Women 16 to 24 years of age who are sexually active and who had a visit in the measurement period","\"Initial Population\"\n\nexists ( [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n    where Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) in Interval[16, 24))\n  and exists ( [\"Patient Characteristic Sex\": \"Female\"] )\n  and exists ( \"Qualifying Encounters\" )\n  and ( exists ( \"Assessments Identifying Sexual Activity\" )\n      or exists ( \"Diagnoses Identifying Sexual Activity\" )\n      or exists ( \"Active Contraceptive Medications\" )\n      or exists ( \"Ordered Contraceptive Medications\" )\n      or exists ( \"Laboratory Tests Identifying Sexual Activity\" )\n      or exists ( \"Diagnostic Studies Identifying Sexual Activity\" )\n      or exists ( \"Procedures Identifying Sexual Activity\" ))\n\nand ( [\"Encounter, Performed\": \"Office Visit\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services - Established Office Visit, 18 and Up\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services-Initial Office Visit, 18 and Up\"]\n  union [\"Encounter, Performed\": \"Preventive Care- Initial Office Visit, 0 to 17\"]\n  union [\"Encounter, Performed\": \"Preventive Care - Established Office Visit, 0 to 17\"]\n  union [\"Encounter, Performed\": \"Home Healthcare Services\"] ) ValidEncounter\n  where ValidEncounter.relevantPeriod during \"Measurement Period\"\n\nand ( [\"Assessment, Performed\": \"Sexually Active\"] SexualActivityAssessment\n    where SexualActivityAssessment.result ~ \"Yes (qualifier value)\"\n      and SexualActivityAssessment.relevantDatetime before \n      end of \"Measurement Period\")\n\nor ( ( [\"Diagnosis\": \"Other Female Reproductive Conditions\"]\n    union [\"Diagnosis\": \"Genital Herpes\"]\n    union [\"Diagnosis\": \"Gonococcal Infections and Venereal Diseases\"]\n    union [\"Diagnosis\": \"Inflammatory Diseases of Female Reproductive Organs\"]\n    union [\"Diagnosis\": \"Chlamydia\"]\n    union [\"Diagnosis\": \"HIV\"]\n    union [\"Diagnosis\": \"Syphilis\"]\n    union [\"Diagnosis\": \"Carrier of Predominantly Sexually Transmitted Infection\"]\n    union [\"Diagnosis\": \"Complications of Pregnancy, Childbirth and the Puerperium\"] ) SexualActivityDiagnosis\n    where SexualActivityDiagnosis.prevalencePeriod overlaps \"Measurement Period\")\n\nor [\"Medication, Active\": \"Contraceptive Medications\"] ActiveContraceptives\n  where ActiveContraceptives.relevantPeriod overlaps \"Measurement Period\"\n\nor [\"Medication, Order\": \"Contraceptive Medications\"] OrderedContraceptives\n  where OrderedContraceptives.authorDatetime during \"Measurement Period\"\n\nor ( [\"Laboratory Test, Order\": \"Pap Test\"]\n  union [\"Laboratory Test, Order\": \"Lab Tests During Pregnancy\"]\n  union [\"Laboratory Test, Order\": \"Lab Tests for Sexually Transmitted Infections\"] ) LabOrders\n  where LabOrders.authorDatetime during \"Measurement Period\"\n\nor [\"Diagnostic Study, Order\": \"Diagnostic Studies During Pregnancy\"] SexualActivityDiagnostics\n  where SexualActivityDiagnostics.authorDatetime during \"Measurement Period\"\n\nor ( [\"Procedure, Performed\": \"Delivery Live Births\"]\n  union [\"Procedure, Performed\": \"Procedures During Pregnancy\"]\n  union [\"Procedure, Performed\": \"Procedures Involving Contraceptive Devices\"] ) ProceduresForSexualActivity\n  where ProceduresForSexualActivity.relevantDatetime during \"Measurement Period\"","Exclusions: \nWomen who are only eligible for the initial population due to a pregnancy test and who had an x-ray or an order for a specified medication within 7 days of the pregnancy test.\nExclude patients whose hospice care overlaps the measurement period.\n\nHospice. \"Has Hospice\"\n  or ( exists ( \"Pregnancy Test Exclusion\" )\n      and not exists ( \"Diagnoses Identifying Sexual Activity\" )\n      and not exists ( \"Active Contraceptive Medications\" )\n      and not exists ( \"Laboratory Tests Identifying Sexual Activity But Not Pregnancy\" )\n      and not exists ( \"Procedures Identifying Sexual Activity\" )\n      and not exists ( \"Assessments Identifying Sexual Activity\" )\n      and not exists ( \"Ordered Contraceptive Medications\" )\n      and not exists ( \"Diagnostic Studies Identifying Sexual Activity\" ))\n\nexists ( [\"Encounter, Performed\": \"Encounter Inpatient\"] DischargeHospice\n    where ( DischargeHospice.dischargeDisposition ~ \"Discharge to home for hospice care (procedure)\"\n        or DischargeHospice.dischargeDisposition ~ \"Discharge to healthcare facility for hospice care (procedure)\")\n      and DischargeHospice.relevantPeriod ends during \"Measurement Period\")\n  or exists ( [\"Intervention, Order\": \"Hospice care ambulatory\"] HospiceOrder\n      where HospiceOrder.authorDatetime during \"Measurement Period\")\n  or exists ( [\"Intervention, Performed\": \"Hospice care ambulatory\"] HospicePerformed\n      where HospicePerformed.relevantPeriod overlaps \"Measurement Period\")\n\nor ( [\"Laboratory Test, Order\": \"Pregnancy Test\"] PregnancyTest\n    with [\"Diagnostic Study, Order\": \"X-Ray Study (all inclusive)\"] XrayOrder\n      such that XrayOrder.authorDatetime occurs 7 days or less on or after day of PregnancyTest.authorDatetime\n    where PregnancyTest.authorDatetime during \"Measurement Period\")\n  union ( [\"Laboratory Test, Order\": \"Pregnancy Test\"] PregnancyTestOrder\n      with [\"Medication, Order\": \"Isotretinoin\"] AccutaneOrder\n        such that AccutaneOrder.authorDatetime occurs 7 days or less on or after day of PregnancyTestOrder.authorDatetime\n      where PregnancyTestOrder.authorDatetime during \"Measurement Period\")\n\nand not ( ( [\"Diagnosis\": \"Other Female Reproductive Conditions\"]\n    union [\"Diagnosis\": \"Genital Herpes\"]\n    union [\"Diagnosis\": \"Gonococcal Infections and Venereal Diseases\"]\n    union [\"Diagnosis\": \"Inflammatory Diseases of Female Reproductive Organs\"]\n    union [\"Diagnosis\": \"Chlamydia\"]\n    union [\"Diagnosis\": \"HIV\"]\n    union [\"Diagnosis\": \"Syphilis\"]\n    union [\"Diagnosis\": \"Carrier of Predominantly Sexually Transmitted Infection\"]\n    union [\"Diagnosis\": \"Complications of Pregnancy, Childbirth and the Puerperium\"] ) SexualActivityDiagnosis\n    where SexualActivityDiagnosis.prevalencePeriod overlaps \"Measurement Period\")\n\nand not [\"Medication, Active\": \"Contraceptive Medications\"] ActiveContraceptives\n  where ActiveContraceptives.relevantPeriod overlaps \"Measurement Period\"\n\nand not ( [\"Laboratory Test, Order\": \"Pap Test\"]\n  union [\"Laboratory Test, Order\": \"Lab Tests During Pregnancy\"]\n  union [\"Laboratory Test, Order\": \"Lab Tests for Sexually Transmitted Infections\"] ) LabOrders\n  where LabOrders.authorDatetime during \"Measurement Period\"\n\nand not ( [\"Procedure, Performed\": \"Delivery Live Births\"]\n  union [\"Procedure, Performed\": \"Procedures During Pregnancy\"]\n  union [\"Procedure, Performed\": \"Procedures Involving Contraceptive Devices\"] ) ProceduresForSexualActivity\n  where ProceduresForSexualActivity.relevantDatetime during \"Measurement Period\"\n\nand not ( [\"Assessment, Performed\": \"Sexually Active\"] SexualActivityAssessment\n    where SexualActivityAssessment.result ~ \"Yes (qualifier value)\"\n      and SexualActivityAssessment.relevantDatetime before \n      end of \"Measurement Period\")\n\nand not [\"Medication, Order\": \"Contraceptive Medications\"] OrderedContraceptives\n  where OrderedContraceptives.authorDatetime during \"Measurement Period\"\n\nand not [\"Diagnostic Study, Order\": \"Diagnostic Studies During Pregnancy\"] SexualActivityDiagnostics\n  where SexualActivityDiagnostics.authorDatetime during \"Measurement Period\"","Women with at least one chlamydia test during the measurement period","exists ( [\"Laboratory Test, Performed\": \"Chlamydia Screening\"] ChlamydiaTest\n    where ChlamydiaTest.result is not null\n      and ChlamydiaTest.relevantDatetime during \"Measurement Period\")","None",null,"Guidance: \n\nCodes to identify sexually active women include codes for: pregnancy, sexually transmitted infections, contraceptives or contraceptive devices, and infertility treatments.\n\nThe denominator exclusion does not apply to patients who qualify for the initial population (IP) based on services other than the pregnancy test alone. These other services include services for sexually transmitted infections, contraceptives or contraceptive devices and infertility treatments. For example, a patient who has both a pregnancy test and a chlamydia diagnosis, either of which would qualify them for the IP, would not be eligible for this denominator exclusion.\n\nPatient self-report for procedures as well as diagnostic studies should be recorded in 'Procedure, Performed' template or 'Diagnostic Study, Performed' template in QRDA-1. Patient self-report is not allowed for laboratory tests.\n\nThis eCQM is a patient-based measure.\n\nThis version of the eCQM uses QDM version 5.5.  Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.",null,null,null,"Positive"]
["T2-119","TIPPS","T2","Controlling High Blood Pressure","Outcome",null,"01/01/21 - 12/31/21","Numeric Data Reporting & Status Update Only",null,"NA","NA",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"0018","NCQA","eCQM - CMS165v9","https://ecqi.healthit.gov/ecqm/ep/2021/cms165v9","Percentage of patients 18-85 years of age who had a diagnosis of hypertension overlapping the measurement period or the year prior to the measurement period, and whose most recent blood pressure was adequately controlled (<140/90mmHg) during the measurement period","Family Medicine; Internal Medicine; Obstetrics & Gynecology; Pediatrics (Optional); Surgery","Individuals","Patients 18-85 years of age who had a visit and diagnosis of essential hypertension overlapping the measurement period or the year prior to the measurement period","\"Initial Population\"\n\nexists [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n  where Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) in Interval[18, 85 )\n    and exists \"Essential Hypertension Diagnosis\"\n    and exists AdultOutpatientEncounters.\"Qualifying Encounters\"\n\n[\"Diagnosis\": \"Essential Hypertension\"] Hypertension\n  where Hypertension.prevalencePeriod overlaps Interval[start of \"Measurement Period\" - 1 year, \n  end of \"Measurement Period\"]\n\nand ( [\"Encounter, Performed\": \"Office Visit\"]\n union [\"Encounter, Performed\": \"Annual Wellness Visit\"]\n union [\"Encounter, Performed\": \"Preventive Care Services - Established Office Visit, 18 and Up\"]\n union [\"Encounter, Performed\": \"Preventive Care Services-Initial Office Visit, 18 and Up\"]\n union [\"Encounter, Performed\": \"Home Healthcare Services\"] ) ValidEncounter\n where ValidEncounter.relevantPeriod during \"Measurement Period\"","Patients with evidence of end stage renal disease (ESRD), dialysis or renal transplant before or during the measurement period. Also exclude patients with a diagnosis of pregnancy during the measurement period.\nExclude patients whose hospice care overlaps the measurement period.\nExclude patients 66 and older who are living long term in an institution for more than 90 consecutive days during the measurement period.\nExclude patients 66 and older with advanced illness and frailty because it is unlikely that patients will benefit from the services being measured.\n\nHospice. \"Has Hospice\"\n  or exists ( \"Pregnancy Or Renal Diagnosis Exclusions\" )\n  or ( exists ( \"End Stage Renal Disease Procedures\" )\n      or exists ( \"End Stage Renal Disease Encounter\" ))\n  or ( exists ( [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n        where Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) >= 65)\n      and ( FrailtyLTI.\"Long Term Care Periods Longer Than 90 Consecutive Days\" ))\n  or FrailtyLTI.\"Advanced Illness and Frailty Exclusion Including Over Age 80\"\n\nexists ( [\"Encounter, Performed\": \"Encounter Inpatient\"] DischargeHospice\n    where ( DischargeHospice.dischargeDisposition ~ \"Discharge to home for hospice care (procedure)\"\n        or DischargeHospice.dischargeDisposition ~ \"Discharge to healthcare facility for hospice care (procedure)\")\n      and DischargeHospice.relevantPeriod ends during \"Measurement Period\")\n  or exists ( [\"Intervention, Order\": \"Hospice care ambulatory\"] HospiceOrder\n      where HospiceOrder.authorDatetime during \"Measurement Period\")\n  or exists ( [\"Intervention, Performed\": \"Hospice care ambulatory\"] HospicePerformed\n      where HospicePerformed.relevantPeriod overlaps \"Measurement Period\")\n\nor ( [\"Diagnosis\": \"Pregnancy\"]\n  union [\"Diagnosis\": \"End Stage Renal Disease\"]\n  union [\"Diagnosis\": \"Kidney Transplant Recipient\"]\n  union [\"Diagnosis\": \"Chronic Kidney Disease, Stage 5\"] ) PregnancyESRDDiagnosis\n  where PregnancyESRDDiagnosis.prevalencePeriod overlaps \"Measurement Period\"\n\nor ( [\"Procedure, Performed\": \"Vascular Access for Dialysis\"]\n  union [\"Procedure, Performed\": \"Kidney Transplant\"]\n  union [\"Procedure, Performed\": \"Dialysis Services\"] ) ESRDProcedure\n  where ESRDProcedure.relevantPeriod starts before \n  end of \"Measurement Period\"\n\nor [\"Encounter, Performed\": \"ESRD Monthly Outpatient Services\"] ESRDEncounter\n  where ESRDEncounter.relevantPeriod starts before \n  end of \"Measurement Period\"\n\nand exists ( \"Long Term Care Periods During Measurement Period\" LongTermCareDuringMP\n    where duration in days of LongTermCareDuringMP > 90)\n\nor //If the measure includes populations age 80 and older, then use this logic:\nexists ( [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n  where ( Global.\"CalendarAgeInYearsAt\"(BirthDate.birthDatetime, start of \"Measurement Period\")in Interval[66, 80])\n   and \"Has Criteria Indicating Frailty\"\n   and ( Count(\"Outpatient Encounters with Advanced Illness\")>= 2\n     or exists ( \"Inpatient Encounter with Advanced Illness\" )\n     or exists \"Dementia Medications In Year Before or During Measurement Period\"))\n or exists ( [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n   where ( Global.\"CalendarAgeInYearsAt\"(BirthDate.birthDatetime, start of \"Measurement Period\")>= 81 )\n    and \"Has Criteria Indicating Frailty\")","Patients whose most recent blood pressure is adequately controlled (systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg) during the measurement period","\"Has Diastolic Blood Pressure Less Than 90\"\n  and \"Has Systolic Blood Pressure Less Than 140\"\n\n\"Lowest Diastolic Reading on Most Recent Blood Pressure Day\".result < 90 'mm[Hg]'\n \nand \"Lowest Systolic Reading on Most Recent Blood Pressure Day\".result < 140 'mm[Hg]'","None",null,"Guidance:\n\nIn reference to the numerator element, only blood pressure readings performed by a clinician or a remote monitoring device are acceptable for numerator compliance with this measure. \n\nDo not include BP readings:\n-Taken during an acute inpatient stay or an ED visit\n-Taken on the same day as a diagnostic test or diagnostic or therapeutic procedure that requires a change in diet or change in medication on or one day before the day of the test or procedure, with the exception of fasting blood tests.\n-Reported by or taken by the member\n\nIf no blood pressure is recorded during the measurement period, the patient's blood pressure is assumed \"not controlled.\"\n\nIf there are multiple blood pressure readings on the same day, use the lowest systolic and the lowest diastolic reading as the most recent blood pressure reading.\n\nThis eCQM is a patient-based measure.\n\nThis version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.",null,null,null,"Positive"]
["T3-102","TIPPS","T3","Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Poor Control (>9.0%)","Outcome",null,"01/01/21 - 12/31/21","Numeric Data Reporting & Status Update Only",null,"NA","NA",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"0059","NCQA","eCQM - CMS 122v9","https://ecqi.healthit.gov/ecqm/ep/2021/cms122v9","Percentage of patients 18-75 years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period","Family Medicine; Internal Medicine; Pediatrics (Optional); Preventive Medicine; Dietician, Registered","Individuals","Patients 18-75 years of age with diabetes with a visit during the measurement period","\"Initial Population\"\n\nexists ( [\"Patient Characteristic Birthdate\"] Birthdate\n\t\twhere Global.\"CalendarAgeInYearsAt\"(Birthdate.birthDatetime, start of \"Measurement Period\")in Interval[18, 75 ))\n\tand exists ( AdultOutpatientEncounters.\"Qualifying Encounters\" )\n\tand exists ( [\"Diagnosis\": \"Diabetes\"] Diabetes\n\t\t\twhere Diabetes.prevalencePeriod overlaps \"Measurement Period\")\n\n( [\"Encounter, Performed\": \"Office Visit\"]\n\tunion [\"Encounter, Performed\": \"Annual Wellness Visit\"]\n\tunion [\"Encounter, Performed\": \"Preventive Care Services - Established Office Visit, 18 and Up\"]\n\tunion [\"Encounter, Performed\": \"Preventive Care Services-Initial Office Visit, 18 and Up\"]\n\tunion [\"Encounter, Performed\": \"Home Healthcare Services\"] ) ValidEncounter\n\twhere ValidEncounter.relevantPeriod during \"Measurement Period\"","Exclude patients whose hospice care overlaps the measurement period.\n\nExclude patients 66 and older who are living long term in an institution for more than 90 consecutive days during the measurement period.\n\nExclude patients 66 and older with advanced illness and frailty because it is unlikely that patients will benefit from the services being measured.\n\nHospice.\"Has Hospice\"\n  or FrailtyLTI.\"Advanced Illness and Frailty Exclusion Not Including Over Age 80\"\n  or ( exists [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n      where ( Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) >= 65 )\n        and FrailtyLTI.\"Long Term Care Periods Longer Than 90 Consecutive Days\")\n \n\nHospice. \"Has Hospice\"\n\nexists ( [\"Encounter, Performed\": \"Encounter Inpatient\"] DischargeHospice\n\t\twhere (DischargeHospice.dischargeDisposition as Code ~ \"Discharge to home for hospice care (procedure)\"\n\t\t\t\tor DischargeHospice.dischargeDisposition as Code ~ \"Discharge to healthcare facility for hospice care (procedure)\")\n\t\t\tand DischargeHospice.relevantPeriod ends during \"Measurement Period\")\n\tor exists ( [\"Intervention, Order\": \"Hospice care ambulatory\"] HospiceOrder\n\t\t\twhere HospiceOrder.authorDatetime during \"Measurement Period\")\n\tor exists ( [\"Intervention, Performed\": \"Hospice care ambulatory\"] HospicePerformed\n\t\t\twhere HospicePerformed.relevantPeriod overlaps \"Measurement Period\")","Patients whose most recent HbA1c level (performed during the measurement period) is >9.0%","\"Has Most Recent Elevated Hba1c\"\n\tor \"Has Most Recent HbA1c Without Result\"\n\tor \"Has No Record Of HbA1c\"\n\nLast([\"Laboratory Test, Performed\": \"HbA1c Laboratory Test\"] HighHbA1c\n\t\twhere HighHbA1c.relevantPeriod during \"Measurement Period\"\n\t\t\tand HighHbA1c.result is not null\n\t\tsort by resultDatetime\n).result > 9 '%'\n \nLast([\"Laboratory Test, Performed\": \"HbA1c Laboratory Test\"] HbA1cNoResult\n\t\twhere HbA1cNoResult.relevantPeriod during \"Measurement Period\"\n\t\tsort by resultDatetime\n).result is null\n \nnot exists [\"Laboratory Test, Performed\": \"HbA1c Laboratory Test\"] NoHbA1c\n\twhere NoHbA1c.relevantPeriod during \"Measurement Period\"","None",null,"Additional definitinos of advanced illness and fraility are available in the measure source: https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS122v9.html#d1e767.\n\nPatient is numerator compliant if most recent HbA1c level >9%, the most recent HbA1c result is missing, or if there are no HbA1c tests performed and results documented during the measurement period. If the HbA1c test result is in the medical record, the test can be used to determine numerator compliance.\n\nOnly patients with a diagnosis of Type 1 or Type 2 diabetes should be included in the denominator of this measure; patients with a diagnosis of secondary diabetes due to another condition should not be included.\n\nThis eCQM is a patient-based measure.\n\nThis version of the eCQM uses QDM version 5.5.  Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.",null,null,null,"Negative"]
["T3-121","TIPPS","T3","Food Insecurity Screening","Process",null,"01/01/22 - 02/28/22","Numeric Data Reporting & Status Update Only",null,"NA","NA",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"NA","Texas HHSC","Texas HHSC","NA","Percentage of patients who were screened for food insecurity using the Hunger Vital Sign (HVS) 2 questions with the screening results documented during the current encounter or during the previous twelve months.","Family Medicine; Internal Medicine; Obstetrics & Gynecology; Pediatrics","Individuals","All attributed patients with an eligible encounter during the measurement period","All attributed patients with an eligible encounter during the measurement period. There are not any age restrictions for denominator inclusion for this measure.","Patient refused to participate","Patients screened for food insecurity using the Hunger Vital Sign (HVS) 2 questions with the screening results documented during the current encounter or during the previous twelve months.\n\nThere are not any age restrictions for numerator inclusion for this measure. Parents, guardians, and caregivers screened using the HVS 2 questions on behalf of the patient's household may be included in the numerator.","The Hunger Vital Sign™ (HVS) is a validated 2-question food insecurity screening tool based on the U.S. Household Food Security Survey Module to identify households at risk of food insecurity if they answer that either or both of the following two statements is ‘Often True’ or ‘Sometimes True’ (vs. ‘Never True’).\n• “Within the past 12 months we worried whether our food would run out before we got money to buy more.” \n• “Within the past 12 months the food we bought just didn’t last and we didn’t have money to get more.” \n\nPatients (including parents, guardians, and caregivers on behalf of the patient's househould) screened for food insecurity using the HVS 2 questions with the screening results documented during the current encounter or during the previous twelve months. \n\nPerformance for this measure is not dependent on a particular result. Performance is met if the documented screening results to both questions are not null (e.g., documented as ‘Often True’, ‘Sometimes True’, or ‘Never True’).","Patients screened for food insecurity using the Hunger Vital Sign (HVS) 2 questions without the screening results documented during the current encounter or during the previous twelve months, and patients screened for food insecurity without using the HVS 2 questions.","None","According to the sponsoring organization for the Hunger Vital Sign™, \"There is no fee or license required to use the Hunger Vital Sign™. We only ask that parties properly cite the tool as follows\":\nHager, E. R., Quigg, A. M., Black, M. M., Coleman, S. M., Heeren, T., Rose-Jacobs, R., Cook, J. T., Ettinger de Cuba, S. E., Casey, P. H., Chilton, M., Cutts, D. B., Meyers A. F., Frank, D. A. (2010). Development and Validity of a 2-Item Screen to Identify Families at Risk for Food Insecurity. Pediatrics, 126(1), 26-32. doi:10.1542/peds.2009-3146.\n\nAdditional translations of the Hunger Vital Sign™ (11 languages total): https://childrenshealthwatch.org/wp-content/uploads/Hunger-Vital-Sign_translations.pdf\n\nAdditional resources and information respective to the Hunger Vital Sign™, including academic publications, toolkits, and other technical assistance: https://childrenshealthwatch.org/public-policy/hunger-vital-sign/",null,null,null,"Positive",null,null,null,null,null,null,null,"In Y1, the data measurement period for T3-121 is 01/01/22-02/28/22. The denominator for this measure is \"All attributed patients with an eligible encounter during the measurement period\". Given that the denominator is not restrictive, even if the TIPPS participating provider does not currently perform the numerator quality action of food insecurity screenings, the denominator is unlikely to be “zero” for a data measurement period of 01/01/22-02/28/22. Moreover, measure is a screening rate. Both positive and negative screens should be included if they meet the numerator inclusion criteria. "]
["T3-122","TIPPS","T3","Maternity Care: Post-Partum Follow-Up and Care Coordination","Process",null,"01/01/21 - 12/31/21","Numeric Data Reporting & Status Update Only",null,"NA","NA",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"NA","CMS","CMS MIPS #336 2020","https://qpp.cms.gov/docs/QPP_quality_measure_specifications/CQM-Measures/2020_Measure_336_MIPSCQM.pdf","Percentage of patients, regardless of age, who gave birth during a 12-month period who were seen for postpartum care within 8 weeks of giving birth and who received a breast-feeding evaluation and education, postpartum depression screening, postpartum glucose screening for gestational diabetes patients, family and contraceptive planning counseling, tobacco use screening and cessation education, healthy lifestyle behavioral advice, and an immunization review and update","Obstetrics & Gynecology","Encounters","All patients, regardless of age, who gave birth during a 12-month period seen for postpartum care visit before or at 8 weeks of giving birth","All patients, regardless of age\nAND\nPatient procedure during performance period (CPT): 59400, 59410, 59430, 59510, 59515, 59610, 59614, 59618, 59622\nAND\nPostpartum care visit before or at 8 weeks post-delivery",null,"Patients receiving the following at a postpartum visit:\n• Breast-feeding evaluation and education, including patient-reported breast-feeding\n• Postpartum depression screening\n• Postpartum glucose screening for gestational diabetes patients\n• Family and contraceptive planning counseling\n• Tobacco use screening and cessation education\n• Healthy lifestyle behavioral advice\n• Immunization review and update","Postpartum screenings, evaluations, and education performed (G9357)","Postpartum screenings, evaluations and education, not performed (G9358)",null,"Definitions:\nBreast-Feeding Evaluation and Education – Patients who were evaluated for breast-feeding before or at 8 weeks postpartum.\nPostpartum Depression Screening – Patients who were screened for postpartum depression before or at 8 weeks postpartum. Questions may be asked either directly by a health care provider or in the form of self- completed paper- or computer-administered questionnaires, and results should be documented in the medical record. Depression screening should include a self-reported validated depression screening tool (e.g., PHQ-2, Beck Depression Inventory, Beck Depression Inventory for Primary Care, Edinburgh Postnatal Depression Scale (EPDS).\nPostpartum Glucose Screening for Gestational Diabetes – Patients who were diagnosed with gestational diabetes during pregnancy who were screened with a glucose screen before or at 8 weeks postpartum.\nFamily and Contraceptive Planning Counseling – Patients who were provided family and contraceptive planning counseling and education (including contraception, if necessary) before or at 8 weeks postpartum.\nTobacco Use Screening and Cessation Education: Patients who were screened for tobacco use before or at 8 weeks postpartum. Patients who used any type of tobacco who were given brief counseling (3 minutes or less) and/or pharmacotherapy.\nHealthy Lifestyle Behavioral Advice: Clinicians should use discretion to determine which patients they deem appropriate for healthy lifestyle counseling. Clinicians may take into account the number of weeks that have passed since childbirth, whether the mother is breast-feeding, the degree to which the mother’s body mass index (BMI) exceeds the normal range, whether postpartum depression is present, and the mother’s own feelings and perceptions of her body weight. Counseling should include suggestions around healthy eating and staying active.\nIf deemed necessary by the clinician, the conversation about healthy lifestyle choices could include a follow-up plan, including a referral to a specialist such as a registered dietitian nutritionist, primary care provider, or mental health professional for lifestyle/behavioral therapy, pharmacological interventions, dietary supplements, exercise counseling or nutrition counseling.\nImmunization Review and Update: Patients whose immunization records were reviewed and who were provided with indicated immunizations, including completing series initiated antepartum or postpartum, at or before 8 weeks postpartum.",null,null,null,"Positive"]
["T3-123","TIPPS","T3","Behavioral Health Risk Assessment for Pregnant Women","Process",null,"01/01/21 - 12/31/21","Numeric Data Reporting & Status Update Only",null,"NA","NA",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"NA","CMS (retired)","Texas HHSC (based on 2017 Medicaid child core set)","NA","Percentage of women, regardless of age, who gave birth during a 12-month period seen at least once for prenatal care who received a behavioral health screening risk assessment that includes the following screenings at the first prenatal visit: depression screening, alcohol use screening, tobacco use screening, drug use screening (illicit and prescription, over the counter), and intimate partner violence screening.","Obstetrics & Gynecology","Encounters","All patients, regardless of age, who gave birth during a 12-month period seen at least once for prenatal care.","LOGIC: \nENCOUNTER Performed, Prenatal Visit: \"2.16.840.1.113883.3.526.3.1264\"\nAND\n     PROCEDURE Performed Vaginal Delivery: \"2.16.840.1.113883.3.526.3.1341\"\n     Attribute: stop datetime Date of Delivery\n     OR \n     PROCEDURE Performed: Cesarean Section Delivery: \"2.16.840.1.113883.3.526.3.1342\"\n     Attribute: stope datetime Dat of Delivery",null,"Patients who received all behavioral health screening risk assessments at the first prenatal visit.\n","Patients who received the following behavioral health screening risk assessments at the first prenatal visit.\nDepression screening:\n• Patients who were screened for depression at the first visit. Questions may be asked either directly by a health care provider or in the form of self-completed paper- or computer-administered questionnaires and results should be documented in the medical record. Depression screening may include a self-reported validated depression screening tool [e.g., PHQ-2, Beck Depression Inventory, Beck Depression Inventory for Primary Care, Edinburgh Postnatal Depression Scale (EPDS)].\nAlcohol use screening:\n• Patients who were screened for any alcohol use at the first visit \nTobacco use screening:\n• Patients who were screened for tobacco use at the first visit \nDrug use (illicit and prescription, over the counter) screening:\n• Patients who were screened for any drug use at the first visit\nIntimate partner violence screening:\n• Patients who were screened for intimate partner violence/abuse at the first visit. Questions may be asked either directly by a health care provider or in the form of self-completed paper- or computer administered questionnaires and results should be documented in the medical record. Intimate partner violence screening may include a self-reported validated depression screening tool (e.g., Hurt, Insult, Threaten, and Scream [HITS], Woman Abuse Screening Tool [WAST], Partner Violence Screen [PVS], Abuse Assessment Screen [AAS]).\nTo satisfactorily meet the numerator, ALL screening components must be performed.\n@@@\nLOGIC:\nAll Patients Identified within the Denominator\nAND\n     RISK CATEGORY/ASSESSMENT Result; Depression Screening Tools Realted to Maternity Care: \"2.16.840.1.113883.3.526.3.1359\"\n     Attirbute: Result Value Present\n     OR\n     INTERVENTION Result; Depression Screening-Procedure: \"2.16.840.1.113883.3.526.3.1360\"\n     Attribute: Result Value Present\nAND\nRISK CATEGORY/ASSESSMENT Result; Alcohol Use Screening: \"2.16.840.1.113883.3.526.3.1361\"\nAttribute: Result Value Present\nAND\nRISK CATEGORY/ASSESSMENT Result; Tobacco Use Screening: \"2.16.840.1.113883.3.526.3.1362\"\nAttribute: Result Value Present\nAND\nRISK CATEGORY/ASSESSMENT Result; Illicit, Prescription and Over the Counter Drug Use Screening: \"2.16.840.1.113883.3.526.3.1363\"\nAttribute: Result Value Present\nAND\nRISK CATEGORY/ASSESSMENT Result, Intimate Partner Violence Screening-Tool; \"2.16.840.1.113883.3.526.3.1364\"\nAttribute: Result Value Present","NA",null,"• To satisfactorily meet the numerator, all screening components must be performed.\n• The specifications for this measure do not include upper or lower age restrictions.\n• If an eligible woman has more than one birth during the measurement year, states should count each delivery separately in the Denominator (D). To be counted toward the numerator, each delivery must have a BHRA conducted at the first prenatal visit within the specified time frame for each delivery.\n@@@\nAdditional guidance can be found in the Medicaid and Chip Child Core Set Technical Specifications and Resource Manual for Federal Fiscal Year 2017\nhttps://www.medicaid.gov/medicaid/quality-of-care/downloads/medicaid-and-chip-child-core-set-manual.pdf \n@@@\nAllowable Exceptions: \n- Measure is specified for prenatal visits. For TIPPS reporting purposes, providers MAY include settings in addition to OB that may provide care to pregnant women.  \n- Measure is specified so that denominator inclusion is determined by a delivery during the measurement period and a prenatal visit prior to delivery. For TIPPS reporting purposes, providers MAY determine denominator inclusion by a prenatal visit conducted during the measurement period, rather than delivery date within the measurement period. \nProviders should keep record of above exceptions and note them in the qualitative fields when reporting baseline or performance rates. Providers must apply exceptions consistently across all baseline and performance years. ",null,null,null,"Positive"]
["T3-124","TIPPS","T3","Depression Response at Twelve Months","Outcome",null,"01/01/21 - 12/31/21","Numeric Data Reporting & Status Update Only",null,"NA","NA",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,1885,"MN Community Measurement","MN Community Measurement","https://helpdesk.mncm.org/helpdesk/KB/View/24185684-supplemental-guide--depression-care-measures-specifications-and-calculation ","The percentage of adolescent patients (12 to 17 years of age) and adult patients (18 years of age or older) with Major Depression or Dysthymia who demonstrated a response to treatment 12 months (+/- 60 days) after an index event","Family Medicine; Internal Medicine; Pediatrics; Psychiatry; Social Worker","Individuals","The eligible population (12 years of age or older at the index event) who had index events during the denominator identification period. ","Denominator Identification Period: Patients indexed in this timeframe comprise the measure denominator.\n\nAn index event occurs when ALL the following criteria are met during an encounter*:\n• a PHQ-9 or PHQ-9M result greater than nine\n• an active diagnosis of Major Depression or Dysthymia (Major Depression or Dysthymia Value Set)\n• the patient is NOT in a prior measure assessment period\n\n* For this measure, an encounter includes but is not limited to any of the following: office visit, psychiatry or psychotherapy visit, telephone, or online encounter. PHQ-9 or PHQ-9M score greater than 9 can be documented on the same date or up to seven days prior to the encounter (index event) and this date occurs during the denominator identification measurement period. This allows for pre-visit planning and administering the PHQ-9 or PHQ-9M just prior to an encounter. \n\nAny member of the health care team can administer a PHQ-9 or PHQ-9M assessment tool to a patient. Additionally, patients can self-administer via patient portal, email, or mail.","Required Exclusions - The following exclusions must be applied to the eligible population:\n• Patient had an active diagnosis of Bipolar Disorder (Bipolar Disorder Value Set) any time prior to the end of their measure assessment period\n• Patient had an active diagnosis of Schizophrenia or Psychotic Disorder (Schizophrenia Psychotic Disorder Value Set) any time prior to the end of their measure assessment period\n\nAllowable Exclusions - The following exclusions can be applied to the eligible population:\n• Patient had an active diagnosis of Personality Disorder – Emotionally Labile\n(Personality Disorder - Emotionally Labile Value Set) any time prior to the end of their measure assessment period\n• Patient had an active diagnosis of Pervasive Developmental Disorder (Pervasive Disorder Value Set) any time prior to the end of their measure assessment period\n• Patient was a permanent nursing home resident at any time during the denominator identification period or measure assessment period\n• Patient was in hospice or receiving palliative care at any time during the denominator identification period or measure assessment period\n• Patient died prior to the end of their measure assessment period","The number of patients in the denominator who demonstrated a response to treatment, with a PHQ-9 or PHQ-9M result that is reduced by at least 50 percent since the index PHQ-9/PHQ-9M result, 12 months (+/- 60 days) after an index event.","Measure Assessment Period for Rate Calculation: For each patient, the measure assessment period begins with an index event and is 14 months (12 months + 60 days) in length. Follow-up scores obtained in this timeframe from patients in the measure denominator are evaluated for numerator compliance.\n\nAny member of the health care team can administer a PHQ-9 or PHQ-9M assessment tool to a patient. Additionally, patients can self-administer via patient portal, email, or mail.",null,"For TIPPS reporting purposes, no rounding will be accepted in calculating a percent reduction equal to or greater than 50 percent. Additionally, according to the measure steward (MNCM), the measure steward does not anticipate releasing new Value Sets until late October or early November each year, so for TIPPS reporting purposes, the value sets contained in electronic clinical quality measure (eCQM) \"Depression REMISSION at Twelve Months\" (CMS159v9) may be referenced as the value sets for T3-124: Depression RESPONSE at Twelve Months since the diagnoses and measure stewards are the same for both measures. See https://ecqi.healthit.gov/ecqm/ep/2021/cms159v9. Also, see https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS159v9.html.","TIPPS SFY22 Reporting Period 1: \n• Denominator Identification Period: November 1, 2019 through October 31, 2020\n• Numerator Measure Assessment Period for Rate Calculation**: September 2, 2020 through December 30, 2021\n\nDenominator Identification Period: Patients indexed in this timeframe with a qualifying denominator index event comprise the measure denominator.\n\nNumerator Measure Assessment Period for Rate Calculation: For each patient, the numerator measure assessment period begins with a qualifying denominator index event and is 14 months (12 months +/- 60 days) in length. Follow-up scores obtained in this timeframe from patients in the measure denominator are evaluated for numerator criteria performance met. (**The Numerator Measure Assessment Period for Rate Calculation represents the first and last possible dates of follow-up based on the denominator identification period. Due to the +/- 60-day calculation, the dates do not fall exactly on the first or last day of the month. Each patient’s individual measure assessment period is initiated with a denominator index event. Patients are assessed at 12-months (+/- 60 days) after their denominator index event.)\n\nIdentify the 12-month (+/- 60 days) Numerator Measure Assessment Period for a qualifying denominator index event. If more than one PHQ-9/PHQ-9M score occurs during the identified Numerator Measure Assessment Period, identify the most recent (latest) PHQ-9/PHQ-9M score within the Numerator Measure Assessment Period, and use this score to assess numerator criteria performance met. \n\nPatients with no submitted PHQ-9/PHQ-9M scores within the Numerator Measure Assessment Period remain in the denominator but are not counted in the numerator.\n\nFor TIPPS reporting purposes, the following examples show how to calculate depression response.\nDepression Response = (Response Score - Index Score)/(Index Score)\n\nExample A:\n• Index Score: 16\n• Response Score: 8\n• Depression Response = (8-16)/16 = -0.50 (decrease)\n• PERFORMANCE MET (decrease in score greater than or equal to 50%)\n\nExample B: \n• Index Score of 16\n• Response Score of 10\n• Depression Response = (10-16)/16 = -0.375 (decrease)\n• PERFORMANCE NOT MET (decrease in score was not greater than or equal to 50%)\n\nExample C: \n• Index Score of 16\n• Response Score of 18; Increased\n• Depression Response = (18-16)/16 = +0.125 (increase)\n• PERFORMANCE NOT MET (increase in score)",null,null,null,"Positive"]
["T3-125","TIPPS","T3","Weight Assessment and Counseling for Nutrition and Physical Activity for Children/ Adolescents (Weight Assessment Only)","Process",null,"01/01/21 - 12/31/21","Numeric Data Reporting & Status Update Only",null,"NA","NA",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"0024","NCQA","eCQM - CMS155v9","https://ecqi.healthit.gov/ecqm/ep/2021/cms155v9","Percentage of patients 3-17 years of age who had an outpatient visit with a Primary Care Physician (PCP) or Obstetrician/Gynecologist (OB/GYN) and who had evidence of the following during the measurement period. Only one rate is reported: Percentage of patients with height, weight, and body mass index (BMI) percentile documentation","Family Medicine; Pediatrics; Dietician, Registered","Individuals","Patients 3-17 years of age with at least one outpatient visit with a primary care physician (PCP) or an obstetrician/gynecologist (OB/GYN) during the measurement period","exists [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n  where Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) in Interval[3, 17 )\n    and exists ( \"Qualifying Encounter\" )\n\n( [\"Encounter, Performed\": \"Office Visit\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services-Individual Counseling\"]\n  union [\"Encounter, Performed\": \"Preventive Care, Established Office Visit, 0 to 17\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services, Initial Office Visit, 0 to 17\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services - Group Counseling\"]\n  union [\"Encounter, Performed\": \"Home Healthcare Services\"] ) ValidEncounter\n  where ValidEncounter.relevantPeriod during \"Measurement Period\"","Patients who have a diagnosis of pregnancy during the measurement period.\n\nExclude patients whose hospice care overlaps the measurement period.\n\nHospice.\"Has Hospice\"\n  or exists ( \"Pregnancy Diagnosis Which Overlaps Measurement Period\" )\n ","Patients who had a height, weight and body mass index (BMI) percentile recorded during the measurement period","exists ( \"BMI Percentile in Measurement Period\" )\n  and exists ( \"Height in Measurement Period\" )\n  and exists ( \"Weight in Measurement Period\" )","None","Only rate 1 of the measure is being reported: Percentage of patients with height, weight, and body mass index (BMI) percentile documentation.","Guidance:\nThe visit must be performed by a PCP or OB/GYN. \nBecause BMI norms for youth vary with age and sex, this measure evaluates whether BMI percentile, rather than an absolute BMI value, is assessed.\n\nThis eCQM is a patient-based measure.\n\nThis version of the eCQM uses QDM version 5.5.  Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.\n",null,null,null,"Positive"]
["C1-105","CHIRP","C1 (UHRIP)","Health Information Exchange (HIE) Participation","Structure",null,"NA","Status Update Only",null,"NA","NA",null,"NA",null,null,null,null,null,"NA","NA","NA","NA","Reporting on status with enrollment in a public HIE, including submission of ADT and CCDM data","NA","NA",null,null,null,null,null,null,null,null,null,null,null,"N/A"]
["C1-126","CHIRP","C1 (UHRIP)","Healthcare Quality Learning Collaborative Participation","Structure",null,"09/01/20 - 08/31/21","Status Update Only",null,"NA","NA",null,"NA",null,null,null,null,null,"NA","NA","NA","NA","Reporting on participation in a Healthcare Quality Learning Collaborative. A Healthcare Quality Learning Collaborative is any conference, workshop, stakeholder forum, stakeholder meeting related to improving healthcare quality. It may take place anywhere, not only in the provider’s SDA, and events may be virtual or in person.","NA","NA",null,null,null,null,null,null,null,null,null,null,null,"N/A"]
["C1-127","CHIRP","C1 (UHRIP)","Medication Reconciliation: Number of Unintentional Medication Discrepancies per Medication per Patient","Outcome",null,"01/01/21 - 12/31/21","Numeric Data Reporting & Status Update Only",null,"NA","NA",null,"All Payer",null,null,null,null,null,"2456","HHSC (Adapted from Brigham and Women's Hospital)","National Quality Forum (NQF)","https://www.qualityforum.org/QPS/2456","This measure assesses the actual quality of the medication reconciliation process by identifying errors in admission and discharge medication orders due to problems with the medication reconciliation process. The target population is any hospitalized patient. The time frame is the hospitalization period. At the time of admission, the admission orders are compared to the preadmission medication list (PAML) compiled by trained pharmacist (i.e., the gold standard) to look for discrepancies and identify which discrepancies were unintentional using brief medical record review. This process is repeated at the time of discharge where the discharge medication list is compared to the PAML and medications ordered during the hospitalization.","NA","Encounters","The patient denominator is the sum of the number of medications in the gold standard medication lists plus the number of unintentionally ordered additional medications in a random sample of all adults admitted to the hospital. See \"HHSC Program Specific Modifications\" for sampling specifications for CHIRP reporting purposes.",null,"Patients that are discharged or expire before a gold standard medication list can be obtained.","For each sampled inpatient in the denominator, the total number of unintentional medication discrepancies in admission orders plus the total number of unintentional medication discrepancies in discharge orders.",null,null,"For CHIRP reporting purposes, the sampling of patients should includes all admitted patients (not only adults). The denominator therefore is the sum of medications in the gold standard medication list plus the number of unintentionally ordered additional medications in a random sample of all admitted patients. A pharmacist, pharmacy resident, or a certified pharmacy technician may collect the gold standard medication history. A certified pharmacy technician would include a pharmacy technician that has earned either the ASHP Medication Reconciliation Certification or the Pharmacy Technicians Certification Board’s (PTCB) Medication History Certificate. The Gold Standard Medication History is the list of medications that the patient was taking prior to\nadmission. Within 24 hours after admission, a trained pharmacist, pharmacy resident, or certified pharmacy technician must interview each patient selected for the 6-month sample and obtain the Gold Standard Medication History. Note that this is in addition to, and separate from, any pre-admission medication list that was created as part of normal care.\n\nCHIRP SFY22 Reporting Period 1: \n• For CHIRP reporting, the minimum sample size is 76 patients per year. If a hospital does not have 76 patients to include in their sample, they may report the data based on all the patients that are included in the denominator. \n• For example, if there were 1,000 inpatient admissions and a CHIRP participating hospital was sampling 1-2 patients per week to select for the “gold standard” medication interviews, this would result in anywhere between 52-104 patients with completed “gold standard” medication lists per measure specifications. If the CHIRP participating hospital had completed 104 “gold standard” medication interviews, then a minimum of 76 of those cases (or up to all 104 cases) must be used to report the data for this measure. If the CHIRP participating hospital had completed 52 “gold standard” medication interviews, then all 52 cases would be used to report the data for this measure.\n• For another example, for those CHIRP participating hospitals with much lower inpatient admission volume to begin with, e.g., if there were 100 inpatient admissions and the participant was sampling 2 patients per month to select for the “gold standard” medication interviews, this would result in 24 patients with completed “gold standard” medication lists per measure specifications. All 24 of these cases would be used to report the data for this measure (since 24 is less than the minimum sample size of 76).   \n\nExample of rate calculation: If among those patients sampled to receive the gold standard medication interview, there are 145 gold standard medications and 50 unintentionally ordered additional medications, and 110 unintentional discrepancies are identified, the measure outcome would be 110/195 = 0.5641 discrepancies per medication per patient for that hospital.",null,null,null,null,"Negative",null,null,null,null,null,null,null,"Helpful resources (not required to use) \n\nIdentifying Discrepancies Flowchart:  https://www.leapfroggroup.org/sites/default/files/Files/Identifying%20Discrepancies%20Flow%20Chart_0_0.pdf?token=NKOpMllV\n\nTaking a good medication history: https://www.hospitalmedicine.org/clinical-topics/clinical-topic-videos/taking-a-good-medication-history-video/\n\nMedication Reconciliation: https://www.hospitalmedicine.org/clinical-topics/medication-reconciliation/\n\nMedication Reconciliation Worksheet: https://view.officeapps.live.com/op/view.aspx?src=https%3A%2F%2Fwww.leapfroggroup.org%2Fsites%2Fdefault%2Ffiles%2FFiles%2FMedRec_Worksheet_2022.docx%3Ftoken%3D606YTZH7&wdOrigin=BROWSELINK\n\nMedication Reconciliation Workbook: https://view.officeapps.live.com/op/view.aspx?src=https%3A%2F%2Fwww.leapfroggroup.org%2Fsites%2Fdefault%2Ffiles%2FFiles%2FMedRec_Workbook_2022.xlsx%3Ftoken%3Dc2tblZFX&wdOrigin=BROWSELINK"]
["C2-103","CHIRP","C2 (ACIA Rural Hospital Best Practices)","Preventive Care and Screening: Influenza Immunization","Process",null,"01/01/21 - 12/31/21","Numeric Data Reporting & Status Update Only",null,"NA","NA",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"0041","AMA-PCPI","eCQM - CMS147v10","https://ecqi.healthit.gov/ecqm/ep/2021/cms147v10","Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization","Allergy & Immunology; Family Medicine; Internal Medicine; Obstetrics & Gynecology; Otolaryngology; Pediatrics; Preventive Medicine","Individuals","Initial population: All patients aged 6 months and older\nInitial population and seen for a visit during the measurement period, and seen for a visit between October 1 and March 31\n*For DPP reporting purposes, report denominator as individuals with encounters that fall within the measurement period, e.g., for CY2021, the denominator would include encounters from January 2021 - March 2021 and October 2021 - December 2021 (See \"Program Specific Modifications\" cell).","Initial Population\nexists ( [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n    where Global.\"CalendarAgeInMonthsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) >= 6)\n  and ( exists \"Qualifying Encounter During Measurement Period\"\n      or exists \"Hemodialysis During Measurement Period\"\n      or exists \"Peritoneal Dialysis During Measurement Period\")\n \n\"Initial Population\"\n  and ( exists \"Encounter During Influenza Season\"\n      or exists \"Hemodialysis During Influenza Season\"\n      or exists \"Peritoneal Dialysis During Influenza Season\")\n\n[\"Encounter, Performed\": \"Encounter-Influenza\"] FluEncounter\n  where FluEncounter.relevantPeriod starts during \"Influenza Season\"\n\n[\"Procedure, Performed\": \"Hemodialysis\"] FluSeasonHemodialysis\n  where FluSeasonHemodialysis.relevantPeriod overlaps \"Influenza Season\"\n\n[\"Procedure, Performed\": \"Peritoneal Dialysis\"] PeritonealDialysis\n  where PeritonealDialysis.relevantPeriod overlaps \"Measurement Period\"","Documentation of medical reason(s) for not receiving influenza immunization (e.g., patient allergy, other medical reasons).\nDocumentation of patient reason(s) for not receiving influenza immunization (e.g., patient declined, other patient reasons).\nDocumentation of system reason(s) for not receiving influenza immunization (e.g., vaccine not available, other system reasons).\n\nDenominator Exceptions\nexists \"Medical Patient or System Reason for Not Performing Influenza Vaccination\"\n  or exists \"Medical Patient or System Reason for Not Administering Influenza Vaccine\"\n  or exists \"Diagnosis of Allergy to Egg\"\n  or exists \"Egg Substance Allergy\"\n  or exists \"Diagnosis of Allergy to Influenza Vaccine\"\n  or exists \"Diagnosis of Intolerance to Influenza Vaccine\"\n  or exists \"Intolerance of Influenza Vaccination Procedure\"\n  or exists \"Allergy or Intolerance to Influenza Vaccine","Patients who received an influenza immunization OR who reported previous receipt of an influenza immunization","exists \"Influenza Vaccination Procedure\"\n  or exists \"Influenza Immunization Administered\"\n  or exists \"Influenza Vaccine Previously Received\"\n*For DPP reporting purposes, report numerator as individuals who received an influenza immunization OR who reported previous receipt of an influenza immunization within the measurement period, e.g., for denominator encounters in January 2021 – March 2021, the numerator would include influenza immunization received in August 2020 - March 2021, and for denominator encounters in October 2021 - December 2021, the numerator would include influenza immunization received in August 2021 - December 2021. An Individual with multiple eligible encounters during the data measurement period only has to have the numerator met once to be counted as Numerator Performance Met. (See \"Program Specific Modifications\" cell and please note the measure steward's definition of \"Previous Receipt\" in the \"Additional Information\" cell.)","None","For DPP reporting purposes, report denominator as individuals with encounters that fall within the measurement period, e.g., for CY2021, the denominator would include encounters from January 2021 - March 2021 and October 2021 - December 2021. \n \nFor DPP reporting purposes, report numerator as individuals who received an influenza immunization OR who reported previous receipt of an influenza immunization within the measurement period, e.g., for denominator encounters in January 2021 – March 2021, the numerator would include influenza immunization received in August 2020 - March 2021, and for denominator encounters in October 2021 - December 2021, the numerator would include influenza immunization received in August 2021 - December 2021. An Individual with multiple eligible encounters during the data measurement period only has to have the numerator met once to be counted as Numerator Performance Met. \n\nPlease note the measure steward's definition of \"Previous Receipt\" (see the \"Additional Information\" cell).","Definitions: \nPrevious Receipt - receipt of the current season's influenza immunization from another provider OR from same provider prior to the visit to which the measure is applied (typically, prior vaccination would include influenza vaccine given since August 1st)",null,null,null,"Positive"]
["C2-104","CHIRP","C2 (ACIA Rural Hospital Best Practices)","Preventive Care & Screening: Tobacco Use: Screening & Cessation Intervention","Process",null,"01/01/21 - 12/31/21","Numeric Data Reporting & Status Update Only",null,"NA","NA",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"0028","PCPI","eCQM - CMS138v9","https://ecqi.healthit.gov/ecqm/ep/2021/cms138v9","Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 12 months AND who received tobacco cessation intervention if identified as a tobacco user\n\nOnly one rate is reported:\nPercentage of patients aged 18 years and older who were screened for tobacco use one or more times within 12 months AND who received tobacco cessation intervention if identified as a tobacco user","*HHSC is determining how to align the measure specifications for this measure with CHIRP participants and will provide any measure-specific guidance to impacted CHIRP participants as needed.\n\nAllergy & Immunology; Dermatology; Family Medicine; Internal Medicine; Obstetrics & Gynecology; Ophthalmology; Orthopaedic Surgery; Otolaryngology; Physical Medicine & Rehabilitation; Plastic Surgery; Pediatrics (Optional); Preventive Medicine; Psychiatry & Neurology; Neurosurgical Surgery; Surgery; Thoracic Surgery; Urology; Audiologist; Occupational Therapist; Physical Therapist; Podiatrist; Social Worker; Speech Language Pathologist; Urgent Care","Individuals","*HHSC is determining how to align the measure specifications for this measure with CHIRP participants and will provide any measure-specific guidance to impacted CHIRP participants as needed.\n\nAll patients aged 18 years and older seen for at least two visits or at least one preventive visit during the measurement period","\"Initial Population\"\n\nexists ( [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n    where Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) >= 18)\n  and ( Count(\"Office Based Visit During Measurement Period\")>= 2\n      or exists \"Preventive Visit During Measurement Period\")","Documentation of medical reason(s) for not screening for tobacco use OR for not providing tobacco cessation intervention for patients identified as tobacco users (e.g., limited life expectancy, other medical reason)\n\nexists \"Medical Reason for Not Screening for Tobacco Use\"\n  or exists \"Medical Reason for Not Counseling Tobacco User\"\n  or exists \"Medical Reason for Not Ordering Tobacco Cessation Pharmacotherapy\"\n  or \"Has Limited Life Expectancy\"\n\n[\"Assessment, Not Performed\": \"Tobacco Use Screening\"] NoTobaccoUseScreening\n  where NoTobaccoUseScreening.authorDatetime during \"Measurement Period\"\n    and NoTobaccoUseScreening.negationRationale in \"Medical Reason\"\n\nor [\"Intervention, Not Performed\": \"Tobacco Use Cessation Counseling\"] NoTobaccoCessationCounseling\n  where NoTobaccoCessationCounseling.authorDatetime during \"Measurement Period\"\n    and NoTobaccoCessationCounseling.negationRationale in \"Medical Reason\"\n\nor [\"Medication, Not Ordered\": \"Tobacco Use Cessation Pharmacotherapy\"] NoCessationPharmacotherapyOrdered\n  where NoCessationPharmacotherapyOrdered.authorDatetime during \"Measurement Period\"\n    and NoCessationPharmacotherapyOrdered.negationRationale in \"Medical Reason\"\n\nor exists ( [\"Diagnosis\": \"Limited Life Expectancy\"] LimitedLifeExpectancy\n    where LimitedLifeExpectancy.prevalencePeriod overlaps after \"Measurement Period\")","Patients who were screened for tobacco use at least once within 12 months AND who received tobacco cessation intervention if identified as a tobacco user","Criteria 3\n\"Most Recent Tobacco Use Screening Indicates Tobacco Non User\" is not null\n  or ( \"Most Recent Tobacco Use Screening Indicates Tobacco User\" is not null\n      and ( exists \"Tobacco Cessation Counseling Given\"\n          or exists \"Tobacco Cessation Pharmacotherapy Ordered\"\n          or exists \"Active Pharmacotherapy for Tobacco Cessation\"))\n\n(Last([\"Assessment, Performed\": \"Tobacco Use Screening\"] TobaccoUseScreening\n    where TobaccoUseScreening.relevantDatetime during \"Measurement Period\"\n    sort by relevantDatetime)) MostRecentTobaccoUseScreening\n  where MostRecentTobaccoUseScreening.result in \"Tobacco Non-User\"\n \n(Last([\"Assessment, Performed\": \"Tobacco Use Screening\"] TobaccoUseScreening\n    where TobaccoUseScreening.relevantDatetime during \"Measurement Period\"\n    sort by relevantDatetime)) MostRecentTobaccoUseScreening\n  where MostRecentTobaccoUseScreening.result in \"Tobacco User\"\n\n[\"Intervention, Performed\": \"Tobacco Use Cessation Counseling\"] TobaccoCessationCounseling\n  where TobaccoCessationCounseling.relevantDatetime during \"Measurement Period\"\n\n[\"Medication, Order\": \"Tobacco Use Cessation Pharmacotherapy\"] CessationPharmacotherapyOrdered\n  where CessationPharmacotherapyOrdered.authorDatetime during \"Measurement Period\"\n\n[\"Medication, Active\": \"Tobacco Use Cessation Pharmacotherapy\"] TakingCessationPharmacotherapy\n  where TakingCessationPharmacotherapy.relevantPeriod overlaps after \"Measurement Period\"","None","*HHSC is determining how to align the measure specifications for this measure with CHIRP participants and will provide any measure-specific guidance to impacted CHIRP participants as needed.\n\nOnly one rate is reported. If using the E.H.R. version of the specifications, the denominator is all individuals that meet the initial population (Criteria 1) and the numerator is all individuals from the denominator that meet all applicable criteria (for example, meet numerator criteria 1 if included only in denominator criteria 1, or meet numerator criteria 1, 2, and 3, if included in denominator criteria 1, 2, and 3). ","Definitions:\nTobacco Use - Includes any type of tobacco\nTobacco Cessation Intervention - Includes brief counseling (3 minutes or less), and/or pharmacotherapy -- Note: Concepts aligned with brief counseling (e.g., minimal and intensive advice/counseling interventions conducted both in person and over the phone) are included in the value set for the numerator. Other concepts such as written self-help materials (e.g., brochures, pamphlets) and complementary/alternative therapies are not included in the value set and do not qualify for the numerator. Brief counseling also may be of longer duration or be performed more frequently, as evidence shows there is a dose-response relationship between the intensity of counseling provided (either length or frequency) and tobacco cessation rates (U.S. Preventive Services Task Force, 2015).\n\n\nGuidance: \nThe requirement of two or more visits is to establish that the eligible professional or eligible clinician has an existing relationship with the patient for certain types of encounters. \n\nTo satisfy the intent of this measure, a patient must have at least one tobacco use screening during the 12-month period. If a patient has multiple tobacco use screenings during the 12-month period, only the most recent screening, which has a documented status of tobacco user or tobacco non-user, will be used to satisfy the measure requirements.\n\nIf a patient uses any type of tobacco (i.e., smokes or uses smokeless tobacco), the expectation is that they should receive tobacco cessation intervention: either counseling and/or pharmacotherapy.\n\nAs noted above in a recommendation statement from the USPSTF, the current evidence is insufficient to recommend electronic nicotine delivery systems (ENDS) including electronic cigarettes for tobacco cessation. Additionally, ENDS are not currently classified as tobacco in the recent evidence review to support the update of the USPSTF recommendation given that the devices do not burn or use tobacco leaves. In light of the current lack of evidence, the measure does not currently capture e-cigarette usage as either tobacco use or a cessation aid.\n\nIf tobacco use status of a patient is unknown, the patient does not meet the screening component required to be counted in the numerator and should be considered a measure failure. Instances where tobacco use status of \"unknown\" is recorded include: 1) the patient was not screened; or 2) the patient was screened and the patient (or caregiver) was unable to provide a definitive answer. If the patient does not meet the screening component of the numerator but has an allowable medical exception, then the patient should be removed from the denominator of the measure and reported as a valid exception.\n\nIn order to promote a team-based approach to patient care, the tobacco cessation intervention can be performed by another healthcare provider; therefore, the tobacco use screening and tobacco cessation intervention do not need to be performed by the same provider or clinician.   \n\nThe medical reason exception may be applied to either the screening data element OR to any of the applicable tobacco cessation intervention data elements (counseling and/or pharmacotherapy) included in the measure. \n\nIf a patient has a diagnosis of limited life expectancy, that patient has a valid denominator exception for not being screened for tobacco use or for not receiving tobacco use cessation intervention (counseling and/or pharmacotherapy) if identified as a tobacco user.\n\nThis measure contains three reporting rates which aim to identify patients who were screened for tobacco use (rate/population 1), patients who were identified as tobacco users and who received tobacco cessation intervention (rate/population 2), and a comprehensive look at the overall performance on tobacco screening and cessation intervention (rate/population 3). By separating this measure into various reporting rates, the eligible professional or eligible clinician will be able to better ascertain where gaps in performance exist, and identify opportunities for improvement. The overall rate (rate/population 3) can be utilized to compare performance to published versions of this measure prior to the 2018 performance year, when the measure had a single performance rate. \n \nThis eCQM is a patient-based measure.\n\nThis version of the eCQM uses QDM version 5.5.  Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.",null,null,null,"Positive",null,null,null,null,null,null,null,"Measure is a screening rate. Both positive and negative screens should be included if they meet the numerator inclusion criteria. "]
["C2-128","CHIRP","C2 (ACIA Maternal Care)","AIM Collaborative Participation","Structure",null,"NA","Status Update Only",null,"NA","NA",null,"NA",null,null,null,null,null,"NA","NA","NA","NA","Reporting on status of participating in the available Texas AIM Collaboratives. ","NA","NA",null,null,null,null,null,null,null,null,null,null,null,"N/A"]
["C2-129","CHIRP","C2 (ACIA Maternal Care)","Severe Maternal Morbidity","Outcome",null,"01/01/21 - 12/31/21","Numeric Data Reporting & Status Update Only",null,"NA","NA",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"NA","AIM","AIM","https://safehealthcareforeverywoman.org/aim/resources/aim-data-resources/","The percentage of mothers who experience Severe Maternal Morbidity (SMM)","NA","Encounters","All mothers during their birth admission","Exclude ectopics and miscarriages ",null,"Among the denominator, all cases with any SMM code",null,null,null,"see AIM SMM Codes List:\nhttp://safehealthcareforeverywoman.org/aim-program/aim-data/\n",null,null,null,"Negative"]
["C2-130","CHIRP","C2 (ACIA Maternal Care)","PC-02 Cesarean Section","Outcome",null,"01/01/21 - 12/31/21","Numeric Data Reporting & Status Update Only",null,"NA","NA",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"0471","The Joint Commission","The Joint Commission\n(PC-02/ePC-02 2021) ","PC-02 (chart abstracted): https://manual.jointcommission.org/releases/TJC2021A/MIF0167.html\nePC-02 (E.H.R. abstracted): https://www.jointcommission.org/-/media/tjc/documents/measurement/specification-manuals/2021-reporting-period/ecqm_specifications_reportingperiod_2021.zip","Nulliparous women with a term, singleton baby in a vertex position delivered by cesarean birth","NA","Encounters","Nulliparous patients with an ICD-10-CM Principal or Other Diagnosis Code for outcome of delivery as defined in Appendix A, Table 11.08 and with a delivery of a newborn with 37 weeks or more gestation completed or with an ICD-10-PCS Principal or Other Procedure Codes for delivery as defined in Appendix A, Tables 11.01.1.",null,"• ICD-10-CM Principal Diagnosis Code or ICD-10-CM Other Diagnosis Codes for multiple gestations and other presentations as defined in Appendix A, Table 11.09\n• Less than 8 years of age\n• Greater than or equal to 65 years of age\n• Length of Stay >120 days\n• Gestational Age < 37 weeks or UTD","Patients with cesarean births with ICD-10-PCS Principal Procedure Code or ICD-10-PCS Other Procedure Codes for cesarean birth as defined in Appendix A, Table 11.06.",null,null,"Chart abstracted measures are included in the CHIRP specifications, as well as a link to the eCQI e-measure. Hospitals may use either the chart abstracted measure or the eCQI e-measure to align with their existing TJC reporting infrastructure. Hospitals should indicate which version of the measure is utilized at the time of CHIRP reporting. ",null,null,null,null,"Negative"]
["C2-131","CHIRP","C2 (ACIA Hospital Safety)","Hospital Safety Collaborative Participation","Structure",null,"09/01/20 - 08/31/21","Status Update Only",null,"NA","NA",null,"NA",null,null,null,null,null,"NA","NA","NA","NA","Reporting on status of participating in a hospital safety collaborative. A Hospital Safety Learning Collaborative is any conference, workshop, stakeholder forum, stakeholder meeting related to improving hospital safety. It may take place anywhere, not only in the provider’s SDA, and events may be virtual or in person. ","NA","NA",null,null,null,null,null,null,null,null,null,null,null,"N/A"]
["C2-132","CHIRP","C2 (ACIA Hospital Safety)","Catheter-Associated Urinary Tract Infection (CAUTI) Outcome Measure","Outcome",null,"01/01/21 - 12/31/21","Numeric Data Reporting & Status Update Only",null,"NA","NA",null,"All payer",null,null,null,null,null,"0138","CDC","CDC/NHSN","https://www.cdc.gov/nhsn/enrolled-facilities/index.html","This measure calculates the total number of healthcare-associated CAUTI among patients in bedded inpatient care locations, from the total number of indwelling urinary catheter days for each location under surveillance for CAUTI during the associated data period. This measure is risk-adjusted.","NA","Encounters","Total number of predicted healthcare-associated CAUTI among inpatient care locations under surveillance for CAUTI during the data period, based on the national CAUTI baseline Data is calculated using the facility's number of catheter days and the following significant risk factors: Acute Care Hospitals: CDC Location, Facility bed size, Medical school affiliation, and Facility type Critical Access Hospitals: Medical school affiliation Long-Term Acute Hospitals: Average length of stay, Setting type, and Location type Inpatient Rehabilitation Facilities: Setting type, Proportion of admissions with traumatic and non-traumatic spinal cord dysfunction, Proportion of admissions with stroke",null,null,"Total number of observed healthcare-associated CAUTI among patients in bedded inpatient care locations (excluding patients in Level II or III neonatal ICUs).",null,null,null,"Use the SIR – CAU Data for Hospital IQR report used for NHSN reporting, which includes only units reported to CMS. ",null,null,null,"Negative",null,null,null,null,null,null,null,"Measure is reported as a Standardized Infection Ratios (SIR), where the numerator is reported as the number of actual observed infections, and the denominator is reported as the number of predicted infections (as calculated by National Healthcare Safety Network [NHSN]). Do not report the denominator using rounding."]
["C2-133","CHIRP","C2 (ACIA Hospital Safety)","Central Line Associated Bloodstream Infection (CLABSI) Outcome Measure","Outcome",null,"01/01/21 - 12/31/21","Numeric Data Reporting & Status Update Only",null,"NA","NA",null,"All payer",null,null,null,null,null,"0139","CDC","CDC/NHSN","https://www.cdc.gov/nhsn/enrolled-facilities/index.html","Standardized Infection Ratio (SIR) of healthcare-associated, central line-associated bloodstream infections (CLABSI) will be calculated among patients in bedded inpatient care locations.","NA","Encounters","Total number of predicted healthcare-associated CLABSI among patients in bedded inpatient care locations, calculated using the facility's number of central line days and the following significant risk factors: - Acute Care Hospitals: CDC location, facility bed size, medical school affiliation, facility type, birthweight category (NICU locations only) - Critical Access Hospitals: no significant risk factors, calculation based intercept only model - Inpatient Rehabilitation Facilities: Proportion of admissions with stroke, proportion of admissions in other non-specific diagnostic categories - Long Term Acute Care Hospitals: CDC location type , facility bed size, average length of stay, proportion of admissions on a ventilator, proportion of admissions on hemodialysis",null,null,"Total number of observed healthcare-associated CLABSIs among patients in bedded inpatient care locations.",null,null,null,"Use the SIR – CLAB Data for Hospital IQR report used for NHSN reporting, which includes only units reported to CMS. \n",null,null,null,"Negative",null,null,null,null,null,null,null,"Measure is reported as a Standardized Infection Ratios (SIR), where the numerator is reported as the number of actual observed infections, and the denominator is reported as the number of predicted infections (as calculated by National Healthcare Safety Network [NHSN]). Do not report the denominator using rounding."]
["C2-134","CHIRP","C2 (ACIA Hospital Safety)","Facility-wide Inpatient Hospital-onset Clostridium difficile Infection (CDI) Outcome Measure","Outcome",null,"01/01/21 - 12/31/21","Numeric Data Reporting & Status Update Only",null,"NA","NA",null,"All payer",null,null,null,null,null,"1717","CDC","CDC/NHSN","https://www.cdc.gov/nhsn/enrolled-facilities/index.html","This measure calculates the total number of observed hospital-onset CDI LabID events among all inpatients in the facility, excluding well baby-nurseries and NICUs, from the total number of expected hospital-onset CDI LabID events, determined through the facility's number of inpatient days, bed size, affiliation with a medical school, microbiological test used to identify C. difficile, and community onset CDI admission prevalence rate.","NA","Encounters","Total number of predicted hospital-onset CDI LabID events, calculated using the facility's number of inpatient days, facility type, CDI event reporting from Emergency Department and 24 hour observation units, bed size, ICU bed size, affiliation with medical school, microbiological test method used to identify C. difficile, and community-onset CDI admission prevalence rate.",null,null,"Total number of observed hospital-onset CDI LabID events among all inpatients in the facility, excluding well baby-nurseries and NICUs",null,null,null,null,null,null,null,"Negative",null,null,null,null,null,null,null,"Measure is reported as a Standardized Infection Ratios (SIR), where the numerator is reported as the number of actual observed infections, and the denominator is reported as the number of predicted infections (as calculated by National Healthcare Safety Network [NHSN]). Do not report the denominator using rounding."]
["C2-135","CHIRP","C2 (ACIA Hospital Safety)","Harmonized Procedure Specific Surgical Site Infection (SSI) Outcome Measure","Outcome",null,"01/01/21 - 12/31/21","Numeric Data Reporting & Status Update Only",null,"NA","NA",null,"All payer",null,null,null,null,null,"0753","CDC","CDC/NHSN","https://www.cdc.gov/nhsn/enrolled-facilities/index.html","Facility adjusted Standardized Infection Ratio (SIR) for deep incisional and organ/space Surgical Site Infections (SSI) at the primary incision site among adult patients aged >= 18 years as reported through the CDC National Health and Safety Network (NHSN).","NA","Encounters","An NHSN Operative Procedure is a procedure: that is included in the ICD-10-PCS or CPT NHSN operative procedure code mapping. And takes place during an operation where at least one incision (including laparoscopic approach and cranial Burr holes) is made through the skin or mucous membrane, or reoperation via an incision that was left open during a prior operative procedure And takes place in an operating room (OR), defined as a patient care area that met the Facilities Guidelines Institute s (FGI) or American Institute of Architects (AIA) criteria for an operating room when it was constructed or renovated. This may include an operating room, C-section room, interventional radiology room, or a cardiac catheterization lab. Exclusions: Otherwise eligible procedures that are assigned an ASA score of 6 are not eligible for NHSN SSI surveillance.",null,null,"Deep incisional primary (DIP) and organ/space SSIs during the 30-day postoperative period among patients = 18 years of age, who undergo inpatient colon surgeries or abdominal hysterectomies. SSIs will be identified before discharge from the hospital, upon readmission to the same hospital, or during outpatient care or admission to another hospital (post-discharge surveillance). Numerator Exclusion SSI events with PATOS* field = yes.",null,null,"Please add together the predicted number for each of the two types of procedures (colon and hysterectomys) and enter that sum into the denominator in the CHIRP template. Please add together the observed number for each of the two types of procedures and enter that into the numerator in the CHIRP template. This is the appropriate way to create the pooled rate according to the CDC. ","Use the Complex 30 day SSI data for Hospital IQR or Hospital IPPS report from NHSN reporting.  This report is also known as the CMS model using 2015 baseline which would be for reporting hysterectomy and colon procedures.  ",null,null,null,"Negative",null,null,null,null,null,null,null,"Measure is reported as a Standardized Infection Ratios (SIR), where the numerator is reported as the number of actual observed infections for the two types of procedures (colon and hysterectomy), and the denominator is reported as the number of predicted infections for the two types of procedures (colon and hysterectomy) as calculated by National Healthcare Safety Network (NHSN). Do not report the denominator using rounding. The “Complex 30-day SSI data for Hospital IQR” or the “Hospital IPPS report from NHSN” reporting must be used to calculate the denominator; this report is also known as the “CMS model using 2015 baseline”, which would be used for reporting the colon and hysterectomy procedures."]
["C2-155","CHIRP","C2 (ACIA Pediatric)","Pediatric SSI","Outcome",null,"01/01/21 - 12/31/21","Numeric Data Reporting & Status Update Only",null,"NA","NA",null,"All payer",null,null,null,null,null,"NA","Children’s Hospitals’ Solutions for Patient Safety National Children’s Network","CHSPS","https://www.solutionsforpatientsafety.org/wp-content/uploads/sps-operating-definitions_MAY-2020.pdf","This measure answers the question: How often is a patient harmed due to surgical site infection following selected surgeries?","NA","Encounters","Number of designated surgical procedures during the applicable reporting period. Three surgery categories are considered for this measurement. ","All patients who experience one of the below surgical procedures:\n Spinal fusion surgeries as defined by NHSN (FUSN).\n Procedures such as growing construct placements and adjustments should be included if a facility routinely uses CPT or ICD-10 codes included in the FUSN category for such procedures.\n Neurosurgical shunt surgeries as defined by NHSN (VSHN)\n Procedures such as third ventriculostomy and external ventricular drain placement are included even though technically these are not shunt procedures.\n The CPT code 44055 (correction of malrotation) should be used only if the procedure involves a ventricular shunt.\n Cardiothoracic surgeries as defined by NHSN (CARD)","Patients with physician/advanced practice nurse/physician assistant documentation of an active infection at the time of the surgical procedure.\n Detailed criteria for an infection at time of surgery (PATOS) is available in the NHSN Manual (link above).\n Signs/symptoms of infection can include but not be limited to: fever, ","Number of SSIs related to designated surgical procedures.","Surgical Site Infection Definitions:\n\n Superficial Incisional SSI\nInfection occurs within 30 days of the operative procedure (procedure date is day\n1) AND involves only skin and subcutaneous tissue of the incision AND patient\nhas at least one of the following:\na. purulent drainage from the superficial incision.\nb. organisms identified from an aseptically-obtained specimen from the superficial incision or subcutaneous tissue by a culture or non-culture based microbiologic testing method which is performed for purposes of clinical diagnosis or treatment (for example, not Active Surveillance Culture/Testing (ASC/AST).\nc. superficial incision that is deliberately opened by a surgeon, attending physician or other designee and culture or non-culture based testing is not performed, AND patient has at least one of the following signs or symptoms: pain or tenderness; localized swelling; erythema; or heat.\nd. diagnosis of a superficial incisional SSI by the surgeon or attending physician or other designee.\nNote: The following do not meet the superficial SSI definition: Diagnosis or treatment of cellulitis (redness/warmth/swelling) by itself; stitch abscess alone (minimal inflammation and discharge confined to the points of suture penetration); localized stab wound or pin site infection\n\n Deep Incisional SSI\nInfection occurs within 90 days AND involves deep soft tissues (e.g., fascial and muscle layers) of the incision AND patient has at least one of the following:\na. purulent drainage from the deep incision.\nb. a deep incision spontaneously dehisces or is deliberately opened by a surgeon, attending physician, or other designee  and organism is identified by culture or non-culture based microbiologic testing method which is performed for purposes of clinical diagnosis or treatment or culture or non-culture based microbiologic testing method is not performed and the patient has at least one of the following signs or symptoms: fever (>38°C); localized pain or tenderness. A culture or non-culture-based test that has a negative finding does not meet this criterion.\nc. an abscess or other evidence of infection involving the deep incision that is detected on gross anatomical or histopathologic exam, or imaging test.\n\n Organ/Space SSI\nInfection occurs within 90 days after the operative procedure AND infection involves any part of the body deeper than the fascial/muscle layers that is opened or manipulated during the operative procedure AND patient has at least one of the following:\na. Purulent drainage from a drain that is placed in the organ/space (for example, closed suction drainage system, open drain, T-tube drain, CT guided drainage)\nb. organisms are identified from fluid or tissue in the organ/space by a culture or non-culture based microbiologic testing method which is performed for purposes of clinical diagnosis or treatment\nc. An abscess or other evidence of infection involving the organ/space that is detected on gross anatomical or histopathologic exam, or imaging test evidence suggestive of infection. And Meets at least one criterion for a specific organ/space infection site (listed in Table 3, NHSN Manual, http://www.cdc.gov/nhsn/PDFs/pscManual/9pscSSIcurrent.pdf)",null,null,null,null,null,null,"Negative"]
["C2-156","CHIRP","C2 (ACIA Pediatric)","Hospital Safety Collaborative Participation","Structure",null,"09/01/20 - 08/31/21","Status Update Only",null,"NA","NA",null,"NA",null,null,null,null,null,"NA","NA","NA","NA","Reporting on status of participation in a pediatric hospital safety collaborative ","NA","NA",null,null,null,null,null,null,null,null,null,null,null,"N/A"]
["C2-157","CHIRP","C2 (ACIA Pediatric)","Pediatric Adverse Drug Events","Outcome",null,"01/01/21 - 12/31/21","Numeric Data Reporting & Status Update Only",null,"NA","NA",null,"All payer",null,null,null,null,null,"NA","Children’s Hospitals’ Solutions for Patient Safety National Children’s Network","CHSPS","https://www.solutionsforpatientsafety.org/wp-content/uploads/sps-operating-definitions_MAY-2020.pdf","This measure answers the question: How often is a patient harmed due to failure to procure (not related to a drug shortage), store, prescribe, dispense, administer, or monitor medication as intended?","NA","Encounters","Total number patient days. ","All patients are included who are defined as inpatient or under observation at the hospital.","Enteral feeds are not counted as drug errors.\nBlood products are not counted as drug errors.","Number of adverse drug events per NCC MERP’s Index for Categorizing Medication Errors.\nNumerators will be reported as Level E and combined Level F-I as defined below.\nE = An error occurred that may have contributed to or resulted in temporary harm to the patient and required intervention\nF = An error occurred that may have contributed to or resulted in temporary harm to the patient and required initial or prolonged hospitalization\nG = An error occurred that may have contributed to or resulted in permanent patient harm\nH = An error occurred that required intervention necessary to sustain life\nI = An error occurred that contributed to or resulted in the patient’s death",null,null,null,"NCC MERP Medication Error Index: https://www.nccmerp.org/types-medication-errors",null,null,null,"Negative"]
["C2-158","CHIRP","C2 (ACIA Pediatric)","Pediatric CLABSI","Outcome",null,"01/01/21 - 12/31/21","Numeric Data Reporting & Status Update Only",null,"NA","NA",null,"All payer",null,null,null,null,null,"NA","Children’s Hospitals’ Solutions for Patient Safety National Children’s Network","CHSPS","https://www.solutionsforpatientsafety.org/wp-content/uploads/sps-operating-definitions_MAY-2020.pdf","This measure answers the question: How often is a patient harmed due to central line associated blood stream infections (CLABSIs)?","NA","Encounters","Total number of central line days during the time period.","All patients are included who are defined as inpatient or under observation at the hospital including one calendar day post discharge (including the CLABSIs related to Mucosal Barrier Injuries (MBIs)).","Infection must not be present on admission into the hospital as defined by NHSN. For most infections, this means that the infection does not become evident until two calendar days or more after admission, but each infection must be assessed individually.","Number of patients with a CLABSI event, as defined by CDC guidelines. For this measure, distinction is not made between an infection due to CVC/PICC insertion and one due to maintenance practices.",null,null,null,null,null,null,null,"Negative"]
["C2-159","CHIRP","C2 (ACIA Pediatric)","Pediatric CAUTI","Outcome",null,"01/01/21 - 12/31/21","Numeric Data Reporting & Status Update Only",null,"NA","NA",null,"All payer",null,null,null,null,null,"NA","Children’s Hospitals’ Solutions for Patient Safety National Children’s Network","CHSPS","https://www.solutionsforpatientsafety.org/wp-content/uploads/sps-operating-definitions_MAY-2020.pdf","This measure answers the question: How often are patients harmed by the occurrence of a catheter associated urinary tract infections?","NA","Encounters","Total number of indwelling urinary catheter days during the time period.","All patients admitted to an inpatient unit are included who are defined as inpatient or under observation at the hospital with an indwelling urinary catheter.","Observation patients admitted to observation units and patients admitted to neonatal intensive care units will be excluded. \n\nInfection must not be incubating at the time of the admission into the hospital. For most infections, this means that the infection does not become evident until 48 hours or more after admission, but each infection must be assessed individually. There is no minimum period of time that the catheter must be in place in order for the UTI to be considered catheter associated. ","Number of patients contracting an infection, as defined by CDC guidelines.",null,null,null,null,null,null,null,"Negative"]
["C2-160","CHIRP","C2 (ACIA Pediatric)","Engagement in Integrated Behavioral Health","Process",null,"01/01/21 - 12/31/21","Numeric Data Reporting & Status Update Only",null,"NA","NA",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"NA","Texas HHSC (Developed by Meadows Mental Health Policy Institute)","NA","NA","The percentage of children or youth initiating behavioral health care who received, or whose caregivers received, at least one follow-up behavioral health care or care management contact within 30 days of initiating behavioral health contact.","NA","Individuals","The unduplicated number of children and youth who were documented in the electronic health record as having had an initial behavioral health service or contact (in-person, virtual, or telephonic).","Behavioral health contact can include an assessment, a treatment session, or any other type of contact that had a behavioral health focus and that was documented in the clinical record.","Children/youth and caregivers/families who refused subsequent behavioral health care or other assistance that was offered at the initial behavioral health contact, and for whom such refusal was documented in the clinical record, should be excluded from the analysis.","The unduplicated number of children or youth who received, or whose caregivers received, a second contact (in-person, virtual, or telephonic) from a behavioral health provider, care coordinator, or care manager within 30 days of initial behavioral health contact, as documented in the electronic health record.",null,null,null,"For individuals who have multiple denominator eligible encounters, “initial encounter\" is defined as the first encounter within the measurement period.",null,null,null,"Positive"]
["C2-141","CHIRP","C2 (ACIA Psychiatric Care Transitions)","Written transition procedures that include formal MCO relationship or EDEN notification/ ADT Feed for psychiatric patients\n","Structure",null,"NA","Status Update Only",null,"NA","NA",null,"NA",null,null,null,null,null,"NA","NA","NA","NA","Reporting on status of developing and implementing standard operating policies and procedures for providing a member's managed care plan with expedient notification of admission, transfer, or discharge from hospitalization for psychiatric illness. \n\nNotification can use any format (electronic data exchange, phone call, fax, secure email, etc), the question is whether there is a standardized procedure across the organization that staff are expected to follow. If an organization uses an HIE or EHR that automatically transmits notifications to MCOs when medical data is entered into the EHR, then having standard operating procedures for entering patient data into the EHR is also considered the standardized procedure for notifying the MCO.   ","NA","NA",null,null,null,null,null,null,null,null,null,null,null,"N/A"]
["C2-142","CHIRP","C2 (ACIA Care Transitions)","Written transition procedures that include formal MCO relationship or EDEN notification/ ADT Feed for non-psychiatric patients","Structure",null,"NA","Status Update Only",null,"NA","NA",null,"NA",null,null,null,null,null,"NA","NA","NA","NA","Reporting on status of developing and implementing standard operating policies and procedures for providing a member's managed care plan with expedient notification of admission, transfer, or discharge from hospitalization. \n\nNotification can use any format (electronic data exchange, phone call, fax, secure email, etc), the question is whether there is a standardized procedure across the organization that staff are expected to follow. If an organization uses an HIE or EHR that automatically transmits notifications to MCOs when medical data is entered into the EHR, then having standard operating procedures for entering patient data into the EHR is also considered the standardized procedure for notifying the MCO.   ","NA","NA",null,null,null,null,null,null,null,null,null,null,null,"N/A"]
["R1-101","RAPPS","R1","Care team includes personnel in a care coordination role not requiring clinical licensure","Structure",null,"NA","Status Update Only",null,"NA","NA",null,"NA",null,null,null,null,null,"NA","NA","NA","NA","Reporting of care team composition, number of encounters performed by personnel in a care coordination role not requiring clinical licensure (e.g., community health workers, promotor(a)s, any social workers that are not a licensed clinical social worker, patient navigators, and medical assistants that perform care coordination)","NA","NA",null,null,null,null,null,null,null,null,null,null,null,"N/A",null,null,null,null,null,null,null,"A care coordination role typically involves functions or responsibilities to review a client’s care plan to proactively confirm that any needed appointments, specialty services, labs, tests, and community resources are being coordinated and completed. Examples of personnel not requiring clinical licensure AND who may be performing a care coordination role typically include community health workers, promotor(a)s, any social workers that are not a licensed clinical social worker, patient navigators, and medical assistants."]
["R1-143","RAPPS","R1","Telehealth to provide virtual medical appointments with a primary care or specialty care provider ","Structure",null,"NA","Status Update Only",null,"NA","NA",null,"NA",null,null,null,null,null,"NA","NA","NA","NA","Reporting on usage of telehealth to provide virtual medical appointments with a primary care or specialty care provider ","NA","NA",null,null,null,null,null,null,null,null,null,null,null,"N/A"]
["R1-144","RAPPS","R1","Use of electronic health record (EHR)","Structure",null,"NA","Status Update Only",null,"NA","NA",null,"NA",null,null,null,null,null,"NA","NA","NA","NA","Reporting on use of electronic health record (EHR)","NA","NA",null,null,null,null,null,null,null,null,null,null,null,"N/A"]
["R2-103","RAPPS","R2","Preventive Care and Screening: Influenza Immunization ","Process",null,"01/01/21 - 12/31/21","Numeric Data Reporting & Status Update Only",null,"NA","NA",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"0041","AMA-PCPI","eCQM - CMS147v10","https://ecqi.healthit.gov/ecqm/ep/2021/cms147v10","Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization","Allergy & Immunology; Family Medicine; Internal Medicine; Obstetrics & Gynecology; Otolaryngology; Pediatrics; Preventive Medicine","Individuals","Initial population: All patients aged 6 months and older\nInitial population and seen for a visit during the measurement period, and seen for a visit between October 1 and March 31\n*For DPP reporting purposes, report denominator as individuals with encounters that fall within the measurement period, e.g., for CY2021, the denominator would include encounters from January 2021 - March 2021 and October 2021 - December 2021 (See \"Program Specific Modifications\" cell).","Initial Population\nexists ( [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n    where Global.\"CalendarAgeInMonthsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) >= 6)\n  and ( exists \"Qualifying Encounter During Measurement Period\"\n      or exists \"Hemodialysis During Measurement Period\"\n      or exists \"Peritoneal Dialysis During Measurement Period\")\n \n\"Initial Population\"\n  and ( exists \"Encounter During Influenza Season\"\n      or exists \"Hemodialysis During Influenza Season\"\n      or exists \"Peritoneal Dialysis During Influenza Season\")\n\n[\"Encounter, Performed\": \"Encounter-Influenza\"] FluEncounter\n  where FluEncounter.relevantPeriod starts during \"Influenza Season\"\n\n[\"Procedure, Performed\": \"Hemodialysis\"] FluSeasonHemodialysis\n  where FluSeasonHemodialysis.relevantPeriod overlaps \"Influenza Season\"\n\n[\"Procedure, Performed\": \"Peritoneal Dialysis\"] PeritonealDialysis\n  where PeritonealDialysis.relevantPeriod overlaps \"Measurement Period\"","Documentation of medical reason(s) for not receiving influenza immunization (e.g., patient allergy, other medical reasons).\nDocumentation of patient reason(s) for not receiving influenza immunization (e.g., patient declined, other patient reasons).\nDocumentation of system reason(s) for not receiving influenza immunization (e.g., vaccine not available, other system reasons).\n\nDenominator Exceptions\nexists \"Medical Patient or System Reason for Not Performing Influenza Vaccination\"\n  or exists \"Medical Patient or System Reason for Not Administering Influenza Vaccine\"\n  or exists \"Diagnosis of Allergy to Egg\"\n  or exists \"Egg Substance Allergy\"\n  or exists \"Diagnosis of Allergy to Influenza Vaccine\"\n  or exists \"Diagnosis of Intolerance to Influenza Vaccine\"\n  or exists \"Intolerance of Influenza Vaccination Procedure\"\n  or exists \"Allergy or Intolerance to Influenza Vaccine","Patients who received an influenza immunization OR who reported previous receipt of an influenza immunization","exists \"Influenza Vaccination Procedure\"\n  or exists \"Influenza Immunization Administered\"\n  or exists \"Influenza Vaccine Previously Received\"\n*For DPP reporting purposes, report numerator as individuals who received an influenza immunization OR who reported previous receipt of an influenza immunization within the measurement period, e.g., for denominator encounters in January 2021 – March 2021, the numerator would include influenza immunization received in August 2020 - March 2021, and for denominator encounters in October 2021 - December 2021, the numerator would include influenza immunization received in August 2021 - December 2021. An Individual with multiple eligible encounters during the data measurement period only has to have the numerator met once to be counted as Numerator Performance Met. (See \"Program Specific Modifications\" cell and please note the measure steward's definition of \"Previous Receipt\" in the \"Additional Information\" cell.)","None","For DPP reporting purposes, report denominator as individuals with encounters that fall within the measurement period, e.g., for CY2021, the denominator would include encounters from January 2021 - March 2021 and October 2021 - December 2021. \n \nFor DPP reporting purposes, report numerator as individuals who received an influenza immunization OR who reported previous receipt of an influenza immunization within the measurement period, e.g., for denominator encounters in January 2021 – March 2021, the numerator would include influenza immunization received in August 2020 - March 2021, and for denominator encounters in October 2021 - December 2021, the numerator would include influenza immunization received in August 2021 - December 2021. An Individual with multiple eligible encounters during the data measurement period only has to have the numerator met once to be counted as Numerator Performance Met. \n\nPlease note the measure steward's definition of \"Previous Receipt\" (see the \"Additional Information\" cell).","Definitions: \nPrevious Receipt - receipt of the current season's influenza immunization from another provider OR from same provider prior to the visit to which the measure is applied (typically, prior vaccination would include influenza vaccine given since August 1st)",null,null,null,"Positive"]
["R2-102","RAPPS","R2","Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Poor Control (>9.0%)","Outcome",null,"01/01/21 - 12/31/21","Numeric Data Reporting & Status Update Only",null,"NA","NA",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"0059","NCQA","eCQM - CMS 122v9","https://ecqi.healthit.gov/ecqm/ep/2021/cms122v9","Percentage of patients 18-75 years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period","Family Medicine; Internal Medicine; Pediatrics (Optional); Preventive Medicine; Dietician, Registered","Individuals","Patients 18-75 years of age with diabetes with a visit during the measurement period","\"Initial Population\"\n\nexists ( [\"Patient Characteristic Birthdate\"] Birthdate\n\t\twhere Global.\"CalendarAgeInYearsAt\"(Birthdate.birthDatetime, start of \"Measurement Period\")in Interval[18, 75 ))\n\tand exists ( AdultOutpatientEncounters.\"Qualifying Encounters\" )\n\tand exists ( [\"Diagnosis\": \"Diabetes\"] Diabetes\n\t\t\twhere Diabetes.prevalencePeriod overlaps \"Measurement Period\")\n\n( [\"Encounter, Performed\": \"Office Visit\"]\n\tunion [\"Encounter, Performed\": \"Annual Wellness Visit\"]\n\tunion [\"Encounter, Performed\": \"Preventive Care Services - Established Office Visit, 18 and Up\"]\n\tunion [\"Encounter, Performed\": \"Preventive Care Services-Initial Office Visit, 18 and Up\"]\n\tunion [\"Encounter, Performed\": \"Home Healthcare Services\"] ) ValidEncounter\n\twhere ValidEncounter.relevantPeriod during \"Measurement Period\"","Exclude patients whose hospice care overlaps the measurement period.\n\nExclude patients 66 and older who are living long term in an institution for more than 90 consecutive days during the measurement period.\n\nExclude patients 66 and older with advanced illness and frailty because it is unlikely that patients will benefit from the services being measured.\n\nHospice.\"Has Hospice\"\n  or FrailtyLTI.\"Advanced Illness and Frailty Exclusion Not Including Over Age 80\"\n  or ( exists [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n      where ( Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) >= 65 )\n        and FrailtyLTI.\"Long Term Care Periods Longer Than 90 Consecutive Days\")\n \n\nHospice. \"Has Hospice\"\n\nexists ( [\"Encounter, Performed\": \"Encounter Inpatient\"] DischargeHospice\n\t\twhere (DischargeHospice.dischargeDisposition as Code ~ \"Discharge to home for hospice care (procedure)\"\n\t\t\t\tor DischargeHospice.dischargeDisposition as Code ~ \"Discharge to healthcare facility for hospice care (procedure)\")\n\t\t\tand DischargeHospice.relevantPeriod ends during \"Measurement Period\")\n\tor exists ( [\"Intervention, Order\": \"Hospice care ambulatory\"] HospiceOrder\n\t\t\twhere HospiceOrder.authorDatetime during \"Measurement Period\")\n\tor exists ( [\"Intervention, Performed\": \"Hospice care ambulatory\"] HospicePerformed\n\t\t\twhere HospicePerformed.relevantPeriod overlaps \"Measurement Period\")","Patients whose most recent HbA1c level (performed during the measurement period) is >9.0%","\"Has Most Recent Elevated Hba1c\"\n\tor \"Has Most Recent HbA1c Without Result\"\n\tor \"Has No Record Of HbA1c\"\n\nLast([\"Laboratory Test, Performed\": \"HbA1c Laboratory Test\"] HighHbA1c\n\t\twhere HighHbA1c.relevantPeriod during \"Measurement Period\"\n\t\t\tand HighHbA1c.result is not null\n\t\tsort by resultDatetime\n).result > 9 '%'\n \nLast([\"Laboratory Test, Performed\": \"HbA1c Laboratory Test\"] HbA1cNoResult\n\t\twhere HbA1cNoResult.relevantPeriod during \"Measurement Period\"\n\t\tsort by resultDatetime\n).result is null\n \nnot exists [\"Laboratory Test, Performed\": \"HbA1c Laboratory Test\"] NoHbA1c\n\twhere NoHbA1c.relevantPeriod during \"Measurement Period\"","None",null,"Additional definitinos of advanced illness and fraility are available in the measure source: https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS122v9.html#d1e767.\n\nPatient is numerator compliant if most recent HbA1c level >9%, the most recent HbA1c result is missing, or if there are no HbA1c tests performed and results documented during the measurement period. If the HbA1c test result is in the medical record, the test can be used to determine numerator compliance.\n\nOnly patients with a diagnosis of Type 1 or Type 2 diabetes should be included in the denominator of this measure; patients with a diagnosis of secondary diabetes due to another condition should not be included.\n\nThis eCQM is a patient-based measure.\n\nThis version of the eCQM uses QDM version 5.5.  Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.",null,null,null,"Negative"]
["B1-145","DPP BHS","B1","Certified Community Behavioral Health Clinic (CCBHC) Certification Status","Structure",null,"NA","Status Update Only",null,"NA","Status Update Only",null,"NA",null,null,null,null,null,"NA","NA","NA","NA","Reporting on status of CCBHC certification","NA","NA",null,null,null,null,null,null,null,null,null,null,null,"N/A"]
["B1-146","DPP BHS","B1","Provide patients with services by using remote technology including audio/video, client portals and apps for the provision of services such as telehealth, assessment collection and remote health monitoring/ screening","Structure",null,"NA","Status Update Only",null,"NA","Status Update Only",null,"NA",null,null,null,null,null,"NA","NA","NA","NA","Reporting on the use of remote technology including audio/video, client portals and apps for the provision of services such as telehealth, assessment collection and remote health monitoring/screening","NA","NA",null,null,null,null,null,null,null,null,null,null,null,"N/A"]
["B1-147","DPP BHS","B1","Provide integrated physical and behavioral health care services to children and adults with serious mental illness","Structure",null,"NA","Status Update Only",null,"NA","Status Update Only",null,"NA",null,null,null,null,null,"NA","NA","NA","NA","Reporting on integrated physical and behavioral health care services to children and adults with serious mental illness","NA","NA",null,null,null,null,null,null,null,null,null,null,null,"N/A"]
["B1-148","DPP BHS","B1","Participate in electronic exchange of clinical data with other healthcare providers/ entities","Structure",null,"NA","Status Update Only",null,"NA","Status Update Only",null,"NA",null,null,null,null,null,"NA","NA","NA","NA","Reporting on the participation in electronic exchange of clinical data with other healthcare providers/entities","NA","NA",null,null,null,null,null,null,null,null,null,null,null,"N/A"]
["B2-149","DPP BHS","B2","Preventive Care & Screening: Unhealthy Alcohol Use: Screening & Brief Counseling","Process",null,"01/01/21 - 06/30/21","Numeric Data Reporting & Status Update Only",null,"01/01/21 - 12/31/21","Numeric Data Reporting & Status Update",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"2152","AMA-PCPI","CMS MIPS #431 2020","https://qpp-cm-prod-content.s3.amazonaws.com/uploads/786/2020+CQM+Specifications+and+Supporting+Docs.zip","Percentage of patients aged 18 years and older who were screened for unhealthy alcohol use using a systematic screening method at least once within the last 24 months AND who received brief counseling if identified as an unhealthy alcohol user","Psychiatry, Mental/Behavioral Health","Individuals","All patients aged 18 years and older seen for at least two visits or at least one preventive visit during the measurement period","Denominator Criteria (Eligible Cases):\nPatients aged ≥ 18 years\nAND\nAt least two patient encounters during the performance period (CPT or HCPCS): 90791, 90792,\n90832, 90834, 90837, 90845, 96156, 96158, 97165, 97166, 97167, 97168, 97802, 97803, 97804,\n99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, G0270, G0271\nWITHOUT\nTelehealth Modifier: GQ, GT, 95, POS 02\nOR\nAt Least One Preventive Visit during the performance period (CPT or HCPCS): 99385*,\n99386*, 99387*, 99395*, 99396*, 99397*, 99401*, 99402*, 99403*, 99404*, 99411*, 99412*, 99429*,\nG0438, G0439\nWITHOUT\nTelehealth Modifier: GQ, GT, 95, POS 02","Exception: Documentation of medical reason(s) for not screening for unhealthy alcohol use (e.g., limited life expectancy, other medical reasons) (G9623)","Patients who were screened for unhealthy alcohol use using a systematic screening method at least once within the last 24 months AND who received brief counseling if identified as an unhealthy alcohol user","Patient identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method and received brief counseling (G9621)\n\nOR\n\nPatient not identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method (G9622)","Patient not screened for unhealthy alcohol use using a systematic screening method OR patient did not receive brief counseling if identified as an unhealthy alcohol user, reason not given (G9624)",null,"Definitions:\nSystematic screening method – For purposes of this measure, one of the following systematic methods to assess unhealthy alcohol use must be utilized. Systematic screening methods and thresholds for defining unhealthy alcohol use include:\n\n• AUDIT Screening Instrument (score ≥ 8)\n• AUDIT-C Screening Instrument (score ≥ 4 for men; score ≥ 3 for women)\n• Single Question Screening - How many times in the past year have you had 5 (for men) or 4 (for women and all adults older than 65 years) or more drinks in a day? (response ≥ 2)\n\nBrief counseling – Brief counseling for unhealthy alcohol use refers to one or more counseling sessions, a minimum of 5-15 minutes, which may include: feedback on alcohol use and harms; identification of high risk situations for drinking and coping strategies; increased motivation and the development of a personal plan to reduce drinking.",null,null,null,"Positive",null,null,null,null,null,null,null,"Measure is a screening rate. Both positive and negative screens should be included if they meet the numerator inclusion criteria. "]
["B2-150","DPP BHS","B2","Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk Assessment","Process",null,"01/01/21 - 06/30/21","Numeric Data Reporting & Status Update Only",null,"01/01/21 - 12/31/21","Numeric Data Reporting & Status Update",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"1365","AMA-PCPI","eCQM - CMS177v9","https://ecqi.healthit.gov/ecqm/ep/2021/cms177v9","Percentage of patient visits for those patients aged 6 through 17 years with a diagnosis of major depressive disorder with an assessment for suicide risk","Psychiatry, Mental/Behavioral Health","Encounters","All patient visits for those patients aged 6 through 17 years with a diagnosis of major depressive disorder","\"Initial Population\"\n\n\"Major Depressive Disorder Encounter\" MDDEncounter\n  with [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n    such that Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) >= 6\n      and Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) < 17\n\n( [\"Encounter, Performed\": \"Office Visit\"]\n  union [\"Encounter, Performed\": \"Outpatient Consultation\"]\n  union [\"Encounter, Performed\": \"Psych Visit - Diagnostic Evaluation\"]\n  union [\"Encounter, Performed\": \"Psych Visit - Family Psychotherapy\"]\n  union [\"Encounter, Performed\": \"Psych Visit - Psychotherapy\"]\n  union [\"Encounter, Performed\": \"Psychoanalysis\"]\n  union [\"Encounter, Performed\": \"Group Psychotherapy\"]\n  union [\"Encounter, Performed\": \"Telehealth Services\"] ) ValidEncounter\n  where exists ( ValidEncounter.diagnoses EncounterDiagnosis\n      where EncounterDiagnosis.code in \"Major Depressive Disorder-Active\")\n    and ValidEncounter.relevantPeriod during \"Measurement Period\"","None","Patient visits with an assessment for suicide risk","\"Major Depressive Disorder Encounter\" MDDEncounter\n  with [\"Intervention, Performed\": \"Suicide risk assessment (procedure)\"] SuicideRiskAssessment\n    such that SuicideRiskAssessment.relevantDatetime during MDDEncounter.relevantPeriod\n\n( [\"Encounter, Performed\": \"Office Visit\"]\n  union [\"Encounter, Performed\": \"Outpatient Consultation\"]\n  union [\"Encounter, Performed\": \"Psych Visit - Diagnostic Evaluation\"]\n  union [\"Encounter, Performed\": \"Psych Visit - Family Psychotherapy\"]\n  union [\"Encounter, Performed\": \"Psych Visit - Psychotherapy\"]\n  union [\"Encounter, Performed\": \"Psychoanalysis\"]\n  union [\"Encounter, Performed\": \"Group Psychotherapy\"]\n  union [\"Encounter, Performed\": \"Telehealth Services\"] ) ValidEncounter\n  where exists ( ValidEncounter.diagnoses EncounterDiagnosis\n      where EncounterDiagnosis.code in \"Major Depressive Disorder-Active\")\n    and ValidEncounter.relevantPeriod during \"Measurement Period\"","None",null,"Definitions:\nNumerator Definition: The specific type and magnitude of the suicide risk assessment is intended to be at the discretion of the individual clinician and should be specific to the needs of the patient. At a minimum, suicide risk assessment should evaluate:\n1. Risk (e.g., age, sex, stressors, comorbid conditions, hopelessness, impulsivity) and protective factors (e.g., religious belief, concern not to hurt family) that may influence the desire to attempt suicide.\n2. Current severity of suicidality.\n3. Most severe point of suicidality in episode and lifetime.\n \nLow burden tools to track suicidal ideation and behavior such as the Columbia-Suicidal Severity Rating Scale can also be used. Because no validated assessment tool or instrument fully meets the aforementioned requirements for the suicide risk assessment, individual tools or instruments have not been explicitly included in coding.\n\n\nGuidance:\nThis eCQM is an episode-based measure. A suicide risk assessment should be performed at every visit for major depressive disorder during the measurement period. \n\nIn recognition of the growing use of integrated and team-based care, the diagnosis of depression and the assessment for suicide risk need not be performed by the same provider or clinician. \n\nSuicide risk assessments completed via telehealth services can also meet numerator performance. \n\nThis measure is an episode-of-care measure; the level of analysis for this measure is every visit for major depressive disorder during the measurement period. For example, at every visit for MDD, the patient should have a suicide risk assessment.\n\nUse of a standardized tool(s) or instrument(s) to assess suicide risk will meet numerator performance, so long as the minimum criteria noted above is evaluated. Standardized tools can be mapped to the concept \"Intervention, Performed\": \"Suicide risk assessment (procedure)\" included in the numerator logic below, as no individual suicide risk assessment tool or instrument would satisfy the requirements alone.\n\nThis version of the eCQM uses QDM version 5.5.  Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.",null,null,null,"Positive",null,null,null,null,null,null,null,"Measure is a screening rate. Both positive and negative screens should be included if they meet the numerator inclusion criteria. "]
["B2-151","DPP BHS","B2","Adult Major Depressive Disorder (MDD): Suicide Risk Assessment ","Process",null,"01/01/21 - 06/30/21","Numeric Data Reporting & Status Update Only",null,"01/01/21 - 12/31/21","Numeric Data Reporting & Status Update",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"0104","AMA-PCPI","eCQM - CMS161v9","https://ecqi.healthit.gov/ecqm/ep/2021/cms161v9","All patient visits during which a new diagnosis of MDD or a new diagnosis of recurrent MDD was identified for patients aged 18 years and older with a suicide risk assessment completed during the visit","Pyschiatry, Mental/Behavioral Health","Encounters","Patient visits during which a new diagnosis of MDD, single or recurrent episode, was identified","\"Initial Population\"\n\n\"New or Recurrent Major Depressive Disorder Encounter\" NewOrRecurrentMDDEncounter\n  with [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n    such that Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) >= 17\n\n\"Major Depressive Disorder Encounter\" NewOrRecurrentMDDEncounter\n  without \"Major Depressive Disorder Encounter\" PriorMDDEpisodeEncounter\n    such that PriorMDDEpisodeEncounter !~ NewOrRecurrentMDDEncounter\n      and PriorMDDEpisodeEncounter.relevantPeriod ends 104 days or less before day of start of NewOrRecurrentMDDEncounter.relevantPeriod\n  where NewOrRecurrentMDDEncounter.relevantPeriod during \"Measurement Period\"\n\n( [\"Encounter, Performed\": \"Psych Visit - Diagnostic Evaluation\"]\n  union [\"Encounter, Performed\": \"Emergency Department Visit\"]\n  union [\"Encounter, Performed\": \"Office Visit\"]\n  union [\"Encounter, Performed\": \"Outpatient Consultation\"]\n  union [\"Encounter, Performed\": \"Psych Visit - Psychotherapy\"]\n  union [\"Encounter, Performed\": \"Psychoanalysis\"]\n  union [\"Encounter, Performed\": \"Telehealth Services\"] ) ValidEncounter\n  where exists ( ValidEncounter.diagnoses EncounterDiagnosis\n      where EncounterDiagnosis.code in \"Major Depressive Disorder-Active\")","None","Patient visits during which a new diagnosis of MDD, single or recurrent episode, was identified and a suicide risk assessment was completed during the visit","\"New or Recurrent Major Depressive Disorder Encounter\" NewOrRecurrentMDDEncounter\n  with [\"Intervention, Performed\": \"Suicide risk assessment (procedure)\"] SuicideRiskAssessment\n    such that SuicideRiskAssessment.relevantDatetime during NewOrRecurrentMDDEncounter.relevantPeriod\n\n\"Major Depressive Disorder Encounter\" NewOrRecurrentMDDEncounter\n  without \"Major Depressive Disorder Encounter\" PriorMDDEpisodeEncounter\n    such that PriorMDDEpisodeEncounter !~ NewOrRecurrentMDDEncounter\n      and PriorMDDEpisodeEncounter.relevantPeriod ends 104 days or less before day of start of NewOrRecurrentMDDEncounter.relevantPeriod\n  where NewOrRecurrentMDDEncounter.relevantPeriod during \"Measurement Period\"\n\n( [\"Encounter, Performed\": \"Psych Visit - Diagnostic Evaluation\"]\n  union [\"Encounter, Performed\": \"Emergency Department Visit\"]\n  union [\"Encounter, Performed\": \"Office Visit\"]\n  union [\"Encounter, Performed\": \"Outpatient Consultation\"]\n  union [\"Encounter, Performed\": \"Psych Visit - Psychotherapy\"]\n  union [\"Encounter, Performed\": \"Psychoanalysis\"]\n  union [\"Encounter, Performed\": \"Telehealth Services\"] ) ValidEncounter\n  where exists ( ValidEncounter.diagnoses EncounterDiagnosis\n      where EncounterDiagnosis.code in \"Major Depressive Disorder-Active\")","None",null,"Definitions:\nThe specific type and magnitude of the suicide risk assessment is intended to be at the discretion of the individual clinician and should be specific to the needs of the patient. At a minimum, suicide risk assessment should evaluate:\n1) Suicidal ideation\n2) Patient's intent of initiating a suicide attempt\nAND, if either is present,\n3) Patient plans for a suicide attempt\n4) Whether the patient has means for completing suicide\n\nLow burden tools to track suicidal ideation and behavior such as the Columbia-Suicide Severity Rating Scale (C-SSRS) and the Suicide Assessment Five-Step Evaluation and Triage (SAFE-T) can also be used. Because no validated assessment tool or instrument fully meets the aforementioned requirements for the suicide risk assessment, individual tools or instruments have not been explicitly included in coding.\n\n\nGuidance:\nThis eCQM is an episode-of-care measure and should be reported for each instance of a new or recurrent episode of major depressive disorder (MDD); every new or recurrent episode will count separately in the Initial Population.\n\nAs the guidelines state, it is important to assess for additional factors which may increase or decrease suicide risk, such as presence of additional symptoms (e.g., psychosis, severe anxiety, hopelessness, severe chronic pain); presence of substance abuse, history and seriousness of previous attempts, particularly, recent suicidal behavior, current stressors and potential protective factors (e.g., positive reasons for living, strong social support), family history of suicide or mental illness or recent exposure to suicide, impulsivity and potential for risk to others, including history of violence or violent or homicidal ideas, plans, or intentions, and putting one's affairs in order (e.g., giving away possessions, writing a will). In addition, although the measure focuses on the initial visit, it is critical that suicide risk be monitored especially for the 90 days following the initial visit and throughout MDD treatment.\n\nIt is expected that a suicide risk assessment will be completed at the visit during which a new diagnosis is made or at the visit during which a recurrent episode is first identified (i.e., at the initial evaluation). For the purposes of this measure, an episode of major depressive disorder (MDD) would be considered to be recurrent if a patient has not had an MDD-related encounter in the past 105 days. If there is a gap of 105 or more days between visits for major depressive disorder (MDD), that would imply a recurrent episode. The 105-day look-back period is an operational provision and not a clinical recommendation, or definition of relapse, remission, or recurrence.\n\nIn recognition of the growing use of integrated and team-based care, the diagnosis of depression and the assessment for suicide risk need not be performed by the same provider or clinician.\n\nSuicide risk assessments completed via telehealth services can also meet numerator performance.\n\nUse of a standardized tool(s) or instrument(s) to assess suicide risk will meet numerator performance. Standardized tools can be mapped to the concept \"Intervention, Performed\": \"Suicide risk assessment (procedure)\" included in the numerator logic below.\n\nThe logic statement for the age requirement, as written, captures patients who turn 18 years old during the measurement period so that these patients are included in the measure, so long as the minimum criteria noted above is evaluated. To ensure all patients with major depressive disorder (MDD) are assessed for suicide risk, there are two clinical quality measures addressing suicide risk assessment; CMS 177 covers children and adolescents aged 6 through 17, and CMS 161 covers the adult population aged 18 years and older, as no individual suicide risk assessment tool or instrument would satisfy the requirements alone.\n\nThis version of the eCQM uses QDM version 5.5.  Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.",null,null,null,"Positive",null,null,null,null,null,null,null,"Measure is a screening rate. Both positive and negative screens should be included if they meet the numerator inclusion criteria. "]
["B2-152","DPP BHS","B2","Follow-Up After Hospitalization for Mental Illness 7-Day (discharges from state hospital)","Outcome (Intermediate)",null,"01/01/21 - 06/30/21","Numeric Data Reporting & Status Update Only",null,"01/01/21 - 12/31/21","Numeric Data Reporting & Status Update",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"0576","NCQA","CMS MIPS #391 2020","https://qpp-cm-prod-content.s3.amazonaws.com/uploads/786/2020+CQM+Specifications+and+Supporting+Docs.zip","The percentage of discharges for patients 6 years of age and older who were hospitalized for treatment of selected mental illness or intentional self-harm diagnoses and who had a follow-up visit. The percentage of discharges for which the patient received follow-up within 7 days after discharge.","Discharges from state hospitals and Sunrise Canyon Hospital","Encounters","Patients 6 years of age and older who were discharged from an acute inpatient setting (including acute care psychiatric facilities) with a principal diagnosis of mental illness or intentional self-harm on or between January 1 and December 1 of the measurement period\n\nNote that the denominator is limited to discharges from State Hospitals and Sunrise Canyon Hospital.","Patients aged 6 years and older as of the date of discharge\nAND\nDiagnosis for mental illness (ICD-10-CM): F20.0, F20.1, F20.2, F20.3, F20.5, F20.81, F20.89, F20.9, F21, F22, F23, F24, F25.0, F25.1, F25.8, F25.9, F28, F29, F30.10, F30.11, F30.12, F30.13, F30.2, F30.3, F30.4, F30.8, F30.9, F31.0, F31.10, F31.11, F31.12, F31.13, F31.2, F31.30, F31.31, F31.32, F31.4, F31.5, F31.60, F31.61, F31.62, F31.63, F31.64, F31.70, F31.71, F31.72, F31.73, F31.74, F31.75, F31.76, F31.77, F31.78, F31.81, F31.89, F31.9, F32.0, F32.1, F32.2, F32.3, F32.4, F32.5, F32.8, F32.81, F32.89, F32.9, F33.0, F33.1,\nF33.2, F33.3, F33.40, F33.41, F33.42, F33.8, F33.9, F34.0, F34.1, F34.8, F34.81, F34.89, F34.9, F39, F42, F42.2, F42.3, F42.4, F42.8, F42.9, F43.0, F43.10, F43.11, F43.12, F43.20, F43.21, F43.22, F43.23, F43.24, F43.25, F43.29, F43.8, F43.9, F44.89, F53, F53.0, F53.1, F60.0, F60.1, F60.2, F60.3, F60.4, F60.5, F60.6, F60.7, F60.81, F60.89, F60.9, F63.0, F63.1, F63.2, F63.3, F63.81, F63.89, F63.9, F68.10, F68.11, F68.12, F68.13, F68.8, F68.A, F84.0, F84.2, F84.3, F84.5, F84.8, F84.9, F90.0, F90.1, F90.2, F90.8, F90.9, F91.0,\nF91.1, F91.2, F91.3, F91.8, F91.9, F93.0, F93.8, F93.9, F94.0, F94.1, F94.2, F94.8, F94.9 \nOR\nDiagnosis of intentional self-harm (ICD-10-CM): T14.91XA, T14.91XD, T14.91XS, T36.0X2A, T36.0X2D, T36.0X2S, T36.1X2A, T36.1X2D, T36.1X2S, T36.2X2A, T36.2X2D, T36.2X2S, T36.3X2A, T36.3X2D, T36.3X2S, T36.4X2A, T36.4X2D, T36.4X2S, T36.5X2A, T36.5X2D, T36.5X2S, T36.6X2A, T36.6X2D, T36.6X2S, T36.7X2A, T36.7X2D, T36.7X2S, T36.8X2A, T36.8X2D, T36.8X2S, T36.92XA, T36.92XD, T36.92XS, T37.0X2A, T37.0X2D, T37.0X2S, T37.1X2A, T37.1X2D, T37.1X2S, T37.2X2A, T37.2X2D, T37.2X2S, T37.3X2A, T37.3X2D, T37.3X2S, T37.4X2A, T37.4X2D, T37.4X2S, T37.5X2A, T37.5X2D, T37.5X2S, T37.8X2A, T37.8X2D, T37.8X2S, T37.92XA, T37.92XD, T37.92XS, T38.0X2A, T38.0X2D, T38.0X2S, T38.1X2A, T38.1X2D, T38.1X2S, T38.2X2A,T38.2X2D, T38.2X2S, T38.3X2A, T38.3X2D, T38.3X2S, T38.4X2A, T38.4X2D, T38.4X2S, T38.5X2A, T38.5X2D, T38.5X2S, T38.6X2A, T38.6X2D, T38.6X2S, T38.7X2A, T38.7X2D, T38.7X2S, T38.802A, T38.802D, T38.802S, T38.812A, T38.812D, T38.812S, T38.892A, T38.892D, T38.892S, T38.902A, T38.902D, T38.902S, T38.992A, T38.992D, T38.992S, T39.012A, T39.012D, T39.012S, T39.092A, T39.092D, T39.092S, T39.1X2A, T39.1X2D, T39.1X2S, T39.2X2A, T39.2X2D, T39.2X2S, T39.312A, T39.312D, T39.312S, T39.392A, T39.392D, T39.392S, T39.4X2A, T39.4X2D, T39.4X2S, T39.8X2A, T39.8X2D, T39.8X2S, T39.92XA, T39.92XD, T39.92XS, T40.0X2A, T40.0X2D, T40.0X2S, T40.1X2A, T40.1X2D, T40.1X2S, T40.2X2A, T40.2X2D, T40.2X2S, T40.3X2A, T40.3X2D, T40.3X2S, T40.4X2A, T40.4X2D, T40.4X2S, T40.5X2A, T40.5X2D, T40.5X2S, T40.602A, T40.602D, T40.602S, T40.692A, T40.692D, T40.692S, T40.7X2A, T40.7X2D, T40.7X2S, T40.8X2A, T40.8X2D, T40.8X2S, T40.902A, T40.902D, T40.902S, T40.992A, T40.992D, T40.992S, T41.0X2A, T41.0X2D, T41.0X2S, T41.1X2A, T41.1X2D, T41.1X2S, T41.202A, T41.202D, T41.202S, T41.292A, T41.292D, T41.292S, T41.3X2A, T41.3X2D, T41.3X2S, T41.42XA, T41.42XD, T41.42XS, T41.5X2A, T41.5X2D, T41.5X2S, T42.0X2A, T42.0X2D, T42.0X2S, T42.1X2A, T42.1X2D, T42.1X2S, T42.2X2A, T42.2X2D, T42.2X2S, T42.3X2A, T42.3X2D, T42.3X2S, T42.4X2A, T42.4X2D, T42.4X2S, T42.5X2A, T42.5X2D, T42.5X2S, T42.6X2A, T42.6X2D, T42.6X2S, T42.72XA, T42.72XD, T42.72XS, T42.8X2A, T42.8X2D, T42.8X2S, T43.012A, T43.012D, T43.012S, T43.022A, T43.022D, T43.022S, T43.1X2A, T43.1X2D, T43.1X2S, T43.202A, T43.202D, T43.202S, T43.212A, T43.212D, T43.212S, T43.222A, T43.222D, T43.222S, T43.292A, T43.292D, T43.292S, T43.3X2A, T43.3X2D, T43.3X2S, T43.4X2A, T43.4X2D, T43.4X2S, T43.502A, T43.502D, T43.502S, T43.592A, T43.592D, T43.592S, T43.602A, T43.602D, T43.602S, T43.612A, T43.612D, T43.612S, T43.622A, T43.622D, T43.622S, T43.632A, T43.632D, T43.632S, T43.642A, T43.642D, T43.642S, T43.692A, T43.692D, T43.692S, T43.8X2A, T43.8X2D, T43.8X2S, T43.92XA, T43.92XD, T43.92XS, T44.0X2A, T44.0X2D, T44.0X2S, T44.1X2A, T44.1X2D, T44.1X2S, T44.2X2A, T44.2X2D, T44.2X2S, T44.3X2A, T44.3X2D, T44.3X2S, T44.4X2A, T44.4X2D, T44.4X2S, T44.5X2A, T44.5X2D, T44.5X2S, T44.6X2A, T44.6X2D, T44.6X2S, T44.7X2A, T44.7X2D, T44.7X2S, T44.8X2A, T44.8X2D, T44.8X2S, T44.902A, T44.902D, T44.902S, T44.992A, T44.992D, T44.992S, T45.0X2A, T45.0X2D, T45.0X2S, T45.1X2A, T45.1X2D, T45.1X2S, T45.2X2A, T45.2X2D, T45.2X2S, T45.3X2A, T45.3X2D, T45.3X2S, T45.4X2A, T45.4X2D, T45.4X2S, T45.512A, T45.512D, T45.512S, T45.522A, T45.522D, T45.522S, T45.602A, T45.602D, T45.602S, T45.612A, T45.612D, T45.612S, T45.622A, T45.622D, T45.622S, T45.692A, T45.692D, T45.692S, T45.7X2A, T45.7X2D, T45.7X2S, T45.8X2A, T45.8X2D, T45.8X2S, T45.92XA, T45.92XD, T45.92XS, T46.0X2A, T46.0X2D, T46.0X2S, T46.1X2A, T46.1X2D, T46.1X2S, T46.2X2A, T46.2X2D, T46.2X2S, T46.3X2A, T46.3X2D, T46.3X2S, T46.4X2A, T46.4X2D, T46.4X2S, T46.5X2A, T46.5X2D, T46.5X2S, T46.6X2A, T46.6X2D, T46.6X2S, T46.7X2A, T46.7X2D, T46.7X2S, T46.8X2A, T46.8X2D, T46.8X2S, T46.902A, T46.902D, T46.902S, T46.992A, T46.992D, T46.992S, T47.0X2A, T47.0X2D, T47.0X2S, T47.1X2A, T47.1X2D, T47.1X2S, T47.2X2A, T47.2X2D, T47.2X2S, T47.3X2A, T47.3X2D, T47.3X2S, T47.4X2A, T47.4X2D, T47.4X2S, T47.5X2A, T47.5X2D, T47.5X2S, T47.6X2A, T47.6X2D, T47.6X2S, T47.7X2A, T47.7X2D, T47.7X2S, T47.8X2A, T47.8X2D, T47.8X2S, T47.92XA, T47.92XD, T47.92XS, T48.0X2A, T48.0X2D, T48.0X2S, T48.1X2A, T48.1X2D, T48.1X2S, T48.202A, T48.202D, T48.202S, T48.292A, T48.292D, T48.292S, T48.3X2A, T48.3X2D, T48.3X2S, T48.4X2A, T48.4X2D, T48.4X2S, T48.5X2A, T48.5X2D, T48.5X2S, T48.6X2A, T48.6X2D, T48.6X2S, T48.902A, T48.902D, T48.902S, T48.992A, T48.992D, T48.992S, T49.0X2A, T49.0X2D, T49.0X2S, T49.1X2A, T49.1X2D, T49.1X2S, T49.2X2A, T49.2X2D, T49.2X2S, T49.3X2A, T49.3X2D, T49.3X2S, T49.4X2A, T49.4X2D, T49.4X2S, T49.5X2A, T49.5X2D, T49.5X2S, T49.6X2A, T49.6X2D, T49.6X2S, T49.7X2A, T49.7X2D, T49.7X2S, T49.8X2A, T49.8X2D, T49.8X2S, T49.92XA, T49.92XD, T49.92XS, T50.0X2A, T50.0X2D, T50.0X2S, T50.1X2A, T50.1X2D, T50.1X2S, T50.2X2A, T50.2X2D, T50.2X2S, T50.3X2A, T50.3X2D, T50.3X2S, T50.4X2A, T50.4X2D, T50.4X2S, T50.5X2A, T50.5X2D, T50.5X2S, T50.6X2A, T50.6X2D, T50.6X2S, T50.7X2A, T50.7X2D, T50.7X2S, T50.8X2A, T50.8X2D, T50.8X2S, T50.902A, T50.902D, T50.902S, T50.992A, T50.992D, T50.992S, T50.A12A, T50.A12D, T50.A12S, T50.A22A, T50.A22D, T50.A22S, T50.A92A, T50.A92D, T50.A92S, T50.B12A, T50.B12D, T50.B12S, T50.B92A, T50.B92D, T50.B92S, T50.Z12A, T50.Z12D, T50.Z12S, T50.Z92A, T50.Z92D, T50.Z92S, T51.0X2A, T51.0X2D, T51.0X2S, T51.1X2A, T51.1X2D, T51.1X2S, T51.2X2A, T51.2X2D, T51.2X2S, T51.3X2A, T51.3X2D, T51.3X2S, T51.8X2A, T51.8X2D, T51.8X2S, T51.92XA, T51.92XD, T51.92XS, T52.0X2A, T52.0X2D, T52.0X2S, T52.1X2A, T52.1X2D, T52.1X2S, T52.2X2A, T52.2X2D, T52.2X2S, T52.3X2A, T52.3X2D, T52.3X2S, T52.4X2A, T52.4X2D, T52.4X2S, T52.8X2A, T52.8X2D, T52.8X2S, T52.92XA, T52.92XD, T52.92XS, T53.0X2A, T53.0X2D, T53.0X2S, T53.1X2A, T53.1X2D, T53.1X2S, T53.2X2A, T53.2X2D, T53.2X2S, T53.3X2A, T53.3X2D, T53.3X2S, T53.4X2A, T53.4X2D, T53.4X2S, T53.5X2A, T53.5X2D, T53.5X2S, T53.6X2A, T53.6X2D, T53.6X2S, T53.7X2A, T53.7X2D, T53.7X2S, T53.92XA, T53.92XD, T53.92XS, T54.0X2A, T54.0X2D, T54.0X2S, T54.1X2A, T54.1X2D, T54.1X2S, T54.2X2A, T54.2X2D, T54.2X2S, T54.3X2A, T54.3X2D, T54.3X2S, T54.92XA, T54.92XD, T54.92XS, T55.0X2A, T55.0X2D, T55.0X2S, T55.1X2A, T55.1X2D, T55.1X2S, T56.0X2A, T56.0X2D, T56.0X2S, T56.1X2A, T56.1X2D, T56.1X2S, T56.2X2A, T56.2X2D, T56.2X2S, T56.3X2A, T56.3X2D, T56.3X2S, T56.4X2A, T56.4X2D, T56.4X2S, T56.5X2A, T56.5X2D, T56.5X2S, T56.6X2A, T56.6X2D, T56.6X2S, T56.7X2A, T56.7X2D, T56.7X2S, T56.812A, T56.812D, T56.812S, T56.892A, T56.892D, T56.892S, T56.92XA, T56.92XD, T56.92XS, T57.0X2A, T57.0X2D, T57.0X2S, T57.1X2A, T57.1X2D, T57.1X2S, T57.2X2A, T57.2X2D, T57.2X2S, T57.3X2A, T57.3X2D, T57.3X2S, T57.8X2A, T57.8X2D, T57.8X2S, T57.92XA, T57.92XD, T57.92XS, T58.02XA, T58.02XD, T58.02XS, T58.12XA, T58.12XD, T58.12XS, T58.2X2A, T58.2X2D, T58.2X2S, T58.8X2A, T58.8X2D, T58.8X2S, T58.92XA, T58.92XD, T58.92XS, T59.0X2A, T59.0X2D, T59.0X2S, T59.1X2A, T59.1X2D, T59.1X2S, T59.2X2A, T59.2X2D, T59.2X2S, T59.3X2A, T59.3X2D, T59.3X2S, T59.4X2A, T59.4X2D, T59.4X2S, T59.5X2A, T59.5X2D, T59.5X2S, T59.6X2A, T59.6X2D, T59.6X2S, T59.7X2A, T59.7X2D, T59.7X2S, T59.812A, T59.812D, T59.812S, T59.892A, T59.892D, T59.892S, T59.92XA, T59.92XD, T59.92XS, T60.0X2A, T60.0X2D, T60.0X2S, T60.1X2A, T60.1X2D, T60.1X2S, T60.2X2A, T60.2X2D, T60.2X2S, T60.3X2A, T60.3X2D, T60.3X2S, T60.4X2A, T60.4X2D, T60.4X2S, T60.8X2A, T60.8X2D, T60.8X2S, T60.92XA, T60.92XD, T60.92XS, T61.02XA, T61.02XD, T61.02XS, T61.12XA, T61.12XD, T61.12XS, T61.772A, T61.772D, T61.772S, T61.782A, T61.782D, T61.782S, T61.8X2A, T61.8X2D, T61.8X2S, T61.92XA, T61.92XD, T61.92XS, T62.0X2A, T62.0X2D, T62.0X2S, T62.1X2A, T62.1X2D, T62.1X2S, T62.2X2A, T62.2X2D, T62.2X2S, T62.8X2A, T62.8X2D, T62.8X2S, T62.92XA, T62.92XD, T62.92XS, T63.002A, T63.002D, T63.002S T63.012A, T63.012D, T63.012S, T63.022A, T63.022D, T63.022S, T63.032A, T63.032D, T63.032S, T63.042A, T63.042D, T63.042S, T63.062A, T63.062D, T63.062S, T63.072A, T63.072D, T63.072S, T63.082A, T63.082D, T63.082S, T63.092A, T63.092D, T63.092S, T63.112A, T63.112D, T63.112S, T63.122A, T63.122D, T63.122S, T63.192A, T63.192D, T63.192S, T63.2X2A, T63.2X2D, T63.2X2S, T63.302A, T63.302D, T63.302S, T63.312A, T63.312D, T63.312S, T63.322A, T63.322D, T63.322S, T63.332A, T63.332D, T63.332S, T63.392A, T63.392D, T63.392S, T63.412A, T63.412D, T63.412S, T63.422A, T63.422D, T63.422S, T63.432A, T63.432D, T63.432S, T63.442A, T63.442D, T63.442S, T63.452A, T63.452D, T63.452S, T63.462A, T63.462D, T63.462S, T63.482A, T63.482D, T63.482S, T63.512A, T63.512D, T63.512S, T63.592A, T63.592D, T63.592S, T63.612A, T63.612D, T63.612S, T63.622A, T63.622D, T63.622S, T63.632A, T63.632D, T63.632S, T63.692A, T63.692D, T63.692S, T63.712A, T63.712D, T63.712S, T63.792A, T63.792D, T63.792S, T63.812A, T63.812D, T63.812S, T63.822A, T63.822D, T63.822S, T63.832A, T63.832D, T63.832S, T63.892A, T63.892D, T63.892S, T63.92XA, T63.92XD, T63.92XS, T64.02XA, T64.02XD, T64.02XS, T64.82XA, T64.82XD, T64.82XS, T65.0X2A, T65.0X2D, T65.0X2S, T65.1X2A, T65.1X2D, T65.1X2S, T65.212A, T65.212D, T65.212S, T65.222A, T65.222D, T65.222S, T65.292A, T65.292D, T65.292S, T65.3X2A, T65.3X2D, T65.3X2S, T65.4X2A, T65.4X2D, T65.4X2S, T65.5X2A, T65.5X2D, T65.5X2S, T65.6X2A, T65.6X2D, T65.6X2S, T65.812A, T65.812D, T65.812S, T65.822A, T65.822D, T65.822S, T65.832A, T65.832D, T65.832S, T65.892A, T65.892D, T65.892S, T65.92XA, T65.92XD, T65.92XS, T71.112A, T71.112D, T71.112S, T71.122A, T71.122D, T71.122S, T71.132A, T71.132D, T71.132S, T71.152A, T71.152D, T71.152S, T71.162A, T71.162D, T71.162S, T71.192A, T71.192D, T71.192S, T71.222A, T71.222D, T71.222S, T71.232A, T71.232D, T71.232S, T50.911, T50.912, T50.913, T50.914, T50.915, T50.916 \nAND\nPatient encounter during the performance period (CPT): 99221, 99222, 99223, 99231, 99232, 99233, 99238, 99239, 99291\nAND\nPatient alive at time of acute inpatient setting discharge\nAND\nPatient is discharged from an acute inpatient setting on or between January 1 and December 1 of the measurement period","Exclude discharges followed by readmission or direct transfer to a non-acute facility within the 30- day follow-up period, regardless of principal diagnosis for the readmission.\nExclude discharges followed by readmission or direct transfer to an acute facility within the 30-day follow-up period if the principal diagnosis was for non-mental health.\nClinician documented reason patient was not able to complete 7 day follow-up from acute inpatient setting discharge (i.e., patient death prior to follow-up visit, patient non-compliance for visit follow-up) (G9406)\nPatients who use hospice services any time during the measurement period (G9760)","A follow-up visit with a mental health provider within 7 days after acute inpatient discharge. Do not include visits that occur on the date of discharge (G9405)","Patient received follow-up within 7 days after discharge (G9405)","Patient did not receive follow-up within 7 days after discharge (G9407)","Providers are only reporting rate 2 of the MIPS measure for follow-up within 7 days after discharge. For DPP BHS program reporting, the denominator is limited to state hospitals and Sunrise Canyon Hospital.\n\nThe 2020 measure steward guidance includes contradictory guidance to both include and exclude follow-up visits occuring on the day of discharge. The 2021 guidance excludes the day of discharge, but for SFY22 the DPP reporting uses the 2020 measure specifications. Since this guidance is contradictory, providers have the option to include or exclude the day of discharge when calculating their rates for program year 1 (SFY22). However, when measure specifications for program year 2 are updated to use the 2021 specs, HHSC will expect providers to exclude the day of discharge for program year 2 (SFY23). It is up to the provider whether they would like to set up their systems to exclude the day of discharge now and maintain consistency from year 1 to year 2, or include the day of discharge for this measurement period and plan to update for the next year. ","An eligible provider is one who delivers mental health services and meets any of the following criteria:\n• An MD or doctor of osteopathy (DO) who is certified as a psychiatrist or child psychiatrist by the American Medical Specialties Board of Psychiatry and Neurology or by the American Osteopathic Board of Neurology and Psychiatry; or, if not certified, who successfully completed an accredited program of graduate medical or osteopathic education in psychiatry or child psychiatry and is licensed to practice patient care psychiatry or child psychiatry, if required by the state of practice.\n• An individual who is licensed as a psychologist in his/her state of practice, if required by the state of practice.\n• An individual who is certified in clinical social work by the American Board of Examiners; who is listed on the National Association of Social Worker’s Clinical Register; or who has a master’s degree in social work and is licensed or certified to practice as a social worker, if required by the state of practice.\n• A registered nurse (RN) who is certified by the American Nurses Credentialing Center (a subsidiary of the American Nurses Association) as a psychiatric nurse or mental health clinical nurse specialist, or who has a master’s degree in nursing with a specialization in\npsychiatric/mental health and two years of supervised clinical experience and is licensed to practice as a psychiatric or mental health nurse, if required by the state of practice.\n• An individual (normally with a master’s or a doctoral degree in marital and family therapy and at least two years of supervised clinical experience) who is practicing as a marital and family therapist and is licensed or a certified counselor by the state of practice, or if licensure or certification is not required by the state of practice, who is eligible for clinical membership in the American Association for Marriage and Family Therapy.\n• An individual (normally with a master’s or doctoral degree in counseling and at least two years of supervised clinical experience) who is practicing as a professional counselor and who is licensed or certified to do so by the state of practice, or if licensure or certification is not required by the state of practice, is a National Certified Counselor with a Specialty Certification in Clinical Mental Health Counseling from the National Board for Certified Counselors (NBCC).\n• A certified Community Mental Health Center (CMHC), or the comparable term (e.g. behavioral health organization, mental health agency, behavioral health agency) used within the state in which it is located, or a Certified Community Behavioral Health Clinic (CCBHC).\nOnly authorized CMHCs are considered mental health providers. To be authorized as a CMHC, an entity must meet one of the following criteria:\n- The entity has been certified by CMS to meet the conditions of participation (CoPs) that community mental health centers (CMHCs) must meet in order to participate in the Medicare program, as defined in the Code of Federal Regulations Title 42. CMS defines a\nCMHC as an entity that meets applicable licensing or certification requirements for CMHCs in the State in which it is located and provides the set of services specified in section 1913(c)(1) of the Public Health Service Act (PHS Act).\n- The entity has been licensed, operated, authorized, or otherwise recognized by a state or county in which it is located.\nOnly authorized CCBHCs are considered mental health providers. To be authorized as a CCBHC, an entity must meet one of the following criteria:\n- Has been certified by a State Medicaid agency as meeting criteria established by the Secretary for participation in the Medicaid CCBHC demonstration program pursuant to Protecting Access to Medicare Act § 223(a) (42 U.S.C. § 1396a note); or as meeting\ncriteria within the State’s Medicaid Plan to be considered a CCBHC.\n- Has been recognized by the Substance Abuse and Mental Health Services Administration, through the award of grant funds or otherwise, as a CCBHC that meets the certification criteria of a Certified Community Behavioral Health Clinic",null,null,null,"Positive",null,null,null,null,null,null,null,"The denominator specifications are the same for measures B2-152 and B2-153. Please note the denominator specifications for B2-152 and B2-153 are limited to discharges from State Hospitals and Sunrise Canyon Hospital, and the denominator values for each respective payer type should be the same for B2-152 and B2-153. For a given payer type, the B2-153 numerator value must be equal to or greater than the numerator value for B2-152."]
["B2-153","DPP BHS","B2","Follow-Up after Hospitalization for Mental Illness 30-Day (discharges from state hospital)","Outcome (Intermediate)",null,"01/01/21 - 06/30/21","Numeric Data Reporting & Status Update Only",null,"01/01/21 - 12/31/21","Numeric Data Reporting & Status Update",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"0576","NCQA","CMS MIPS #391 2020","https://qpp-cm-prod-content.s3.amazonaws.com/uploads/786/2020+CQM+Specifications+and+Supporting+Docs.zip","The percentage of discharges for patients 6 years of age and older who were hospitalized for treatment of selected mental illness or intentional self-harm diagnoses and who had a follow-up visit. The percentage of discharges for which the patient received follow-up within 30 days after discharge","Discharges from state hospitals and Sunrise Canyon Hospital","Encounters","Patients 6 years of age and older who were discharged from an acute inpatient setting (including acute care psychiatric facilities) with a principal diagnosis of mental illness or intentional self-harm on or between January 1 and December 1 of the measurement period\n\nNote that the denominator is limited to discharges from state hospitals and Sunrise Canyon Hospital.","Patients aged 6 years and older as of the date of discharge\nAND\nDiagnosis for mental illness (ICD-10-CM): F20.0, F20.1, F20.2, F20.3, F20.5, F20.81, F20.89, F20.9, F21,\nF22, F23, F24, F25.0, F25.1, F25.8, F25.9, F28, F29, F30.10, F30.11, F30.12, F30.13, F30.2, F30.3, F30.4,\nF30.8, F30.9, F31.0, F31.10, F31.11, F31.12, F31.13, F31.2, F31.30, F31.31, F31.32, F31.4, F31.5, F31.60,\nF31.61, F31.62, F31.63, F31.64, F31.70, F31.71, F31.72, F31.73, F31.74, F31.75, F31.76, F31.77, F31.78,\nF31.81, F31.89, F31.9, F32.0, F32.1, F32.2, F32.3, F32.4, F32.5, F32.8, F32.81, F32.89, F32.9, F33.0, F33.1,\nF33.2,F33.3, F33.40, F33.41, F33.42, F33.8, F33.9, F34.0, F34.1, F34.8, F34.81, F34.89, F34.9, F39, F42,\nF42.2, F42.3, F42.4, F42.8, F42.9, F43.0, F43.10, F43.11, F43.12, F43.20, F43.21, F43.22, F43.23, F43.24,\nF43.25, F43.29, F43.8, F43.9, F44.89, F53, F53.0, F53.1, F60.0, F60.1, F60.2, F60.3, F60.4, F60.5, F60.6,\nF60.7, F60.81, F60.89, F60.9, F63.0, F63.1, F63.2, F63.3, F63.81, F63.89, F63.9, F68.10, F68.11, F68.12,\nF68.13, F68.8, F68.A, F84.0, F84.2, F84.3, F84.5, F84.8, F84.9, F90.0, F90.1, F90.2, F90.8, F90.9, F91.0,\nF91.1, F91.2, F91.3, F91.8, F91.9, F93.0, F93.8, F93.9, F94.0, F94.1, F94.2, F94.8, F94.9\nOR\nDiagnosis of intentional self-harm (ICD-10-CM): T14.91XA, T14.91XD, T14.91XS, T36.0X2A, T36.0X2D,\nT36.0X2S, T36.1X2A, T36.1X2D, T36.1X2S, T36.2X2A, T36.2X2D, T36.2X2S, T36.3X2A, T36.3X2D,\nT36.3X2S, T36.4X2A, T36.4X2D, T36.4X2S, T36.5X2A, T36.5X2D, T36.5X2S, T36.6X2A, T36.6X2D, T36.6X2S,\nT36.7X2A, T36.7X2D, T36.7X2S, T36.8X2A, T36.8X2D, T36.8X2S, T36.92XA, T36.92XD, T36.92XS, T37.0X2A,\nT37.0X2D, T37.0X2S, T37.1X2A, T37.1X2D, T37.1X2S, T37.2X2A, T37.2X2D, T37.2X2S, T37.3X2A, T37.3X2D,\nT37.3X2S, T37.4X2A, T37.4X2D, T37.4X2S, T37.5X2A, T37.5X2D, T37.5X2S, T37.8X2A, T37.8X2D, T37.8X2S,\nT37.92XA, T37.92XD, T37.92XS, T38.0X2A, T38.0X2D, T38.0X2S, T38.1X2A, T38.1X2D, T38.1X2S, T38.2X2A,\nT38.2X2D, T38.2X2S, T38.3X2A, T38.3X2D, T38.3X2S, T38.4X2A, T38.4X2D, T38.4X2S, T38.5X2A, T38.5X2D,\nT38.5X2S, T38.6X2A, T38.6X2D, T38.6X2S, T38.7X2A, T38.7X2D, T38.7X2S, T38.802A, T38.802D, T38.802S,\nT38.812A, T38.812D, T38.812S, T38.892A, T38.892D, T38.892S, T38.902A, T38.902D, T38.902S, T38.992A,\nT38.992D, T38.992S, T39.012A, T39.012D, T39.012S, T39.092A, T39.092D, T39.092S, T39.1X2A, T39.1X2D,\nT39.1X2S, T39.2X2A, T39.2X2D, T39.2X2S, T39.312A, T39.312D, T39.312S, T39.392A, T39.392D, T39.392S,\nT39.4X2A, T39.4X2D, T39.4X2S, T39.8X2A, T39.8X2D, T39.8X2S, T39.92XA, T39.92XD, T39.92XS, T40.0X2A,\nT40.0X2D, T40.0X2S, T40.1X2A, T40.1X2D, T40.1X2S, T40.2X2A, T40.2X2D, T40.2X2S, T40.3X2A, T40.3X2D,\nT40.3X2S, T40.4X2A, T40.4X2D, T40.4X2S, T40.5X2A, T40.5X2D, T40.5X2S, T40.602A, T40.602D, T40.602S,\nT40.692A, T40.692D, T40.692S, T40.7X2A, T40.7X2D, T40.7X2S, T40.8X2A, T40.8X2D, T40.8X2S, T40.902A,\nT40.902D, T40.902S, T40.992A, T40.992D, T40.992S, T41.0X2A, T41.0X2D, T41.0X2S, T41.1X2A, T41.1X2D,\nT41.1X2S, T41.202A, T41.202D, T41.202S, T41.292A, T41.292D, T41.292S, T41.3X2A, T41.3X2D, T41.3X2S,\nT41.42XA, T41.42XD, T41.42XS, T41.5X2A, T41.5X2D, T41.5X2S, T42.0X2A, T42.0X2D, T42.0X2S, T42.1X2A,\nT42.1X2D, T42.1X2S, T42.2X2A, T42.2X2D, T42.2X2S, T42.3X2A, T42.3X2D, T42.3X2S, T42.4X2A, T42.4X2D,\nT42.4X2S, T42.5X2A, T42.5X2D, T42.5X2S, T42.6X2A, T42.6X2D, T42.6X2S, T42.72XA, T42.72XD, T42.72XS,\nT42.8X2A, T42.8X2D, T42.8X2S, T43.012A, T43.012D, T43.012S, T43.022A, T43.022D, T43.022S, T43.1X2A,\nT43.1X2D, T43.1X2S, T43.202A, T43.202D, T43.202S, T43.212A, T43.212D, T43.212S, T43.222A, T43.222D,\nT43.222S, T43.292A, T43.292D, T43.292S, T43.3X2A, T43.3X2D, T43.3X2S, T43.4X2A, T43.4X2D, T43.4X2S,\nT43.502A, T43.502D, T43.502S, T43.592A, T43.592D, T43.592S, T43.602A, T43.602D, T43.602S, T43.612A,\nT43.612D, T43.612S, T43.622A, T43.622D, T43.622S, T43.632A, T43.632D, T43.632S, T43.642A, T43.642D,\nT43.642S, T43.692A, T43.692D, T43.692S, T43.8X2A, T43.8X2D, T43.8X2S, T43.92XA, T43.92XD, T43.92XS,\nT44.0X2A, T44.0X2D, T44.0X2S, T44.1X2A, T44.1X2D, T44.1X2S, T44.2X2A, T44.2X2D, T44.2X2S, T44.3X2A,\nT44.3X2D, T44.3X2S, T44.4X2A, T44.4X2D, T44.4X2S, T44.5X2A, T44.5X2D, T44.5X2S, T44.6X2A, T44.6X2D,\nT44.6X2S, T44.7X2A, T44.7X2D, T44.7X2S, T44.8X2A, T44.8X2D, T44.8X2S, T44.902A, T44.902D, T44.902S, \nT44.992A, T44.992D, T44.992S, T45.0X2A, T45.0X2D, T45.0X2S, T45.1X2A, T45.1X2D, T45.1X2S, T45.2X2A,\nT45.2X2D, T45.2X2S, T45.3X2A, T45.3X2D, T45.3X2S, T45.4X2A, T45.4X2D, T45.4X2S, T45.512A, T45.512D,\nT45.512S, T45.522A, T45.522D, T45.522S, T45.602A, T45.602D, T45.602S, T45.612A, T45.612D, T45.612S,\nT45.622A, T45.622D, T45.622S, T45.692A, T45.692D, T45.692S, T45.7X2A, T45.7X2D, T45.7X2S, T45.8X2A,\nT45.8X2D, T45.8X2S, T45.92XA, T45.92XD, T45.92XS, T46.0X2A, T46.0X2D, T46.0X2S, T46.1X2A, T46.1X2D,\nT46.1X2S, T46.2X2A, T46.2X2D, T46.2X2S, T46.3X2A, T46.3X2D, T46.3X2S, T46.4X2A, T46.4X2D, T46.4X2S,\nT46.5X2A, T46.5X2D, T46.5X2S, T46.6X2A, T46.6X2D, T46.6X2S, T46.7X2A, T46.7X2D, T46.7X2S, T46.8X2A,\nT46.8X2D, T46.8X2S, T46.902A, T46.902D, T46.902S, T46.992A, T46.992D, T46.992S, T47.0X2A, T47.0X2D,\nT47.0X2S, T47.1X2A, T47.1X2D, T47.1X2S, T47.2X2A, T47.2X2D, T47.2X2S, T47.3X2A, T47.3X2D, T47.3X2S,\nT47.4X2A, T47.4X2D, T47.4X2S, T47.5X2A, T47.5X2D, T47.5X2S, T47.6X2A, T47.6X2D, T47.6X2S, T47.7X2A,\nT47.7X2D, T47.7X2S, T47.8X2A, T47.8X2D, T47.8X2S, T47.92XA, T47.92XD, T47.92XS, T48.0X2A, T48.0X2D,\nT48.0X2S, T48.1X2A, T48.1X2D, T48.1X2S, T48.202A, T48.202D, T48.202S, T48.292A, T48.292D, T48.292S,\nT48.3X2A, T48.3X2D, T48.3X2S, T48.4X2A, T48.4X2D, T48.4X2S, T48.5X2A, T48.5X2D, T48.5X2S, T48.6X2A,\nT48.6X2D, T48.6X2S, T48.902A, T48.902D, T48.902S, T48.992A, T48.992D, T48.992S, T49.0X2A, T49.0X2D,\nT49.0X2S, T49.1X2A, T49.1X2D, T49.1X2S, T49.2X2A, T49.2X2D, T49.2X2S, T49.3X2A, T49.3X2D, T49.3X2S,\nT49.4X2A, T49.4X2D, T49.4X2S, T49.5X2A, T49.5X2D, T49.5X2S, T49.6X2A, T49.6X2D, T49.6X2S, T49.7X2A,\nT49.7X2D, T49.7X2S, T49.8X2A, T49.8X2D, T49.8X2S, T49.92XA, T49.92XD, T49.92XS, T50.0X2A, T50.0X2D,\nT50.0X2S, T50.1X2A, T50.1X2D, T50.1X2S, T50.2X2A, T50.2X2D, T50.2X2S, T50.3X2A, T50.3X2D, T50.3X2S,\nT50.4X2A, T50.4X2D, T50.4X2S, T50.5X2A, T50.5X2D, T50.5X2S, T50.6X2A, T50.6X2D, T50.6X2S, T50.7X2A,\nT50.7X2D, T50.7X2S, T50.8X2A, T50.8X2D, T50.8X2S, T50.902A, T50.902D, T50.902S, T50.992A, T50.992D,\nT50.992S, T50.A12A, T50.A12D, T50.A12S, T50.A22A, T50.A22D, T50.A22S, T50.A92A, T50.A92D, T50.A92S,\nT50.B12A, T50.B12D, T50.B12S, T50.B92A, T50.B92D, T50.B92S, T50.Z12A, T50.Z12D, T50.Z12S, T50.Z92A,\nT50.Z92D, T50.Z92S, T51.0X2A, T51.0X2D, T51.0X2S, T51.1X2A, T51.1X2D, T51.1X2S, T51.2X2A, T51.2X2D,\nT51.2X2S, T51.3X2A, T51.3X2D, T51.3X2S, T51.8X2A, T51.8X2D, T51.8X2S, T51.92XA, T51.92XD, T51.92XS,\nT52.0X2A, T52.0X2D, T52.0X2S, T52.1X2A, T52.1X2D, T52.1X2S, T52.2X2A, T52.2X2D, T52.2X2S, T52.3X2A,\nT52.3X2D, T52.3X2S, T52.4X2A, T52.4X2D, T52.4X2S, T52.8X2A, T52.8X2D, T52.8X2S, T52.92XA, T52.92XD,\nT52.92XS, T53.0X2A, T53.0X2D, T53.0X2S, T53.1X2A, T53.1X2D, T53.1X2S, T53.2X2A, T53.2X2D, T53.2X2S,\nT53.3X2A, T53.3X2D, T53.3X2S, T53.4X2A, T53.4X2D, T53.4X2S, T53.5X2A, T53.5X2D, T53.5X2S, T53.6X2A,\nT53.6X2D, T53.6X2S, T53.7X2A, T53.7X2D, T53.7X2S, T53.92XA, T53.92XD, T53.92XS, T54.0X2A, T54.0X2D,\nT54.0X2S, T54.1X2A, T54.1X2D, T54.1X2S, T54.2X2A, T54.2X2D, T54.2X2S, T54.3X2A, T54.3X2D, T54.3X2S,\nT54.92XA, T54.92XD, T54.92XS, T55.0X2A, T55.0X2D, T55.0X2S, T55.1X2A, T55.1X2D, T55.1X2S, T56.0X2A,\nT56.0X2D, T56.0X2S, T56.1X2A, T56.1X2D, T56.1X2S, T56.2X2A, T56.2X2D, T56.2X2S, T56.3X2A, T56.3X2D,\nT56.3X2S, T56.4X2A, T56.4X2D, T56.4X2S, T56.5X2A, T56.5X2D, T56.5X2S, T56.6X2A, T56.6X2D, T56.6X2S,\nT56.7X2A, T56.7X2D, T56.7X2S, T56.812A, T56.812D, T56.812S, T56.892A, T56.892D, T56.892S, T56.92XA,\nT56.92XD, T56.92XS, T57.0X2A, T57.0X2D, T57.0X2S, T57.1X2A, T57.1X2D, T57.1X2S, T57.2X2A, T57.2X2D,\nT57.2X2S, T57.3X2A, T57.3X2D, T57.3X2S, T57.8X2A, T57.8X2D, T57.8X2S, T57.92XA, T57.92XD, T57.92XS,\nT58.02XA, T58.02XD, T58.02XS, T58.12XA, T58.12XD, T58.12XS, T58.2X2A, T58.2X2D, T58.2X2S, T58.8X2A,\nT58.8X2D, T58.8X2S, T58.92XA, T58.92XD, T58.92XS, T59.0X2A, T59.0X2D, T59.0X2S, T59.1X2A, T59.1X2D,\nT59.1X2S, T59.2X2A, T59.2X2D, T59.2X2S, T59.3X2A, T59.3X2D, T59.3X2S, T59.4X2A, T59.4X2D, T59.4X2S,\nT59.5X2A, T59.5X2D, T59.5X2S, T59.6X2A, T59.6X2D, T59.6X2S, T59.7X2A, T59.7X2D, T59.7X2S, T59.812A,\nT59.812D, T59.812S, T59.892A, T59.892D, T59.892S, T59.92XA, T59.92XD, T59.92XS, T60.0X2A, T60.0X2D,\nT60.0X2S, T60.1X2A, T60.1X2D, T60.1X2S, T60.2X2A, T60.2X2D, T60.2X2S, T60.3X2A, T60.3X2D, T60.3X2S,\nT60.4X2A, T60.4X2D, T60.4X2S, T60.8X2A, T60.8X2D, T60.8X2S, T60.92XA, T60.92XD, T60.92XS, T61.02XA,\nT61.02XD, T61.02XS, T61.12XA, T61.12XD, T61.12XS, T61.772A, T61.772D, T61.772S, T61.782A, T61.782D,\nT61.782S, T61.8X2A, T61.8X2D, T61.8X2S, T61.92XA, T61.92XD, T61.92XS, T62.0X2A, T62.0X2D, T62.0X2S,\nT62.1X2A, T62.1X2D, T62.1X2S, T62.2X2A, T62.2X2D, T62.2X2S, T62.8X2A, T62.8X2D, T62.8X2S, T62.92XA,\nT62.92XD, T62.92XS, T63.002A, T63.002D, T63.002S T63.012A, T63.012D, T63.012S, T63.022A, T63.022D,\nT63.022S, T63.032A, T63.032D, T63.032S, T63.042A, T63.042D, T63.042S, T63.062A, T63.062D, T63.062S,\nT63.072A, T63.072D, T63.072S, T63.082A, T63.082D, T63.082S, T63.092A, T63.092D, T63.092S, T63.112A,\nT63.112D, T63.112S, T63.122A, T63.122D, T63.122S, T63.192A, T63.192D, T63.192S, T63.2X2A, T63.2X2D,\nT63.2X2S, T63.302A, T63.302D, T63.302S, T63.312A, T63.312D, T63.312S, T63.322A, T63.322D, T63.322S,\nT63.332A, T63.332D, T63.332S, T63.392A, T63.392D, T63.392S, T63.412A, T63.412D, T63.412S, T63.422A, \nT63.422D, T63.422S, T63.432A, T63.432D, T63.432S, T63.442A, T63.442D, T63.442S, T63.452A, T63.452D,\nT63.452S, T63.462A, T63.462D, T63.462S, T63.482A, T63.482D, T63.482S, T63.512A, T63.512D, T63.512S,\nT63.592A, T63.592D, T63.592S, T63.612A, T63.612D, T63.612S, T63.622A, T63.622D, T63.622S, T63.632A,\nT63.632D, T63.632S, T63.692A, T63.692D, T63.692S, T63.712A, T63.712D, T63.712S, T63.792A, T63.792D,\nT63.792S, T63.812A, T63.812D, T63.812S, T63.822A, T63.822D, T63.822S, T63.832A, T63.832D, T63.832S,\nT63.892A, T63.892D, T63.892S, T63.92XA, T63.92XD, T63.92XS, T64.02XA, T64.02XD, T64.02XS, T64.82XA,\nT64.82XD, T64.82XS, T65.0X2A, T65.0X2D, T65.0X2S, T65.1X2A, T65.1X2D, T65.1X2S, T65.212A, T65.212D,\nT65.212S, T65.222A, T65.222D, T65.222S, T65.292A, T65.292D, T65.292S, T65.3X2A, T65.3X2D, T65.3X2S,\nT65.4X2A, T65.4X2D, T65.4X2S, T65.5X2A, T65.5X2D, T65.5X2S, T65.6X2A, T65.6X2D, T65.6X2S, T65.812A,\nT65.812D, T65.812S, T65.822A, T65.822D, T65.822S, T65.832A, T65.832D, T65.832S, T65.892A, T65.892D,\nT65.892S, T65.92XA, T65.92XD, T65.92XS, T71.112A, T71.112D, T71.112S, T71.122A, T71.122D, T71.122S,\nT71.132A, T71.132D, T71.132S, T71.152A, T71.152D, T71.152S, T71.162A, T71.162D, T71.162S, T71.192A,\nT71.192D, T71.192S, T71.222A, T71.222D, T71.222S, T71.232A, T71.232D, T71.232S, T50.911, T50.912,\nT50.913, T50.914, T50.915, T50.916\nAND\nPatient encounter during the performance period (CPT): 99221, 99222, 99223, 99231, 99232, 99233,\n99238, 99239, 99291\nAND\nPatient alive at time of acute inpatient setting discharge\nAND\nPatient is discharged from an acute inpatient setting on or between January 1 and December 1 of the measurement period\n","Exclude discharges followed by readmission or direct transfer to a non-acute facility within the 30- day follow-up period, regardless of principal diagnosis for the readmission.\nExclude discharges followed by readmission or direct transfer to an acute facility within the 30-day follow-up period if the principal diagnosis was for non-mental health.\nClinician documented reason patient was not able to complete 30 day follow-up from acute inpatient setting discharge (e.g., patient death prior to follow-up visit, patient non-compliant for visit follow-up) (G9403)\nPatients who use hospice services any time during the measurement period (G9760)","A follow-up visit with a mental health provider within 30 days after acute inpatient discharge. Do not include visits that occur on the date of discharge (G9402)","Patient received follow-up on the date of discharge or within 30 days after discharge (G9402)","Patient did not receive follow-up within 30 days after discharge (G9404)","Providers are only reporting rate 1 of the MIPS measure for follow-up within 30 days after discharge. For DPP BHS program reporting, the denominator is limited to state hospitals and Sunrise Canyon Hospital.\n\nThe 2020 measure steward guidance includes contradictory guidance to both include and exclude follow-up visits occuring on the day of discharge. The 2021 guidance excludes the day of discharge, but for SFY22 the DPP reporting uses the 2020 measure specifications. Since this guidance is contradictory, providers have the option to include or exclude the day of discharge when calculating their rates for program year 1 (SFY22). However, when measure specifications for program year 2 are updated to use the 2021 specs, HHSC will expect providers to exclude the day of discharge for program year 2 (SFY23). It is up to the provider whether they would like to set up their systems to exclude the day of discharge now and maintain consistency from year 1 to year 2, or include the day of discharge for this measurement period and plan to update for the next year.  ","An eligible provider is one who delivers mental health services and meets any of the following criteria:\n• An MD or doctor of osteopathy (DO) who is certified as a psychiatrist or child psychiatrist by the American Medical Specialties Board of Psychiatry and Neurology or by the American Osteopathic Board of Neurology and Psychiatry; or, if not certified, who successfully completed an accredited program of graduate medical or osteopathic education in psychiatry or child psychiatry and is licensed to practice patient care psychiatry or child psychiatry, if required by the state of practice.\n• An individual who is licensed as a psychologist in his/her state of practice, if required by the state of practice.\n• An individual who is certified in clinical social work by the American Board of Examiners; who is listed on the National Association of Social Worker’s Clinical Register; or who has a master’s degree in social work and is licensed or certified to practice as a social worker, if required by the state of practice.\n• A registered nurse (RN) who is certified by the American Nurses Credentialing Center (a subsidiary of the American Nurses Association) as a psychiatric nurse or mental health clinical nurse specialist, or who has a master’s degree in nursing with a specialization in\npsychiatric/mental health and two years of supervised clinical experience and is licensed to practice as a psychiatric or mental health nurse, if required by the state of practice.\n• An individual (normally with a master’s or a doctoral degree in marital and family therapy and at least two years of supervised clinical experience) who is practicing as a marital and family therapist and is licensed or a certified counselor by the state of practice, or if licensure or certification is not required by the state of practice, who is eligible for clinical membership in the American Association for Marriage and Family Therapy.\n• An individual (normally with a master’s or doctoral degree in counseling and at least two years of supervised clinical experience) who is practicing as a professional counselor and who is licensed or certified to do so by the state of practice, or if licensure or certification is not required by the state of practice, is a National Certified Counselor with a Specialty Certification in Clinical Mental Health Counseling from the National Board for Certified Counselors (NBCC).\n• A certified Community Mental Health Center (CMHC), or the comparable term (e.g. behavioral health organization, mental health agency, behavioral health agency) used within the state in which it is located, or a Certified Community Behavioral Health Clinic (CCBHC).\nOnly authorized CMHCs are considered mental health providers. To be authorized as a CMHC, an entity must meet one of the following criteria:\n- The entity has been certified by CMS to meet the conditions of participation (CoPs) that community mental health centers (CMHCs) must meet in order to participate in the Medicare program, as defined in the Code of Federal Regulations Title 42. CMS defines a\nCMHC as an entity that meets applicable licensing or certification requirements for CMHCs in the State in which it is located and provides the set of services specified in section 1913(c)(1) of the Public Health Service Act (PHS Act).\n- The entity has been licensed, operated, authorized, or otherwise recognized by a state or county in which it is located.\nOnly authorized CCBHCs are considered mental health providers. To be authorized as a CCBHC, an entity must meet one of the following criteria:\n- Has been certified by a State Medicaid agency as meeting criteria established by the Secretary for participation in the Medicaid CCBHC demonstration program pursuant to Protecting Access to Medicare Act § 223(a) (42 U.S.C. § 1396a note); or as meeting\ncriteria within the State’s Medicaid Plan to be considered a CCBHC.\n- Has been recognized by the Substance Abuse and Mental Health Services Administration, through the award of grant funds or otherwise, as a CCBHC that meets the certification criteria of a Certified Community Behavioral Health Clinic",null,null,null,"Positive",null,null,null,null,null,null,null,"The denominator specifications are the same for measures B2-152 and B2-153. Please note the denominator specifications for B2-152 and B2-153 are limited to discharges from State Hospitals and Sunrise Canyon Hospital, and the denominator values for each respective payer type should be the same for B2-152 and B2-153. For a given payer type, the B2-153 numerator value must be equal to or greater than the numerator value for B2-152."]
["B2-154","DPP BHS","B2","Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up","Process",null,"01/01/21 - 06/30/21","Numeric Data Reporting & Status Update Only",null,"01/01/21 - 12/31/21","Numeric Data Reporting & Status Update",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"0421","CMS","CMS MIPS #128 2020","https://qpp.cms.gov/docs/QPP_quality_measure_specifications/CQM-Measures/2019_Measure_128_MIPSCQM.pdf","Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous twelve months of the current encounter. Normal parameters: Age 18 years and older BMI ≥ 18.5 and < 25 kg/m2.","Pyschiatry, Mental/Behavioral Health","Individuals","All patients aged 18 and older on the date of the encounter with at least one eligible encounter during the measurement period","Patients aged ≥18 years on date of encounter\nAND\nPatient encounter during the performance period (CPT or HCPCS): 90791, 90792, 90832, 90834, 90837, 96156, 96158, 97161, 97162, 97163, 97165, 97166, 97167, 97802, 97803, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99236, 99304, 99305, 99306, 99307, 99308, 99309,99310, 99315, 99316, 99318, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99339, 99340, 99385*, 99386*, 99387*, 99395*, 99396*, 99397*, 99401*, 99402*, D7111, D7140, D7210, D7220, D7230, D7240, D7241, D7250, D7251, G0101, G0108, G0270, G0271, G0402, G0438, G0439, G0447, G0473\nWITHOUT\nTelehealth Modifier: GQ, GT, 95, POS 02","BMI not documented, documentation the patient is not eligible for BMI calculation: G8422\nOR\nBMI is documented as being outside of normal limits, follow-up plan is not documented, documentation the patient is not eligible: G8938\n\nNot Eligible for BMI Calculation or Follow-Up Plan (Denominator Exclusion) – A patient is not eligible if one or more of the following reasons are documented:\n•Patients receiving palliative or hospice care on the date of the current encounter or any time prior to the current encounter\n•Patients who are pregnant on the date of the current encounter or any time during the measurement period prior to the current encounter\n•Patients who refuse measurement of height and/or weight on the date of the current encounter or any time during the measurement period prior to the current encounter\n\nPatients with a documented BMI outside normal limits and a documented reason for not completing BMI follow-up plan during the current encounter or within the previous 12 months of the current encounter (Denominator Exception) –\n•Patients with a documented Medical Reason. The Medical Reason exception could include, but is not limited to, the following patients as deemed appropriate by the health care provider\n•Elderly patients (65 or older) for whom weight reduction/weight gain would complicate other underlying health conditions such as the following examples:\nillness or physical disability\noMental illness, dementia, confusion\noNutritional deficiency, such as vitamin/mineral deficiency\n•Patient is in an urgent or emergent medical situation where time","Patients with a documented BMI during the encounter or during the previous twelve months, AND when the BMI is outside of normal parameters, a follow-up plan is documented during the encounter or during the previous twelve months of the current encounter","Performance Met: BMI is documented within normal parameters and no follow-up plan is required (G8420)\nOR\nPerformance Met: BMI is documented as above normal parameters and a follow-up plan is documented (G8417)\nOR\nPerformance Met: BMI is documented as below normal parameters and a follow-up plan is documented (G8418)\n\nPerformance Met for G8417 & G8418\n•If the provider documents a BMI and a follow-up plan at the current visit OR\n•If the patient has a documented BMI within the previous twelve months of the current encounter, the provider documents a follow-up plan at the current visit OR\n•If the patient has a documented BMI within the previous twelve months of the current encounter AND the patient has a documented follow-up plan for a BMI outside normal parameters within the previous twelve months of the current visit","Performance Not Met: BMI not documented and no reason is given (G8421)\nOR\nPerformance Not Met: BMI documented outside of normal parameters, no follow-up plan documented, no reason given (G8419)",null,"Definitions:\n\nBMI – Body mass index (BMI), is a number calculated using the Quetelet index: weight divided by height squared (W/H2) and is commonly used to classify weight categories. BMI can be calculated using:\nMetric Units: BMI = Weight (kg) / (Height (m) x Height (m))\nOR\nEnglish Units: BMI = Weight (lbs) / (Height (in) x Height (in)) x 703\n\nFollow-Up Plan – Proposed outline of treatment to be conducted as a result of a BMI outside of normal parameters. A follow-up plan may include, but is not limited to:\n•Documentation of education\n•Referral (for example a Registered Dietitian Nutritionist (RDN), occupational therapist, physical therapist, primary care provider, exercise physiologist, mental health professional, or surgeon), for lifestyle/behavioral therapy\n•Pharmacological interventions\n•Dietary supplements\n•Exercise counseling\n•Nutrition counseling",null,null,null,"Positive",null,null,null,null,null,null,null,"Measure is a screening rate. Both positive and negative screens should be included if they meet the numerator inclusion criteria. "]

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[null,{"$f":"IF(OR(E22=\"NA\", E22=0, $E$7=\"Structure\"), 1, 0)","v":0},null,"Attributed Population Inclusion Criteria",{"$f":"IFERROR(VLOOKUP($E$5, 'Attribution Methodology SFY22'!$C:$L, 3, FALSE), \"\")","v":"The Physician Practice’s Group’s attributed population includes any individual that meets at least one of the criteria below:\na) One primary care service or preventive service provided during the measurement period; OR\nb) One ambulatory encounter during the measurement period; OR\nc) One prenatal or postnatal visit during the measurement period"}]
[null,0,null,"Primary Care Service - HCPCS Codes",{"$f":"IFERROR(VLOOKUP($E$5, 'Attribution Methodology SFY22'!$C:$L, 4, FALSE), \"\")","v":"99201–99205: New patient, office, or other outpatient visit\n99211–99215: Established patient, office, or other outpatient visit\n99304–99306: New patient, nursing facility care\n99307–99310: Established patient, nursing facility care\n99315–99316: Established patient, discharge day management service\n99318: Established patient, other nursing facility service\n99324–99328: New patient, domiciliary or rest home visit\n99334–99337: Established patient, domiciliary or rest home visit\n99339–99340: Established patient, physician supervision of patient (patient not present) in home, domiciliary, or rest home\n99341–99345: New patient, home visit\n99347–99350: Established patient, home visit"}]
[null,0,null,"Preventive Care Service - Value Sets",{"$f":"IFERROR(VLOOKUP($E$5, 'Attribution Methodology SFY22'!$C:$L, 5, FALSE), \"\")","v":"Encounter, Performed: Annual Wellness Visit:  2.16.840.1.113883.3.526.2.1363\nEncounter, Performed: Preventive Care - Initial Office Visit 0 to 17: 2.16.840.1.113883.3.464.1003.101.12.1022.\nEncounter, Performed: Preventive Care - Established Office Visit 0 to 17: 2.16.840.1.113883.3.464.1003.101.12.1024\nEncounter, Performed: Preventive Care - Initial Office Visit, 18 and Up: 2.16.840.1.113883.3.464.1003.101.12.1023\nEncounter, Performed: Preventive Care - Established Office Visit, 18 and Up: 2.16.840.1.113883.3.464.1003.101.12.1025 \nEncounter, Performed: Preventive Care Services - Individual Counseling: 2.16.840.1.113883.3.464.1003.101.12.1026"}]
[null,0,null,"Ambulatory Encounter - Value Sets",{"$f":"IFERROR(VLOOKUP($E$5, 'Attribution Methodology SFY22'!$C:$L, 6, FALSE), \"\")","v":"Encounter, Performed: Office Visit: 2.16.840.1.113883.3.464.1003.101.12.1001\nEncounter, Performed: Face-to-Face Interaction: 2.16.840.1.113883.3.464.1003.101.12.1048\nEncounter, Performed: Ophthalmological Services: 2.16.840.1.113883.3.526.3.1285\nEncounter, Performed: Outpatient Consultation: 2.16.840.1.113883.3.464.1003.101.12.1008\nEncounter, Performed: Psych Visit - Psychotherapy: 2.16.840.1.113883.3.526.3.1496\nEncounter, Performed: Ambulatory/ED Visit: 2.16.840.1.113883.3.464.1003.101.12.1061\nEncounter, Performed: Psych Visit - Diagnostic Evaluation: 2.16.840.1.113883.3.526.3.1492\nEncounter, Performed: Psychoanalysis: 2.16.840.1.113883.3.526.3.1141\nEncounter, Performed: Occupational Therapy Evaluation: 2.16.840.1.113883.3.526.3.1011\nProcedure, Performed: Hemodialysis: 2.16.840.1.113883.3.526.3.1083\nProcedure, Performed: Peritoneal Dialysis: 2.16.840.1.113883.3.526.3.1084\nEncounter, Performed: Health & Behavioral Assessment - Individual: 2.16.840.1.113883.3.526.3.1020\nEncounter, Performed: Health and Behavioral Assessment - Initial: 2.16.840.1.113883.3.526.3.1245\nEncounter, Performed: Health and Behavioral Assessment, Reassessment: 2.16.840.1.113883.3.526.3.1529\n*Encounter, Performed: Preventive Care Services - Other: 2.16.840.1.113883.3.464.1003.101.12.1030 \nEncounter, Performed: Speech and Hearing Evaluation: 2.16.840.1.113883.3.526.3.1530\nEncounter, Performed: Outpatient Encounters for Preventive Care: 2.16.840.1.113762.1.4.1047.9\n*NOTE: “Preventive Care Services – Other” value set includes codes that have been replaced by 96160 and 96161 in TX Health Steps. For TIPPS reporting purposes, 96160 and 96161 should be included as ambulatory encounters."}]
[null,0,"Attribution Step 2","Measure-Specific Denominator Population Definition",{"$f":"IFERROR(VLOOKUP($E$5, 'Attribution Methodology SFY22'!$C:$L, 7, FALSE), \"\")","v":"The measure-specific denominator population (Step 2) includes the individuals or encounters from the TIPPS attributed population (Step 1) that meet all criteria under the \"Eligible Physician Specialties and Other Clinicians\", \"Denominator Inclusions\", and \"Denominator Exclusions\" as applicable for each quality measure, as defined in the TIPPS Measure Specifications. \n\nPhysician groups may refer to the most recent NUCC Health Care Provider Taxonomy Code Set (https://taxonomy.nucc.org/) for the definitions and taxonomy codes for physician specialties, physician subspecialties, and other clinicians, as defined by the National Uniform Claim Committee (NUCC). The NUCC provider taxonomy definitions and codes for physician subspecialties that are nested within an eligible physician specialty may be included if these subspecialists perform the quality actions described in the measure based on the services provided and the measure specific-denominator coding. Nurse Practitioners and Physician Assistants, as defined by NUCC, practicing under the listed eligible physician specialties or practicing equivalent services may also be included."}]
[null,{"$f":"IF(OR(E27=\"NA\", E27=0), 1, 0)","v":0},null,"Eligible Physician Specialties and Other Clinicians",{"$f":"IFERROR(VLOOKUP($E$2, 'Measure Specifications SFY22'!$A:$AK, 24, FALSE), \"\")","v":"Family Medicine; Internal Medicine; Pediatrics (Optional); Preventive Medicine; Dietician, Registered"}]
[null,0,null,"NQF ID",{"$f":"IFERROR(VLOOKUP($E$2, 'Measure Specifications SFY22'!$A:$AK,19, FALSE), \"\")","v":"0059"}]
[null,0,null,"Measure Steward",{"$f":"IFERROR(VLOOKUP($E$2, 'Measure Specifications SFY22'!$A:$AK, 20, FALSE), \"\")","v":"NCQA"}]
[null,0,null,"Measure Specs Source (Version)",{"$f":"IFERROR(VLOOKUP($E$2, 'Measure Specifications SFY22'!$A:$AK, 21, FALSE), \"\")","v":"eCQM - CMS 122v9"}]
[null,0,null,"Link to Measure Specs Source",{"$f":"IFERROR(VLOOKUP($E$2, 'Measure Specifications SFY22'!$A:$AK, 22, FALSE), \"\")","v":"https://ecqi.healthit.gov/ecqm/ep/2021/cms122v9"}]
[null,0,null,"Measure Description",{"$f":"IFERROR(VLOOKUP($E$2, 'Measure Specifications SFY22'!$A:$AK, 23, FALSE), \"\")","v":"Percentage of patients 18-75 years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period"}]
[null,0,null,"Denominator Unit of Measurement",{"$f":"IFERROR(VLOOKUP($E$2, 'Measure Specifications SFY22'!$A:$AK, 25, FALSE), \"\")","v":"Individuals"}]
[null,0,null,"Denominator Description",{"$f":"IFERROR(VLOOKUP($E$2, 'Measure Specifications SFY22'!$A:$AK, 26, FALSE), \"\")","v":"Patients 18-75 years of age with diabetes with a visit during the measurement period"}]
[null,0,null,"Denominator Inclusions",{"$f":"IFERROR(VLOOKUP($E$2, 'Measure Specifications SFY22'!$A:$AK, 27, FALSE), \"\")","v":"\"Initial Population\"\n\nexists ( [\"Patient Characteristic Birthdate\"] Birthdate\n\t\twhere Global.\"CalendarAgeInYearsAt\"(Birthdate.birthDatetime, start of \"Measurement Period\")in Interval[18, 75 ))\n\tand exists ( AdultOutpatientEncounters.\"Qualifying Encounters\" )\n\tand exists ( [\"Diagnosis\": \"Diabetes\"] Diabetes\n\t\t\twhere Diabetes.prevalencePeriod overlaps \"Measurement Period\")\n\n( [\"Encounter, Performed\": \"Office Visit\"]\n\tunion [\"Encounter, Performed\": \"Annual Wellness Visit\"]\n\tunion [\"Encounter, Performed\": \"Preventive Care Services - Established Office Visit, 18 and Up\"]\n\tunion [\"Encounter, Performed\": \"Preventive Care Services-Initial Office Visit, 18 and Up\"]\n\tunion [\"Encounter, Performed\": \"Home Healthcare Services\"] ) ValidEncounter\n\twhere ValidEncounter.relevantPeriod during \"Measurement Period\""}]
[null,0,null,"Denominator Exclusions",{"$f":"IFERROR(VLOOKUP($E$2, 'Measure Specifications SFY22'!$A:$AK, 28, FALSE), \"\")","v":"Exclude patients whose hospice care overlaps the measurement period.\n\nExclude patients 66 and older who are living long term in an institution for more than 90 consecutive days during the measurement period.\n\nExclude patients 66 and older with advanced illness and frailty because it is unlikely that patients will benefit from the services being measured.\n\nHospice.\"Has Hospice\"\n  or FrailtyLTI.\"Advanced Illness and Frailty Exclusion Not Including Over Age 80\"\n  or ( exists [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n      where ( Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) >= 65 )\n        and FrailtyLTI.\"Long Term Care Periods Longer Than 90 Consecutive Days\")\n \n\nHospice. \"Has Hospice\"\n\nexists ( [\"Encounter, Performed\": \"Encounter Inpatient\"] DischargeHospice\n\t\twhere (DischargeHospice.dischargeDisposition as Code ~ \"Discharge to home for hospice care (procedure)\"\n\t\t\t\tor DischargeHospice.dischargeDisposition as Code ~ \"Discharge to healthcare facility for hospice care (procedure)\")\n\t\t\tand DischargeHospice.relevantPeriod ends during \"Measurement Period\")\n\tor exists ( [\"Intervention, Order\": \"Hospice care ambulatory\"] HospiceOrder\n\t\t\twhere HospiceOrder.authorDatetime during \"Measurement Period\")\n\tor exists ( [\"Intervention, Performed\": \"Hospice care ambulatory\"] HospicePerformed\n\t\t\twhere HospicePerformed.relevantPeriod overlaps \"Measurement Period\")"}]
[null,0,null,"Numerator Description",{"$f":"IFERROR(VLOOKUP($E$2, 'Measure Specifications SFY22'!$A:$AK, 29, FALSE), \"\")","v":"Patients whose most recent HbA1c level (performed during the measurement period) is >9.0%"}]
[null,0,null,"Numerator Inclusion (Performance Met) ",{"$f":"IFERROR(VLOOKUP($E$2, 'Measure Specifications SFY22'!$A:$AK, 30, FALSE), \"\")","v":"\"Has Most Recent Elevated Hba1c\"\n\tor \"Has Most Recent HbA1c Without Result\"\n\tor \"Has No Record Of HbA1c\"\n\nLast([\"Laboratory Test, Performed\": \"HbA1c Laboratory Test\"] HighHbA1c\n\t\twhere HighHbA1c.relevantPeriod during \"Measurement Period\"\n\t\t\tand HighHbA1c.result is not null\n\t\tsort by resultDatetime\n).result > 9 '%'\n \nLast([\"Laboratory Test, Performed\": \"HbA1c Laboratory Test\"] HbA1cNoResult\n\t\twhere HbA1cNoResult.relevantPeriod during \"Measurement Period\"\n\t\tsort by resultDatetime\n).result is null\n \nnot exists [\"Laboratory Test, Performed\": \"HbA1c Laboratory Test\"] NoHbA1c\n\twhere NoHbA1c.relevantPeriod during \"Measurement Period\""}]
[null,0,null,"Numerator Exclusion (Performance Not Met) ",{"$f":"IFERROR(VLOOKUP($E$2, 'Measure Specifications SFY22'!$A:$AK, 31, FALSE), \"\")","v":"None"}]
[null,1,null,"HHSC Program Specific Modifications",{"$f":"IFERROR(VLOOKUP($E$2, 'Measure Specifications SFY22'!$A:$AK, 32, FALSE), \"\")","v":0}]
[null,0,null,"Measure Steward Additional Information",{"$f":"IFERROR(VLOOKUP($E$2, 'Measure Specifications SFY22'!$A:$AK, 33, FALSE), \"\")","v":"Additional definitinos of advanced illness and fraility are available in the measure source: https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS122v9.html#d1e767.\n\nPatient is numerator compliant if most recent HbA1c level >9%, the most recent HbA1c result is missing, or if there are no HbA1c tests performed and results documented during the measurement period. If the HbA1c test result is in the medical record, the test can be used to determine numerator compliance.\n\nOnly patients with a diagnosis of Type 1 or Type 2 diabetes should be included in the denominator of this measure; patients with a diagnosis of secondary diabetes due to another condition should not be included.\n\nThis eCQM is a patient-based measure.\n\nThis version of the eCQM uses QDM version 5.5.  Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM."}]
[null,{"$f":"IF(OR(E42=\"NA\", E42=0, $E$7=\"Structure\"), 1, 0)","v":0},"Attribution Step 3","Reporting Payer Types*",{"$f":"IFERROR(VLOOKUP($E$5, 'Attribution Methodology SFY22'!$C:$L, 8, FALSE), \"\")","v":"*Measures must be stratified by the required reporting payer types unless otherwise specified under \"Required Reporting Payer Type Stratification\" in the \"Measure Specifications SFY22\" tab. For example, some measures may only require reporting by one of more of the following reporting payer types below. \n\n• Medicaid Managed Care** (includes STAR, STAR+PLUS, and STAR Kids)\n• Other Medicaid (includes other Medicaid Managed Care programs and Medicaid Fee-For-Service (FFS))\n• Uninsured (includes No insurance; County-based or other public medical assistance)\n• All Payer (includes Medicaid Managed Care, Other Medicaid, Uninsured, and all other payer types such as CHIP, Medicare, Medicare/Medicaid Dual Eligibles, and Commercial Insurance)\n\n**In the reporting template, providers will indicate whether the provider's system can report the required reporting payer type of “Medicaid Managed Care\" as outlined above to include STAR, STAR+PLUS, and STAR Kids. If provider's system cannot report “Medicaid Managed Care\" as outlined above, then the provider may alternatively report the “Medicaid Managed Care” payer type as \"Medicaid\" (includes all Medicaid Managed Care programs and Medicaid FFS). This alternative will only be available during Year 1 of the DPP. As a result of using this alternative, the required reporting payer types would be as shown below:  \n• Medicaid (includes all Medicaid Managed Care programs and Medicaid FFS)\n• Uninsured (includes No insurance; County-based or other public medical assistance)\n• All Payer (includes Medicaid, Uninsured, and all other payer types such as CHIP, Medicare, Medicare/Medicaid Dual Eligibles, and Commercial Insurance)"}]
[null,null,null,"Payer Type Assignment Methodology",{"$f":"IFERROR(VLOOKUP($E$5, 'Attribution Methodology SFY22'!$C:$L, 9, FALSE), \"\")","v":"The payer type assignment methodology depends on the unit of measurement (e.g., “Individual” or “Encounter”) of the measure-specific denominator (Step 2), as defined in the TIPPS Measure Specifications. \n\n1. Individual: A unit of measurement is an “individual” if a person can only be counted once in the denominator in a given measurement period. Payer type will be determined either by the most recent payer type on record for the individual at the end of the measurement period OR as any individual with a Medicaid-enrolled service at any point in the measurement period, even if their most recent payer type of record is not Medicaid. The same assignment methodology for determining Medicaid must be applied consistently across the measurement period.\n\n2. Encounter: A unit of measurement is an “encounter” if a person can be counted in the denominator more than once in a given measurement period. Payer type will be determined by the payer type on record for the qualifying encounter (visit or admission)."}]
[null,{"$f":"IF(OR(E44=\"NA\", E44=0, $E$7=\"Structure\"), 1, 0)","v":0},null,"Allowable Exclusion(s)",{"$f":"IFERROR(VLOOKUP($E$5, 'Attribution Methodology SFY22'!$C:$L, 10, FALSE), \"\")","v":"Encounters with an individual incarcerated in a state or federal facility during the measurement period"}]
[null,1,"Measure Alignment","Blank Field (intentionally left blank)",{"$f":"IFERROR(VLOOKUP($E$2, 'Measure Specifications SFY22'!$A:$AK, 34, FALSE), \"\")","v":0}]
[null,1,null,"Blank Field (intentionally left blank)",{"$f":"IFERROR(VLOOKUP($E$2, 'Measure Specifications SFY22'!$A:$AK, 35, FALSE), \"\")","v":0}]
[null,1,null,"Blank Field (intentionally left blank)",{"$f":"IFERROR(VLOOKUP($E$2, 'Measure Specifications SFY22'!$A:$AK,36, FALSE), \"\")","v":0}]
[null,null,null,"Performance Directionality",{"$f":"IFERROR(VLOOKUP($E$2, 'Measure Specifications SFY22'!$A:$AK,37, FALSE), \"\")","v":"Negative"}]
[null,null,null,"Public Notes",{"$f":"IFERROR(VLOOKUP($E$2, 'Measure Specifications SFY22'!$A:$AS,45, FALSE), \"\")","v":0}]

{"sheet":"Additional Reporting Info SFY22","index":5,"n_rows":5,"n_cols":2,"rows_kept":5,"cut":false,"hidden":false,"merged":[[0,0,0,1]]}
["Additional Reporting Information"]
["Measure Stewards","The measures proposed are drawn from measures developed by authoritative agencies of outcome measurement such as the National Committee for Quality Assurance (NCQA), Centers for Disease Control (CDC), and American Medical Association's Physician Consortium for Performance Improvement (AMA-PCPI). These agencies are referred to as the \"Measure Steward\". These measures have been validated and tested to ensure that the outcomes are measuring what they aim to measure. In some cases, where validated measures did not previously exist, measures were adapted based on evidence-based guidelines and practices and experience from the Texas Delivery System Reform Incentive Payment Program. The outcomes are salient to aspects of patient care that reflect better health and satisfaction with services, improved efficiencies in health care delivery and cost savings."]
["Data Sources","Included measures have been specified using electronic health record (EHR) and claims data available to healthcare providers. In certain cases, measures have been adapted from measures specified for health plans. Providers should use the most complete data available and ensure that the rates reported are representative of the entire population served.\n\nProviders are responsible for adhering to measure specifications and in cases where a variance from a designated measure source is required due to variances in data sources, providers should keep a record of and such variances to ensure consistency, and make a note of such variances when reporting each measurement year. Providers may opt to use local or proprietary codes or values mapped to the standard codes included in the measure specifications. Providers that use local or proprietary codes must maintain documentation that includes a crosswalk of relevant codes, descriptions, and clinical information if applicable. "]
["Measurement Periods","The data measurement period required for a given reporting period is identified under \"Data Measurement Period\" in the Measure Specifications SFY22 Tab. Additionally, measure-specific denominator specifications may place additional limitations on the measurement period used for denominator inclusion. This may include using only a portion of the measurement period for denominator inclusion or identifying encounters and/or diagnosis that occur before the measurement period for denominator inclusion (a lookback period). \n\nAll measures are specified for a 12-month Data Measurement Period, unless otherwise specified under \"Data Measurement Period\". In those cases where the Data Measurement Period is not specified for 12 months (e.g., a data measurement period instead of 6 months of data), providers should include all denominator cases that meet the denominator inclusion requirements for the 12-month data measurement period that will eventually be reported, including any lookback requirements. This means that when reporting 6 months of data, providers should be able to use the same logic that they will use when reporting 12 months of data, reporting all data as of the end date of the 6-month data measurement period. \n"]
["Sampling Requirements","Participating providers should use the most complete data available and ensure that the rate reported is representative of the entire population attributed to the participant. All cases that meet the eligible population per measure denominator specifications must be included. However, for measures in which all required data elements are not available to the participant electronically (E.H.R., claims data, or registry) or are of poor quality, participants may conduct a sample to determine the rate for a given performance year. \n\nParticipants should follow the sampling methodology included in the measure specifications by the measure steward, or if no sampling methodology is specified by the measure steward, participants should follow the HHSC sampling methodology identified below:\n\nHHSC Sampling Methodology\nFirst, participants must use available administrative data to determine the initial denominator population (e.g., the denominator specifications must still first be applied to determine the initial pool of eligible denominator cases). Then, from the initial denominator population, a minimum sample size of cases will be randomly selected such that all initially eligible cases have an equal chance of being selected for the sample and the resulting sample is representative of the entire initial denominator population for the measure. In the reporting template, participants will indicate if the data being reported used a sampling methodology, and in the qualitative responses, participants should clarify whether the measure steward's or HHSC's sampling methodology is being used when describing the sampled reporting. Participants should maintain records of sampling methodology and random selection.\n\nHHSC Minimum Sample Size for All Payer\n•  For a measurement period where the denominator size is less than or equal to 75, participants must report on all cases. No sampling is allowed.\n•  For a measurement period where the denominator size is less than or equal to 380 but greater than 75, participants must report on a random sample of not less than 76 cases.\n•  For a measurement period where the denominator size is greater than 380, participants must report on a random sample of cases that is not less than 20% of all cases; however, participants may cap the total sample size at 411 cases.\n\nIt is recommended to select an oversample of 10-15% of the sample size for substitution in the event that cases in the original sample are excluded from the measure."]

{"sheet":"Change Log","index":6,"n_rows":204,"n_cols":18,"rows_kept":204,"cut":false,"hidden":false,"merged":[]}
["DPP Measure Specifications File - Change Log"]
["Change ID","Tab Name","SFY","Measure ID","Measure Title","Description of Change(s) Made","File Version Reflecting Change","Change Publish Date","Column1","Column2","Column3","Column4","CHIRP","TIPPS","RAPPS","DPP BHS","SFY22","SFY23"]
[1,"Measure Specifications SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"Reporting Payer Type Stratification updated to remove reference to Medicaid managed care plan","v1.2","2021-03-08","Yes","NG",null,null,null,null,null,null,"X"]
[2,"Attribution Methodology SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"In Step 2 of the “Attribution Methodology” for all DPPs, the criteria under the \"Eligible Physician Specialties and Other Clinicians\" has been clarified to provide reference to the NUCC Health Care Provider Taxonomy Code Set (https://taxonomy.nucc.org/) for the definitions and taxonomy codes for physician specialties, subspecialties, and other clinicians, as defined by the National Uniform Claim Committee (NUCC). Additional guidance clarified that the NUCC provider taxonomy definitions and codes for physician subspecialties that are nested within an eligible physician specialty may be included if these subspecialists perform the quality actions described in the measure based on the services provided and the measure specific-denominator coding, and Nurse Practitioners and Physician Assistants, as defined by NUCC, practicing under the listed eligible physician specialties or practicing equivalent services may also be included.","v1.2","2021-03-08","Yes","JJ",null,null,null,null,null,null,"X"]
[3,"Measure Specifications SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"HHSC has also updated the names of the provider types listed under “Eligible Physician Specialties and Other Clinicians for Outpatient Measures” to align with the provider taxonomy names used by NUCC. ","v1.2","2021-03-08","Yes","JJ",null,null,null,null,null,null,"X"]
[4,"Measure Specifications SFY22","SFY22","T3-121",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Food Insecurity Screening"},"Measure Description and Numerator specifications have been updated to clarify that the HVS screening with results documented may occur during the current encounter or during the previous twelve months. Numerator Inclusion has also been updated to include the HVS 2-question screening statements.\n\nDenominator and Numerator specifications have been updated to clarify there are no age restrictions for this measure for denominator inclusion, and while there are also no age restrictions for this measure for numerator inclusion, parents, guardians, and caretakers may be screened for numerator inclusion. \n\nThe Additional Information has been updated to clarify use of the HVS 2 questions is free with proper citation, provide 11 language translations, and share resources relevant to use of HVS.\n\nThe \"Eligible Physicians/Other Clinicians\" has been updated to: \"Family Medicine; Internal Medicine; Obstetrics & Gynecology; Pediatrics\". ","v1.2","2021-03-08","Yes","JJ",null,null,null,null,null,null,"X"]
[5,"Measure Specifications SFY22","SFY22","B2-152",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Follow-Up After Hospitalization for Mental Illness 7-Day (discharges from state hospital)"},"Replaced \"mental health professional\" with \"mental health provider\" to align with NCQA recommendations. Added definition of Mental Health Provider to Additional Information.","v1.2","2021-03-08","No","BTM",null,null,null,null,null,null,"X"]
[6,"Measure Specifications SFY22","SFY22","B2-153",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Follow-Up after Hospitalization for Mental Illness 30-Day (discharges from state hospital)"},"Replaced \"mental health professional\" with \"mental health provider\" to align with NCQA recommendations. Removed date of discharge visits from numerator inclusions for consistency with numerator description. Added NCQA definition of Mental Health Provider to Additional Information.","v1.2","2021-03-08","No","BTM",null,null,null,null,null,null,"X"]
[7,"Measure Specifications SFY22","SFY22","B2-154",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up"},"Added new measure \"Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up\" as a benchmark measure.","v1.2","2021-03-08","Yes","BTM",null,null,null,null,null,null,"X"]
[8,"Measure Specifications SFY22","SFY22","T2-116",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Testing"},"Added Texas Health Steps checkup codes 99383, 99384, 99385, 99393, 99394, 99395 to denominator inclusions.","v1.2","2021-03-08","Yes","BTM",null,null,null,null,null,null,"X"]
[9,"Measure Specifications SFY22","SFY22","T2-104",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Preventive Care & Screening: Tobacco Use: Screening & Cessation Intervention"},"Added definitions and measure guidance to the Additional Information section.","v1.2","2021-03-08","No","BTM",null,null,null,null,null,null,"X"]
[10,"Measure Specifications SFY22","SFY22","T2-112",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Cervical Cancer Screening"},"Added measure guidance, including the allowance of self-report procedures in the Additional Information section.","v1.2","2021-03-08","No","BTM",null,null,null,null,null,null,"X"]
[11,"Measure Specifications SFY22","SFY22","T2-113",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Childhood Immunization Status"},"Added definitions and measure guidance in the Additional Information section.","v1.2","2021-03-08","No","BTM",null,null,null,null,null,null,"X"]
[12,"Measure Specifications SFY22","SFY22","T2-113",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Childhood Immunization Status"},"Added definitions (including screening tools) and measure guidance in the Additional Information section. ","v1.2","2021-03-08","No","BTM",null,null,null,null,null,null,"X"]
[13,"Measure Specifications SFY22","SFY22","T2-115",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Preventive Care and Screening: Screening for Depression and Follow-Up Plan"},"Added definitions and measure guidance in the Additional Information section.","v1.2","2021-03-08","No","BTM",null,null,null,null,null,null,"X"]
[14,"Measure Specifications SFY22","SFY22","T2-117",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Tobacco Use and Help with Quitting Among Adolescents"},"Added measure guidance in the Additional Information section.","v1.2","2021-03-08","No","BTM",null,null,null,null,null,null,"X"]
[15,"Measure Specifications SFY22","SFY22","T2-118",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Chlamydia Screening in Women"},"Added measure guidance in the Additional Information section.","v1.2","2021-03-08","No","BTM",null,null,null,null,null,null,"X"]
[16,"Measure Specifications SFY22","SFY22","T3-122",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Maternity Care: Post-Partum Follow-Up and Care Coordination"},"Added definitions in the Additional Information section.","v1.2","2021-03-08","No","BTM",null,null,null,null,null,null,"X"]
[17,"Measure Specifications SFY22","SFY22","C2-104",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Preventive Care & Screening: Tobacco Use: Screening & Cessation Intervention"},"Added definitions and measure guidance in the Additional Information section.","v1.2","2021-03-08","No","BTM",null,null,null,null,null,null,"X"]
[18,"Measure Specifications SFY22","SFY22","C2-103",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Preventive Care and Screening: Influenza Immunization"},"Added definitions and measure guidance in the Additional Information section.","v1.2","2021-03-08","No","BTM",null,null,null,null,null,null,"X"]
[19,"Measure Specifications SFY22","SFY22","B2-150",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk Assessment"},"Added definitions and measure guidance in the Additional Information section.","v1.2","2021-03-08","No","BTM",null,null,null,null,null,null,"X"]
[20,"Measure Specifications SFY22","SFY22","B2-151",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Adult Major Depressive Disorder (MDD): Suicide Risk Assessment "},"Added definitions and measure guidance in the Additional Information section.","v1.2","2021-03-08","No","BTM",null,null,null,null,null,null,"X"]
[21,"Measure Specifications SFY22","SFY22","B2-154",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up"},"Added definitions in the Additional Information section.","v1.2","2021-03-08","No","BTM",null,null,null,null,null,null,"X"]
[22,"Measure Specifications SFY22","SFY22","R2-103",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Preventive Care and Screening: Influenza Immunization "},"Added definitions and measure guidance in the Additional Information section.","v1.2","2021-03-08","No","BTM",null,null,null,null,null,null,"X"]
[23,"Attribution Methodology SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"In Step 3 of the Attribution Methodology for all DPPs, the payer type assignment methodology for measures with \"Individual\" as the unit of measurement has been updated such that: Payer type will be determined either by the most recent payer type on record for the individual at the end of the measurement period OR as any individual with a Medicaid-enrolled service at any point in the measurement period, even if their most recent payer type of record is not Medicaid. The same assignment methodology for determining Medicaid must be applied consistently across the measurement period.","v1.2","2021-03-08","Yes","JJ",null,null,null,null,null,null,"X"]
[24,"Attribution Methodology SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"In Step 3 of the Attribution Methodology for TIPPS, the attributed population inclusion criteria b) has been changed from two ambulatory encounters to one ambulatory encounter during the measurement period.","v1.2","2021-03-08","Yes","JJ",null,null,null,null,null,null,"X"]
[25,"Attribution Methodology SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"C2 - ACIA Maternal Care removed reference to \"prenatal and postnatal visit\" in Step 1","v1.2","2021-03-08","Yes","JJ",null,null,null,null,null,null,"X"]
[26,"Attribution Methodology SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"In Step 3 of the Attribution Methodology for all programs, the Reporting Payer Types and Allowable Exclusions have been modified to remove reference to reporting managed care specific rates.","v1.2","2021-03-08","Yes","NG",null,null,null,null,null,null,"X"]
[27,"Measure Specifications SFY22","SFY22","T3-123",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Behavioral Health Risk Assessment for Pregnant Women"},"Denominator, Numerator, and Additional Information specifications have been clarified to describe the Denominator Identification Period (index period) and Measure Assessment Period for Rate Calculation (assessment period) for a given measurement year.","v1.2","2021-03-08","Yes","JJ",null,null,null,null,null,null,"X"]
[28,"Measure Specifications SFY22","SFY22","T1-X",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"Measure removed: CG-CAHPS Patient-Centered Medical Home (PCMH) Item Set","v1.2","2021-03-08","Yes","NG",null,null,null,null,null,null,"X"]
[29,"Measure Specifications SFY22","SFY22","T1-X",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"Measure removed: SDOH Data Infrastructure: Screening for SDOH, e.g. food insecurity","v1.2","2021-03-08","Yes","NG",null,null,null,null,null,null,"X"]
[30,"Measure Specifications SFY22","SFY22","T3-X",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"Measure removed: Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics","v1.2","2021-03-08","Yes","NG",null,null,null,null,null,null,"X"]
[31,"Measure Specifications SFY22","SFY22","C1-X",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"Measure removed: Data Quality Review","v1.2","2021-03-08","Yes","NG",null,null,null,null,null,null,"X"]
[32,"Measure Specifications SFY22","SFY22","C2-X",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"Measure removed:PC-03 Antenatal Steroids","v1.2","2021-03-08","Yes","NG",null,null,null,null,null,null,"X"]
[33,"Measure Specifications SFY22","SFY22","C2-X",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"Measure removed: Post-discharge appointment for behavioral health","v1.2","2021-03-08","Yes","NG",null,null,null,null,null,null,"X"]
[34,"Measure Specifications SFY22","SFY22","C2-X",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"Measure removed: Rate of 30-day readmissions for BH Conditions","v1.2","2021-03-08","Yes","NG",null,null,null,null,null,null,"X"]
[35,"Measure Specifications SFY22","SFY22","C2-X",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"Measure removed: Follow-Up After Hospitalization for Mental Illness","v1.2","2021-03-08","Yes","NG",null,null,null,null,null,null,"X"]
[36,"Measure Specifications SFY22","SFY22","C2-X",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"Measure removed: Post-discharge appointment for heart failure","v1.2","2021-03-08","Yes","NG",null,null,null,null,null,null,"X"]
[37,"Measure Specifications SFY22","SFY22","C2-X",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"Measure removed: Transition Record with Specified Elements Received by Discharged Patients (Discharges from Inpatient Facility)","v1.2","2021-03-08","Yes","NG",null,null,null,null,null,null,"X"]
[38,"Measure Specifications SFY22","SFY22","C2-X",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"Measure removed: Use of validated screening tool for food insecurity","v1.2","2021-03-08","Yes","NG",null,null,null,null,null,null,"X"]
[39,"Measure Specifications SFY22","SFY22","C2-X",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"Measure removed: Food Insecurity Screening","v1.2","2021-03-08","Yes","NG",null,null,null,null,null,null,"X"]
[40,"Measure Specifications SFY22","SFY22","C2-X",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"Measure removed: Adult Major Depressive Disorder: Suicide Risk Assessment","v1.2","2021-03-08","Yes","NG",null,null,null,null,null,null,"X"]
[41,"Measure Specifications SFY22","SFY22","C2-X",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"Measure removed: Follow-Up After ED Visits for Mental Illness","v1.2","2021-03-08","Yes","NG",null,null,null,null,null,null,"X"]
[42,"Measure Specifications SFY22","SFY22","C2-X",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"Measure removed: Use of validated screening tool for food insecurity and suicide risk","v1.2","2021-03-08","Yes","NG",null,null,null,null,null,null,"X"]
[43,"Measure Specifications SFY22","SFY22","C2-X",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"Measure removed: Inpatient Influenza Immunization IMM-2","v1.2","2021-03-08","Yes","NG",null,null,null,null,null,null,"X"]
[44,"Prog Component Elig Reqs SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"Removed reference to \"managed care\", changed \"CY2019 or CY2020\" to \"CY2021\", and updated minimum volume requirement percentage to 50% instead of 60%","v1.2","2021-03-08","Yes","BTM",null,null,null,null,null,null,"X"]
[45,"Prog Component Elig Reqs SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"Removed reference to \"managed care\", changed \"CY2019 or CY2020\" to \"CY2021\", and updated minimum volume requirement percentage to 50% instead of 60%","v1.2","2021-03-08","Yes","BTM",null,null,null,null,null,null,"X"]
[46,"Measure Specifications SFY22","SFY22","T1-107",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Same-day, walk-in, or after-hours appointments in the outpatient setting"},"Measure changed from \"Providers demonstrate connectivity to/participation in local HIE\" to \"Reporting on status with enrollment in a public HIE\"","v1.2","2021-03-08","No","BTM",null,null,null,null,null,null,"X"]
[47,"Measure Specifications SFY22","SFY22","T1-108",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Pre-visit planning and/or standing order protocols"},"Measure changed from \"Telehealth to provide virtual medical appointments and/or consultations with a psychiatrist or a psychologist\" to \"Reporting of availability of telehealth for specialty services and in what setting\"","v1.2","2021-03-08","No","BTM",null,null,null,null,null,null,"X"]
[48,"Measure Specifications SFY22","SFY22","T2-104",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Preventive Care & Screening: Tobacco Use: Screening & Cessation Intervention"},"Updated measure to reflect reporting of only one rate: Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 12 months AND who received tobacco cessation intervention if identified as a tobacco user.","v1.2","2021-03-08","Yes","BTM",null,null,null,null,null,null,"X"]
[49,"Measure Specifications SFY22","SFY22","T2-112",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Cervical Cancer Screening"},"Updated measure to reflect reporting of only one rate:  All patients who are compliant for Meningococcal, Tdap and HPV during the specified timeframes","v1.2","2021-03-08","Yes","BTM",null,null,null,null,null,null,"X"]
[50,"Measure Specifications SFY22","SFY22","T3-122",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Maternity Care: Post-Partum Follow-Up and Care Coordination"},"Updated measure title to Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Poor Control (>9.0%)","v1.2","2021-03-08","No","BTM",null,null,null,null,null,null,"X"]
[51,"Measure Specifications SFY22","SFY22","T3-122",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Maternity Care: Post-Partum Follow-Up and Care Coordination"},"Updated denominator exclusions to match measure source by adding long term care and advanced frailty. Added definitions and measure guidance in the Additional Information section.","v1.2","2021-03-08","No","BTM",null,null,null,null,null,null,"X"]
[52,"Measure Specifications SFY22","SFY22","T3-124",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Depression Response at Twelve Months"},"Added new measure \"Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents\" as a benchmark measure. Measure will only be reported for one rate: Percentage of patients with height, weight, and body mass index (BMI) percentile documentation.","v1.2","2021-03-08","Yes","BTM",null,null,null,null,null,null,"X"]
[53,"Measure Specifications SFY22","SFY22","C2-160",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Engagement in Integrated Behavioral Health"},"Added new measure \"Engagement in Integrated Behavioral Health\".","v1.2","2021-03-08","Yes","NG",null,null,null,null,null,null,"X"]
[54,"Measure Specifications SFY22","SFY22","C2-130",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"PC-02 Cesarean Section"},"Added reference to ePC-02 option for reporting. ","v1.2","2021-03-08","Yes","NG",null,null,null,null,null,null,"X"]
[55,"Introduction SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"Contact changed to \"dppquality@hhs.texas.gov\"","v1.3","2021-04-06","Yes","JJ","2021-03-25",null,null,null,null,null,"X"]
[56,"Prog Component Elig Reqs SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"Removed \"Children's Hospital\" from C2 - ACIA Psychiatric Care Transitions","v1.3","2021-04-06","Yes","JJ","2021-03-25",null,null,null,null,null,"X"]
[57,"Attribution Methodology SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"CHIRP Program Component \"C2 - ACIA Pediatric Hospital Safety\" updated to \"C2 - ACIA Pediatric\". Additionally, the reporting payer types for this module were clarified; only C2-116: Engagement in Integrated Behavioral Health is stratified by payer type (see \"Reporting Payer Types\" for Medicaid, Uninsured, Other), while the pediatric hospital safety measures (C2-111; C2-112; C2-113; C2-114; C2-115) are not stratified by payer type but reported as \"All payer\".","v1.3","2021-04-06","No","JJ","2021-03-25",null,null,null,null,null,"X"]
[58,"Attribution Methodology SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"Added Program Component \"C2 - ACIA Psychiatric Care Transitions\"","v1.3","2021-04-06","Yes","JJ","2021-03-25",null,null,null,null,null,"X"]
[59,"Attribution Methodology SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"Added Program Component \"C2 - ACIA Care Transitions\"","v1.3","2021-04-06","Yes","JJ","2021-03-25",null,null,null,null,null,"X"]
[60,"Attribution Methodology SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"Step 3 of Attribution Methodology across all applicable DPPs. Allowable Exclusion(s) changed from \"Individual with a total time of incarceration during the measurement period that exceeded 45 days\" to \"Encounters with an individual incarcerated in a state or federal facility during the measurement period\".","v1.3","2021-04-06","Yes","JJ","2021-03-25","On 08/09/21, JJ made a revision to \"Description of Change(s) Made\" since the description was inaccurate; no changes were needed elsewhere however. The corrected description will be reflected in v1.6 even though the actual change was reflected in v1.3. Previously the description was \"Step 3 of Attribution Methodology across all applicable DPPs. Allowable Exclusion(s) changed to \"Individual with a total time of incarceration during the measurement period that exceeded 45 days\", which was incorrect.",null,null,null,null,"X"]
[61,"Measure Specifications SFY22","SFY22","T3-124",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Depression Response at Twelve Months"},"The \"Q3 Performance Requirements\" for T3-123 have been updated from \"Data Reporting & Status Update\" to \"P4P - Benchmark & Status Update\".","v1.3","2021-04-06","Yes","JJ","2021-04-05",null,null,null,null,null,"X"]
[62,"Measure Specifications SFY22","SFY22","C2-104",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Preventive Care & Screening: Tobacco Use: Screening & Cessation Intervention"},"C2-119 has been updated to reflect that only one rate reported will be reported (instead of three rates).","v1.3","2021-04-06","Yes","JJ","2021-04-05",null,null,null,null,null,"X"]
[63,"Measure Specifications SFY22","SFY22","B2-152",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Follow-Up After Hospitalization for Mental Illness 7-Day (discharges from state hospital)"},"Clarified that the denominator is limited to State Hospitals and Sunrise Canyon Hospital in the denominator description and program specific modifications section. Updated \"eligible physician specialties and other\" (column X) to \"Discharges from state hospitals and Sunrise Canyon Hospital\".","v1.3","2021-04-06","Yes","BTM","2021-04-06",null,null,null,null,null,"X"]
[64,"Measure Specifications SFY22","SFY22","B2-153",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Follow-Up after Hospitalization for Mental Illness 30-Day (discharges from state hospital)"},"Clarified that the denominator is limited to State Hospitals and Sunrise Canyon Hospital in the denominator description and program specific modifications section. Updated \"eligible physician specialties and other\" (column X) to \"Discharges from state hospitals and Sunrise Canyon Hospital\".","v1.3","2021-04-06","Yes","BTM","2021-04-06",null,null,null,null,null,"X"]
[65,"Additional Reporting Info SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"For the \"Measure Stewards\" section, the language has been updated from \"The measures proposed for public comment are drawn from\" to \"The measures proposed are drawn from\"","v1.3","2021-04-06","No","JJ","2021-04-06",null,null,null,null,null,"X"]
[66,"Prog Component Elig Reqs SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"Reversed Change ID 57 in order to keep/add \"Children's Hospital\" accurately listed in C2 - ACIA Psychiatric Care Transitions","v1.4","2021-05-11","Yes","JJ","2021-04-29",null,null,null,null,null,"X"]
[67,"Prog Component Elig Reqs SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"Removed \"Children's Hospital\" from C2 - ACIA Care Transitions, such that the resulting eligible provider classes for the C2 - ACIA Care Transitions module are “state-owned hospitals that are not IMDs” and “urban hospitals”.","v1.4","2021-05-11","Yes","JJ","2021-04-29","on 05/12/21, JJ updated the \"Description of Changes Made\" for Change ID 68 to become: Removed \"Children's Hospital\" from C2 - ACIA Care Transitions, such that the resulting eligible provider classes for the C2 - ACIA Care Transitions module are “state-owned hospitals that are not IMDs” and “urban hospitals”. Although the effective change for Change ID 68 was reflected in v1.4, the update to the \"Description of Changes Made\" for Change ID 68 will be reflected in v1.5. No edits are needed to the effective change already reflected in v1.4.",null,null,null,null,"X"]
[68,"Measure Specifications SFY22","SFY22","T3-123",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Behavioral Health Risk Assessment for Pregnant Women"},"\"Program Specific Modification\" information added: \"According to the measure steward (MNCM), the measure steward does not anticipate releasing new Value Sets until late October or early November each year, so for TIPPS reporting purposes, the value sets contained in electronic clinical quality measure (eCQM) \"Depression REMISSION at Twelve Months\" (CMS159v9) may be referenced as the value sets for T3-123: Depression RESPONSE at Twelve Months since the diagnoses and measure stewards are the same for both measures (https://ecqi.healthit.gov/measure-data-elements/158561).\"","v1.4","2021-05-11","Yes","JJ","2021-04-09",null,null,null,null,null,"X"]
[69,"Measure Specifications SFY22","SFY22","ALL",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"A \"Performance Directionality\" column has been added to indicate whether the performance directionality of a quality measure is positive (better performance is higher), negative (better performance is lower), or N/A.","v1.5","2021-08-02","Yes","JJ","2021-07-26",null,null,null,null,null,"X"]
[70,"Measure Specifications SFY22","SFY22","B2-152",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Follow-Up After Hospitalization for Mental Illness 7-Day (discharges from state hospital)"},"The 50th Percentile National Benchmark for B2-108 has been corrected to 36.78.","v1.5","2021-08-02","Yes","JJ","2021-05-14",null,null,null,null,null,"X"]
[71,"Measure Specifications SFY22","SFY22","B2-153",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Follow-Up after Hospitalization for Mental Illness 30-Day (discharges from state hospital)"},"The 50th Percentile National Benchmark for B2-108 has been corrected to 59.38.","v1.5","2021-08-02","Yes","JJ","2021-05-14",null,null,null,null,null,"X"]
[72,"Measure Specifications SFY22","SFY22","T2-113",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Childhood Immunization Status"},"Under \"Numerator Performance Met\", the criteria describing Hepatitis B numerator inclusion conditions was previously incorrectly describing Hepatitis A; the numerator inclusion conditions for Hepatitis B have been corrected.\n\n…from\n  \"Hepatitis B Immunizations or Procedures\" HepatitisBVaccination1,\n  \"Hepatitis B Immunizations or Procedures\" HepatitisBVaccination2,\n  \"Hepatitis B Immunizations or Procedures\" HepatitisBVaccination3\n  where HepatitisBVaccination2.relevantDatetime 1 day or more after day of HepatitisBVaccination1.relevantDatetime\n    and HepatitisBVaccination3.relevantDatetime 1 day or more after day of HepatitisBVaccination2.relevantDatetime\n  return HepatitisBVaccination1\n\n( ( [\"Laboratory Test, Performed\": \"Anti Hepatitis B Virus Surface Ab\"] HepatitisBAntigenTest\n    where HepatitisBAntigenTest.result as Code in \"Positive Finding\" )\n  union ( [\"Diagnosis\": \"Anaphylaxis due to Hepatitis B vaccine (disorder)\"] HepatitisBReaction\n      return \"Laboratory Test, Performed\" { relevantDatetime: start of HepatitisBReaction.prevalencePeriod } )\n  union ( [\"Diagnosis\": \"Anaphylactic Reaction to Common Baker's Yeast\"] YeastReaction\n      return \"Laboratory Test, Performed\" { relevantDatetime: start of YeastReaction.prevalencePeriod } )\n  union ( [\"Diagnosis\": \"Hepatitis B\"] HepatitisBDiagnosis\n      return \"Laboratory Test, Performed\" { relevantDatetime: start of HepatitisBDiagnosis.prevalencePeriod } ) ) HepBConditions\n  where ( HepBConditions.relevantDatetime during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])","v1.5","2021-08-02","Yes","JJ","2021-05-28",null,null,null,null,null,"X"]
[73,"Measure Specifications SFY22","SFY22","T3-123",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Behavioral Health Risk Assessment for Pregnant Women"},"Updated the \"Additional Information\" column to provide guidance on the Denominator Identification Period and Measure Assessment Period for Q1 reporting period versus Q3 reporting period. \n\nDenominator Identification Period: Patients indexed in this timeframe comprise the measure denominator.\n• TIPPS Baseline (Q1 and Q3 Reporting Periods): November 1, 2019 through October 31, 2020\n\nMeasure Assessment Period for Rate Calculation: For each patient, the measure assessment period begins with an index event and is 14 months (12 months + 60 days) in length. Follow-up scores obtained in this timeframe from patients in the measure denominator are evaluated for numerator compliance.\n• TIPPS Baseline (Q1 Reporting Period: 01/01/21-06/30/21): September 2, 2020 through June 30, 2021*\n• TIPPS Baseline (Q3 Reporting Period: 01/01/21-12/31/21): September 2, 2020 through December 30, 2021*","v1.5","2021-08-02","No","JJ","2021-05-28",null,null,null,null,null,"X"]
[74,"Measure Specifications SFY22","SFY22","T2-112",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Cervical Cancer Screening"},"Updated the \"Additional Information\" to the 2021 measure guidance (removal of co-testing requirement). The measure was correctly linked to the 2021 measure specification.","v1.5","2021-08-02","No","BTM","2021-06-17",null,null,null,null,null,"X"]
[75,"Measure Specifications SFY22","SFY22","B2-152",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Follow-Up After Hospitalization for Mental Illness 7-Day (discharges from state hospital)"},"The \"Q3 Performance Requirements\" for B2-108, B2-109, and B2-110 have been corrected from \"Data Reporting & Status Update\" to \"P4P - Benchmark & Status Update\"","v1.5","2021-08-02","Yes","JJ","2021-07-26",null,null,null,null,null,"X"]
[76,"Measure Specifications SFY22","SFY22","B2-153",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Follow-Up after Hospitalization for Mental Illness 30-Day (discharges from state hospital)"},"The \"Q3 Performance Requirements\" for B2-108, B2-109, and B2-110 have been corrected from \"Data Reporting & Status Update\" to \"P4P - Benchmark & Status Update\"","v1.5","2021-08-02","Yes","JJ","2021-07-26",null,null,null,null,null,"X"]
[77,"Measure Specifications SFY22","SFY22","B2-154",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up"},"The \"Q3 Performance Requirements\" for B2-108, B2-109, and B2-110 have been corrected from \"Data Reporting & Status Update\" to \"P4P - Benchmark & Status Update\"","v1.5","2021-08-02","Yes","JJ","2021-07-26",null,null,null,null,null,"X"]
[78,"Measure Specifications SFY22","SFY22","T2-104",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Preventive Care & Screening: Tobacco Use: Screening & Cessation Intervention"},"Added \"Pediatrics (Optional)\" to the \"Eligible Physician Specialties and Other Clinicians\" cell. The “Eligible Physician Specialties and Other Clinicians” are adapted from those identified for the CMS Medicare Merit-based Incentive Payment System (MIPS) program. However, HHSC discussed that for select measures, in which the denominator includes adults starting at 18 years old and is not a measure specific to providing maternal care, a revision to the Measure Specifications file will be updated to include “Pediatrics” as an OPTIONAL specialty since a pediatric specialist or subspecialist may be providing ongoing preventive or primary care for a young adult (18 years or older). ","v1.5","2021-08-02","Yes","JJ","2021-07-01",null,null,null,null,null,"X"]
[79,"Measure Specifications SFY22","SFY22","C2-104",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Preventive Care & Screening: Tobacco Use: Screening & Cessation Intervention"},"Added \"Pediatrics (Optional)\" to the \"Eligible Physician Specialties and Other Clinicians\" cell. The “Eligible Physician Specialties and Other Clinicians” are adapted from those identified for the CMS Medicare Merit-based Incentive Payment System (MIPS) program. However, HHSC discussed that for select measures, in which the denominator includes adults starting at 18 years old and is not a measure specific to providing maternal care, a revision to the Measure Specifications file will be updated to include “Pediatrics” as an OPTIONAL specialty since a pediatric specialist or subspecialist may be providing ongoing preventive or primary care for a young adult (18 years or older). ","v1.5","2021-08-02","Yes","JJ","2021-07-01",null,null,null,null,null,"X"]
[80,"Measure Specifications SFY22","SFY22","T2-114",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Immunization for Adolescents"},"Added \"Pediatrics (Optional)\" to the \"Eligible Physician Specialties and Other Clinicians\" cell. The “Eligible Physician Specialties and Other Clinicians” are adapted from those identified for the CMS Medicare Merit-based Incentive Payment System (MIPS) program. However, HHSC discussed that for select measures, in which the denominator includes adults starting at 18 years old and is not a measure specific to providing maternal care, a revision to the Measure Specifications file will be updated to include “Pediatrics” as an OPTIONAL specialty since a pediatric specialist or subspecialist may be providing ongoing preventive or primary care for a young adult (18 years or older). ","v1.5","2021-08-02","Yes","JJ","2021-07-01",null,null,null,null,null,"X"]
[81,"Measure Specifications SFY22","SFY22","R2-X",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"Measure removed: Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Testing.\n\nAdded \"Pediatrics (Optional)\" to the \"Eligible Physician Specialties and Other Clinicians\" cell. The “Eligible Physician Specialties and Other Clinicians” are adapted from those identified for the CMS Medicare Merit-based Incentive Payment System (MIPS) program. However, HHSC discussed that for select measures, in which the denominator includes adults starting at 18 years old and is not a measure specific to providing maternal care, a revision to the Measure Specifications file will be updated to include “Pediatrics” as an OPTIONAL specialty since a pediatric specialist or subspecialist may be providing ongoing preventive or primary care for a young adult (18 years or older). ","v1.5","2021-08-02","Yes","JJ","2021-07-01",null,null,null,null,null,"X"]
[82,"Measure Specifications SFY22","SFY22","T2-118",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Chlamydia Screening in Women"},"Added \"Pediatrics (Optional)\" to the \"Eligible Physician Specialties and Other Clinicians\" cell. The “Eligible Physician Specialties and Other Clinicians” are adapted from those identified for the CMS Medicare Merit-based Incentive Payment System (MIPS) program. However, HHSC discussed that for select measures, in which the denominator includes adults starting at 18 years old and is not a measure specific to providing maternal care, a revision to the Measure Specifications file will be updated to include “Pediatrics” as an OPTIONAL specialty since a pediatric specialist or subspecialist may be providing ongoing preventive or primary care for a young adult (18 years or older). ","v1.5","2021-08-02","Yes","JJ","2021-07-01",null,null,null,null,null,"X"]
[83,"Measure Specifications SFY22","SFY22","T3-122",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Maternity Care: Post-Partum Follow-Up and Care Coordination"},"Added \"Pediatrics (Optional)\" to the \"Eligible Physician Specialties and Other Clinicians\" cell. The “Eligible Physician Specialties and Other Clinicians” are adapted from those identified for the CMS Medicare Merit-based Incentive Payment System (MIPS) program. However, HHSC discussed that for select measures, in which the denominator includes adults starting at 18 years old and is not a measure specific to providing maternal care, a revision to the Measure Specifications file will be updated to include “Pediatrics” as an OPTIONAL specialty since a pediatric specialist or subspecialist may be providing ongoing preventive or primary care for a young adult (18 years or older). ","v1.5","2021-08-02","Yes","JJ","2021-07-01",null,null,null,null,null,"X"]
[84,"Measure Specifications SFY22","SFY22","T2-114",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Immunization for Adolescents"},"Updated the \"Measure Specs Source\" from \"Medicaid Adult Core Set 2020\" to \"CMIT (CMS Measures Inventory Tool)\" with the associated link to measure specifications source: https://cmit.cms.gov/CMIT_public/ViewMeasure?MeasureId=2838#tab1. Updated the \"Denominator Description\" to \"Ages 18 to 75 as of December 31 of the measurement year with diabetes (type 1 and type 2).\" Updated the \"Denominator Inclusions\" to add two ways to identify patients with diabetes: by claim/encounter data and by pharmacy data. Updated the \"Program Specific Modifications\" to \"For TIPPS reporting purposes, the word \"beneficiary\" or \"member\" has been replaced with \"patient,\" and the word \"State\" has been replaced with \"provider\". Lastly, updated the \"Additional Information\" to clarify \"The last publicly available measure specifications for T2-114 were available through the Medicaid Adult Core Set 2019 measure specifications; however the measure has since been retired form the Medicaid Adult Core Set. As a HEDIS measure, the measure specifications are not publicly available without licensed purchase; in the absence of publicly available measure specifications for T2-114, a link to CMIT (CMS Measures Inventory Tool) is instead provided as the measure specifications source. Value sets adapted from Medicaid Adult Core Set 2020 Adult HEDIS codes\".","v1.5","2021-08-02","Yes","JJ","2021-07-09",null,null,null,null,null,"X"]
[85,"Measure Specifications SFY22","SFY22","R2-X",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"Measure removed: Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Testing\n\nUpdated the \"Measure Specs Source\" from \"Medicaid Adult Core Set 2020\" to \"CMIT (CMS Measures Inventory Tool)\" with the associated link to measure specifications source: https://cmit.cms.gov/CMIT_public/ViewMeasure?MeasureId=2838#tab1. Updated the \"Denominator Description\" to \"Ages 18 to 75 as of December 31 of the measurement year with diabetes (type 1 and type 2).\" Updated the \"Denominator Inclusions\" to add two ways to identify patients with diabetes: by claim/encounter data and by pharmacy data. Updated the \"Program Specific Modifications\" to \"For TIPPS reporting purposes, the word \"beneficiary\" or \"member\" has been replaced with \"patient,\" and the word \"State\" has been replaced with \"provider\". Lastly, updated the \"Additional Information\" to clarify \"The last publicly available measure specifications for T2-114 were available through the Medicaid Adult Core Set 2019 measure specifications; however the measure has since been retired form the Medicaid Adult Core Set. As a HEDIS measure, the measure specifications are not publicly available without licensed purchase; in the absence of publicly available measure specifications for T2-114, a link to CMIT (CMS Measures Inventory Tool) is instead provided as the measure specifications source. Value sets adapted from Medicaid Adult Core Set 2020 Adult HEDIS codes\".","v1.5","2021-08-02","Yes","JJ","2021-07-09",null,null,null,null,null,"X"]
[86,"Measure Specifications SFY22","SFY22","C2-160",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Engagement in Integrated Behavioral Health"},"Updated \"Additional Information\" to clarify that for individuals who have multiple denominator eligible encounters, “initial encounter\" is defined as the first encounter within the measurement period.","v1.5","2021-08-02","No","BTM","2021-07-12",null,null,null,null,null,"X"]
[87,"Measure Specifications SFY22","SFY22","T3-123",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Behavioral Health Risk Assessment for Pregnant Women"},"Updated \"Numerator Inclusion\" to add that \"Any member of the health care team can administer a PHQ-9 or PHQ-9M assessment tool to a patient. Additionally, patients can self-administer via patient portal, email, or mail.\" This information is also already included with the \"Denominator Inclusion\".","v1.5","2021-08-02","No","JJ","2021-07-16",null,null,null,null,null,"X"]
[88,"Measure Specifications SFY22","SFY22","C2-104",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Preventive Care & Screening: Tobacco Use: Screening & Cessation Intervention"},"Edited \"Numerator Inclusion (Performance Met)\" to remove criteria 1 and 2, which are not used for DPP reporting and were causing confusion. Also edited \"Additional Information\" to remove discussion of rate 2 as the performance rate as the DPP reporting uses rate 3 only. ","v1.5","2021-08-02","No","JQ","2021-07-20",null,null,null,null,null,"X"]
[89,"Measure Specifications SFY22","SFY22","T2-104",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Preventive Care & Screening: Tobacco Use: Screening & Cessation Intervention"},"Edited \"Numerator Inclusion (Performance Met)\" to remove criteria 1 and 2, which are not used for DPP reporting and were causing confusion. Also edited \"Additional Information\" to remove discussion of rate 2 as the performance rate as the DPP reporting uses rate 3 only. ","v1.5","2021-08-02","No","JQ","2021-07-21",null,null,null,null,null,"X"]
[90,"Measure Specifications SFY22","SFY22","B2-152",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Follow-Up After Hospitalization for Mental Illness 7-Day (discharges from state hospital)"},"Updated \"Program Specific Modifications to add \"The 2020 measure steward guidance includes contradictory guidance to both include and exclude follow-up visits occurring on the day of discharge. The 2021 guidance excludes the day of discharge, but for SFY22 the DPP reporting uses the 2020 measure specifications. Since this guidance is contradictory, providers have the option to include or exclude the day of discharge when calculating their rates for program year 1 (SFY22). However, when measure specifications for program year 2 are updated to use the 2021 specs, HHSC will expect providers to exclude the day of discharge for program year 2 (SFY23). It is up to the provider whether they would like to set up their systems to exclude the day of discharge now and maintain consistency from year 1 to year 2, or include the day of discharge for this measurement period and plan to update for the next year.\"","v1.5","2021-08-02","Yes","JQ","2021-07-21",null,null,null,null,null,"X"]
[91,"Measure Specifications SFY22","SFY22","B2-153",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Follow-Up after Hospitalization for Mental Illness 30-Day (discharges from state hospital)"},"Updated \"Program Specific Modifications to add \"The 2020 measure steward guidance includes contradictory guidance to both include and exclude follow-up visits occurring on the day of discharge. The 2021 guidance excludes the day of discharge, but for SFY22 the DPP reporting uses the 2020 measure specifications. Since this guidance is contradictory, providers have the option to include or exclude the day of discharge when calculating their rates for program year 1 (SFY22). However, when measure specifications for program year 2 are updated to use the 2021 specs, HHSC will expect providers to exclude the day of discharge for program year 2 (SFY23). It is up to the provider whether they would like to set up their systems to exclude the day of discharge now and maintain consistency from year 1 to year 2, or include the day of discharge for this measurement period and plan to update for the next year.\"","v1.5","2021-08-02","Yes","JQ","2021-07-21",null,null,null,null,null,"X"]
[92,"Measure Specs Viewer SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"The \"Specs Viewer\" tab has been updated to show the \"Performance Directionality\".","v1.5","2021-08-02","No","JJ","2021-07-26",null,null,null,null,null,"X"]
[93,"Measure Specifications SFY22","SFY22","T2-115",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Preventive Care and Screening: Screening for Depression and Follow-Up Plan"},"Updated measure specifications, including Program Specific Modifications, to align denominator and numerator criteria with calendar year measurement period for TIPPS reporting purposes.","v1.5","2021-08-02","No","BTM","2021-07-30",null,null,null,null,null,"X"]
[94,"Measure Specifications SFY22","SFY22","C2-103",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Preventive Care and Screening: Influenza Immunization"},"Updated measure specifications, including Program Specific Modifications, to align denominator and numerator criteria with calendar year measurement period for CHIRP reporting purposes.","v1.5","2021-08-02","No","JJ","2021-07-30",null,null,null,null,null,"X"]
[95,"Measure Specifications SFY22","SFY22","R2-103",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Preventive Care and Screening: Influenza Immunization "},"Updated measure specifications, including Program Specific Modifications, to align denominator and numerator criteria with calendar year measurement period for RAPPS reporting purposes.","v1.5","2021-08-02","No","JJ","2021-07-30",null,null,null,null,null,"X"]
[96,"Measure Specifications SFY22","SFY22","ALL",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"The \"Final Measure IDs\" have been updated.","v2.0","2021-12-01","Yes","JJ","2021-11-22",null,null,null,null,null,"X"]
[97,"Measure Specifications SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"\"Required Reporting Payer Types\" updated.","v2.0","2021-12-01","Yes","JJ","2021-10-29",null,null,null,null,null,"X"]
[98,"Measure Specifications SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"DPP BHS Program Component 2 (B2) \"Reporting Period 1 - Reporting Requirements\" and \"Reporting Period 2 - Reporting Requirements\" updated to reflect \"Numeric Data Reporting & Status Update\"","v2.0","2021-12-01","Yes","JJ","2021-10-29",null,null,null,null,null,"X"]
[99,"Measure Specifications SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"DPP BHS Program Component 2 (R2) \"Q1 Reporting Requirements\" and \"Q3 Reporting Requirements\" updated to reflect \"Numeric Data Reporting & Status Update\"","v2.0","2021-12-01","Yes","JJ","2021-10-29",null,null,null,null,null,"X"]
[100,"Measure Specifications SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"For DPP BHS, Column \"Achievement Payer Type (for P4P)\" removed.","v2.0","2021-12-01","Yes","JJ","2021-10-29",null,null,null,null,null,"X"]
[101,"Measure Specifications SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"For DPP BHS, Column \"P4P Goal Calculation Type\" removed.","v2.0","2021-12-01","Yes","JJ","2021-10-29",null,null,null,null,null,"X"]
[102,"Measure Specifications SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"For DPP BHS, Column \"National Benchmark Source\" removed.","v2.0","2021-12-01","Yes","JJ","2021-10-29",null,null,null,null,null,"X"]
[103,"Measure Specifications SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"For DPP BHS, Column \"25th Percentile National Benchmark\" removed.","v2.0","2021-12-01","Yes","JJ","2021-10-29",null,null,null,null,null,"X"]
[104,"Measure Specifications SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"For DPP BHS, Column \"50th Percentile National Benchmark\" removed.","v2.0","2021-12-01","Yes","JJ","2021-10-29",null,null,null,null,null,"X"]
[105,"Measure Specifications SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"For DPP BHS, Column header names updated to describe the two semiannual reporting periods as \"Reporting Period 1\" and \"Reporting Period 2\" instead of \"Q1\" and \"Q3\".","v2.0","2021-12-01","Yes","JJ","2021-10-29",null,null,null,null,null,"X"]
[106,"Attribution Methodology SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"For DPP BHS, \"Reporting Payer Types*\" updated to reflect the reporting payer types and guidance around the reporting alternative for \"Medicaid Managed Care\" such that in the reporting template, providers will indicate whether the provider's system can report the required reporting payer type of “Medicaid Managed Care\" to include STAR, STAR+PLUS, and STAR Kids. If provider's system cannot report “Medicaid Managed Care\", then the provider may alternatively report the “Medicaid Managed Care” payer type as \"Medicaid\" (includes all Medicaid Managed Care programs and Medicaid FFS). This alternative will only be available during Year 1 of the DPP.","v2.0","2021-12-01","Yes","JJ","2021-10-29",null,null,null,null,null,"X"]
[107,"Prog Component Elig Reqs SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"Column header names updated to \"Program Component Eligibility Requirements\"","v2.0","2021-12-01","Yes","JJ","2021-10-29",null,null,null,null,null,"X"]
[108,"Prog Component Elig Reqs SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"DPP BHS Program Component 2 (B2) \"Program Component Eligibility: Minimum Volume Requirements\" updated to \"N/A\".","v2.0","2021-12-01","Yes","JJ","2021-10-29",null,null,null,null,null,"X"]
[109,"Introduction SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"For DPP BHS, The \"Introduction\" updated to match all v2.0 changes made in respective tabs.","v2.0","2021-12-01","Yes","JJ","2021-10-29",null,null,null,null,null,"X"]
[110,"Measure Specifications SFY22","SFY22","B2-152",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Follow-Up After Hospitalization for Mental Illness 7-Day (discharges from state hospital)"},"Clarified the Measure Type to \"Outcome (Intermediate)\"","v2.0","2021-12-01","No","JJ","2021-11-16",null,null,null,null,null,"X"]
[111,"Measure Specifications SFY22","SFY22","B2-153",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Follow-Up after Hospitalization for Mental Illness 30-Day (discharges from state hospital)"},"Clarified the Measure Type to \"Outcome (Intermediate)\"","v2.0","2021-12-01","No","JJ","2021-11-16",null,null,null,null,null,"X"]
[112,"Attribution Methodology SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"In the Attribution Methodology Step 3, the \"Reporting Payer Types*\" updated to reflect the reporting payer types and guidance around the reporting alternative for \"Medicaid Managed Care\" such that in the reporting template, providers will indicate whether the provider's system can report the required reporting payer type of “Medicaid Managed Care\". If provider's system cannot report “Medicaid Managed Care\", then the provider may alternatively report the “Medicaid Managed Care” payer type as \"Medicaid\" (includes all Medicaid Managed Care programs and Medicaid FFS). This alternative will only be available during Year 1 of the DPP.","v3.0","2022-02-28","Yes","JJ","2022-02-22",null,null,null,null,null,"X"]
[113,"Measure Specifications SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"Column \"Achievement Payer Type (for P4P)\" removed.","v3.0","2022-02-28","Yes","JJ","2022-02-22",null,null,null,null,null,"X"]
[114,"Measure Specifications SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"Column \"P4P Goal Calculation Type\" removed.","v3.0","2022-02-28","Yes","JJ","2022-02-22",null,null,null,null,null,"X"]
[115,"Measure Specifications SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"Column \"National Benchmark Source\" removed.","v3.0","2022-02-28","Yes","JJ","2022-02-22",null,null,null,null,null,"X"]
[116,"Measure Specifications SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"Column \"25th Percentile National Benchmark\" removed.","v3.0","2022-02-28","Yes","JJ","2022-02-22",null,null,null,null,null,"X"]
[117,"Measure Specifications SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"Column \"50th Percentile National Benchmark\" removed.","v3.0","2022-02-28","Yes","JJ","2022-02-22",null,null,null,null,null,"X"]
[118,"Measure Specifications SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"\"Reporting Period 1 - Reporting Requirements\" and \"Reporting Period 2 - Reporting Requirements\" have been updated to align with the associated removals of pay-for-performance requirements in SFY22","v3.0","2022-02-28","Yes","JJ","2022-02-22",null,null,null,null,null,"X"]
[119,"Measure Specifications SFY22","SFY22","ALL",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"The \"Final Measure IDs\" have been updated.","v3.0","2022-02-28","No","JJ","2022-02-22",null,null,null,null,null,"X"]
[120,"Measure Specifications SFY22","SFY22","R2-X",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"Measure removed: Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Testing","v3.0","2022-02-28","Yes","JJ","2021-10-29",null,null,null,null,null,"X"]
[121,"Measure Specifications SFY22","SFY22","R2-102",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Poor Control (>9.0%)"},"New measure added: Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Poor Control (>9.0%)","v3.0","2022-02-28","Yes","JJ","2021-10-29",null,null,null,null,null,"X"]
[122,"Measure Specifications SFY22","SFY22","C1-127",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Medication Reconciliation: Number of Unintentional Medication Discrepancies per Medication per Patient"},"New measure added: Medication Reconciliation: Number of Unintentional Medication Discrepancies per Medication per Patient","v3.0","2022-02-28","Yes","JQ","2021-11-02","02/16/22: JQ updated \"HHSC Program Specific Modifications\" to reflect decreased minimum sample size and clarify denominator definition and align the specs for this measure across SFY22 and SFY23.",null,null,null,null,"X"]
[123,"Measure Specifications SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"Column header names updated to describe the two semiannual reporting periods as \"Reporting Period 1\" and \"Reporting Period 2\" instead of \"Q1\" and \"Q3\". The expected dates for these semiannual reporting periods are \"TBD\" while pending CMS approval.","v3.0","2022-02-28","No","JJ","2022-02-22",null,null,null,null,null,"X"]
[124,"Prog Component Elig Reqs SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"RAPPS Program Component 2 (R2) \"Program Component Eligibility: Minimum Volume Requirements\" updated to \"N/A\".","v3.0","2022-02-28","Yes","JJ","2021-10-29",null,null,null,null,null,"X"]
[125,"Measure Specifications SFY22","SFY22","C2-132",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Catheter-Associated Urinary Tract Infection (CAUTI) Outcome Measure"},"Added additional information to specify which NHSN report to use for reporting this measure. ","v3.0","2022-02-28","Yes","JQ","2021-11-02",null,null,null,null,null,"X"]
[126,"Measure Specifications SFY22","SFY22","C2-133",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Central Line Associated Bloodstream Infection (CLABSI) Outcome Measure"},"Added additional information to specify which NHSN report to use for reporting this measure. ","v3.0","2022-02-28","Yes","JQ","2021-11-02",null,null,null,null,null,"X"]
[127,"Measure Specifications SFY22","SFY22","C2-135",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Harmonized Procedure Specific Surgical Site Infection (SSI) Outcome Measure"},"Added additional information to specify which NHSN report to use for reporting this measure. ","v3.0","2022-02-28","Yes","JQ","2021-11-02",null,null,null,null,null,"X"]
[128,"Measure Specifications SFY22","SFY22","C1-126",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Healthcare Quality Learning Collaborative Participation"},"Changed name of measure, removed \"SDA\" from name as the collaborative is not limited to within the SDA. Changed measure description to describe what constitutes a Healthcare Quality Learning Collaborative. ","v3.0","2022-02-28","Yes","JQ","2021-11-02",null,null,null,null,null,"X"]
[129,"Measure Specifications SFY22","SFY22","C2-131",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Hospital Safety Collaborative Participation"},"Changed measure description to describe what constitutes a Hospital Safety Collaborative. ","v3.0","2022-02-28","Yes","JQ","2021-11-02",null,null,null,null,null,"X"]
[130,"Prog Component Elig Reqs SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"Changed the TIPPS T2 and T3 \"Program Component Eligibility: Minimum Volume Requirements\" to be \">=30 Medicaid managed care patients (includes STAR, STAR+PLUS, and STAR Kids)\"","v3.0","2022-02-28","Yes","JJ","2021-11-23",null,null,null,null,null,"X"]
[131,"Measure Specifications SFY22","SFY22","T3-124",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Depression Response at Twelve Months"},"Updated the \"HHSC Program Specific Modifications\" and \"Additional Information\" columns for more detail/clarity.","v3.0","2022-02-28","No","JJ","2021-12-13",null,null,null,null,null,"X"]
[132,"Measure Specifications SFY22","SFY22","B2-149",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Preventive Care & Screening: Unhealthy Alcohol Use: Screening & Brief Counseling"},"Updated the \"Denominator Inclusions\" to remove 96150, 96151, and 96152 and instead replace with 96156 and 96158 for \"patient encounters\". Additionally, removed 96160 and 96161 from \"preventive visits\"","v3.0","2022-02-28","No","JJ","2021-12-13",null,null,null,null,null,"X"]
[133,"Additional Reporting Info SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"The \"Sampling Requirements\" have been updated to clarify the \"HHSC Minimum Sample Size for All Payer\"","v3.0","2022-02-28","No","JJ","2021-12-15",null,null,null,null,null,"X"]
[134,"Measure Specifications SFY22","SFY23","C1-127",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Medication Reconciliation: Number of Unintentional Medication Discrepancies per Medication per Patient"},"Updated the measure name. Updated \"HHSC Program Specific Modifications\" to reflect decreased minimum sample size and clarify denominator definition. ","v3.0","2022-02-28","Yes","JQ","2022-02-16",null,null,null,null,null,null,"X"]
[135,"Introduction SFY22","SFY22",null,{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"The \"Introduction\" updated to match all v3.0 changes made in respective tabs.","v3.0","2022-02-28","No","JJ","2022-02-22",null,null,null,null,null,"X"]
[136,"Measure Specifications SFY22","SFY22","C2-133",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Central Line Associated Bloodstream Infection (CLABSI) Outcome Measure"},"Removed the words \"and Adjusted Ranking Metric\" from the measure description. ","v3.0","2022-02-28","No","JQ","2022-02-22",null,null,null,null,null,"X"]
[137,"Measure Specifications SFY22","SFY22","C2-135",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Harmonized Procedure Specific Surgical Site Infection (SSI) Outcome Measure"},"Removed the words \"and Adjusted Ranking Metric\" from the measure description. ","v3.0","2022-02-28","No","JQ","2022-02-22",null,null,null,null,null,"X"]
[138,"Measure Specifications SFY23","SFY23","C2-133",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Central Line Associated Bloodstream Infection (CLABSI) Outcome Measure"},"Removed the words \"and Adjusted Ranking Metric\" from the measure description. ","v3.0","2022-02-28","No","JQ","2022-02-22",null,null,null,null,null,null,"X"]
[139,"Measure Specifications SFY23","SFY23","C2-135",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Harmonized Procedure Specific Surgical Site Infection (SSI) Outcome Measure"},"Removed the words \"and Adjusted Ranking Metric\" from the measure description. ","v3.0","2022-02-28","No","JQ","2022-02-22",null,null,null,null,null,null,"X"]
[140,"Measure Specifications SFY22","SFY22","B2-152",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Follow-Up After Hospitalization for Mental Illness 7-Day (discharges from state hospital)"},"Added \"Public Notes\" column and information for this measure.","v4.0","2022-04-08","No","JJ","2022-03-18",null,null,null,null,"X","X"]
[141,"Measure Specifications SFY22","SFY22","B2-153",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Follow-Up after Hospitalization for Mental Illness 30-Day (discharges from state hospital)"},"Added \"Public Notes\" column and information for this measure.","v4.0","2022-04-08","No","JJ","2022-03-18",null,null,null,null,"X","X"]
[142,"Introduction SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"The \"Introduction SFY22\" tab has respectively been updated to reflect the measures to be reported for state fiscal year (SFY) 2022 directed payment program(s) (DPP) operated by the Texas Health and Human Services Commission (HHSC) as approved by the Center for Medicare and Medicaid Services (CMS). ","v4.0","2022-04-08",null,null,null,null,"X","X","X",null,"X"]
[143,"Measure Specifications SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"For TIPPS, CHIRP, and RAPPS, the \"Reporting Period 1\", \"Reporting Period 1 - Data Measurement Period\", and \"Reporting Period 1 - Reporting Requirements\" information has been updated.","v4.0","2022-04-08",null,null,null,null,"X","X","X",null,"X"]
[144,"Measure Specifications SFY22","SFY22","C1-127",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Medication Reconciliation: Number of Unintentional Medication Discrepancies per Medication per Patient"},"\"HHSC Program Specific Modifications\" have been updated.","v4.0","2022-04-08",null,null,null,null,"X",null,null,null,"X"]
[145,"Measure Specifications SFY22","SFY22","T3-124",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Depression Response at Twelve Months"},"\"HHSC Program Specific Modifications\" have been updated.","v4.0","2022-04-08",null,null,null,null,null,"X",null,null,"X"]
[146,"Attribution Methodology SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"Added CHIRP Attribution Methodology criteria for the \"C1 (UHRIP)\" Program Component","v5.0","2022-05-06",null,null,null,null,"X",null,null,null,"X"]
[147,"Measure Specifications SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"\"Public Notes\" have been populated for some CHIRP, TIPPS, and DPP BHS measures.","v5.0","2022-05-06",null,null,null,null,"X","X",null,"X","X"]
[148,"Additional Reporting Info SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"The information on \"Measurement Periods\" has been clarified. ","v5.0","2022-05-06",null,null,null,null,"X","X","X",null,"X"]
[149,"Prog Component Elig Reqs SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"Corrected the eligible provider classes for the \"C2 (ACIA Care Transitions) - ACIA rate enhancement\" module such that this module includes \"State-owned Hospitals that are not Institutions for Mental Diseases (IMDs)\" and \"Urban Hospitals\". NOTE: During the publication of v3.0, \"Urban Hospitals\" had been inadvertently left off of this module.","v5.0","2022-05-06",null,null,null,null,"X",null,null,null,"X"]
[150,"Measure Specifications SFY22","SFY22","T3-124",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Depression Response at Twelve Months"},"\"Measure Steward Additional Information\" has been clarified for TIPPS Year 1 Reporting Period 1.","v5.0","2022-05-06",null,null,null,null,null,"X",null,null,"X"]
[151,"Measure Specifications SFY22","SFY22","C2-131",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Hospital Safety Collaborative Participation"},"Clarified the measurement period for participation is 9/1/20 to 8/31/21. ","v5.0","2022-05-06",null,null,null,null,"X",null,null,null,"X"]
[152,"Measure Specifications SFY22","SFY22","C2-156",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Hospital Safety Collaborative Participation"},"Clarified the measurement period for participation is 9/1/20 to 8/31/21. ","v5.0","2022-05-06",null,null,null,null,"X",null,null,null,"X"]
[153,"Measure Specifications SFY22","SFY22","C1-126",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Healthcare Quality Learning Collaborative Participation"},"Clarified the measurement period for participation is 9/1/20 to 8/31/21. ","v5.0","2022-05-06",null,null,null,null,"X",null,null,null,"X"]
[154,"Measure Specifications SFY22","SFY22","C2-135",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Harmonized Procedure Specific Surgical Site Infection (SSI) Outcome Measure"},"Removed reference to a calculator to combine the rates of the colon and hysterectomy procedures into one pooled rate in the template as that was not included inadvertently. Added instructions in the Program Specific modifications to add the predicted number of events for each procedure and enter that into the denominator of the CHIRP template, and add the observed number of events for each procedure and enter that into the numerator of the CHIRP template to report the correct pooled rate. ","v5.0","2022-05-06",null,null,null,null,"X",null,null,null,"X"]
[155,"Measure Specifications SFY22","SFY22","C1-127",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Medication Reconciliation: Number of Unintentional Medication Discrepancies per Medication per Patient"},"Added language to the HHSC Program Specific modifications to clarify that pharmacists, pharmacy residents, and certain certified pharmacy technicians may take the gold standard medication history from the patient, and added definition of gold standard medication history. Also added links in the public notes section for guidance from external sources. ","v5.0","2022-05-06",null,null,null,null,"X",null,null,null,"X"]
[156,"Measure Specifications SFY22","SFY22","C2-103",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Preventive Care and Screening: Influenza Immunization"},"Updated the \"Numerator Inclusion\" and \"HHSC Program Specific Modification\" information to clarify the dates for numerator inclusion of allowable influenza immunization receipt.","v6.0","2022-05-20",null,null,null,null,"X",null,null,null,"X"]
[157,"Measure Specifications SFY22","SFY22","T2-103",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Preventive Care and Screening: Influenza Immunization"},"Updated the \"Numerator Inclusion\" and \"HHSC Program Specific Modification\" information to clarify the dates for numerator inclusion of allowable influenza immunization receipt.","v6.0","2022-05-20",null,null,null,null,null,"X",null,null,"X"]
[158,"Measure Specifications SFY22","SFY22","R2-103",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Preventive Care and Screening: Influenza Immunization "},"Updated the \"Numerator Inclusion\" and \"HHSC Program Specific Modification\" information to clarify the dates for numerator inclusion of allowable influenza immunization receipt.","v6.0","2022-05-20","Yes","JJ","2022-05-19",null,null,null,"X",null,"X"]
[159,"Measure Specifications SFY22","SFY22","C2-103",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Preventive Care and Screening: Influenza Immunization"},"Updated the \"Numerator Inclusion\" and \"HHSC Program Specific Modification\" information to clarify that an Individual with multiple eligible encounters during the calendar year only has to have the numerator met once to be counted as Numerator Performance Met.","v7.0","2022-08-09",null,null,null,null,"X",null,null,null,"X"]
[160,"Measure Specifications SFY22","SFY22","R2-103",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Preventive Care and Screening: Influenza Immunization "},"Updated the \"Numerator Inclusion\" and \"HHSC Program Specific Modification\" information to clarify that an Individual with multiple eligible encounters during the calendar year only has to have the numerator met once to be counted as Numerator Performance Met.","v7.0","2022-08-09","Yes","JJ","2022-08-04",null,null,null,"X",null,"X"]
[161,"Measure Specifications SFY22","SFY22","T2-103",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Preventive Care and Screening: Influenza Immunization"},"Updated the \"Numerator Inclusion\" and \"HHSC Program Specific Modification\" information to clarify that an Individual with multiple eligible encounters during the calendar year only has to have the numerator met once to be counted as Numerator Performance Met.","v7.0","2022-08-09",null,null,null,null,null,"X",null,null,"X"]
[162,"Measure Specifications SFY22","SFY22","T1-101",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Care team includes personnel in a care coordination role not requiring clinical licensure"},"Updated the \"Measure Description\" and \"Public Notes\" information to clarify that examples of personnel not requiring clinical licensure AND who may be performing a care coordination role typically include community health workers, promotor(a)s, any social workers that are not a licensed clinical social worker, patient navigators, and medical assistants. A care coordination role typically involves functions or responsibilities to review a client’s care plan to proactively confirm that any needed appointments, specialty services, labs, tests, and community resources are being coordinated and completed. ","v7.0","2022-08-09",null,null,null,null,null,"X",null,null,"X"]
[163,"Measure Specifications SFY22","SFY22","R1-101",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Care team includes personnel in a care coordination role not requiring clinical licensure"},"Updated the \"Measure Description\" and \"Public Notes\" information to clarify that examples of personnel not requiring clinical licensure AND who may be performing a care coordination role typically include community health workers, promotor(a)s, any social workers that are not a licensed clinical social worker, patient navigators, and medical assistants. A care coordination role typically involves functions or responsibilities to review a client’s care plan to proactively confirm that any needed appointments, specialty services, labs, tests, and community resources are being coordinated and completed. ","v7.0","2022-08-09","No","JJ","2022-08-04",null,null,null,"X",null,"X"]
[164,"Measure Specifications SFY22","SFY22","T3-121",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Food Insecurity Screening"},"Updated the \"Public Notes\" information to emphasize that in Y1, the data measurement period for T3-121 is 01/01/22-02/28/22 and since the denominator is not restrictive, even if the TIPPS participating provider does not currently perform the numerator quality action of food insecurity screenings, the denominator is unlikely to be “zero” for a data measurement period of 01/01/22-02/28/22. ","v7.0","2022-08-09",null,null,null,null,null,"X",null,null,"X"]
[165,"Measure Specifications SFY22","SFY22","C2-132",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Catheter-Associated Urinary Tract Infection (CAUTI) Outcome Measure"},"Updated the \"Public Notes\" information to clarify that the denominator should NOT be reported using rounding. This measure is reported as a Standardized Infection Ratios (SIR), where the numerator is reported as the number of actual observed infections, and the denominator is reported as the number of predicted infections (as calculated by National Healthcare Safety Network [NHSN], which is usually expressed to multiple decimal places and should not be reported using rounding).","v7.0","2022-08-09",null,null,null,null,"X",null,null,null,"X"]
[166,"Measure Specifications SFY22","SFY22","C2-133",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Central Line Associated Bloodstream Infection (CLABSI) Outcome Measure"},"Updated the \"Public Notes\" information to clarify that the denominator should NOT be reported using rounding. This measure is reported as a Standardized Infection Ratios (SIR), where the numerator is reported as the number of actual observed infections, and the denominator is reported as the number of predicted infections (as calculated by National Healthcare Safety Network [NHSN], which is usually expressed to multiple decimal places and should not be reported using rounding).","v7.0","2022-08-09",null,null,null,null,"X",null,null,null,"X"]
[167,"Measure Specifications SFY22","SFY22","C2-134",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Facility-wide Inpatient Hospital-onset Clostridium difficile Infection (CDI) Outcome Measure"},"Updated the \"Public Notes\" information to clarify that the denominator should NOT be reported using rounding. This measure is reported as a Standardized Infection Ratios (SIR), where the numerator is reported as the number of actual observed infections, and the denominator is reported as the number of predicted infections (as calculated by National Healthcare Safety Network [NHSN], which is usually expressed to multiple decimal places and should not be reported using rounding).","v7.0","2022-08-09",null,null,null,null,"X",null,null,null,"X"]
[168,"Measure Specifications SFY22","SFY22","C2-135",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Harmonized Procedure Specific Surgical Site Infection (SSI) Outcome Measure"},"Updated the \"Public Notes\" information to clarify that the denominator should NOT be reported using rounding and that the “Complex 30-day SSI data for Hospital IQR” or the “Hospital IPPS report from NHSN” reporting must be used to calculate the denominator; this report is also known as the “CMS model using 2015 baseline”, which would be used for reporting the colon and hysterectomy procedures. This measure is reported as a Standardized Infection Ratios (SIR), where the numerator is reported as the number of actual observed infections for each of the two types of procedures (colon and hysterectomy), and the denominator is reported as the number of predicted infections for each of the two types of procedures (colon and hysterectomy, as calculated by National Healthcare Safety Network [NHSN], which is usually expressed to multiple decimal places and should not be reported using rounding).","v7.0","2022-08-09",null,null,null,null,"X",null,null,null,"X"]
[169,"Measure Specifications SFY22","SFY22","C2-104",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Preventive Care & Screening: Tobacco Use: Screening & Cessation Intervention"},"Added an asterisk explaining that \"*HHSC is determining how to align the measure specifications for this measure with CHIRP participants and will provide any measure-specific guidance to impacted CHIRP participants as needed.\"","v7.0","2022-08-09",null,null,null,null,"X",null,null,null,"X"]
[170,"Additional Reporting Info SFY22","SFY22","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"Clarified the reporting guidance for sampled data.","v7.0","2022-08-09","No","JJ","2022-08-08",null,null,null,null,null,"X"]
[171,"Measure Specifications SFY22","SFY22","C2-141",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Written transition procedures that include formal MCO relationship or EDEN notification/ ADT Feed for psychiatric patients\n"},"Clarified meaning of \"written transition procedures\" ","v7.0","2022-08-09",null,null,null,null,"X",null,null,null,"X"]
[172,"Measure Specifications SFY22","SFY22","C2-142",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Written transition procedures that include formal MCO relationship or EDEN notification/ ADT Feed for non-psychiatric patients"},"Clarified meaning of \"written transition procedures\" ","v7.0","2022-08-09",null,null,null,null,"X",null,null,null,"X"]
[173,"Measure Specifications SFY22","SFY22","C1-127",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Medication Reconciliation: Number of Unintentional Medication Discrepancies per Medication per Patient"},"Added examples to clarify sampling requirements to HHSC Program Specific Modifications tab and added links to the Public Notes to provide helpful resources. ","v7.0","2022-08-09",null,null,null,null,"X",null,null,null,"X"]
[174,"Introduction SFY23","SFY23","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"The \"Introduction SFY23\" tab has respectively been updated to reflect the measures to be reported for state fiscal year (SFY) 2023 directed payment program(s) (DPP) operated by the Texas Health and Human Services Commission (HHSC) as approved by the Center for Medicare and Medicaid Services (CMS). ","v2.0","2022-08-09","No","WC","2022-08-08",null,"X","X","X","X",null,"X"]
[175,"Measure Specifications SFY23","SFY23","B2-152",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Follow-Up After Hospitalization for Mental Illness 7-Day (discharges from state hospital)"},"Added \"Public Notes\" column and information for this measure.","v2.0","2022-08-09","No","JJ","2022-03-18",null,null,null,null,"X",null,"X"]
[176,"Measure Specifications SFY23","SFY23","B2-153",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Follow-Up after Hospitalization for Mental Illness 30-Day (discharges from state hospital)"},"Added \"Public Notes\" column and information for this measure.","v2.0","2022-08-09","No","JJ","2022-03-18",null,null,null,null,"X",null,"X"]
[177,"Prog Component Elig Reqs SFY23","SFY23","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"Corrected the eligible provider classes for the \"C2 (ACIA Care Transitions) - ACIA rate enhancement\" module such that this module includes \"State-owned Hospitals that are not Institutions for Mental Diseases (IMDs)\" and \"Urban Hospitals\". NOTE: During the publication of v1.1, \"Urban Hospitals\" had been inadvertently left off of this module.","v2.0","2022-08-09","Yes","JJ","2022-04-28","This \"correction\" is to rectify an internal error made during the publication of v1.1. For this module, the provider class eligiblities should have always been: \"State-owned Hospitals that are not Institutions for Mental Diseases (IMDs)\" and \"Urban Hospitals\".","X",null,null,null,null,"X"]
[178,"Measure Specifications SFY23","SFY23","C2-131",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Hospital Safety Collaborative Participation"},"Clarified the measurement period for participation is 9/1/21 to 8/31/22. ","v2.0","2022-08-09","No","JQ","2022-05-04",null,"X",null,null,null,null,"X"]
[179,"Measure Specifications SFY23","SFY23","C2-156",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Hospital Safety Collaborative Participation"},"Clarified the measurement period for participation is 9/1/21 to 8/31/22. ","v2.0","2022-08-09","No","JQ","2022-05-04",null,"X",null,null,null,null,"X"]
[180,"Measure Specifications SFY23","SFY23","C1-126",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Healthcare Quality Learning Collaborative Participation"},"Clarified the measurement period for participation is 9/1/21 to 8/31/22. ","v2.0","2022-08-09","No","JQ","2022-05-04",null,"X",null,null,null,null,"X"]
[181,"Measure Specifications SFY23","SFY23","C1-127",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Medication Reconciliation: Number of Unintentional Medication Discrepancies per Medication per Patient"},"Added language to the HHSC Program Specific modifications to clarify that pharmacists, pharmacy residents, and certain certified pharmacy technicians may take the gold standard medication history from the patient, and added definition of gold standard medication history. Also added links in the public notes section for guidance from external sources. Corrected a typo in the Reporting period to say SFY23 instead of SFY22","v2.0","2022-08-09","No","JQ","2022-05-04",null,"X",null,null,null,null,"X"]
[182,"Measure Specifications SFY23","SFY23","C2-103",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Preventive Care and Screening: Influenza Immunization"},"Updated the \"Numerator Inclusion\" and \"HHSC Program Specific Modification\" information to clarify the dates for denominator inclusion and the dates for numerator inclusion of allowable influenza immunization receipt, per the data measurement periods for Year 2 Reporting Period 1 versus Year 2 Reporting Period 2. Additionally, clarified that an Individual with multiple eligible encounters during the calendar year only has to have the numerator met once to be counted as Numerator Performance Met.","v2.0","2022-08-09","No","JJ","2022-08-04",null,"X",null,null,null,null,"X"]
[183,"Measure Specifications SFY23","SFY23","T2-103",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Preventive Care and Screening: Influenza Immunization"},"Updated the \"Numerator Inclusion\" and \"HHSC Program Specific Modification\" information to clarify the dates for denominator inclusion and the dates for numerator inclusion of allowable influenza immunization receipt, per the data measurement periods for Year 2 Reporting Period 1 versus Year 2 Reporting Period 2. Additionally, clarified that an Individual with multiple eligible encounters during the calendar year only has to have the numerator met once to be counted as Numerator Performance Met.","v2.0","2022-08-09","No","JJ","2022-08-04",null,null,"X",null,null,null,"X"]
[184,"Measure Specifications SFY23","SFY23","R2-103",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Preventive Care and Screening: Influenza Immunization "},"Updated the \"Numerator Inclusion\" and \"HHSC Program Specific Modification\" information to clarify the dates for denominator inclusion and the dates for numerator inclusion of allowable influenza immunization receipt, per the data measurement periods for Year 2 Reporting Period 1 versus Year 2 Reporting Period 2. Additionally, clarified that an Individual with multiple eligible encounters during the calendar year only has to have the numerator met once to be counted as Numerator Performance Met.","v2.0","2022-08-09","No","JJ","2022-08-04",null,null,null,"X",null,null,"X"]
[185,"Measure Specifications SFY23","SFY23","T1-101",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Care team includes personnel in a care coordination role not requiring clinical licensure"},"Updated the \"Measure Description\" and \"Public Notes\" information to clarify that examples of personnel not requiring clinical licensure AND who may be performing a care coordination role typically include community health workers, promotor(a)s, any social workers that are not a licensed clinical social worker, patient navigators, and medical assistants. A care coordination role typically involves functions or responsibilities to review a client’s care plan to proactively confirm that any needed appointments, specialty services, labs, tests, and community resources are being coordinated and completed. ","v2.0","2022-08-09","No","JJ","2022-08-04",null,null,"X",null,null,null,"X"]
[186,"Measure Specifications SFY23","SFY23","R1-101",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Care team includes personnel in a care coordination role not requiring clinical licensure"},"Updated the \"Measure Description\" and \"Public Notes\" information to clarify that examples of personnel not requiring clinical licensure AND who may be performing a care coordination role typically include community health workers, promotor(a)s, any social workers that are not a licensed clinical social worker, patient navigators, and medical assistants. A care coordination role typically involves functions or responsibilities to review a client’s care plan to proactively confirm that any needed appointments, specialty services, labs, tests, and community resources are being coordinated and completed. ","v2.0","2022-08-09","No","JJ","2022-08-04",null,null,null,"X",null,null,"X"]
[187,"Measure Specifications SFY23","SFY23","T3-121",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Food Insecurity Screening"},"Updated the \"Public Notes\" information to clarify that since the denominator is not restrictive, even if the TIPPS participating provider does not currently perform the numerator quality action of food insecurity screenings, the denominator is unlikely to be “zero”. ","v2.0","2022-08-09","No","JJ","2022-08-04",null,null,null,null,null,null,"X"]
[188,"Measure Specifications SFY23","SFY23","C2-132",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Catheter-Associated Urinary Tract Infection (CAUTI) Outcome Measure"},"Updated the \"Public Notes\" information to clarify that the denominator should NOT be reported using rounding. This measure is reported as a Standardized Infection Ratios (SIR), where the numerator is reported as the number of actual observed infections, and the denominator is reported as the number of predicted infections (as calculated by National Healthcare Safety Network [NHSN], which is usually expressed to multiple decimal places and should not be reported using rounding).","v2.0","2022-08-09","No","JJ","2022-08-04",null,null,null,null,null,null,"X"]
[189,"Measure Specifications SFY23","SFY23","C2-133",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Central Line Associated Bloodstream Infection (CLABSI) Outcome Measure"},"Updated the \"Public Notes\" information to clarify that the denominator should NOT be reported using rounding. This measure is reported as a Standardized Infection Ratios (SIR), where the numerator is reported as the number of actual observed infections, and the denominator is reported as the number of predicted infections (as calculated by National Healthcare Safety Network [NHSN], which is usually expressed to multiple decimal places and should not be reported using rounding).","v2.0","2022-08-09","No","JJ","2022-08-04",null,null,null,null,null,null,"X"]
[190,"Measure Specifications SFY23","SFY23","C2-134",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Facility-wide Inpatient Hospital-onset Clostridium difficile Infection (CDI) Outcome Measure"},"Updated the \"Public Notes\" information to clarify that the denominator should NOT be reported using rounding. This measure is reported as a Standardized Infection Ratios (SIR), where the numerator is reported as the number of actual observed infections, and the denominator is reported as the number of predicted infections (as calculated by National Healthcare Safety Network [NHSN], which is usually expressed to multiple decimal places and should not be reported using rounding).","v2.0","2022-08-09","No","JJ","2022-08-04",null,null,null,null,null,null,"X"]
[191,"Measure Specifications SFY23","SFY23","C2-135",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Harmonized Procedure Specific Surgical Site Infection (SSI) Outcome Measure"},"Updated the \"Public Notes\" information to clarify that the denominator should NOT be reported using rounding and that the “Complex 30-day SSI data for Hospital IQR” or the “Hospital IPPS report from NHSN” reporting must be used to calculate the denominator; this report is also known as the “CMS model using 2015 baseline”, which would be used for reporting the colon and hysterectomy procedures. This measure is reported as a Standardized Infection Ratios (SIR), where the numerator is reported as the number of actual observed infections for each of the two types of procedures (colon and hysterectomy), and the denominator is reported as the number of predicted infections for each of the two types of procedures (colon and hysterectomy, as calculated by National Healthcare Safety Network [NHSN], which is usually expressed to multiple decimal places and should not be reported using rounding).","v2.0","2022-08-09","No","JJ","2022-08-04",null,null,null,null,null,null,"X"]
[192,"Measure Specifications SFY23","SFY23","C2-104",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Preventive Care & Screening: Tobacco Use: Screening & Cessation Intervention"},"Added an asterisk explaining that \"*HHSC is determining how to align the measure specifications for this measure with CHIRP participants and will provide any measure-specific guidance to impacted CHIRP participants as needed.\"","v2.0","2022-08-09","Yes","JJ","2022-08-04",null,"X",null,null,null,null,"X"]
[193,"Attribution Methodology SFY23","SFY23","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"Added CHIRP Attribution Methodology criteria for the \"C1 (UHRIP)\" Program Component","v2.0","2022-08-09","No","JJ","2022-04-26",null,"X",null,null,null,null,"X"]
[194,"Attribution Methodology SFY23","SFY23","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"Updated information in Step 3 \"Reporting Payer Types*\" to clarify that unlike in Year 1 (SFY 22), there are no reporting exceptions for the \"Medicaid Managed Care\" payer type in Year 2 (SFY 23). In Year 2 (SFY 22), measures with the required reporting payer type of \"Medicaid Managed Care\" must be reported by \"Medicaid Managed Care\".","v2.0","2022-08-09","Yes","JJ","2022-08-04",null,"X",null,null,null,null,"X"]
[195,"Attribution Methodology SFY23","SFY23","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"Updated information in Step 3 \"Reporting Payer Types*\" to clarify that unlike in Year 1 (SFY 22), there are no reporting exceptions for the \"Medicaid Managed Care\" payer type in Year 2 (SFY 23). In Year 2 (SFY 22), measures with the required reporting payer type of \"Medicaid Managed Care\" must be reported by \"Medicaid Managed Care\".","v2.0","2022-08-09","Yes","JJ","2022-08-04",null,null,"X",null,null,null,"X"]
[196,"Attribution Methodology SFY23","SFY23","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"Updated information in Step 3 \"Reporting Payer Types*\" to clarify that unlike in Year 1 (SFY 22), there are no reporting exceptions for the \"Medicaid Managed Care\" payer type in Year 2 (SFY 23). In Year 2 (SFY 22), measures with the required reporting payer type of \"Medicaid Managed Care\" must be reported by \"Medicaid Managed Care\".","v2.0","2022-08-09","Yes","JJ","2022-08-04",null,null,null,"X",null,null,"X"]
[197,"Attribution Methodology SFY23","SFY23","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"Updated information in Step 3 \"Reporting Payer Types*\" to clarify that unlike in Year 1 (SFY 22), there are no reporting exceptions for the \"Medicaid Managed Care\" payer type in Year 2 (SFY 23). In Year 2 (SFY 22), measures with the required reporting payer type of \"Medicaid Managed Care\" must be reported by \"Medicaid Managed Care\".","v2.0","2022-08-09","Yes","JJ","2022-08-04",null,null,null,null,"X",null,"X"]
[198,"Measure Specifications SFY23","SFY23","T3-124",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Depression Response at Twelve Months"},"Updated the \"Measure Steward Additional Information\" to clarify the \"Denominator Identification Period\" and the\n\"Numerator Measure Assessment Period for Rate Calculation\", per the data measurement periods for Year 2 Reporting Period 1 versus Year 2 Reporting Period 2.","v2.0","2022-08-09","Yes","JJ","2022-08-05",null,null,"X",null,null,null,"X"]
[199,"Additional Reporting Info SFY23","SFY23","N/A",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"N/A"},"Clarified the reporting guidance for sampled data.","v2.0","2022-08-09","No","JJ","2022-08-08",null,null,null,null,null,null,"X"]
[200,"Measure Specifications SFY23","SFY23","C2-141",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Written transition procedures that include formal MCO relationship or EDEN notification/ ADT Feed for psychiatric patients\n"},"Clarified meaning of \"written transition procedures\" ","v2.0","2022-08-09","No","JQ","2022-08-08",null,"X",null,null,null,null,"X"]
[201,"Measure Specifications SFY23","SFY23","C2-142",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Written transition procedures that include formal MCO relationship or EDEN notification/ ADT Feed for non-psychiatric patients"},"Clarified meaning of \"written transition procedures\" ","v2.0","2022-08-09","No","JQ","2022-08-08",null,"X",null,null,null,null,"X"]
[202,"Measure Specifications SFY23","SFY23","C1-127",{"$f":"IFERROR(INDEX(Table178[], MATCH(Table511[[#This Row],[Measure ID]],Table178[Final Measure ID],0),4),\"N/A\")","v":"Medication Reconciliation: Number of Unintentional Medication Discrepancies per Medication per Patient"},"Added examples to clarify sampling requirements to HHSC Program Specific Modifications tab and added links to the Public Notes to provide helpful resources. ","v2.0","2022-08-09","No","JQ","2022-08-08",null,"X",null,null,null,null,"X"]

{"sheet":"Introduction SFY23","index":7,"n_rows":62,"n_cols":2,"rows_kept":62,"cut":false,"hidden":true,"merged":[]}
["Directed Payment Program (DPP) Measure Specifications for State Fiscal Year (SFY) 2023"]
["File Version & Publication Date","v2.0 August 9, 2022"]
["File Description","This file includes detailed instructions for the measures to be reported for state fiscal year (SFY) 2023 directed payment program(s) (DPP) operated by the Texas Health and Human Services Commission (HHSC), as approved by the Center for Medicare and Medicaid Services (CMS)."]
["File Version Updates","The proposed SFY 2023 DPP measures and measure specifications were first published in January 2022 as v1.0, and the CMS-approved SFY 2022 measures and measure specifications were first published in August 2022 (as v2.0). \n\nHHSC will continue to release file version updates on an as needed basis. Please refer to the DPP-specific \"Quality\" webpage for the most up-to-date file version: https://www.hhs.texas.gov/services/health/medicaid-chip/provider-information/medicaid-chip-directed-payment-programs."]
["Contact","dppquality@hhs.texas.gov"]
[]
["Prog Component Elig Reqs SFY23"]
["Tab Overview","This tab identifies the Program Component Eligibility Requirements for each DPP, including Provider Class Eligibility Requirements and Minimum Volume Requirements, which define provider eligibility to participate in a given program component or module of the DPP. The program component eligibility requirements have been developed by HHSC for program reporting purposes. More information about the program components in a given DPP are detailed in the respective DPP Requirements documents."]
[]
["Attribution Methodology SFY23"]
["Tab Overview","This tab outlines the steps to identify the specific population that should be included in the denominator and numerator of provider-reported measures for each DPP: \nStep 1: Determine the DPP attributed population\nStep 2: Determine the measure-specific denominator population \nStep 3: Stratify the measure-specific denominator population by payer type. \n\nThe attribution methodology has been developed by HHSC for DPP program reporting purposes. "]
[]
["Measure Specifications SFY23"]
["Tab Overview","This tab lists all the measures included in each program component/module of a DPP and the corresponding measure specifications such as denominator and numerator inclusion and exclusion criteria. Measure specifications are developed by a measure steward external to HHSC, unless otherwise noted under the \"Measure Steward\" field. For each measure, the measure steward, the measure specifications source, and the publicly accessible link to the measure specifications source are included.\n\nThis tab also outlines helpful reporting information including the data measurement period for a given reporting period and the reporting payer type stratification for each measure as required by HHSC for program reporting purposes. Definitions of fields included in this tab are further described below. "]
["Field","Definition"]
["Final Measure ID","The DPP-specific alphanumeric identifier designated to an individual measure"]
["DPP Shorthand","The DPP-specific program name abbreviation"]
["Program Component","The DPP-specific program component or module. More information about the program components in a given DPP are detailed in the respective DPP Requirements documents found on the HHSC DPP webpages."]
["Measure Name","The name of the measure"]
["Measure Type","“Structure Measure”, “Process Measure”, \"Outcome (Intermediate) Measure\", and “Outcome Measure” are measure type classifications commonly used in health care quality measurement. “Structure Measures” are a type of measure that helps provide a sense of a health care organization’s capacity, infrastructure, and strategy for delivering evidence-based best practices for high quality care. “Process Measures” are a type of measure that helps indicate what a health care organization does to maintain or improve health, often reflecting generally accepted recommendations for clinical practice. \"Outcome (Intermediate) Measures\" are a type of measure that helps assess the change produced by a healthcare intervention that leads to a long-term outcome. “Outcome Measures” are a type of measure that helps reflect the impact of the health care service or intervention on the health status of patients. https://www.ahrq.gov/talkingquality/measures/types.html; https://www.cms.gov/files/document/blueprint-glossary-and-acronyms.pdf"]
["Blank Field (intentionally left blank)"]
["Reporting Period 1 - Data Measurement Period","The start and end dates for data measurement of the measures reported during the Reporting Period 1"]
["Reporting Period 1 - Reporting Requirements","The reporting requirements for the Reporting Period 1, e.g., may be described either as \"Status Update Only\" or \"Numeric Data Reporting & Status Update\""]
["Blank Field (intentionally left blank)"]
["Reporting Period 2 - Data Measurement Period","The start and end dates for data measurement of the measures reported during the Reporting Period 2"]
["Reporting Period 2 - Reporting Requirements","The reporting requirements for the Reporting Period 2, e.g., may be described either as \"Status Update Only\" or \"Numeric Data Reporting & Status Update\""]
["Blank Field (intentionally left blank)"]
["Required Reporting Payer Types","The payer type stratifications to meet DPP reporting requirements. Depending on the measure, one or more payer type stratifications may be required. More information about the required reporting payer type stratifications are detailed in Step 3 of the Attribution Methodology as well as in the respective DPP Requirements documents found on the respective HHSC DPP webpages."]
["Blank Field (intentionally left blank)"]
["Blank Field (intentionally left blank)"]
["Blank Field (intentionally left blank)"]
["Blank Field (intentionally left blank)"]
["Blank Field (intentionally left blank)"]
["NQF ID","The numeric identifier assigned by the National Quality Forum (NQF) to a measure. Please note this is not a field listing the measure's current NQF Endorsement Status. Please note measures with an NQF ID may be endorsed, not endorsed, or no longer endorsed by NQF and not all measures have an NQF ID."]
["Measure Steward","The organization responsible for development and maintenance of the data specifications for the measure and often the inclusion of clinical guidelines or recommendations related to the measure and endorsement of the measure."]
["Measure Specs Source (Version)","The source for publicly accessing the measure specifications. The version information for the publicly accessible measure specifications are included in parentheses."]
["Link to Measure Specs Source","The weblink to the publicly available measure specifications source. Please note when HHSC includes any \"HHSC Program Specific Modifications\" to a measure, these HHSC program-specific modifications will not be found in the original measure specifications source. "]
["Measure Description","Brief description of the measure. This field is taken from the measure steward's measure specifications as identified in the publicly available measure specifications source."]
["Eligible Physician Specialties and Other Clinicians","For certain outpatient-based measures, HHSC has outlined which physician specialties and other clinicians are eligible for denominator inclusion, as described in Step 2 of the Attribution Methodology. The listing of eligible physician specialties and other clinicians is adapted from those identified for the CMS Medicare Merit-based Incentive Payment System (MIPS) program. \n\nAs described in Step 2 of the Attribution Methodology, please refer to the most recent NUCC Health Care Provider Taxonomy Code Set (https://taxonomy.nucc.org/) for the definitions and taxonomy codes for physician specialties, subspecialties, and other clinicians, as defined by the National Uniform Claim Committee (NUCC)."]
["Unit of Measurement","The unit of measurement for the denominator (e.g., \"Individual\" or \"Encounter\") determines the payer type assignment methodology as further described in Step 3 of the \"Attribution Methodology\" tab."]
["Denominator Description","The description of the defined denominator population, from which eligible numerator cases will ultimately be identified. This field is taken from the measure steward's measure specifications as identified in the publicly available measure specifications source."]
["Denominator Inclusions","The detailed denominator inclusion criteria for defining what qualifies into the denominator population. This field is taken from the measure steward's measure specifications as identified in the publicly available measure specifications source. Not all measure stewards provide detailed denominator inclusion criteria for a measure."]
["Denominator Exclusions","The detailed denominator exclusion criteria for defining what should be removed from the denominator population. Some measure specifications may state \"denominator exclusions\" as \"denominator exceptions\", which should all be removed from the denominator population. This field is taken from the measure steward's measure specifications as identified in the publicly available measure specifications source. Not all measure stewards provide detailed denominator exclusion criteria for a measure."]
["Numerator Description","The description of the eligible cases that meet the measure's objective for measurement. Numerator cases must be derived from the denominator population. This field is taken from the measure steward's measure specifications as identified in the publicly available measure specifications source."]
["Numerator Inclusion (Performance Met) ","The detailed numerator inclusion criteria for defining what qualifies as meeting the measure's objective for measurement. This field is taken from the measure steward's measure specifications as identified in the publicly available measure specifications source. Not all measure stewards provide detailed numerator inclusion criteria for a measure."]
["Numerator Exclusion (Performance Not Met) ","The detailed numerator exclusion criteria for defining what does not qualify as meeting the measure's objective for measurement. This field is taken from the measure steward's measure specifications as identified in the publicly available measure specifications source. Not all measure stewards provide detailed numerator exclusion criteria for a measure."]
["HHSC Program Specific Modifications","For DPP-specific reporting purposes, any modifications made by HHSC to the measure steward's measure specifications will be indicated in this field."]
["Measure Steward Additional Information","If applicable, any additional information from the measure steward that is helpful for understanding the measure specifications will be included in this field. This field is taken from the measure steward's measure specifications as identified in the publicly available measure specifications source. "]
["Blank Field (intentionally left blank)"]
["Blank Field (intentionally left blank)"]
["Blank Field (intentionally left blank)"]
["Performance Directionality","The performance directionality of a measure can be \"positive\" (i.e., better performance on the measure is demonstrated by a higher rate), \"negative\" (i.e., better performance on the measure is demonstrated by a lower rate), or \"N/A\" (i.e., the measure does not have a numeric performance calculation)."]
["Public Notes","These notes are helpful reminders about any denominator and/or numerator specifications or reporting information unique to a given measure."]
[]
["Additional DPP Reporting Info"]
["Tab Overview","This tab includes helpful additional information relevant to DPP reporting including guidance concerning allowable data sources and sampling methodology. The rules on allowable data sources and sampling methodology, including minimum sample size requirements, have been developed by HHSC for program reporting purposes. "]
[]
["Specs Viewer SFY23"]
["Tab Overview","A printer friendly version of the measure specifications and attribution methodology. Can be used to print specifications for individual measures by selecting Measure ID in cell E2."]
[]
["Change Log"]
["Tab Overview","The proposed SFY 2023 DPP measures and measure specifications were first published in January 2022 as v1.0. When the next file version is published, the Change Log tab will include the changes made to this file since v1.0, and highlighted yellow cells will represent the most recently published changes."]

{"sheet":"Prog Component Elig Reqs SFY23","index":8,"n_rows":35,"n_cols":4,"rows_kept":35,"cut":false,"hidden":true,"merged":[[0,0,0,1],[0,2,0,3]]}
["Directed Payment Program (DPP) Information",null,"Program Component Eligibility Requirements"]
["DPP Shorthand","Program Component (Module) Information","Provider Class Eligibility Requirements","Minimum Volume Requirements"]
["TIPPS","T1 - Uniform dollar increase paid on a monthly basis","Physician Practice Groups affiliated with a Health-Related Institution (HRI)","N/a"]
["TIPPS","T1 - Uniform dollar increase paid on a monthly basis","Physician Practice Groups affiliated with a hospital receiving the Indirect Medical Education add-on (IME)"]
["TIPPS","T2 - Uniform rate enhancement paid semiannually","Physician Practice Groups affiliated with a Health-Related Institution (HRI)",">=30 Medicaid Managed Care patients (includes STAR, STAR+PLUS, and STAR Kids) in CY2022 in at least 50 percent of the measures in the program component"]
["TIPPS","T2 - Uniform rate enhancement paid semiannually","Physician Practice Groups affiliated with a hospital receiving the Indirect Medical Education add-on (IME)"]
["TIPPS","T3 - Rate enhancement for certain outpatient services","Physician Practice Groups affiliated with a Health-Related Institution (HRI)",">=30 Medicaid Managed Care patients (includes STAR, STAR+PLUS, and STAR Kids) in CY2022 in at least 50 percent of the measures in the program component"]
["TIPPS","T3 - Rate enhancement for certain outpatient services","Physician Practice Groups affiliated with a hospital receiving the Indirect Medical Education add-on (IME)"]
["TIPPS","T3 - Rate enhancement for certain outpatient services","Other Physician Practice Groups that are not HRI or IME "]
["CHIRP","C1 (UHRIP) - UHRIP rate enhancement","Children’s Hospitals","N/a"]
["CHIRP","C1 (UHRIP) - UHRIP rate enhancement","Rural Hospitals"]
["CHIRP","C1 (UHRIP) - UHRIP rate enhancement","State-owned Hospitals that are not Institutions for Mental Diseases (IMDs)"]
["CHIRP","C1 (UHRIP) - UHRIP rate enhancement","Urban Hospitals"]
["CHIRP","C1 (UHRIP) - UHRIP rate enhancement","Non-state-owned IMDs"]
["CHIRP","C1 (UHRIP) - UHRIP rate enhancement","State-owned IMDs"]
["CHIRP","C2 (ACIA Maternal Care) - ACIA rate enhancement","Children’s Hospitals",">=30 Medicaid Managed Care patients (includes STAR and STAR+PLUS) live births in CY2021 or CY2020"]
["CHIRP","C2 (ACIA Maternal Care) - ACIA rate enhancement","State-owned Hospitals that are not Institutions for Mental Diseases (IMDs)"]
["CHIRP","C2 (ACIA Maternal Care) - ACIA rate enhancement","Urban Hospitals"]
["CHIRP","C2 (ACIA Hospital Safety) - ACIA rate enhancement","State-owned Hospitals that are not Institutions for Mental Diseases (IMDs)",">=1 Medicaid Managed Care patients (includes STAR and STAR+PLUS) in CY2021 for at least one of the measures in the program component module. "]
["CHIRP","C2 (ACIA Hospital Safety) - ACIA rate enhancement","Urban Hospitals"]
["CHIRP","C2 (ACIA Pediatric) - ACIA rate enhancement","Children's Hospitals",">=1 Medicaid Managed Care patients (includes STAR and STAR+PLUS) in CY2021 for at least one of the measures in the program component module. "]
["CHIRP","C2 (ACIA Psychiatric Care Transitions) - ACIA rate enhancement","Children's Hospitals",">=30 Medicaid Managed Care (includes STAR and STAR+PLUS) Psychiatric Discharges in CY2021 or CY2020\n\nPsychiatric discharges include revenue codes: \n114 Private medical or general-psychiatric\n124 Semi-private 2 bed (medical or general)-psychiatric\n134 Semi-private 3 and 4 beds-psychiatric\n144 Private (deluxe)-psychiatric\n204 Intensive care-psychiatric\n1001 Behavioral health accommodations - residential treatment - psychiatric"]
["CHIRP","C2 (ACIA Psychiatric Care Transitions) - ACIA rate enhancement","State-owned Hospitals that are not Institutions for Mental Diseases (IMDs)"]
["CHIRP","C2 (ACIA Psychiatric Care Transitions) - ACIA rate enhancement","Urban Hospitals"]
["CHIRP","C2 (ACIA Psychiatric Care Transitions) - ACIA rate enhancement","Non-state-owned IMDs"]
["CHIRP","C2 (ACIA Psychiatric Care Transitions) - ACIA rate enhancement","State-owned IMDs"]
["CHIRP","C2 (ACIA Care Transitions) - ACIA rate enhancement","State-owned Hospitals that are not Institutions for Mental Diseases (IMDs)",">=30 Medicaid Managed Care (includes STAR and STAR+PLUS) Non-Psychiatric Discharges in CY2021 or CY2020"]
["CHIRP","C2 (ACIA Care Transitions) - ACIA rate enhancement","Urban Hospitals"]
["CHIRP","C2 (ACIA Rural Hospitals Best Practices) - ACIA rate enhancement","Rural Hospitals",">=1 Medicaid Managed Care patient (includes STAR and STAR+PLUS) in CY2021 for at least one of the measures in the program component module. "]
["DPP BHS","B1 - Dollar increase","Community Mental Health Centers (CMHCs)","N/a"]
["DPP BHS","B1 - Dollar increase","Local Behavioral Health Authorities (LBHAs)"]
["DPP BHS","B2 - Percent increase","Community Mental Health Centers (CMHCs)","N/a"]
["DPP BHS","B2 - Percent increase","Local Behavioral Health Authorities (LBHAs)"]
["RAPPS","R1 - Dollar increase","Rural Health Clinics (RHCs)","N/a"]
["RAPPS","R2 - Percent rate increase","Rural Health Clinics (RHCs)","N/a"]

{"sheet":"Attribution Methodology SFY23","index":9,"n_rows":20,"n_cols":12,"rows_kept":20,"cut":false,"hidden":true,"merged":[[0,0,3,1]]}
["In each Directed Payment Program (DPP), the attribution methodology for reporting quality measures is determined by the following process:"]
[]
[]
[]
["Directed Payment Program (DPP) Information",null,null,"Step 1: Determine the DPP attributed population for process and outcome measures",null,null,null,null,"Step 2: Determine the measure-specific denominator population","Step 3: Stratify the measure-specific denominator population by required reporting payer type"]
["DPP","Program Name","Program Component (Module)","Attributed Population Definition","Attributed Population Inclusion Criteria","Primary Care Service - CPT/HCPCS Codes","Preventive Care Service - Value Sets","Ambulatory Encounter - Value Sets and CPT/HCPCS Codes","Measure-Specific Denominator Population Definition","Reporting Payer Types*","Payer Type Assignment Methodology","Allowable Exclusion(s)"]
["TIPPS","Texas Incentives for Physician and Professional Services","T1","N/a","N/a","N/a","N/a","N/a","N/a","N/a","N/a","N/a"]
["TIPPS","Texas Incentives for Physician and Professional Services","T2","The TIPPS attributed population is the individuals a participating provider, as approved in the enrollment application, is accountable for under the TIPPS program, using a retrospective attribution methodology as defined by the \"Attributed Population Inclusion Criteria\". ","The participating provider’s attributed population includes any individual that meets at least one of the criteria below:\na) One primary care service or preventive service provided during the measurement period; OR\nb) One ambulatory encounter during the measurement period; OR\nc) One prenatal or postnatal visit during the measurement period","99202–99205: New patient, office or other outpatient visit\n99211–99215: Established patient, office or other outpatient visit\n99304–99306: Initial nursing facility visit\n99307–99310: Subsequent nursing facility visit\n99315–99316: Nursing facility discharge day management\n99318: Nursing facility annual assessment\n99324–99328: New patient, domiciliary or rest home visit\n99334–99337: Established patient, domiciliary or rest home visit\n99339–99340: Established patient, physician supervision of patient (patient not present) in home, domiciliary, or rest home\n99341–99345: New patient, home visit\n99347–99350: Established patient, home visit","Annual Wellness Visit: 2.16.840.1.113883.3.526.2.1363\nPreventive Care Services - Initial Office Visit, 0 to 17: 2.16.840.1.113883.3.464.1003.101.12.1022.\nPreventive Care Services - Established Office Visit, 0 to 17: 2.16.840.1.113883.3.464.1003.101.12.1024\nPreventive Care Services - Initial Office Visit, 18 and Up: 2.16.840.1.113883.3.464.1003.101.12.1023\nPreventive Care Services - Established Office Visit, 18 and Up: 2.16.840.1.113883.3.464.1003.101.12.1025 \nPreventive Care Services - Individual Counseling: 2.16.840.1.113883.3.464.1003.101.12.1026","Office Visit: 2.16.840.1.113883.3.464.1003.101.12.1001\nFace-to-Face Interaction: 2.16.840.1.113883.3.464.1003.101.12.1048\nOphthalmological Services: 2.16.840.1.113883.3.526.3.1285\nOutpatient Consultation: 2.16.840.1.113883.3.464.1003.101.12.1008\nPsych Visit - Psychotherapy: 2.16.840.1.113883.3.526.3.1496\nAmbulatory/ED Visit: 2.16.840.1.113883.3.464.1003.101.12.1061\nPsych Visit - Diagnostic Evaluation: 2.16.840.1.113883.3.526.3.1492\nPsychoanalysis: 2.16.840.1.113883.3.526.3.1141\nOccupational Therapy Evaluation: 2.16.840.1.113883.3.526.3.1011\nHemodialysis: 2.16.840.1.113883.3.526.3.1083\nPeritoneal Dialysis: 2.16.840.1.113883.3.526.3.1084\nPreventive Care Services - Other: 2.16.840.1.113883.3.464.1003.101.12.1030 \nSpeech and Hearing Evaluation: 2.16.840.1.113883.3.526.3.1530\nOutpatient Encounters for Preventive Care: 2.16.840.1.113762.1.4.1047.9\n96156: Health behavior assessment, or re-assessment\n96158–96159: Health behavior intervention, individual, face-to-face\n96160: Administration and interpretation of patient-focused health risk assessment\n96161: Administration and interpretation of caregiver-focused health risk assessment","The measure-specific denominator population (Step 2) includes the individuals or encounters from the TIPPS attributed population (Step 1) that meet all criteria under the \"Eligible Physician Specialties and Other Clinicians\", \"Denominator Inclusions\", and \"Denominator Exclusions\" as applicable for each quality measure, as defined in the \"Measure Specifications SFY23\" tab. \n\nParticipating providers may refer to the most recent NUCC Health Care Provider Taxonomy Code Set (https://taxonomy.nucc.org/) for the definitions and taxonomy codes for physician specialties, physician subspecialties, and other clinicians, as defined by the National Uniform Claim Committee (NUCC). The NUCC provider taxonomy definitions and codes for physician subspecialties that are nested within an eligible physician specialty may be included if these subspecialists perform the quality actions described in the measure based on the services provided and the measure specific-denominator coding. Nurse Practitioners and Physician Assistants, as defined by NUCC, practicing under the listed eligible physician specialties or practicing equivalent services may also be included.","*Measures must be stratified by the required reporting payer types as specified under \"Required Reporting Payer Types\" in the \"Measure Specifications SFY23\" tab. For example, some measures may only require reporting by one or more of the following reporting payer types below.\n\nPlease note unlike in SFY22 (Year 1), there are no reporting exceptions for the \"Medicaid Managed Care\" payer type in SFY23 (Year 2). In SFY23 (Year 2), measures with the required reporting payer type of \"Medicaid Managed Care\" must be reported by \"Medicaid Managed Care\" as described below.\n\n• Medicaid Managed Care (includes STAR, STAR+PLUS, and STAR Kids)\n• Other Medicaid (includes other Medicaid Managed Care programs and Medicaid Fee-For-Service (FFS))\n• Uninsured (includes No insurance; County-based or other public medical assistance)\n• All Payer (includes Medicaid Managed Care, Other Medicaid, Uninsured, and all other payer types such as CHIP, Medicare, Medicare/Medicaid Dual Eligibles, and Commercial Insurance)","The payer type assignment methodology depends on the “Denominator Unit of Measurement” (e.g., “Individual” or “Encounter”) of the measure-specific denominator (Step 2), as defined in the “Measure Specifications SFY23” tab.\n\n1. Individual: If a person can only be counted once in the denominator in a given measurement period, then the unit of measurement is an “individual”. For measures with “Individual” as the “Denominator Unit of Measurement”, the payer type assignment will be determined either by the most recent payer type on record for the individual at the end of the measurement period OR as any individual with a Medicaid Managed Care-enrolled service at any point in the measurement period, even if their most recent payer type of record is not Medicaid Managed Care. The same assignment methodology for determining Medicaid Managed Care must be applied consistently across the measurement period.\n\n2. Encounter: If a person can be counted in the denominator more than once in a given measurement period, then the unit of measurement is an “encounter”. For measures with “Encounter” as the “Denominator Unit of Measurement”, the payer type assignment will be determined by the payer type on record for the qualifying encounter (e.g., visit or admission).","Encounters with an individual incarcerated in a state or federal facility during the measurement period"]
["TIPPS","Texas Incentives for Physician and Professional Services","T3","The TIPPS attributed population is the individuals a participating provider, as approved in the enrollment application, is accountable for under the TIPPS program, using a retrospective attribution methodology as defined by the \"Attributed Population Inclusion Criteria\". ","The participating provider’s attributed population includes any individual that meets at least one of the criteria below:\na) One primary care service or preventive service provided during the measurement period; OR\nb) One ambulatory encounter during the measurement period; OR\nc) One prenatal or postnatal visit during the measurement period","99202–99205: New patient, office or other outpatient visit\n99211–99215: Established patient, office or other outpatient visit\n99304–99306: Initial nursing facility visit\n99307–99310: Subsequent nursing facility visit\n99315–99316: Nursing facility discharge day management\n99318: Nursing facility annual assessment\n99324–99328: New patient, domiciliary or rest home visit\n99334–99337: Established patient, domiciliary or rest home visit\n99339–99340: Established patient, physician supervision of patient (patient not present) in home, domiciliary, or rest home\n99341–99345: New patient, home visit\n99347–99350: Established patient, home visit","Annual Wellness Visit: 2.16.840.1.113883.3.526.2.1363\nPreventive Care Services - Initial Office Visit, 0 to 17: 2.16.840.1.113883.3.464.1003.101.12.1022.\nPreventive Care Services - Established Office Visit, 0 to 17: 2.16.840.1.113883.3.464.1003.101.12.1024\nPreventive Care Services - Initial Office Visit, 18 and Up: 2.16.840.1.113883.3.464.1003.101.12.1023\nPreventive Care Services - Established Office Visit, 18 and Up: 2.16.840.1.113883.3.464.1003.101.12.1025 \nPreventive Care Services - Individual Counseling: 2.16.840.1.113883.3.464.1003.101.12.1026","Office Visit: 2.16.840.1.113883.3.464.1003.101.12.1001\nFace-to-Face Interaction: 2.16.840.1.113883.3.464.1003.101.12.1048\nOphthalmological Services: 2.16.840.1.113883.3.526.3.1285\nOutpatient Consultation: 2.16.840.1.113883.3.464.1003.101.12.1008\nPsych Visit - Psychotherapy: 2.16.840.1.113883.3.526.3.1496\nAmbulatory/ED Visit: 2.16.840.1.113883.3.464.1003.101.12.1061\nPsych Visit - Diagnostic Evaluation: 2.16.840.1.113883.3.526.3.1492\nPsychoanalysis: 2.16.840.1.113883.3.526.3.1141\nOccupational Therapy Evaluation: 2.16.840.1.113883.3.526.3.1011\nHemodialysis: 2.16.840.1.113883.3.526.3.1083\nPeritoneal Dialysis: 2.16.840.1.113883.3.526.3.1084\nPreventive Care Services - Other: 2.16.840.1.113883.3.464.1003.101.12.1030 \nSpeech and Hearing Evaluation: 2.16.840.1.113883.3.526.3.1530\nOutpatient Encounters for Preventive Care: 2.16.840.1.113762.1.4.1047.9\n96156: Health behavior assessment, or re-assessment\n96158–96159: Health behavior intervention, individual, face-to-face\n96160: Administration and interpretation of patient-focused health risk assessment\n96161: Administration and interpretation of caregiver-focused health risk assessment","The measure-specific denominator population (Step 2) includes the individuals or encounters from the TIPPS attributed population (Step 1) that meet all criteria under the \"Eligible Physician Specialties and Other Clinicians\", \"Denominator Inclusions\", and \"Denominator Exclusions\" as applicable for each quality measure, as defined in the \"Measure Specifications SFY23\" tab. \n\nParticipating providers may refer to the most recent NUCC Health Care Provider Taxonomy Code Set (https://taxonomy.nucc.org/) for the definitions and taxonomy codes for physician specialties, physician subspecialties, and other clinicians, as defined by the National Uniform Claim Committee (NUCC). The NUCC provider taxonomy definitions and codes for physician subspecialties that are nested within an eligible physician specialty may be included if these subspecialists perform the quality actions described in the measure based on the services provided and the measure specific-denominator coding. Nurse Practitioners and Physician Assistants, as defined by NUCC, practicing under the listed eligible physician specialties or practicing equivalent services may also be included.","*Measures must be stratified by the required reporting payer types as specified under \"Required Reporting Payer Types\" in the \"Measure Specifications SFY23\" tab. For example, some measures may only require reporting by one or more of the following reporting payer types below.\n\nPlease note unlike in SFY22 (Year 1), there are no reporting exceptions for the \"Medicaid Managed Care\" payer type in SFY23 (Year 2). In SFY23 (Year 2), measures with the required reporting payer type of \"Medicaid Managed Care\" must be reported by \"Medicaid Managed Care\" as described below.\n\n• Medicaid Managed Care (includes STAR, STAR+PLUS, and STAR Kids)\n• Other Medicaid (includes other Medicaid Managed Care programs and Medicaid Fee-For-Service (FFS))\n• Uninsured (includes No insurance; County-based or other public medical assistance)\n• All Payer (includes Medicaid Managed Care, Other Medicaid, Uninsured, and all other payer types such as CHIP, Medicare, Medicare/Medicaid Dual Eligibles, and Commercial Insurance)","The payer type assignment methodology depends on the “Denominator Unit of Measurement” (e.g., “Individual” or “Encounter”) of the measure-specific denominator (Step 2), as defined in the “Measure Specifications SFY23” tab.\n\n1. Individual: If a person can only be counted once in the denominator in a given measurement period, then the unit of measurement is an “individual”. For measures with “Individual” as the “Denominator Unit of Measurement”, the payer type assignment will be determined either by the most recent payer type on record for the individual at the end of the measurement period OR as any individual with a Medicaid Managed Care-enrolled service at any point in the measurement period, even if their most recent payer type of record is not Medicaid Managed Care. The same assignment methodology for determining Medicaid Managed Care must be applied consistently across the measurement period.\n\n2. Encounter: If a person can be counted in the denominator more than once in a given measurement period, then the unit of measurement is an “encounter”. For measures with “Encounter” as the “Denominator Unit of Measurement”, the payer type assignment will be determined by the payer type on record for the qualifying encounter (e.g., visit or admission).","Encounters with an individual incarcerated in a state or federal facility during the measurement period"]
["CHIRP","Comprehensive Hospital Increased Reimbursement Program","C1 (UHRIP)","The Attributed Population is not applicable for C1 structure measures.\n\nUsing a retrospective attribution methodology, the CHIRP attributed population includes the individuals that a participating Hospital, as approved in the enrollment application, is accountable for under CHIRP, as defined by the Attributed Population Inclusion Criteria. ","The Hospital’s attributed population includes any individual that meets the criteria below:\na) One encounter during the measurement period","N/a","N/a","N/a","The measure-specific denominator population (Step 2) includes the individuals or encounters from the CHIRP attributed population (Step 1) that meet all criteria under the \"Eligible Physician Specialties and Other Clinicians\", \"Denominator Inclusions\", and \"Denominator Exclusions\" as applicable for each quality measure, as defined in the CHIRP Measure Specifications. \n\nHospitals may refer to the most recent NUCC Health Care Provider Taxonomy Code Set (https://taxonomy.nucc.org/) for the definitions and taxonomy codes for physician specialties, physician subspecialties, and other clinicians, as defined by the National Uniform Claim Committee (NUCC). The NUCC provider taxonomy definitions and codes for physician subspecialties that are nested within an eligible physician specialty may be included if these subspecialists perform the quality actions described in the measure based on the services provided and the measure specific-denominator coding. Nurse Practitioners and Physician Assistants, as defined by NUCC, practicing under the listed eligible physician specialties or practicing equivalent services may also be included.","*Measures must be stratified by the required reporting payer types as specified under \"Required Reporting Payer Types\" in the \"Measure Specifications SFY23\" tab. For example, some measures may only require reporting by one or more of the following reporting payer types below.\n\nPlease note unlike in SFY22 (Year 1), there are no reporting exceptions for the \"Medicaid Managed Care\" payer type in SFY23 (Year 2). In SFY23 (Year 2), measures with the required reporting payer type of \"Medicaid Managed Care\" must be reported by \"Medicaid Managed Care\" as described below.\n\n• Medicaid Managed Care (includes STAR and STAR+PLUS)\n• Other Medicaid (includes other Medicaid Managed Care programs and Medicaid Fee-For-Service (FFS))\n• Uninsured (includes No insurance; County-based or other public medical assistance)\n• All Payer (includes Medicaid Managed Care, Other Medicaid, Uninsured, and all other payer types such as CHIP, Medicare, Medicare/Medicaid Dual Eligibles, and Commercial Insurance)","The payer type assignment methodology depends on the unit of measurement (e.g., “Individual” or “Encounter”) of the measure-specific denominator (Step 2), as defined in the CHIRP Measure Specifications. \n\n1. Individual: A unit of measurement is an “individual” if a person can only be counted once in the denominator in a given measurement period. Payer type will be determined either by the most recent payer type on record for the individual at the end of the measurement period OR as any individual with a Medicaid-enrolled service at any point in the measurement period, even if their most recent payer type of record is not Medicaid. The same assignment methodology for determining Medicaid must be applied consistently across the measurement period.\n\n2. Encounter: A unit of measurement is an “encounter” if a person can be counted in the denominator more than once in a given measurement period. Payer type will be determined by the payer type on record for the qualifying encounter (visit or admission).","N/a"]
["CHIRP","Comprehensive Hospital Increased Reimbursement Program","C2 (ACIA Maternal Care)","The CHIRP attributed population is the individuals a participating provider, as approved in the enrollment application, is accountable for under the CHIRP program, using a retrospective attribution methodology as defined by the \"Attributed Population Inclusion Criteria\". ","The participating provider's attributed population includes any individual that meets at least one of the criteria below:\na) One delivery during the measurement period","N/a","N/a","N/a","The measure-specific denominator population (Step 2) includes the individuals or encounters from the CHIRP attributed population (Step 1) that meet all criteria under the \"Eligible Physician Specialties and Other Clinicians\", \"Denominator Inclusions\", and \"Denominator Exclusions\" as applicable for each quality measure, as defined in the \"Measure Specifications SFY23\" tab. \n\nParticipating providers may refer to the most recent NUCC Health Care Provider Taxonomy Code Set (https://taxonomy.nucc.org/) for the definitions and taxonomy codes for physician specialties, physician subspecialties, and other clinicians, as defined by the National Uniform Claim Committee (NUCC). The NUCC provider taxonomy definitions and codes for physician subspecialties that are nested within an eligible physician specialty may be included if these subspecialists perform the quality actions described in the measure based on the services provided and the measure specific-denominator coding. Nurse Practitioners and Physician Assistants, as defined by NUCC, practicing under the listed eligible physician specialties or practicing equivalent services may also be included.","*Measures must be stratified by the required reporting payer types as specified under \"Required Reporting Payer Types\" in the \"Measure Specifications SFY23\" tab. For example, some measures may only require reporting by one or more of the following reporting payer types below.\n\nPlease note unlike in SFY22 (Year 1), there are no reporting exceptions for the \"Medicaid Managed Care\" payer type in SFY23 (Year 2). In SFY23 (Year 2), measures with the required reporting payer type of \"Medicaid Managed Care\" must be reported by \"Medicaid Managed Care\" as described below.\n\n• Medicaid Managed Care (includes STAR and STAR+PLUS)\n• Other Medicaid (includes other Medicaid Managed Care programs and Medicaid Fee-For-Service (FFS))\n• Uninsured (includes No insurance; County-based or other public medical assistance)\n• All Payer (includes Medicaid Managed Care, Other Medicaid, Uninsured, and all other payer types such as CHIP, Medicare, Medicare/Medicaid Dual Eligibles, and Commercial Insurance)","The payer type assignment methodology depends on the “Denominator Unit of Measurement” (e.g., “Individual” or “Encounter”) of the measure-specific denominator (Step 2), as defined in the “Measure Specifications SFY23” tab.\n\n1. Individual: If a person can only be counted once in the denominator in a given measurement period, then the unit of measurement is an “individual”. For measures with “Individual” as the “Denominator Unit of Measurement”, the payer type assignment will be determined either by the most recent payer type on record for the individual at the end of the measurement period OR as any individual with a Medicaid Managed Care-enrolled service at any point in the measurement period, even if their most recent payer type of record is not Medicaid Managed Care. The same assignment methodology for determining Medicaid Managed Care must be applied consistently across the measurement period.\n\n2. Encounter: If a person can be counted in the denominator more than once in a given measurement period, then the unit of measurement is an “encounter”. For measures with “Encounter” as the “Denominator Unit of Measurement”, the payer type assignment will be determined by the payer type on record for the qualifying encounter (e.g., visit or admission).","Encounters with an individual incarcerated in a state or federal facility during the measurement period"]
["CHIRP","Comprehensive Hospital Increased Reimbursement Program","C2 (ACIA Hospital Safety)","The CHIRP attributed population is the individuals a participating provider, as approved in the enrollment application, is accountable for under the CHIRP program, using a retrospective attribution methodology as defined by the \"Attributed Population Inclusion Criteria\". ","The participating provider's attributed population includes any individual that meets at least one of the criteria below:\na) One encounter during the measurement period","N/a","N/a","N/a","The measure-specific denominator population (Step 2) includes the individuals or encounters from the CHIRP attributed population (Step 1) that meet all criteria under the \"Eligible Physician Specialties and Other Clinicians\", \"Denominator Inclusions\", and \"Denominator Exclusions\" as applicable for each quality measure, as defined in the \"Measure Specifications SFY23\" tab. \n\nParticipating providers may refer to the most recent NUCC Health Care Provider Taxonomy Code Set (https://taxonomy.nucc.org/) for the definitions and taxonomy codes for physician specialties, physician subspecialties, and other clinicians, as defined by the National Uniform Claim Committee (NUCC). The NUCC provider taxonomy definitions and codes for physician subspecialties that are nested within an eligible physician specialty may be included if these subspecialists perform the quality actions described in the measure based on the services provided and the measure specific-denominator coding. Nurse Practitioners and Physician Assistants, as defined by NUCC, practicing under the listed eligible physician specialties or practicing equivalent services may also be included.","*Measures must be stratified by the required reporting payer types as specified under \"Required Reporting Payer Types\" in the \"Measure Specifications SFY23\" tab. For example, some measures may only require reporting by one or more of the following reporting payer types below.\n\nPlease note unlike in SFY22 (Year 1), there are no reporting exceptions for the \"Medicaid Managed Care\" payer type in SFY23 (Year 2). In SFY23 (Year 2), measures with the required reporting payer type of \"Medicaid Managed Care\" must be reported by \"Medicaid Managed Care\" as described below.\n\n• Medicaid Managed Care (includes STAR and STAR+PLUS)\n• Other Medicaid (includes other Medicaid Managed Care programs and Medicaid Fee-For-Service (FFS))\n• Uninsured (includes No insurance; County-based or other public medical assistance)\n• All Payer (includes Medicaid Managed Care, Other Medicaid, Uninsured, and all other payer types such as CHIP, Medicare, Medicare/Medicaid Dual Eligibles, and Commercial Insurance)","The payer type assignment methodology depends on the “Denominator Unit of Measurement” (e.g., “Individual” or “Encounter”) of the measure-specific denominator (Step 2), as defined in the “Measure Specifications SFY23” tab.\n\n1. Individual: If a person can only be counted once in the denominator in a given measurement period, then the unit of measurement is an “individual”. For measures with “Individual” as the “Denominator Unit of Measurement”, the payer type assignment will be determined either by the most recent payer type on record for the individual at the end of the measurement period OR as any individual with a Medicaid Managed Care-enrolled service at any point in the measurement period, even if their most recent payer type of record is not Medicaid Managed Care. The same assignment methodology for determining Medicaid Managed Care must be applied consistently across the measurement period.\n\n2. Encounter: If a person can be counted in the denominator more than once in a given measurement period, then the unit of measurement is an “encounter”. For measures with “Encounter” as the “Denominator Unit of Measurement”, the payer type assignment will be determined by the payer type on record for the qualifying encounter (e.g., visit or admission).","Encounters with an individual incarcerated in a state or federal facility during the measurement period"]
["CHIRP","Comprehensive Hospital Increased Reimbursement Program","C2 (ACIA Pediatric)","The CHIRP attributed population is the individuals a participating provider, as approved in the enrollment application, is accountable for under the CHIRP program, using a retrospective attribution methodology as defined by the \"Attributed Population Inclusion Criteria\". ","The participating provider's attributed population includes any individual that meets at least one of the criteria below:\na) One encounter during the measurement period","N/a","N/a","N/a","The measure-specific denominator population (Step 2) includes the individuals or encounters from the CHIRP attributed population (Step 1) that meet all criteria under the \"Eligible Physician Specialties and Other Clinicians\", \"Denominator Inclusions\", and \"Denominator Exclusions\" as applicable for each quality measure, as defined in the \"Measure Specifications SFY23\" tab. \n\nParticipating providers may refer to the most recent NUCC Health Care Provider Taxonomy Code Set (https://taxonomy.nucc.org/) for the definitions and taxonomy codes for physician specialties, physician subspecialties, and other clinicians, as defined by the National Uniform Claim Committee (NUCC). The NUCC provider taxonomy definitions and codes for physician subspecialties that are nested within an eligible physician specialty may be included if these subspecialists perform the quality actions described in the measure based on the services provided and the measure specific-denominator coding. Nurse Practitioners and Physician Assistants, as defined by NUCC, practicing under the listed eligible physician specialties or practicing equivalent services may also be included.","*Measures must be stratified by the required reporting payer types as specified under \"Required Reporting Payer Types\" in the \"Measure Specifications SFY23\" tab. For example, some measures may only require reporting by one or more of the following reporting payer types below.\n\nPlease note unlike in SFY22 (Year 1), there are no reporting exceptions for the \"Medicaid Managed Care\" payer type in SFY23 (Year 2). In SFY23 (Year 2), measures with the required reporting payer type of \"Medicaid Managed Care\" must be reported by \"Medicaid Managed Care\" as described below.\n\n• Medicaid Managed Care (includes STAR and STAR+PLUS)\n• Other Medicaid (includes other Medicaid Managed Care programs and Medicaid Fee-For-Service (FFS))\n• Uninsured (includes No insurance; County-based or other public medical assistance)\n• All Payer (includes Medicaid Managed Care, Other Medicaid, Uninsured, and all other payer types such as CHIP, Medicare, Medicare/Medicaid Dual Eligibles, and Commercial Insurance)","The payer type assignment methodology depends on the “Denominator Unit of Measurement” (e.g., “Individual” or “Encounter”) of the measure-specific denominator (Step 2), as defined in the “Measure Specifications SFY23” tab.\n\n1. Individual: If a person can only be counted once in the denominator in a given measurement period, then the unit of measurement is an “individual”. For measures with “Individual” as the “Denominator Unit of Measurement”, the payer type assignment will be determined either by the most recent payer type on record for the individual at the end of the measurement period OR as any individual with a Medicaid Managed Care-enrolled service at any point in the measurement period, even if their most recent payer type of record is not Medicaid Managed Care. The same assignment methodology for determining Medicaid Managed Care must be applied consistently across the measurement period.\n\n2. Encounter: If a person can be counted in the denominator more than once in a given measurement period, then the unit of measurement is an “encounter”. For measures with “Encounter” as the “Denominator Unit of Measurement”, the payer type assignment will be determined by the payer type on record for the qualifying encounter (e.g., visit or admission).","Encounters with an individual incarcerated in a state or federal facility during the measurement period"]
["CHIRP","Comprehensive Hospital Increased Reimbursement Program","C2 (ACIA Psychiatric Care Transitions)","N/a","N/a","N/a","N/a","N/a","N/a","N/a","N/a","N/a"]
["CHIRP","Comprehensive Hospital Increased Reimbursement Program","C2 (ACIA Care Transitions)","N/a","N/a","N/a","N/a","N/a","N/a","N/a","N/a","N/a"]
["CHIRP","Comprehensive Hospital Increased Reimbursement Program","C2 (ACIA Rural Hospital Best Practices)","The CHIRP attributed population is the individuals a participating provider, as approved in the enrollment application, is accountable for under the CHIRP program, using a retrospective attribution methodology as defined by the \"Attributed Population Inclusion Criteria\". ","The participating provider's attributed population includes any individual that meets at least one of the criteria below:\na) One encounter during the measurement period","N/a","N/a","N/a","The measure-specific denominator population (Step 2) includes the individuals or encounters from the CHIRP attributed population (Step 1) that meet all criteria under the \"Eligible Physician Specialties and Other Clinicians\", \"Denominator Inclusions\", and \"Denominator Exclusions\" as applicable for each quality measure, as defined in the \"Measure Specifications SFY23\" tab. \n\nParticipating providers may refer to the most recent NUCC Health Care Provider Taxonomy Code Set (https://taxonomy.nucc.org/) for the definitions and taxonomy codes for physician specialties, physician subspecialties, and other clinicians, as defined by the National Uniform Claim Committee (NUCC). The NUCC provider taxonomy definitions and codes for physician subspecialties that are nested within an eligible physician specialty may be included if these subspecialists perform the quality actions described in the measure based on the services provided and the measure specific-denominator coding. Nurse Practitioners and Physician Assistants, as defined by NUCC, practicing under the listed eligible physician specialties or practicing equivalent services may also be included.","*Measures must be stratified by the required reporting payer types as specified under \"Required Reporting Payer Types\" in the \"Measure Specifications SFY23\" tab. For example, some measures may only require reporting by one or more of the following reporting payer types below.\n\nPlease note unlike in SFY22 (Year 1), there are no reporting exceptions for the \"Medicaid Managed Care\" payer type in SFY23 (Year 2). In SFY23 (Year 2), measures with the required reporting payer type of \"Medicaid Managed Care\" must be reported by \"Medicaid Managed Care\" as described below.\n\n• Medicaid Managed Care (includes STAR and STAR+PLUS)\n• Other Medicaid (includes other Medicaid Managed Care programs and Medicaid Fee-For-Service (FFS))\n• Uninsured (includes No insurance; County-based or other public medical assistance)\n• All Payer (includes Medicaid Managed Care, Other Medicaid, Uninsured, and all other payer types such as CHIP, Medicare, Medicare/Medicaid Dual Eligibles, and Commercial Insurance)","The payer type assignment methodology depends on the “Denominator Unit of Measurement” (e.g., “Individual” or “Encounter”) of the measure-specific denominator (Step 2), as defined in the “Measure Specifications SFY23” tab.\n\n1. Individual: If a person can only be counted once in the denominator in a given measurement period, then the unit of measurement is an “individual”. For measures with “Individual” as the “Denominator Unit of Measurement”, the payer type assignment will be determined either by the most recent payer type on record for the individual at the end of the measurement period OR as any individual with a Medicaid Managed Care-enrolled service at any point in the measurement period, even if their most recent payer type of record is not Medicaid Managed Care. The same assignment methodology for determining Medicaid Managed Care must be applied consistently across the measurement period.\n\n2. Encounter: If a person can be counted in the denominator more than once in a given measurement period, then the unit of measurement is an “encounter”. For measures with “Encounter” as the “Denominator Unit of Measurement”, the payer type assignment will be determined by the payer type on record for the qualifying encounter (e.g., visit or admission).","Encounters with an individual incarcerated in a state or federal facility during the measurement period"]
["DPP BHS","Directed Payment Program for Behavioral Health Services","B1","N/a","N/a","N/a","N/a","N/a","N/a","N/a","N/a","N/a"]
["DPP BHS","Directed Payment Program for Behavioral Health Services","B2","The DPP BHS attributed population is the individuals a participating provider, as approved in the enrollment application, is accountable for under the DPP BHS program, using a retrospective attribution methodology as defined by the \"Attributed Population Inclusion Criteria\". ","The participating provider's attributed population includes any individual that meets at least one of the criteria below:\na) One encounter during the measurement period","n/a","n/a","n/a","The measure-specific denominator population (Step 2) includes the individuals or encounters from the DPP BHS attributed population (Step 1) that meet all criteria under the \"Eligible Physician Specialties and Other Clinicians\", \"Denominator Inclusions\", and \"Denominator Exclusions\" as applicable for each quality measure, as defined in the \"Measure Specifications SFY23\" tab. \n\nParticipating providers may refer to the most recent NUCC Health Care Provider Taxonomy Code Set (https://taxonomy.nucc.org/) for the definitions and taxonomy codes for physician specialties, physician subspecialties, and other clinicians, as defined by the National Uniform Claim Committee (NUCC). The NUCC provider taxonomy definitions and codes for physician subspecialties that are nested within an eligible physician specialty may be included if these subspecialists perform the quality actions described in the measure based on the services provided and the measure specific-denominator coding. Nurse Practitioners and Physician Assistants, as defined by NUCC, practicing under the listed eligible physician specialties or practicing equivalent services may also be included.","*Measures must be stratified by the required reporting payer types as specified under \"Required Reporting Payer Types\" in the \"Measure Specifications SFY23\" tab. For example, some measures may only require reporting by one or more of the following reporting payer types below.\n\nPlease note unlike in SFY22 (Year 1), there are no reporting exceptions for the \"Medicaid Managed Care\" payer type in SFY23 (Year 2). In SFY23 (Year 2), measures with the required reporting payer type of \"Medicaid Managed Care\" must be reported by \"Medicaid Managed Care\" as described below.\n\n• Medicaid Managed Care (includes STAR, STAR+PLUS, and STAR Kids)\n• Other Medicaid (includes other Medicaid Managed Care programs and Medicaid Fee-For-Service (FFS))\n• Uninsured (includes No insurance; County-based or other public medical assistance)\n• All Payer (includes Medicaid Managed Care, Other Medicaid, Uninsured, and all other payer types such as CHIP, Medicare, Medicare/Medicaid Dual Eligibles, and Commercial Insurance)","The payer type assignment methodology depends on the “Denominator Unit of Measurement” (e.g., “Individual” or “Encounter”) of the measure-specific denominator (Step 2), as defined in the “Measure Specifications SFY23” tab.\n\n1. Individual: If a person can only be counted once in the denominator in a given measurement period, then the unit of measurement is an “individual”. For measures with “Individual” as the “Denominator Unit of Measurement”, the payer type assignment will be determined either by the most recent payer type on record for the individual at the end of the measurement period OR as any individual with a Medicaid Managed Care-enrolled service at any point in the measurement period, even if their most recent payer type of record is not Medicaid Managed Care. The same assignment methodology for determining Medicaid Managed Care must be applied consistently across the measurement period.\n\n2. Encounter: If a person can be counted in the denominator more than once in a given measurement period, then the unit of measurement is an “encounter”. For measures with “Encounter” as the “Denominator Unit of Measurement”, the payer type assignment will be determined by the payer type on record for the qualifying encounter (e.g., visit or admission).","Encounters with an individual incarcerated in a state or federal facility during the measurement period"]
["RAPPS","Rural Access to Primary and Preventive Services","R1","N/a","N/a","N/a","N/a","N/a","N/a","N/a","N/a","N/a"]
["RAPPS","Rural Access to Primary and Preventive Services","R2","The RAPPS attributed population is the individuals a participating provider, as approved in the enrollment application, is accountable for under the RAPPS program, using a retrospective attribution methodology as defined by the \"Attributed Population Inclusion Criteria\". ","The participating provider's attributed population includes any individual that meets at least one of the criteria below:\na) One encounter during the measurement period","N/a","N/a","N/a","The measure-specific denominator population (Step 2) includes the individuals or encounters from the RAPPS attributed population (Step 1) that meet all criteria under the \"Eligible Physician Specialties and Other Clinicians\", \"Denominator Inclusions\", and \"Denominator Exclusions\" as applicable for each quality measure, as defined in the \"Measure Specifications SFY23\" tab. \n\nParticipating providers may refer to the most recent NUCC Health Care Provider Taxonomy Code Set (https://taxonomy.nucc.org/) for the definitions and taxonomy codes for physician specialties, physician subspecialties, and other clinicians, as defined by the National Uniform Claim Committee (NUCC). The NUCC provider taxonomy definitions and codes for physician subspecialties that are nested within an eligible physician specialty may be included if these subspecialists perform the quality actions described in the measure based on the services provided and the measure specific-denominator coding. Nurse Practitioners and Physician Assistants, as defined by NUCC, practicing under the listed eligible physician specialties or practicing equivalent services may also be included.","*Measures must be stratified by the required reporting payer types as specified under \"Required Reporting Payer Types\" in the \"Measure Specifications SFY23\" tab. For example, some measures may only require reporting by one or more of the following reporting payer types below.\n\nPlease note unlike in SFY22 (Year 1), there are no reporting exceptions for the \"Medicaid Managed Care\" payer type in SFY23 (Year 2). In SFY23 (Year 2), measures with the required reporting payer type of \"Medicaid Managed Care\" must be reported by \"Medicaid Managed Care\" as described below.\n\n• Medicaid Managed Care (includes STAR, STAR+PLUS, and STAR Kids)\n• Other Medicaid (includes other Medicaid Managed Care programs and Medicaid Fee-For-Service (FFS))\n• Uninsured (includes No insurance; County-based or other public medical assistance)\n• All Payer (includes Medicaid Managed Care, Other Medicaid, Uninsured, and all other payer types such as CHIP, Medicare, Medicare/Medicaid Dual Eligibles, and Commercial Insurance)","The payer type assignment methodology depends on the “Denominator Unit of Measurement” (e.g., “Individual” or “Encounter”) of the measure-specific denominator (Step 2), as defined in the “Measure Specifications SFY23” tab.\n\n1. Individual: If a person can only be counted once in the denominator in a given measurement period, then the unit of measurement is an “individual”. For measures with “Individual” as the “Denominator Unit of Measurement”, the payer type assignment will be determined either by the most recent payer type on record for the individual at the end of the measurement period OR as any individual with a Medicaid Managed Care-enrolled service at any point in the measurement period, even if their most recent payer type of record is not Medicaid Managed Care. The same assignment methodology for determining Medicaid Managed Care must be applied consistently across the measurement period.\n\n2. Encounter: If a person can be counted in the denominator more than once in a given measurement period, then the unit of measurement is an “encounter”. For measures with “Encounter” as the “Denominator Unit of Measurement”, the payer type assignment will be determined by the payer type on record for the qualifying encounter (e.g., visit or admission).","Encounters with an individual incarcerated in a state or federal facility during the measurement period"]

{"sheet":"Measure Specifications SFY23","index":10,"n_rows":61,"n_cols":45,"rows_kept":61,"cut":false,"hidden":true,"merged":[]}
["Final Measure ID","DPP Shorthand","Program Component (Module)","Measure Name","Measure Type","Blank Field (intentionally left blank)","Reporting Period 1 - Data Measurement Period","Reporting Period 1 - Reporting Requirements","Blank Field (intentionally left blank)2","Reporting Period 2 - Data Measurement Period","Reporting Period 2 -  Reporting Requirements","Blank Field (intentionally left blank)3","Required Reporting Payer Types","Blank Field (intentionally left blank)4","Blank Field (intentionally left blank)5","Blank Field (intentionally left blank)6","Blank Field (intentionally left blank)7","Blank Field (intentionally left blank)8","NQF ID","Measure Steward","Measure Specs Source (Version)","Link to Measure Specs Source","Measure Description","Eligible Physician Specialties and Other Clinicians","Denominator Unit of Measurement","Denominator Description","Denominator Inclusions","Denominator Exclusions","Numerator Description","Numerator Inclusion (Performance Met) ","Numerator Exclusion (Performance Not Met) ","HHSC Program Specific Modifications","Measure Steward Additional Information","Blank Field (intentionally left blank)9","Blank Field (intentionally left blank)10","Blank Field (intentionally left blank)11","Performance Directionality","Blank Field (intentionally left blank)12","Blank Field (intentionally left blank)13","Blank Field (intentionally left blank)14","Blank Field (intentionally left blank)15","Blank Field (intentionally left blank)16","Blank Field (intentionally left blank)17","Blank Field (intentionally left blank)18","Public Notes"]
["T1-101","TIPPS","T1","Care team includes personnel in a care coordination role not requiring clinical licensure","Structure",null,"NA","Status Update Only",null,"NA","Status Update Only",null,"NA",null,null,null,null,null,"NA","NA","NA","NA","Reporting of care team composition, number of encounters performed by personnel in a care coordination role not requiring clinical licensure (e.g., community health workers, promotor(a)s, any social workers that are not a licensed clinical social worker, patient navigators, and medical assistants that perform care coordination)","NA","NA",null,null,null,null,null,null,null,null,null,null,null,"N/A","T1-103","T1-101",1,1,{"$f":"RIGHT(Table178[[#This Row],[Final Measure ID]],3)","v":"101"},"T1-101",1,"A care coordination role typically involves functions or responsibilities to review a client’s care plan to proactively confirm that any needed appointments, specialty services, labs, tests, and community resources are being coordinated and completed. Examples of personnel not requiring clinical licensure AND who may be performing a care coordination role typically include community health workers, promotor(a)s, any social workers that are not a licensed clinical social worker, patient navigators, and medical assistants."]
["T1-105","TIPPS","T1","Health Information Exchange (HIE) Participation","Structure",null,"NA","Status Update Only",null,"NA","Status Update Only",null,"NA",null,null,null,null,null,"NA","NA","NA","NA","Reporting on status with enrollment in a public HIE, including submission of ADT and CCDM data","NA","NA",null,null,null,null,null,null,null,null,null,null,null,"N/A","T1-107","T1-105",2,1,{"$f":"RIGHT(Table178[[#This Row],[Final Measure ID]],3)","v":"105"},"T1-105",2]
["T1-106","TIPPS","T1","Patient-Centered Medical Home (PCMH) Accreditation or Recognition Status","Structure",null,"NA","Status Update Only",null,"NA","Status Update Only",null,"NA",null,null,null,null,null,"NA","NA","NA","NA","Reporting PCMH accreditation or recognition status or steps to obtain accreditation or recognition","NA","NA",null,null,null,null,null,null,null,null,null,null,null,"N/A","T1-101","T1-106",3,1,{"$f":"RIGHT(Table178[[#This Row],[Final Measure ID]],3)","v":"106"},"T1-106",3]
["T1-107","TIPPS","T1","Same-day, walk-in, or after-hours appointments in the outpatient setting","Structure",null,"NA","Status Update Only",null,"NA","Status Update Only",null,"NA",null,null,null,null,null,"NA","NA","NA","NA","Reporting of availability of same-day, walk-in, or after-hours appointments","NA","NA",null,null,null,null,null,null,null,null,null,null,null,"N/A"]
["T1-108","TIPPS","T1","Pre-visit planning and/or standing order protocols","Structure",null,"NA","Status Update Only",null,"NA","Status Update Only",null,"NA",null,null,null,null,null,"NA","NA","NA","NA","Reporting of processes in place for pre-visit planning and/or standing order protocols ","NA","NA",null,null,null,null,null,null,null,null,null,null,null,"N/A"]
["T1-109","TIPPS","T1","Patient education focused on disease self-management","Structure",null,"NA","Status Update Only",null,"NA","Status Update Only",null,"NA",null,null,null,null,null,"NA","NA","NA","NA","Reporting of availability of self-management education, number of patients with completed education/classes","NA","NA",null,null,null,null,null,null,null,null,null,null,null,"N/A"]
["T1-110","TIPPS","T1","Identification of pregnant women at-risk for Hypertension, Preeclampsia, or Eclampsia; treatment based on best practices; and follow-up with postpartum women diagnosed with Hypertension, Preeclampsia, or Eclampsia ","Structure",null,"NA","Status Update Only",null,"NA","Status Update Only",null,"NA",null,null,null,null,null,"NA","NA","NA","NA","Reporting of processes in place to Identify, treat, and provide follow-up for pregnant women at-risk for Hypertension, Preeclampsia, or Eclampsia","NA","NA",null,null,null,null,null,null,null,null,null,null,null,"N/A"]
["T1-111","TIPPS","T1","Telehealth to provide virtual medical appointments and/or consultations for specialty services, including both physical health and behavioral health services","Structure",null,"NA","Status Update Only",null,"NA","Status Update Only",null,"NA",null,null,null,null,null,"NA","NA","NA","NA","Reporting of availability of telehealth for specialty services and in what setting","NA","NA",null,null,null,null,null,null,null,null,null,null,null,"N/A"]
["T2-103","TIPPS","T2","Preventive Care and Screening: Influenza Immunization","Process",null,"01/01/22 - 06/30/22","Numeric Data Reporting & Status Update",null,"01/01/22 - 12/31/22","Numeric Data Reporting & Status Update",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"0041e","NCQA","eCQI (eCQM: CMS147v11)","https://ecqi.healthit.gov/ecqm/ep/2022/cms147v11\nhttps://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS147v11.html","Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization","Allergy & Immunology; Family Medicine; Internal Medicine; Obstetrics & Gynecology; Otolaryngology; Pediatrics; Preventive Medicine","Individuals","All patients aged 6 months and older, seen for a visit during the measurement period, and seen for a visit between October 1 and March 31\n*For DPP reporting purposes, see below.\nYear 2 Reporting Period 1 (data measurement period: 01/01/22-06/30/22, six months):\n- Report the denominator as individuals with encounters that fall within the measurement period, e.g., for the data measurement period of 01/01/22-06/30/22, the denominator would include encounters from January 2022 - March 2022. (See \"HHSC Program Specific Modifications\" cell).\n\nYear 2 Reporting Period 2 (data measurement period: 01/01/22-12/31/22, 12 months):\n- Report the denominator as individuals with encounters that fall within the measurement period, e.g., for the data measurement period of 01/01/22-12/31/22, the denominator would include encounters from January 2022 - March 2022 and October 2022 - December 2022. (See \"HHSC Program Specific Modifications\" cell).","\"Initial Population\" \nand ( exists \"Encounter During Influenza Season\"\n      or exists \"Hemodialysis During Influenza Season\"\n      or exists \"Peritoneal Dialysis During Influenza Season\" )\n\n\"Encounter During Influenza Season\"\n[\"Encounter, Performed\": \"Encounter-Influenza\"] FluEncounter\n  where FluEncounter.relevantPeriod starts during \"Influenza Season\"\n\n\"Hemodialysis During Influenza Season\"\n[\"Procedure, Performed\": \"Hemodialysis\"] FluSeasonHemodialysis\n  where FluSeasonHemodialysis.relevantPeriod overlaps \"Influenza Season\"\n\n\"Peritoneal Dialysis During Influenza Season\"\n[\"Procedure, Performed\": \"Peritoneal Dialysis\"] PeritonealDialysis\n  where PeritonealDialysis.relevantPeriod overlaps \"Measurement Period\"\n\n\"Initial Population\"\nexists ( [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n    where Global.\"CalendarAgeInMonthsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) >= 6)\n  and ( exists \"Qualifying Encounter During Measurement Period\"\n      or exists \"Hemodialysis During Measurement Period\"\n      or exists \"Peritoneal Dialysis During Measurement Period\")\n \n\"Qualifying Encounter During Measurement Period\"\n( [\"Encounter, Performed\": \"Office Visit\"]\n  union [\"Encounter, Performed\": \"Outpatient Consultation\"]\n  union [\"Encounter, Performed\": \"Care Services in Long-Term Residential Facility\"]\n  union [\"Encounter, Performed\": \"Home Healthcare Services\"]\n  union [\"Encounter, Performed\": \"Patient Provider Interaction\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services, Initial Office Visit, 0 to 17\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services-Initial Office Visit, 18 and Up\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services-Individual Counseling\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services - Group Counseling\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services - Other\"]\n  union [\"Encounter, Performed\": \"Discharge Services - Nursing Facility\"]\n  union [\"Encounter, Performed\": \"Nursing Facility Visit\"]\n  union [\"Encounter, Performed\": \"Annual Wellness Visit\"]\n  union [\"Encounter, Performed\": \"Preventive Care, Established Office Visit, 0 to 17\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services - Established Office Visit, 18 and Up\"]\n  union [\"Encounter, Performed\": \"Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal.\"]\n  union [\"Encounter, Performed\": \"Online Assessments\"]\n  union [\"Encounter, Performed\": \"Telephone Visits\"] ) QualifyingEncounter\n  where QualifyingEncounter.relevantPeriod during \"Measurement Period\"\n\n\"Hemodialysis During Measurement Period\"\n[\"Procedure, Performed\": \"Hemodialysis\"] Hemodialysis\n  where Global.\"NormalizeInterval\" ( Hemodialysis.relevantDatetime, Hemodialysis.relevantPeriod ) overlaps \"Measurement Period\"\n\n\"Peritoneal Dialysis During Measurement Period\"\n[\"Procedure, Performed\": \"Peritoneal Dialysis\"] PeritonealDialysis\n  where Global.\"NormalizeInterval\" ( PeritonealDialysis.relevantDatetime, PeritonealDialysis.relevantPeriod ) overlaps \"Measurement Period\"","Documentation of medical reason(s) for not receiving influenza immunization (e.g., patient allergy, other medical reasons).\nDocumentation of patient reason(s) for not receiving influenza immunization (e.g., patient declined, other patient reasons).\nDocumentation of system reason(s) for not receiving influenza immunization (e.g., vaccine not available, other system reasons).\n\nDenominator Exceptions\nexists \"Medical Patient or System Reason for Not Performing Influenza Vaccination\"\n  or exists \"Medical Patient or System Reason for Not Administering Influenza Vaccine\"\n  or exists \"Diagnosis of Allergy to Egg\"\n  or exists \"Egg Substance Allergy\"\n  or exists \"Diagnosis of Allergy to Influenza Vaccine\"\n  or exists \"Diagnosis of Intolerance to Influenza Vaccine\"\n  or exists \"Intolerance of Influenza Vaccination Procedure\"\n  or exists \"Allergy or Intolerance to Influenza Vaccine","Patients who received an influenza immunization OR who reported previous receipt of an influenza immunization\n\nPer \"Measure Steward Additional Information\", \"Patient self-report for procedures as well as immunizations should be recorded in 'Procedure, Performed' template or 'Immunization, Administered' template in QRDA-1.\"","exists \"Influenza Vaccination Procedure\"\n  or exists \"Influenza Immunization Administered\"\n  or exists \"Influenza Vaccine Previously Received\"\n*For DPP reporting purposes, see below.\nYear 2 Reporting Period 1 (data measurement period: 01/01/22-06/30/22, six months):\n- Report the numerator as individuals who received an influenza immunization OR who reported previous receipt of an influenza immunization within the measurement period, e.g., for denominator encounters in January 2022 – March 2022, the numerator would include influenza immunization received in August 2021 - March 2022. An Individual with multiple eligible encounters during the data measurement period only has to have the numerator met once to be counted as Numerator Performance Met. (See \"Program Specific Modifications\" cell and please note the measure steward's definition of \"Previous Receipt\" in the \"Additional Information\" cell.)\n\nYear 2 Reporting Period 2 (data measurement period: 01/01/22-12/31/22, 12 months):\n- Report the numerator as individuals who received an influenza immunization OR who reported previous receipt of an influenza immunization within the measurement period, e.g., for denominator encounters in January 2022 – March 2022, the numerator would include influenza immunization received in August 2021 - March 2022, and for denominator encounters in October 2022 - December 2022, the numerator would include influenza immunization received in August 2022 - December 2022. An Individual with multiple eligible encounters during the data measurement period only has to have the numerator met once to be counted as Numerator Performance Met. (See \"Program Specific Modifications\" cell and please note the measure steward's definition of \"Previous Receipt\" in the \"Additional Information\" cell.)","None","Please note the measure steward's definition of \"Previous Receipt\" (see the \"Additional Information\" cell).\n\nYear 2 Reporting Period 1 (data measurement period: 01/01/22-06/30/22, six months):\n- Report the denominator as individuals with encounters that fall within the measurement period, e.g., for the data measurement period of 01/01/22-06/30/22, the denominator would include encounters from January 2022 - March 2022. \n- Report the numerator as individuals who received an influenza immunization OR who reported previous receipt of an influenza immunization within the measurement period, e.g., for denominator encounters in January 2022 – March 2022, the numerator would include influenza immunization received in August 2021 - March 2022. An Individual with multiple eligible encounters during the data measurement period only has to have the numerator met once to be counted as Numerator Performance Met.\n\nYear 2 Reporting Period 2 (data measurement period: 01/01/22-12/31/22, 12 months):\n- Report the denominator as individuals with encounters that fall within the measurement period, e.g., for the data measurement period of 01/01/22-12/31/22, the denominator would include encounters from January 2022 - March 2022 and October 2022 - December 2022. \n- Report the numerator as individuals who received an influenza immunization OR who reported previous receipt of an influenza immunization within the measurement period, e.g., for denominator encounters in January 2022 – March 2022, the numerator would include influenza immunization received in August 2021 - March 2022, and for denominator encounters in October 2022 - December 2022, the numerator would include influenza immunization received in August 2022 - December 2022. An Individual with multiple eligible encounters during the data measurement period only has to have the numerator met once to be counted as Numerator Performance Met.","Patient self-report for procedures as well as immunizations should be recorded in 'Procedure, Performed' template or 'Immunization, Administered' template in QRDA-1.\n\nDefinitions: \nPrevious Receipt - receipt of the current season's influenza immunization from another provider OR from same provider prior to the visit to which the measure is applied (typically, prior vaccination would include influenza vaccine given since August 1st)",null,null,null,"Positive"]
["T2-104","TIPPS","T2","Preventive Care & Screening: Tobacco Use: Screening & Cessation Intervention","Process",null,"01/01/22 - 06/30/22","Numeric Data Reporting & Status Update",null,"01/01/22 - 12/31/22","Numeric Data Reporting & Status Update",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"0028e","NCQA","eCQI (eCQM: CMS138v10)","https://ecqi.healthit.gov/ecqm/ep/2022/cms138v10\nhttps://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS138v10.html","Percentage of patients aged 18 years and older who were screened for tobacco use one or more times during the measurement period AND who received tobacco cessation intervention if identified as a tobacco user. Per the \"HHSC Program Specific Modifications\", for TIPPS reporting purposes, only one rate (Rate 3) is reported (e.g., percentage of patients aged 18 years and older who were screened for tobacco use one or more times during the measurement period AND who received tobacco cessation intervention if identified as a tobacco user).","Allergy & Immunology; Dermatology; Family Medicine; Internal Medicine; Obstetrics & Gynecology; Ophthalmology; Orthopedic Surgery; Otolaryngology; Physical Medicine & Rehabilitation; Plastic Surgery; Pediatrics (Optional); Preventive Medicine; Psychiatry & Neurology; Neurosurgical Surgery; Surgery; Thoracic Surgery; Urology; Audiologist; Occupational Therapist; Physical Therapist; Podiatrist; Social Worker; Speech Language Pathologist; Urgent Care","Individuals","All patients aged 18 years and older seen for at least two visits or at least one preventive visit during the measurement period","\"Initial Population\"\nexists ( [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n    where Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) >= 18)\n  and ( Count(\"Qualifying Visit During Measurement Period\")>= 2\n      or exists \"Preventive Visit During Measurement Period\")\n\n\"Qualifying Visit During Measurement Period\"\n( [\"Encounter, Performed\": \"Health behavior intervention, individual, face-to-face; initial 30 minutes\"]\n  union [\"Encounter, Performed\": \"Health behavior assessment, or re-assessment (ie, health-focused clinical interview, behavioral observations, clinical decision making)\"]\n  union [\"Encounter, Performed\": \"Home Healthcare Services\"]\n  union [\"Encounter, Performed\": \"Occupational Therapy Evaluation\"]\n  union [\"Encounter, Performed\": \"Office Visit\"]\n  union [\"Encounter, Performed\": \"Ophthalmological Services\"]\n  union [\"Encounter, Performed\": \"Physical Therapy Evaluation\"]\n  union [\"Encounter, Performed\": \"Psych Visit - Diagnostic Evaluation\"]\n  union [\"Encounter, Performed\": \"Psych Visit - Psychotherapy\"]\n  union [\"Encounter, Performed\": \"Psychoanalysis\"]\n  union [\"Encounter, Performed\": \"Speech and Hearing Evaluation\"]\n  union [\"Encounter, Performed\": \"Telephone Visits\"]\n  union [\"Encounter, Performed\": \"Online Assessments\"] ) OfficeBasedEncounter\n  where OfficeBasedEncounter.relevantPeriod during \"Measurement Period\"\n\n\"\"Preventive Visit During Measurement Period\"\n( [\"Encounter, Performed\": \"Annual Wellness Visit\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services - Established Office Visit, 18 and Up\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services - Group Counseling\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services - Other\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services-Individual Counseling\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services-Initial Office Visit, 18 and Up\"] ) PreventiveEncounter\n  where PreventiveEncounter.relevantPeriod during \"Measurement Period\"","Documentation of medical reason(s) for not screening for tobacco use OR for not providing tobacco cessation intervention for patients identified as tobacco users (e.g., limited life expectancy, other medical reason)\n\nexists \"Medical Reason for Not Screening for Tobacco Use\"\n  or exists \"Medical Reason for Not Counseling Tobacco User\"\n  or exists \"Medical Reason for Not Ordering Tobacco Cessation Pharmacotherapy\"\n  or \"Has Limited Life Expectancy\"","Patients who were screened for tobacco use at least once during the measurement period AND who received tobacco cessation intervention if identified as a tobacco user. Per the \"HHSC Program Specific Modifications\", for TIPPS reporting purposes, only one rate (Rate 3) is reported (e.g., percentage of patients aged 18 years and older who were screened for tobacco use one or more times during the measurement period AND who received tobacco cessation intervention if identified as a tobacco user).","Criteria 3\n\"Most Recent Tobacco Use Screening Indicates Tobacco Non User\" is not null\n  or ( \"Most Recent Tobacco Use Screening Indicates Tobacco User\" is not null\n      and ( exists \"Tobacco Cessation Counseling Given\"\n          or exists \"Tobacco Cessation Pharmacotherapy Ordered\"\n          or exists \"Active Pharmacotherapy for Tobacco Cessation\"))","None","For TIPPS reporting purposes, only one rate (Rate 3) is reported (e.g., percentage of patients aged 18 years and older who were screened for tobacco use one or more times during the measurement period AND who received tobacco cessation intervention if identified as a tobacco user).","Definitions:\nTobacco Use - Includes any type of tobacco\nTobacco Cessation Intervention - Includes brief counseling (3 minutes or less), and/or pharmacotherapy -- Note: Concepts aligned with brief counseling (e.g., minimal and intensive advice/counseling interventions conducted both in person and over the phone) are included in the value set for the numerator. Other concepts such as written self-help materials (e.g., brochures, pamphlets) and complementary/alternative therapies are not included in the value set and do not qualify for the numerator. Brief counseling also may be of longer duration or be performed more frequently, as evidence shows there is a dose-response relationship between the intensity of counseling provided (either length or frequency) and tobacco cessation rates (U.S. Preventive Services Task Force, 2015).\n\nGuidance: \nThe requirement of two or more visits is to establish that the eligible professional or eligible clinician has an existing relationship with the patient for certain types of encounters. \n\nTo satisfy the intent of this measure, a patient must have at least one tobacco use screening during the measurement period. If a patient has multiple tobacco use screenings during the measurement period, only the most recent screening, which has a documented status of tobacco user or tobacco non-user, will be used to satisfy the measure requirements.\n\nIf a patient uses any type of tobacco (i.e., smokes or uses smokeless tobacco), the expectation is that they should receive tobacco cessation intervention: either counseling and/or pharmacotherapy.\n\nAs noted above in a recommendation statement from the USPSTF, the current evidence is insufficient to recommend electronic nicotine delivery systems (ENDS) including electronic cigarettes for tobacco cessation. Additionally, ENDS are not currently classified as tobacco in the recent evidence review to support the update of the USPSTF recommendation given that the devices do not burn or use tobacco leaves. In light of the current lack of evidence, the measure does not currently capture e-cigarette usage as either tobacco use or a cessation aid.\n\nIf tobacco use status of a patient is unknown, the patient does not meet the screening component required to be counted in the numerator and should be considered a measure failure. Instances where tobacco use status of \"unknown\" is recorded include: 1) the patient was not screened; or 2) the patient was screened and the patient (or caregiver) was unable to provide a definitive answer. If the patient does not meet the screening component of the numerator but has an allowable medical exception, then the patient should be removed from the denominator of the measure and reported as a valid exception.\n\nIn order to promote a team-based approach to patient care, the tobacco cessation intervention can be performed by another healthcare provider; therefore, the tobacco use screening and tobacco cessation intervention do not need to be performed by the same provider or clinician.   \n\nThe medical reason exception may be applied to either the screening data element OR to any of the applicable tobacco cessation intervention data elements (counseling and/or pharmacotherapy) included in the measure. \n\nIf a patient has a diagnosis of limited life expectancy, that patient has a valid denominator exception for not being screened for tobacco use or for not receiving tobacco use cessation intervention (counseling and/or pharmacotherapy) if identified as a tobacco user.\n\nThis measure contains three reporting rates which aim to identify patients who were screened for tobacco use (rate/population 1), patients who were identified as tobacco users and who received tobacco cessation intervention (rate/population 2), and a comprehensive look at the overall performance on tobacco screening and cessation intervention (rate/population 3). By separating this measure into various reporting rates, the eligible professional or eligible clinician will be able to better ascertain where gaps in performance exist, and identify opportunities for improvement. The overall rate (rate/population 3) can be utilized to compare performance to published versions of this measure prior to the 2018 performance year, when the measure had a single performance rate. For accountability reporting in the CMS MIPS program, the rate for population 2 is used for performance.\n \nThe denominator of population criteria 2 is a subset of the resulting numerator for population criteria 1, as population criteria 2 is limited to assessing if patients identified as tobacco users received an appropriate tobacco cessation intervention. For all patients, population criteria 1 and 3 are applicable, but population criteria 2 will only be applicable for those patients who are identified as tobacco users. Therefore, data for every patient that meets the initial population criteria will only be submitted for population 1 and 3, whereas data submitted for population 2 will be for a subset of patients who meet the initial population criteria, as the denominator has been further limited to those who were identified as tobacco users.\n\nThis eCQM is a patient-based measure.",null,null,null,"Positive"]
["T2-112","TIPPS","T2","Cervical Cancer Screening","Process",null,"01/01/22 - 06/30/22","Numeric Data Reporting & Status Update",null,"01/01/22 - 12/31/22","Numeric Data Reporting & Status Update",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"0032","NCQA","eCQI (eCQM: CMS124v10)","https://ecqi.healthit.gov/ecqm/ep/2022/cms124v10\nhttps://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS124v10.html","Percentage of women 21-64 years of age who were screened for cervical cancer using either of the following criteria:\n-Women age 21-64 who had cervical cytology performed within the last 3 years\n-Women age 30-64 who had cervical human papillomavirus (HPV) testing performed within the last 5 years","Family Medicine; Internal Medicine; Obstetrics & Gynecology","Individuals","Women 23-64 years of age with a visit during the measurement period","\"Initial Population\"\nexists ( [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n    where Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) in Interval[23, 64))\n  and exists ( [\"Patient Characteristic Sex\": \"Female\"] )\n  and exists \"Qualifying Encounters\"\n\n\"Qualifying Encounters\"\n( [\"Encounter, Performed\": \"Office Visit\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services - Established Office Visit, 18 and Up\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services-Initial Office Visit, 18 and Up\"]\n  union [\"Encounter, Performed\": \"Home Healthcare Services\"]\n  union [\"Encounter, Performed\": \"Telephone Visits\"]\n  union [\"Encounter, Performed\": \"Online Assessments\"] ) ValidEncounter\n  where ValidEncounter.relevantPeriod during \"Measurement Period\"","Women who had a hysterectomy with no residual cervix or a congenital absence of cervix.\n\nExclude patients who are in hospice care for any part of the measurement period.\n\nExclude patients receiving palliative care during the measurement period.\n\nHospice.\"Has Hospice\"\n  or exists \"Absence of Cervix\"\n  or PalliativeCare.\"Palliative Care in the Measurement Period\"\n\n( [\"Procedure, Performed\": \"Hysterectomy with No Residual Cervix\"] NoCervixProcedure\n    where Global.\"NormalizeInterval\" ( NoCervixProcedure.relevantDatetime, NoCervixProcedure.relevantPeriod ) ends on or before \n    end of \"Measurement Period\")\n  union ( [\"Diagnosis\": \"Congenital or Acquired Absence of Cervix\"] NoCervixDiagnosis\n      where NoCervixDiagnosis.prevalencePeriod starts on or before \n      end of \"Measurement Period\")\n\nexists ( [\"Encounter, Performed\": \"Encounter Inpatient\"] DischargeHospice\n    where ( DischargeHospice.dischargeDisposition ~ \"Discharge to home for hospice care (procedure)\"\n        or DischargeHospice.dischargeDisposition ~ \"Discharge to healthcare facility for hospice care (procedure)\")\n      and DischargeHospice.relevantPeriod ends during \"Measurement Period\")\n  or exists ( [\"Intervention, Order\": \"Hospice care ambulatory\"] HospiceOrder\n      where HospiceOrder.authorDatetime during \"Measurement Period\")\n  or exists ( [\"Intervention, Performed\": \"Hospice care ambulatory\"] HospicePerformed\n      where Global.\"NormalizeInterval\" ( HospicePerformed.relevantDatetime, HospicePerformed.relevantPeriod ) overlaps \"Measurement Period\")\n\nPalliativeCare.Palliative Care in the Measurement Period\nexists ( [\"Assessment, Performed\": \"Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)\"] PalliativeAssessment\n    where Global.\"NormalizeInterval\"(PalliativeAssessment.relevantDatetime, PalliativeAssessment.relevantPeriod) overlaps \"Measurement Period\")\n  or exists ( [\"Encounter, Performed\": \"Palliative Care Encounter\"] PalliativeEncounter\n      where PalliativeEncounter.relevantPeriod overlaps \"Measurement Period\")\n  or exists ( [\"Intervention, Performed\": \"Palliative Care Intervention\"] PalliativeIntervention\n      where Global.\"NormalizeInterval\"(PalliativeIntervention.relevantDatetime, PalliativeIntervention.relevantPeriod) overlaps \"Measurement Period\")","Women with one or more screenings for cervical cancer. Appropriate screenings are defined by any one of the following criteria:\n-Cervical cytology performed during the measurement period or the two years prior to the measurement period for women who are at least 21 years old at the time of the test\n-Cervical human papillomavirus (HPV) testing performed during the measurement period or the four years prior to the measurement period for women who are 30 years or older at the time of the test\n\nPer the \"Measure Steward Additional Guidance\", \"Patient self-report for procedures as well as diagnostic studies should be recorded in 'Procedure, Performed' template or 'Diagnostic Study, Performed' template in QRDA-1.\"","exists \"Cervical Cytology Within 3 Years\"\n  or exists \"HPV Test Within 5 Years for Women Age 30 and Older\"\n\n[\"Laboratory Test, Performed\": \"Pap Test\"] CervicalCytology\n  where Global.\"LatestOf\" ( CervicalCytology.relevantDatetime, CervicalCytology.relevantPeriod ) 3 years or less on or before \n  end of \"Measurement Period\"\n    and CervicalCytology.result is not null\n\n[\"Laboratory Test, Performed\": \"HPV Test\"] HPVTest\n  with [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n    such that Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, HPVTest.relevantDatetime ) >= 30\n  where Global.\"LatestOf\" ( HPVTest.relevantDatetime, HPVTest.relevantPeriod ) 5 years or less on or before \n  end of \"Measurement Period\"\n    and HPVTest.result is not null","None",null,"To ensure the measure is only looking for a cervical cytology test only after a woman turns 21 years of age, the youngest age in the initial population is 23.\n\nPatient self-report for procedures as well as diagnostic studies should be recorded in 'Procedure, Performed' template or 'Diagnostic Study, Performed' template in QRDA-1.\n\nEvidence of hrHPV testing within the last 5 years also captures patients who had cotesting; therefore additional methods to identify cotesting are not necessary.",null,null,null,"Positive"]
["T2-113","TIPPS","T2","Childhood Immunization Status","Process",null,"01/01/22 - 06/30/22","Numeric Data Reporting & Status Update",null,"01/01/22 - 12/31/22","Numeric Data Reporting & Status Update",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"0038","NCQA","eCQI (eCQM: CMS117v10)","https://ecqi.healthit.gov/ecqm/ep/2022/cms117v10\nhttps://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS117v10.html","Percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV), one measles, mumps and rubella (MMR); three or four H influenza type B (Hib); three hepatitis B (Hep B); one chicken pox (VZV); four pneumococcal conjugate (PCV); one hepatitis A (Hep A); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday","Family Medicine; Pediatrics","Individuals","Children who turn 2 years of age during the measurement period and who have a visit during the measurement period","\"Initial Population\"\nexists ( [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n    where Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) >= 1\n      and Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, \n      end of \"Measurement Period\" ) = 2)\n  and exists ( \"Qualifying Encounter\" )\n\n\"Qualifying Encounter\"\n( [\"Encounter, Performed\": \"Office Visit\"]\n  union [\"Encounter, Performed\": \"Home Healthcare Services\"]\n  union [\"Encounter, Performed\": \"Preventive Care, Established Office Visit, 0 to 17\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services, Initial Office Visit, 0 to 17\"]\n  union [\"Encounter, Performed\": \"Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal.\"]\n  union [\"Encounter, Performed\": \"Online Assessments\"]\n  union [\"Encounter, Performed\": \"Telephone Visits\"] ) ValidEncounter\n  where ValidEncounter.relevantPeriod during \"Measurement Period\"","Exclude patients whose hospice care overlaps the measurement period\n\nHospice. \"Has Hospice\"\nexists ( [\"Encounter, Performed\": \"Encounter Inpatient\"] DischargeHospice\n    where ( DischargeHospice.dischargeDisposition ~ \"Discharge to home for hospice care (procedure)\"\n        or DischargeHospice.dischargeDisposition ~ \"Discharge to healthcare facility for hospice care (procedure)\")\n      and DischargeHospice.relevantPeriod ends during \"Measurement Period\")\n  or exists ( [\"Intervention, Order\": \"Hospice care ambulatory\"] HospiceOrder\n      where HospiceOrder.authorDatetime during \"Measurement Period\")\n  or exists ( [\"Intervention, Performed\": \"Hospice care ambulatory\"] HospicePerformed\n      where HospicePerformed.relevantPeriod overlaps \"Measurement Period\")","Children who have evidence showing they received recommended vaccines, had documented history of the illness, had a seropositive test result, or had an allergic reaction to the vaccine by their second birthday","( exists ( \"Four DTaP Vaccinations\" )\n    or exists ( \"DTaP Numerator Inclusion Conditions\" ))\n  and ( exists ( \"Three Polio Vaccinations\" )\n      or exists ( \"Polio Numerator Inclusion Conditions\" ))\n  and ( exists ( \"One MMR Vaccination\" )\n      or exists ( \"MMR Numerator Inclusion Conditions\" )\n      or ( exists ( \"Measles Indicators\" )\n          and exists ( \"Mumps Indicators\" )\n          and exists ( \"Rubella Indicators\" )))\n  and ( \"Has Appropriate Number of Hib Immunizations\"\n      or exists ( \"Hib Numerator Inclusion Conditions\" ))\n  and ( exists ( \"Three Hepatitis B Vaccinations\" )\n      or exists ( \"Hepatitis B Numerator Inclusion Conditions\" ))\n  and ( exists ( \"One Chicken Pox Vaccination\" )\n      or exists ( \"Varicella Zoster Numerator Inclusion Conditions\" ))\n  and ( exists ( \"Four Pneumococcal Conjugate Vaccinations\" )\n      or exists ( \"Pneumococcal Conjugate Numerator Inclusion Conditions\" ))\n  and ( exists ( \"One Hepatitis A Vaccinations\" )\n      or exists ( \"Hepatitis A Numerator Inclusion Conditions\" ))\n  and ( \"Has Appropriate Number of Rotavirus Immunizations\"\n      or exists ( \"Rotavirus Numerator Inclusion Conditions\" ))\n  and ( exists ( \"Two Influenza Vaccinations\" )\n      or exists ( \"Influenza Numerator Inclusion Conditions\" ))\n\nfrom\n  \"DTaP Immunizations or Procedures\" DTaPVaccination1,\n  \"DTaP Immunizations or Procedures\" DTaPVaccination2,\n  \"DTaP Immunizations or Procedures\" DTaPVaccination3,\n  \"DTaP Immunizations or Procedures\" DTaPVaccination4\n  where DTaPVaccination2.relevantDatetime 1 day or more after day of DTaPVaccination1.relevantDatetime\n    and DTaPVaccination3.relevantDatetime 1 day or more after day of DTaPVaccination2.relevantDatetime\n    and DTaPVaccination4.relevantDatetime 1 day or more after day of DTaPVaccination3.relevantDatetime\n  return DTaPVaccination1\n\n( [\"Diagnosis\": \"Anaphylactic Reaction to DTaP Vaccine\"]\n  union [\"Diagnosis\": \"Encephalopathy due to Childhood Vaccination\"] ) DTaPConditions\n  where ( start of DTaPConditions.prevalencePeriod during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])\n\nfrom\n  \"Polio Immunizations or Procedures\" PolioVaccination1,\n  \"Polio Immunizations or Procedures\" PolioVaccination2,\n  \"Polio Immunizations or Procedures\" PolioVaccination3\n  where PolioVaccination2.relevantDatetime 1 day or more after day of PolioVaccination1.relevantDatetime\n    and PolioVaccination3.relevantDatetime 1 day or more after day of PolioVaccination2.relevantDatetime\n  return PolioVaccination1\n\n( [\"Diagnosis\": \"Poliomyelitis vaccine adverse reaction (disorder)\"]\n  union [\"Diagnosis\": \"Streptomycin adverse reaction (disorder)\"]\n  union [\"Diagnosis\": \"Polymyxin B adverse reaction (disorder)\"]\n  union [\"Diagnosis\": \"Neomycin adverse reaction (disorder)\"] ) PolioConditions\n  where ( start of PolioConditions.prevalencePeriod during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])\n\n( ( [\"Immunization, Administered\": \"Measles, Mumps and Rubella (MMR) Vaccine\"]\n    union [\"Procedure, Performed\": \"Measles, Mumps and Rubella (MMR) Vaccine Administered\"] ) MMRVaccination\n    where MMRVaccination.relevantDatetime during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])\n\n( [\"Diagnosis\": \"Disorders of the Immune System\"]\n  union [\"Diagnosis\": \"HIV\"]\n  union [\"Diagnosis\": \"Malignant Neoplasm of Lymphatic and Hematopoietic Tissue\"]\n  union [\"Diagnosis\": \"Neomycin adverse reaction (disorder)\"] ) MMRConditions\n  where ( start of MMRConditions.prevalencePeriod during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])\n\n( ( [\"Laboratory Test, Performed\": \"Measles Antibody Test (IgG Antibody Titer)\"] MeaslesTiter\n    where MeaslesTiter.result >= 1.10)\n  union ( [\"Laboratory Test, Performed\": \"Measles Antibody Test (IgG Antibody presence)\"] MeaslesIgGPresence\n      where MeaslesIgGPresence.result as Code in \"Positive Finding”)\n  union ( [\"Diagnosis\": \"Measles\"] MeaslesDiagnosis\n      return \"Laboratory Test, Performed\" { relevantDatetime: start of MeaslesDiagnosis.prevalencePeriod }) ) Measles\n  where ( Measles.relevantDatetime during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])\n\n( ( [\"Laboratory Test, Performed\": \"Mumps Antibody Test (IgG Antibody Titer)\"] MumpsTiter\n    where MumpsTiter.result >= 1.10)\n  union ( [\"Laboratory Test, Performed\": \"Mumps Antibody Test (IgG Antibody presence)\"] MumpsIgGPresence\n      where MumpsIgGPresence.result as Code in \"Positive Finding\")\n  union ( [\"Diagnosis\": \"Mumps\"] MumpsDiagnosis\n      return \"Laboratory Test, Performed\" { relevantDatetime: start of MumpsDiagnosis.prevalencePeriod }) ) Mumps\n  where ( Mumps.relevantDatetime during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])\n\n( ( [\"Laboratory Test, Performed\": \"Rubella Antibody Test (IgG Antibody Titer)\"] RubellaTiter\n    where RubellaTiter.result >= 1.10)\n  union ( [\"Laboratory Test, Performed\": \"Rubella Antibody Test (IgG Antibody presence)\"] RubellaIgGPresence\n      where RubellaIgGPresence.result as Code in \"Positive Finding\")\n  union ( [\"Diagnosis\": \"Rubella\"] RubellaDiagnosis\n      return \"Laboratory Test, Performed\" { relevantDatetime: start of RubellaDiagnosis.prevalencePeriod }) ) Rubella\n  where ( Rubella.relevantDatetime during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])\n\nexists ( \"All Hib Vaccinations\" HibImmunization //union of 3 and 4 dose immunizations\n//4 dose test\n    let has_4_dose: Count(\"Hib 4 Dose Immunizations or Procedures\")> 0\n    where ( has_4_dose //if pt had at least one 4 dose code\n        and Count(distinct(\"All Hib Vaccinations\" HibVaccinations\n              return HibVaccinations.relevantDatetime)\n        )>= 4 //pt must have 4 regimens (e.g., 3,3,4,4 or 4,3,4,4))\n      or ( has_4_dose is false //if pt did not have at least one 4 dose code\n          and Count(distinct(\"All Hib Vaccinations\" HibVaccinations\n                return HibVaccinations.relevantDatetime))>= 3 //pt must have 3 regimens of 3 dose codes))\n\n[\"Diagnosis\": \"Anaphylaxis due to Haemophilus influenzae type b vaccine (disorder)\"] HibReaction\n  where ( start of HibReaction.prevalencePeriod during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])\n\nfrom\n  \"Hepatitis B Immunizations or Procedures\" HepatitisBVaccination1,\n  \"Hepatitis B Immunizations or Procedures\" HepatitisBVaccination2,\n  \"Hepatitis B Immunizations or Procedures\" HepatitisBVaccination3\n  where HepatitisBVaccination2.relevantDatetime 1 day or more after day of HepatitisBVaccination1.relevantDatetime\n    and HepatitisBVaccination3.relevantDatetime 1 day or more after day of HepatitisBVaccination2.relevantDatetime\n  return HepatitisBVaccination1\n \n( ( [\"Laboratory Test, Performed\": \"Anti Hepatitis B Virus Surface Ab\"] HepatitisBAntigenTest\n    where HepatitisBAntigenTest.result as Code in \"Positive Finding\" )\n  union ( [\"Diagnosis\": \"Anaphylaxis due to Hepatitis B vaccine (disorder)\"] HepatitisBReaction\n      return \"Laboratory Test, Performed\" { relevantDatetime: start of HepatitisBReaction.prevalencePeriod } )\n  union ( [\"Diagnosis\": \"Anaphylactic Reaction to Common Baker's Yeast\"] YeastReaction\n      return \"Laboratory Test, Performed\" { relevantDatetime: start of YeastReaction.prevalencePeriod } )\n  union ( [\"Diagnosis\": \"Hepatitis B\"] HepatitisBDiagnosis\n      return \"Laboratory Test, Performed\" { relevantDatetime: start of HepatitisBDiagnosis.prevalencePeriod } ) ) HepBConditions\n where ( HepBConditions.relevantDatetime during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])\n\n( ( [\"Immunization, Administered\": \"Varicella Zoster Vaccine (VZV)\"]\n    union [\"Procedure, Performed\": \"Varicella Zoster Vaccine (VZV) Administered\"] ) ChickenPoxVaccination\n    where ChickenPoxVaccination.relevantDatetime during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])\n\n( ( [\"Laboratory Test, Performed\": \"Varicella Zoster Antibody Test (IgG Antibody Titer)\"] ChickenPoxTiter\n    where ChickenPoxTiter.result >= 1.10)\n  union ( [\"Laboratory Test, Performed\": \"Varicella Zoster Antibody Test (IgG Antibody Presence)\"] ChickenPoxIgGPresence\n      where ChickenPoxIgGPresence.result as Code in \"Positive Finding\")\n  union ( [\"Diagnosis\": \"Disorders of the Immune System\"] ImmuneDisorder\n      return \"Laboratory Test, Performed\" { relevantDatetime: start of ImmuneDisorder.prevalencePeriod })\n  union ( [\"Diagnosis\": \"HIV\"] HIV\n      return \"Laboratory Test, Performed\" { relevantDatetime: start of HIV.prevalencePeriod })\n  union ( [\"Diagnosis\": \"Malignant Neoplasm of Lymphatic and Hematopoietic Tissue\"] LymphaticMalignantNeoplasm\n      return \"Laboratory Test, Performed\" { relevantDatetime: start of LymphaticMalignantNeoplasm.prevalencePeriod })\n  union ( [\"Diagnosis\": \"Neomycin adverse reaction (disorder)\"] NeomycinReaction\n      return \"Laboratory Test, Performed\" { relevantDatetime: start of NeomycinReaction.prevalencePeriod })\n  union ( [\"Diagnosis\": \"Varicella Zoster\"] VaricellaZoster\n      return \"Laboratory Test, Performed\" { relevantDatetime: start of VaricellaZoster.prevalencePeriod }) ) VaricellaZosterConditions\n  where ( VaricellaZosterConditions.relevantDatetime during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])\n\nfrom\n  \"Pneumococcal Conjugate Immunizations or Procedures\" PneumococcalVaccination1,\n  \"Pneumococcal Conjugate Immunizations or Procedures\" PneumococcalVaccination2,\n  \"Pneumococcal Conjugate Immunizations or Procedures\" PneumococcalVaccination3,\n  \"Pneumococcal Conjugate Immunizations or Procedures\" PneumococcalVaccination4\n  where PneumococcalVaccination2.relevantDatetime 1 day or more after day of PneumococcalVaccination1.relevantDatetime\n    and PneumococcalVaccination3.relevantDatetime 1 day or more after day of PneumococcalVaccination2.relevantDatetime\n    and PneumococcalVaccination4.relevantDatetime 1 day or more after day of PneumococcalVaccination3.relevantDatetime\n  return PneumococcalVaccination1\n \n[\"Diagnosis\": \"Pneumococcal vaccine adverse reaction (disorder)\"] PneumococcalReaction\n  where ( start of PneumococcalReaction.prevalencePeriod during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])\n\n( ( [\"Immunization, Administered\": \"Hepatitis A Vaccine\"]\n    union [\"Procedure, Performed\": \"Hepatitis A Vaccine Administered\"] ) HepatitisAVaccination\n    where HepatitisAVaccination.relevantDatetime during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])\n\n( ( [\"Laboratory Test, Performed\": \"Anti Hepatitis A IgG Antigen Test\"] HepatitisAAntigenTest\n    where HepatitisAAntigenTest.result as Code in \"Positive Finding\")\n  union ( [\"Diagnosis\": \"Anaphylactic Reaction to Hepatitis A Vaccine\"] HepatitisAReaction\n      return \"Laboratory Test, Performed\" { relevantDatetime: start of HepatitisAReaction.prevalencePeriod })\n  union ( [\"Diagnosis\": \"Hepatitis A\"] HepatitisADiagnosis\n      return \"Laboratory Test, Performed\" { relevantDatetime: start of HepatitisADiagnosis.prevalencePeriod }) ) HepatitisAConditions\n  where ( HepatitisAConditions.relevantDatetime during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])\n\nexists ( \"All Rotavirus Vaccinations\" RotavirusImmunization\n    let has_3_dose: Count(\"Rotavirus 3 Dose Immunizations or Procedures\")> 0\n    where ( has_3_dose\n        and Count(distinct(\"All Rotavirus Vaccinations\" RotavirusVaccinations\n              return RotavirusVaccinations.relevantDatetime))>= 3)\n      or ( has_3_dose is false\n          and Count(distinct(\"All Rotavirus Vaccinations\" RotavirusVaccinations\n                return RotavirusVaccinations.relevantDatetime))>= 2))\n\n( ( [\"Diagnosis\": \"Anaphylaxis due to rotavirus vaccine (disorder)\"]\n    union [\"Diagnosis\": \"Severe Combined Immunodeficiency\"]\n    union [\"Diagnosis\": \"Intussusception\"] ) RotavirusConditions\n    where ( start of RotavirusConditions.prevalencePeriod during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years]))\n\nfrom\n  \"Influenza Immunizations or Procedures\" FluVaccination1,\n  \"Influenza Immunizations or Procedures\" FluVaccination2\n  where FluVaccination2.relevantDatetime 1 day or more after day of FluVaccination1.relevantDatetime\n  return FluVaccination1\n\n( [\"Diagnosis\": \"Influenza virus vaccine adverse reaction (disorder)\"]\n  union [\"Diagnosis\": \"Malignant Neoplasm of Lymphatic and Hematopoietic Tissue\"]\n  union [\"Diagnosis\": \"Neomycin adverse reaction (disorder)\"]\n  union [\"Diagnosis\": \"HIV\"]\n  union [\"Diagnosis\": \"Disorders of the Immune System\"] ) InfluenzaConditions\n  where ( start of InfluenzaConditions.prevalencePeriod during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])","None",null,"Definitions:\nRecommended vaccines: Vaccines and the schedule of vaccines as recommended by the Advisory Committee on Immunization Practices (ACIP) for children two years of age. The measure may differ slightly from the ACIP recommendations because the measure focuses on immunizations that are appropriate by age 2. Also, there may be small differences when there are shortages for a particular vaccine.\n\nFor the MMR, hepatitis B, VZV and hepatitis A vaccines, numerator inclusion criteria include: evidence of receipt of the recommended vaccine; documented history of the illness; or, a seropositive test result for the antigen. For the DTaP, IPV, Hib, pneumococcal, rotavirus, and influenza vaccines, numerator inclusion criteria include only evidence of receipt of the recommended vaccine. \n\nPatients may be included in the numerator for a particular antigen if they had an anaphylactic reaction to the vaccine. Patients may be included in the numerator for the DTaP vaccine if they have encephalopathy. Patients may be included in the numerator for the IPV vaccine if they have had an anaphylactic reaction to streptomycin, polymyxin B, or neomycin. Patients may be included in the numerator for the influenza, MMR, or varicella vaccines if they have cancer of lymphoreticular or histiocytic tissue, multiple myeloma, leukemia, have had an anaphylactic reaction to neomycin, have immunodeficiency, or have HIV. Patients may be included in the numerator for the hepatitis B vaccine if they have had an anaphylactic reaction to common baker's yeast.\nThe measure allows a grace period by measuring compliance with these recommendations between birth and age two.\nThis eCQM is a patient-based measure.\nThis version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.\n\nRecommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States 2019 (Centers for Disease Control and Prevention, 2019)\n\nHepatitis B (HepB)\n\"(minimum age: birth)\nBirth dose (monovalent HepB vaccine only)\n-- Mother is HBsAg-negative: 1 dose within 24 hours of birth for all medically stable infants ?2,000 grams. Infants <2,000 grams: administer 1 dose at chronological age 1 month or hospital discharge.\n-- Mother is HBsAg-positive:\n- Administer HepB vaccine and 0.5 mL of hepatitis B immune globulin (HBIG) (at separate anatomic sites) within 12 hours of birth, regardless of birth weight. For infants <2,000 grams, administer 3 additional doses of vaccine (total of 4 doses) beginning at age 1 month.\n- Test for HBsAg and anti-HBs at age 9–12 months. If HepB series is delayed, test 1–2 months after final dose.\n-- Mother’s HBsAg status is unknown:\n- Administer HepB vaccine within 12 hours of birth, regardless of birth weight.\n- For infants <2,000 grams, administer 0.5 mL of HBIG in addition to HepB vaccine within 12 hours of birth. Administer 3 additional doses of vaccine (total of 4 doses) beginning at age 1 month.\n- Determine mother’s HBsAg status as soon as possible. If mother is HBsAg-positive, administer 0.5 mL of HBIG to infants ?2,000 grams as soon as possible, but no later than 7 days of age.\nRoutine series\n-- 3-dose series at 0, 1–2, 6–18 months (use monovalent HepB vaccine for doses administered before age 6 weeks)\n-- Infants who did not receive a birth dose should begin the series as soon as feasible (see Table 2).\n-- Administration of 4 doses is permitted when a combination vaccine containing HepB is used after the birth dose.\n-- Minimum age for the final (3rd or 4th ) dose: 24 weeks\n-- Minimum intervals: dose 1 to dose 2: 4 weeks / dose 2 to\ndose 3: 8 weeks / dose 1 to dose 3: 16 weeks (when 4 doses are administered, substitute \"dose 4\" for \"dose 3\" in these calculations) \"\n\nDiphtheria, tetanus, acellular pertussis vaccinations (DTap)\n\"(minimum age: 6 weeks [4 years for Kinrix or Quadracel])\nRoutine vaccination\n-- 5-dose series at 2, 4, 6, 15–18 months, 4–6 years\n- Prospectively: Dose 4 may be given as early as age 12 months if at least 6 months have elapsed since dose 3.\n- Retrospectively: A 4th dose that was inadvertently given as early as 12 months may be counted if at least 4 months have elapsed since dose 3.\"\n\nHaemophilus influenzae type b (Hib)\n\"(minimum age: 6 weeks)\nRoutine vaccination\n-- ActHIB, Hiberix, or Pentacel: 4-dose series at 2, 4, 6, 12–15 months\n-- PedvaxHIB: 3-dose series at 2, 4, 12–15 months\"\n\nPoliovirus (inactivated) (IPV)\n\" (minimum age: 6 weeks)\nRoutine vaccination\n-- 4-dose series at ages 2, 4, 6–18 months, 4–6 years; administer the final dose on or after the 4th birthday and at least 6 months after the previous dose.\n-- 4 or more doses of IPV can be administered before the 4th birthday when a combination vaccine containing IPV is used. However, a dose is still recommended after the 4th birthday and at least 6 months after the previous dose.\"\n\nMeasles, mumps, and rubella (MMR)\n\"(minimum age: 12 months for routine vaccination)\nRoutine vaccination\n-- 2-dose series at 12–15 months, 4–6 years\n Dose 2 may be administered as early as 4 weeks after dose 1\"\n\nPneumococcal\n\"(minimum age: 6 weeks [PCV13], 2 years [PPSV23])\nRoutine vaccination with PCV13\n-- 4-dose series at 2, 4, 6, 12–15 months\"\n\nVaricella (VAR) \n\"(minimum age: 12 months)\nRoutine vaccination\n-- 2-dose series: 12–15 months, 4–6 years\n-- Dose 2 may be administered as early as 3 months after dose 1 (a dose administered after a 4-week interval may be counted).\"\n\nHepatitis A (HepA)\n\"(minimum age: 12 months for routine vaccination)\nRoutine vaccination\n-- 2-dose series (Havrix 6–12 months apart or Vaqta 6–18 months apart, minimum interval 6 months); a series begun before the 2nd birthday should be completed even if the child turns 2 before the second dose is administered.\"\n\nRotavirus (RV) \n\"(minimum age: 6 weeks)\nRoutine vaccination\n-- Rotarix: 2-dose series at 2 and 4 months.\n-- RotaTeq: 3-dose series at 2, 4, and 6 months.\nIf any dose in the series is either RotaTeq or unknown, default to 3-dose series.\"\n\nInfluenza (inactivated)  influenza vaccine (IIV) \n\"(minimum age: 6 months [IIV], 2 years [LAIV  ], 18 years [RIV])\nRoutine vaccination\n-- 1 dose any influenza vaccine appropriate for age and health status annually (2 doses separated by at least 4 weeks for children 6 months–8 years who did not receive at least 2 doses of influenza vaccine before July 1, 2018)\"",null,null,null,"Positive"]
["T2-114","TIPPS","T2","Immunization for Adolescents","Process",null,"01/01/22 - 06/30/22","Numeric Data Reporting & Status Update",null,"01/01/22 - 12/31/22","Numeric Data Reporting & Status Update",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,1407,"NCQA","CMS QPP MIPS (#394 2021)","https://qpp.cms.gov/docs/QPP_quality_measure_specifications/CQM-Measures/2021_Measure_394_MIPSCQM.pdf","The percentage of adolescents 13 years of age who had one dose of meningococcal vaccine (serogroups A, C, W, Y), one tetanus, diphtheria toxoids and acellular pertussis (Tdap) vaccine, and have completed the human papillomavirus (HPV) vaccine series by their 13th birthday. Per the \"HHSC Program Specific Modifications\", for TIPPS reporting purposes, only one rate (Rate 4) is reported (e.g., percentage of patients who are compliant for Meningococcal (serogroups A, C, W, Y), Tdap and HPV during the specified timeframes).","Family Medicine; Pediatrics","Individuals","Adolescents who turn 13 years of age during the measurement period \nNOTE: Patient encounters for this measure conducted via telehealth (e.g., encounters coded with GQ, GT, 95, or POS 02 modifiers) are allowable.","Patients who turn 13 years of age during the measurement period\nAND\nPatient encounter during the performance period (CPT or HCPCS): 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0402\n\nNOTE: Patient encounters for this measure conducted via telehealth (e.g., encounters coded with GQ, GT, 95, or POS 02 modifiers) are allowable.","Meningococcal, Tdap and/or HPV vaccine contraindicated OR patient allergic to the meningococcal, Tdap, and/or HPV vaccine\nOR\nEncephalopathy due to Tdap vaccine\nOR\nPatients who use hospice services any time during the measurement period: G9761","All patients who are numerator compliant for Meningococcal, Tdap and HPV during the specified timeframes. Per the \"HHSC Program Specific Modifications\", for TIPPS reporting purposes, only one rate (Rate 4) is reported (e.g., percentage of patients who are compliant for Meningococcal (serogroups A, C, W, Y), Tdap and HPV during the specified timeframes).","Patient had one dose of meningococcal vaccine (serogroups A, C, W, Y) on or between the patient’s 11th and 13th birthdays (G9414) \nAND\nPatient had one tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap) on or between the patient’s 10th and 13th birthdays (G9416) \nAND\nPatient had at least two HPV vaccines (with at least 146 days between the two) OR three HPV vaccines on or between the patient’s 9th and 13th birthdays (G9762)\n\nPer the \"HHSC Program Specific Modifications\", for TIPPS reporting purposes, only one rate (Rate 4) is reported (e.g., percentage of patients who are compliant for Meningococcal (serogroups A, C, W, Y), Tdap and HPV during the specified timeframes).\n","Patient did not have one dose of meningococcal vaccine on or between the patient’s 11th and 13th birthdays (G9415) \nOR\nPatient did not have one tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap) on or between the patient’s 10th and 13th birthdays (G9417) \nOR\nPatient did not have at least two HPV vaccines (with at least 146 days between the two) OR three HPV vaccines on or between the patient’s 9th and 13th birthdays (G9763)","For TIPPS reporting purposes, only one rate (Rate 4) is reported (e.g., percentage of patients who are compliant for Meningococcal (serogroups A, C, W, Y), Tdap and HPV during the specified timeframes).",null,null,null,null,"Positive"]
["T2-115","TIPPS","T2","Preventive Care and Screening: Screening for Depression and Follow-Up Plan","Process",null,"01/01/22 - 06/30/22","Numeric Data Reporting & Status Update",null,"01/01/22 - 12/31/22","Numeric Data Reporting & Status Update",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"0418","CMS","eCQI (eCQM: CMS2v11)","https://ecqi.healthit.gov/ecqm/ep/2022/cms002v11\nhttps://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS2v11.html","Percentage of patients aged 12 years and older screened for depression on the date of the encounter or up to 14 days prior to the date of the encounter using an age-appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the eligible encounter","Family Medicine; Internal Medicine; Orthopedic Surgery; Pediatrics; Preventive Medicine; Psychiatry & Neurology; Audiologist; Occupational Therapist; Physical Therapist; Social Worker","Individuals","All patients aged 12 years and older at the beginning of the measurement period with at least one eligible encounter during the measurement period","\"Initial Population\":\n\"Patient Age 12 Years or Older at Start of Measurement Period\"\n  and exists ( \"Qualifying Encounter During Measurement Period\" )\n\n\"Patient Age 12 Years or Older at Start of Measurement Period\"\nexists [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n  where Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) >= 12\n\n\"Qualifying Encounter During Measurement Period\"\n( [\"Encounter, Performed\": \"Encounter to Screen for Depression\"]\n  union [\"Encounter, Performed\": \"Physical Therapy Evaluation\"] ) ValidEncounter\n  where ValidEncounter.relevantPeriod during \"Measurement Period\"","Patient Reason(s)\nPatient refuses to participate \nOR\nMedical Reason(s) \nDocumentation of medical reason for not screening patient for depression (e.g., cognitive, functional, or motivational limitations that may impact accuracy of results; patient is in an urgent or emergent situation where time is of the essence and to delay treatment would jeopardize the patient's health status)\n\nPatients who have been diagnosed with depression or with bipolar disorder\nexists \"History of Bipolar or Depression Diagnosis Before Qualifying Encounter\"\n\n( [\"Diagnosis\": \"Bipolar Diagnosis\"]\n  union [\"Diagnosis\": \"Depression Diagnosis\"] ) DiagnosisBipolarorDepression\n  with \"Qualifying Encounter During Measurement Period\" QualifyingEncounter\n    such that DiagnosisBipolarorDepression.prevalencePeriod starts before QualifyingEncounter.relevantPeriod\n\nDenominator Exceptions\n( exists \"Medical or Patient Reason for Not Screening Adolescent for Depression\"\n    and not \"Has Adolescent Depression Screening\")\n  or ( exists \"Medical or Patient Reason for Not Screening Adult for Depression\"\n      and not \"Has Adult Depression Screening\")\n\n[\"Assessment, Not Performed\": \"Adolescent depression screening assessment\"] NoAdolescentScreen\n  with \"Qualifying Encounter During Measurement Period\" QualifyingEncounter\n    such that NoAdolescentScreen.authorDatetime during QualifyingEncounter.relevantPeriod\n  where ( NoAdolescentScreen.negationRationale in \"Patient Declined\"\n      or NoAdolescentScreen.negationRationale in \"Medical Reason\")\n\nand not exists ( [\"Assessment, Performed\": \"Adolescent depression screening assessment\"] AdolescentScreening\n    with \"Qualifying Encounter During Measurement Period\" QualifyingEncounter\n      such that AdolescentScreening.relevantDatetime 14 days or less on or before day of start of QualifyingEncounter.relevantPeriod\n        and AdolescentScreening.result is not null)\n\nor [\"Assessment, Not Performed\": \"Adult depression screening assessment\"] NoAdultScreen\n  with \"Qualifying Encounter During Measurement Period\" QualifyingEncounter\n    such that NoAdultScreen.authorDatetime during QualifyingEncounter.relevantPeriod\n  where ( NoAdultScreen.negationRationale in \"Patient Declined\"\n      or NoAdultScreen.negationRationale in \"Medical Reason\")\n\nand not exists ( [\"Assessment, Performed\": \"Adult depression screening assessment\"] AdultScreening\n    with \"Qualifying Encounter During Measurement Period\" QualifyingEncounter\n      such that AdultScreening.relevantDatetime 14 days or less on or before day of start of QualifyingEncounter.relevantPeriod\n        and AdultScreening.result is not null)","Patients screened for depression on the date of the encounter or up to 14 days prior to the date of the encounter using an age-appropriate standardized tool AND if positive, a follow-up plan is documented on the date of the eligible encounter","( \"Patient Age 12 to 16 Years at Start of Measurement Period\"\n    and ( \"Has Most Recent Adolescent Screening Negative\"\n        or exists \"Most Recent Adolescent Screening Positive and Follow Up Provided\"))\n  or ( \"Patient Age 17 Years at Start of Measurement Period\"\n      and ( \"Has Most Recent Adolescent Screening Negative\"\n          or exists \"Most Recent Adolescent Screening Positive and Follow Up Provided\"\n          or \"Has Most Recent Adult Screening Negative\"\n          or exists \"Most Recent Adult Depression Screening Positive and Follow Up Provided\"))\n  or ( \"Patient Age 18 Years or Older at Start of Measurement Period\"\n      and ( \"Has Most Recent Adult Screening Negative\"\n          or exists \"Most Recent Adult Depression Screening Positive and Follow Up Provided\"))\n \nexists [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n  where Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) < 17\n\nand ( \"Most Recent Adolescent Depression Screening\" AdolescentScreen\n    where AdolescentScreen.result in \"Negative Depression Screening\") is not null\n\nor from\n  \"Most Recent Adolescent Depression Screening\" LastAdolescentScreen,\n  \"Follow Up For Positive Adolescent Depression Screening\" FollowUpPositiveAdolescentScreen,\n  \"Qualifying Encounter During Measurement Period\" QualifyingEncounter\n  where LastAdolescentScreen.relevantDatetime 14 days or less on or before day of start of QualifyingEncounter.relevantPeriod\n    and LastAdolescentScreen.result in \"Positive Depression Screening\"\n    and ( FollowUpPositiveAdolescentScreen.authorDatetime same day as \n      end of QualifyingEncounter.relevantPeriod\n        or FollowUpPositiveAdolescentScreen.relevantDatetime same day as \n        end of QualifyingEncounter.relevantPeriod)\n\nor exists [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n  where Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) = 17\n\nand ( \"Most Recent Adolescent Depression Screening\" AdolescentScreen\n    where AdolescentScreen.result in \"Negative Depression Screening\") is not null\n\nor from\n  \"Most Recent Adolescent Depression Screening\" LastAdolescentScreen,\n  \"Follow Up For Positive Adolescent Depression Screening\" FollowUpPositiveAdolescentScreen,\n  \"Qualifying Encounter During Measurement Period\" QualifyingEncounter\n  where LastAdolescentScreen.relevantDatetime 14 days or less on or before day of start of QualifyingEncounter.relevantPeriod\n    and LastAdolescentScreen.result in \"Positive Depression Screening\"\n    and ( FollowUpPositiveAdolescentScreen.authorDatetime same day as \n      end of QualifyingEncounter.relevantPeriod\n        or FollowUpPositiveAdolescentScreen.relevantDatetime same day as \n        end of QualifyingEncounter.relevantPeriod)\n\nor ( \"Most Recent Adult Depression Screening\" AdultScreen\n    where AdultScreen.result in \"Negative Depression Screening\") is not null\n\nand from\n  \"Most Recent Adult Depression Screening\" LastAdultScreen,\n  \"Follow Up for Positive Adult Depression Screening\" FollowUpPositiveAdultScreen,\n  \"Qualifying Encounter During Measurement Period\" QualifyingEncounter\n  where LastAdultScreen.relevantDatetime 14 days or less on or before day of start of QualifyingEncounter.relevantPeriod\n    and LastAdultScreen.result in \"Positive Depression Screening\"\n    and ( FollowUpPositiveAdultScreen.authorDatetime same day as \n      end of QualifyingEncounter.relevantPeriod\n        or FollowUpPositiveAdultScreen.relevantDatetime same day as \n        end of QualifyingEncounter.relevantPeriod)\n\nor exists [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n  where Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) >= 18\n\nand ( \"Most Recent Adult Depression Screening\" AdultScreen\n    where AdultScreen.result in \"Negative Depression Screening\") is not null\n\nor from\n  \"Most Recent Adult Depression Screening\" LastAdultScreen,\n  \"Follow Up for Positive Adult Depression Screening\" FollowUpPositiveAdultScreen,\n  \"Qualifying Encounter During Measurement Period\" QualifyingEncounter\n  where LastAdultScreen.relevantDatetime 14 days or less on or before day of start of QualifyingEncounter.relevantPeriod\n    and LastAdultScreen.result in \"Positive Depression Screening\"\n    and ( FollowUpPositiveAdultScreen.authorDatetime same day as \n      end of QualifyingEncounter.relevantPeriod\n        or FollowUpPositiveAdultScreen.relevantDatetime same day as \n        end of QualifyingEncounter.relevantPeriod)","None",null,"Definitions:\nScreening: Completion of a clinical or diagnostic tool used to identify people at risk of developing or having a certain disease or condition, even in the absence of symptoms.  \n\nStandardized Depression Screening Tool: A normalized and validated depression screening tool developed for the patient population in which it is being utilized.\n\nExamples of standardized depression screening tools include but are not limited to: \n*  Adolescent Screening Tools (12-17 years) \n   *  Patient Health Questionnaire for Adolescents (PHQ-A)\n   *  Beck Depression Inventory-Primary Care Version (BDI-PC)\n   *  Mood Feeling Questionnaire (MFQ)\n   *  Center for Epidemiologic Studies Depression Scale (CES-D)\n   *  Patient Health Questionnaire (PHQ-9)\n   *  Pediatric Symptom Checklist (PSC-17)\n   *  PRIME MD-PHQ2 \n*  Adult Screening Tools (18 years and older) \n   *  Patient Health Questionnaire (PHQ9)\n   *  Beck Depression Inventory (BDI or BDI-II)\n   *  Center for Epidemiologic Studies Depression Scale (CES-D)\n   *  Depression Scale (DEPS)\n   *  Duke Anxiety-Depression Scale (DADS)\n   *  Geriatric Depression Scale (GDS)\n   *  Cornell Scale for Depression in Dementia (CSDD)\n   *  PRIME MD-PHQ2 \n   *  Hamilton Rating Scale for Depression (HAM-D)\n   *  Quick Inventory of Depressive Symptomatology Self-Report (QID-SR)\n   *  Computerized Adaptive Testing Depression Inventory (CAT-DI)\n   *  Computerized Adaptive Diagnostic Screener (CAD-MDD)\n* Perinatal Screening Tools\n   *  Edinburgh Postnatal Depression Scale\n   *  Postpartum Depression Screening Scale\n   *  Patient Health Questionnaire 9 (PHQ-9)\n   *  Beck Depression Inventory\n   *  Beck Depression Inventory-II\n   *  Center for Epidemiologic Studies Depression Scale\n   *  Zung Self-rating Depression Scale\n   \nFollow-Up Plan: \nDocumented follow-up for a positive depression screening must include one or more of the following:\n *  Referral to a provider for additional evaluation and assessment to formulate a follow-up plan for a positive depression screen\n*  Pharmacological interventions\n*  Other interventions or follow-up for the diagnosis or treatment of depression\n\nThe intent of the measure is to screen for depression in patients who have never had a diagnosis of depression or bipolar disorder prior to the eligible encounter used to evaluate the numerator. Patients who have ever been diagnosed with depression or bipolar disorder will be excluded from the measure. \n\nA depression screen is completed on the date of the encounter or up to 14 days prior to the date of the encounter using an age-appropriate standardized depression screening tool AND if positive, a follow-up plan must be documented on the date of the encounter, such as referral to a provider for additional evaluation, pharmacological interventions, or other interventions for the treatment of depression.\n\nThis measure does not require documentation of a specific score, just whether results of the normalized and validated depression screening tool used are considered positive or negative. Each standardized screening tool provides guidance on whether a particular score is considered positive for depression.  \n\nThis eCQM is a patient-based measure. Depression screening is required once per measurement period, not at all encounters.\n\nScreening Tools:\n *  An age-appropriate, standardized, and validated depression screening tool must be used for numerator compliance.\n *  The name of the age-appropriate standardized depression screening tool utilized must be documented in the medical record.\n *  The depression screening must be reviewed and addressed by the provider, filing the code, on the date of the encounter. Positive pre-screening results indicating a patient is at high risk for self-harm should receive more urgent intervention as determined by the provider practice.\n *  The screening should occur during a qualifying encounter or up to 14 days prior to the date of the qualifying encounter.\n *  The measure assesses the most recent depression screening completed either during the eligible encounter or within the 14 days prior to that encounter. Therefore, a clinician would not be able to complete another screening at the time of the encounter to count towards a follow-up, because that would serve as the most recent screening. In order to satisfy the follow-up requirement for a patient screening positively, the eligible clinician would need to provide one of the aforementioned follow-up actions, which does not include use of a standardized depression screening tool.\n\nFollow-Up Plan:\nThe follow-up plan must be related to a positive depression screening, for example: \"Patient referred for psychiatric evaluation due to positive depression screening.\"\n\nExamples of a follow-up plan include but are not limited to: \n *  Referral to a provider or program for further evaluation for depression, for example, referral to a psychiatrist, psychologist, social worker, mental health counselor, or other mental health service such as family or group therapy, support group, depression management program, or other service for treatment of depression\n *  Other interventions designed to treat depression such as behavioral health evaluation, psychotherapy, pharmacological interventions, or additional treatment options\n\nShould a patient screen positive for depression, a clinician should:\n* Only order pharmacological intervention when appropriate and after sufficient diagnostic evaluation. However, for the purposes of this measure, additional screening and assessment during the qualifying encounter will not qualify as a follow-up plan.\n* Opt to complete a suicide risk assessment when appropriate and based on individual patient characteristics. However, for the purposes of this measure, a suicide risk assessment or additional screening using a standardized tool will not qualify as a follow-up plan.\n\nThis version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.",null,null,null,"Positive"]
["T2-116","TIPPS","T2","Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Testing","Process",null,"01/01/22 - 06/30/22","Numeric Data Reporting & Status Update",null,"01/01/22 - 12/31/22","Numeric Data Reporting & Status Update",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"0057","NCQA","CMS CMIT (CMIT ID: 2838, Revision: 3)","https://cmit.cms.gov/CMIT_public/ViewMeasure?MeasureId=2838#tab1","Percentage of patients ages 18 to 75 with diabetes (type 1 and type 2) who had a hemoglobin A1c (HbA1c) test.","Family Medicine; Internal Medicine; Pediatrics (Optional); Preventive Medicine; Dietician, Registered","Individuals","Ages 18 to 75 as of December 31 of the measurement year with diabetes (type 1 and type 2).",{"$cut":{"chars":32459,"head":"Ages 18 to 75 as of December 31 of the measurement year. \n\nThere are two ways to identify patients with diabetes: by claim/encounter data and by pharmacy data. The provider must use both methods to identify the eligible population, but a patient only needs to be identified by one method to be included in the measure. Patients may be identified as having diabetes during the measurement year or the year prior to the measurement year. \n\nClaim/encounter data. Patients who met any of the following criteria during the measurement year or year prior to the measurement year (count services that occur over both years): \n- At least two outpatient visits (Outpatient Value Set), observation visits (Observation Value Set), ED Visits (ED Value Set), or nonacute inpatient encounters (Nonacute Inpatient Value Set) on different dates of service, with a diagnosis of diabetes (Diabetes Value Set). Visit type need not be the same for the two visits. \n- At least one acute inpatient encounter (Acute Inpatient Value Set) with a diagnosis of diabetes (Diabetes Value Set).\n\nPharmacy data. Patients who were dispensed insulin or oral hypoglycemics/antihyperglycemics on an ambulatory basis during the measurement year or year prior to the measurement year (Diabetes Medications List available at http://www.ncqa.org/hedis-quality-measurement/hedis-measures/hedis-2018).\n\nDiabetes Value Set: \n[E10.10] Type 1 diabetes mellitus with ketoacidosis without coma\n[E10.11] Type 1 diabetes mellitus with ketoacidosis with coma\n[E10.21] Type 1 diabetes mellitus with diabetic nephropathy\n[E10.22] Type 1 diabetes mellitus with diabetic chronic kidney disease\n[E10.29] Type 1 diabetes mellitus with other diabetic kidney complication\n[E10.311] Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edema\n[E10.319] Type 1 diabetes mellitus with unspecified diabetic retinopathy without macular edema\n[E10.321] Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema\n[E10.3211] Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye\n[E10.3212] Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye\n[E10.3213] Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral\n[E10.3219] Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye\n[E10.329] Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema\n[E10.3291] Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye\n[E10.3292] Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye\n[E10.3293] Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral\n[E10.3299] Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye\n[E10.331] Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema\n[E10.3311] Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye\n[E10.3312] Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye\n[E10.3313] Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral\n[E10.3319] Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye\n[E10.339] Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema\n[E10.3391] Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye\n[E10.3392] Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye\n[E10.3393] Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral"}},{"$cut":{"chars":24867,"head":"Exclusions: Patients who do not have a diagnosis of diabetes (Diabetes Value Set), in any setting, during the measurement year or year prior to the measurement year and who had a diagnosis of gestational diabetes or steroid-induced diabetes (Diabetes Exclusions Value Set), in any setting, during the measurement year or the year prior to the measurement year. If the patient was included in this measure based on claim or encounter data, as described in the event/diagnosis criteria, the optional exclusions do not apply because the patient had a diagnosis of diabetes\n\nDiabetes Exclusions Value Set:\n[E08.00] Diabetes mellitus due to underlying condition with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC)\n[E08.01] Diabetes mellitus due to underlying condition with hyperosmolarity with coma\n[E08.10] Diabetes mellitus due to underlying condition with ketoacidosis without coma\n[E08.11] Diabetes mellitus due to underlying condition with ketoacidosis with coma\n[E08.21] Diabetes mellitus due to underlying condition with diabetic nephropathy\n[E08.22] Diabetes mellitus due to underlying condition with diabetic chronic kidney disease\n[E08.29] Diabetes mellitus due to underlying condition with other diabetic kidney complication\n[E08.311] Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema\n[E08.319] Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy without macular edema\n[E08.321] Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema\n[E08.3211] Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, right eye\n[E08.3212] Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, left eye\n[E08.3213] Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, bilateral\n[E08.3219] Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye\n[E08.329] Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema\n[E08.3291] Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, right eye\n[E08.3292] Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, left eye\n[E08.3293] Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, bilateral\n[E08.3299] Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye\n[E08.331] Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema\n[E08.3311] Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, right eye\n[E08.3312] Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, left eye\n[E08.3313] Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, bilateral\n[E08.3319] Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye\n[E08.339] Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema\n[E08.3391] Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, right eye\n[E08.3392] Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, left eye\n[E08.3393] Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, bilateral\n[E08.3399] Di"}},"An HbA1c test (HbA1c Tests Value Set) performed during the measurement year, as identified by claim/encounter or automated laboratory data. ","HbA1c Test Value Set: \n\nCPT: \n83036\n83037 \n\nLOINC: \n17856-6 Hemoglobin A1c/Hemoglobin.total in Blood by HPLC\n4548-4 Hemoglobin A1c/Hemoglobin.total in Blood\n4549-2 Hemoglobin A1c/Hemoglobin.total in Blood by Electrophoresis \n\nSNOMED CT US Edition:\n43396009 Hemoglobin A1c measurement (procedure) \n313835008 Hemoglobin A1c measurement aligned to the Diabetes Control and Complications Trial (procedure) \n",null,"For TIPPS reporting purposes, the word \"beneficiary\" or \"member\" has been replaced with \"patient,\" and the word \"State\" has been replaced with \"provider\". ","There are two ways to identify Members with diabetes: by claim/encounter data and by pharmacy data. The state must use both methods to identify the eligible population, but a patient only needs to be identified by one method to be included in the measure. Members may be identified as having diabetes during the measurement year or the year prior to the measurement year. Claim/encounter data. Members who met any of the following criteria during the measurement year or year prior to the measurement year (count services that occur over both years): At least two outpatient visits (Outpatient Value Set), observation visits (Observation Value Set), ED Visits (ED Value Set), or nonacute inpatient encounters (Nonacute Inpatient Value Set) on different dates of service, with a diagnosis of diabetes (Diabetes Value Set). Visit type need not be the same for the two visits. At least one acute inpatient encounter (Acute Inpatient Value Set) with a diagnosis of diabetes (Diabetes Value Set) Pharmacy data. Members who were dispensed insulin or oral hypoglycemics/antihyperglycemics on an ambulatory basis during the measurement year or year prior to the measurement year (Diabetes Medications List available at http://www.ncqa.org/hedis-quality-measurement/hedis-measures/hedis-2018).\n\nThe last publicly available measure specifications for T2-116 were available through the Medicaid Adult Core Set 2019 measure specifications; however the measure has since been retired form the Medicaid Adult Core Set. As a HEDIS measure, the measure specifications are not publicly available without licensed purchase; in the absence of publicly available measure specifications for T2-116, a link to CMIT (CMS Measures Inventory Tool) is instead provided as the measure specifications source. Value sets adapted from Medicaid Adult Core Set 2020 Adult HEDIS codes.",null,null,null,"Positive"]
["T2-117","TIPPS","T2","Tobacco Use and Help with Quitting Among Adolescents","Process",null,"01/01/22 - 06/30/22","Numeric Data Reporting & Status Update",null,"01/01/22 - 12/31/22","Numeric Data Reporting & Status Update",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"2803","NCQA","CMS QPP MIPS (#402 2021)","https://qpp.cms.gov/docs/QPP_quality_measure_specifications/CQM-Measures/2021_Measure_402_MIPSCQM.pdf","The percentage of adolescents 12 to 20 years of age with a primary care visit during the measurement year for whom tobacco use status was documented and received help with quitting if identified as a tobacco user","Allergy & Immunology;  Dermatology; Family Medicine; Internal Medicine; Obstetrics & Gynecology; Orthopaedic Surgery; Otolaryngology; Pediatrics; Physicial Medicine & Rehabilitation; Preventive Medicine; Psychiatry & Neurology; Surgery; Thoracic Surgery; Social Worker; Urgent Care","Individuals","All patients aged 12-20 years with a visit during the measurement period\nNOTE: Patient encounters for this measure conducted via telehealth (e.g., encounters coded with GQ, GT, 95, or POS 02 modifiers) are allowable.","Patients aged 12-20 years on date of encounter\nAND\nPatient encounter during the performance period (CPT or HCPCS): 90791, 90792, 90832, 90834, 90837, 90839, 90845, 92002, 92004, 92012, 92014, 96156, 96158, 97165, 97166, 97167, 97168, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99406, 99407, G0438, G0439\n\nNOTE: Patient encounters for this measure conducted via telehealth (e.g., encounters coded with GQ, GT, 95, or POS 02 modifiers) are allowable.",null,"Patients who were screened for tobacco use at least once within 18 months (during the measurement period or the six months prior to the measurement period) AND who received tobacco cessation counseling intervention if identified as a tobacco user","Patient documented as tobacco user AND received tobacco cessation intervention (must include at least one of the following: advice given to quit smoking or tobacco use, counseling on the benefits of quitting smoking or tobacco use, assistance with or referral to external smoking or tobacco cessation support programs, or current enrollment in smoking or tobacco use cessation program) if identified as a tobacco user (G9458)\nOR\nCurrently a tobacco non-user (G9459)","Tobacco assessment OR tobacco cessation intervention not performed, reason not given (G9460)","For TIPPS reporting purposes, providers should include Texas Health Steps medical checkup codes 99383, 99384, 99385, 99393, 99394, 99395. ","Definitions:\nTobacco Use Status – Any documentation of smoking or tobacco use status, including ‘never’ or ‘non-use’.\nTobacco User – Any documentation of active or current use of tobacco products, including smoking.\nNUMERATOR NOTE: In the event that a patient is screened for tobacco use and identified as a user but did\nnot receive tobacco cessation counseling, submit G9460",null,null,null,"Positive"]
["T2-118","TIPPS","T2","Chlamydia Screening in Women","Process",null,"01/01/22 - 06/30/22","Numeric Data Reporting & Status Update",null,"01/01/22 - 12/31/22","Numeric Data Reporting & Status Update",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"0033","NCQA","eCQI (eCQM: CMS153v10)","https://ecqi.healthit.gov/ecqm/ep/2022/cms153v10\nhttps://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS153v10.html","Percentage of women 16-24 years of age who were identified as sexually active and who had at least one test for chlamydia during the measurement period","Family Medicine; Obstetrics & Gynecology; Pediatrics","Individuals","Women 16 to 24 years of age who are sexually active and who had a visit in the measurement period","\"Initial Population\"\nexists ( [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n    where Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) in Interval[16, 24))\n  and exists ( [\"Patient Characteristic Sex\": \"Female\"] )\n  and exists ( \"Qualifying Encounters\" )\n  and ( exists ( \"Assessments Identifying Sexual Activity\" )\n      or exists ( \"Diagnoses Identifying Sexual Activity\" )\n      or exists ( \"Active Contraceptive Medications\" )\n      or exists ( \"Ordered Contraceptive Medications\" )\n      or exists ( \"Laboratory Tests Identifying Sexual Activity\" )\n      or exists ( \"Diagnostic Studies Identifying Sexual Activity\" )\n      or exists ( \"Procedures Identifying Sexual Activity\" ))\n\n\"Qualifying Encounters\"\n( [\"Encounter, Performed\": \"Office Visit\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services - Established Office Visit, 18 and Up\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services-Initial Office Visit, 18 and Up\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services, Initial Office Visit, 0 to 17\"]\n  union [\"Encounter, Performed\": \"Preventive Care, Established Office Visit, 0 to 17\"]\n  union [\"Encounter, Performed\": \"Home Healthcare Services\"]\n  union [\"Encounter, Performed\": \"Telephone Visits\"]\n  union [\"Encounter, Performed\": \"Online Assessments\"] ) ValidEncounter\n  where ValidEncounter.relevantPeriod during \"Measurement Period\"\n\n\"Assessments Identifying Sexual Activity\"\n( [\"Assessment, Performed\": \"Sexually Active\"] SexualActivityAssessment\n    where SexualActivityAssessment.result ~ \"Yes (qualifier value)\"\n      and Global.\"NormalizeInterval\" ( SexualActivityAssessment.relevantDatetime, SexualActivityAssessment.relevantPeriod ) before \n      end of \"Measurement Period\")\n\n\"Diagnoses Identifying Sexual Activity\"\n( ( [\"Diagnosis\": \"Diagnoses Used to Indicate Sexual Activity\"]\n    union [\"Diagnosis\": \"HIV\"]\n    union [\"Diagnosis\": \"Complications of Pregnancy, Childbirth and the Puerperium\"] ) SexualActivityDiagnosis\n    where SexualActivityDiagnosis.prevalencePeriod overlaps \"Measurement Period\")\n\n\"Active Contraceptive Medications\"\n[\"Medication, Order\": \"Contraceptive Medications\"] OrderedContraceptives\n  where OrderedContraceptives.authorDatetime during \"Measurement Period\"\n\n\"Ordered Contraceptive Medications\"\n[\"Medication, Active\": \"Contraceptive Medications\"] ActiveContraceptives\n  where ActiveContraceptives.relevantPeriod overlaps \"Measurement Period\"\n\n\n\"Laboratory Tests Identifying Sexual Activity\"\nor ( [\"Laboratory Test, Order\": \"Pap Test\"]\n  union [\"Laboratory Test, Order\": \"Lab Tests During Pregnancy\"]\n  union [\"Laboratory Test, Order\": \"Lab Tests for Sexually Transmitted Infections\"] ) LabOrders\n  where LabOrders.authorDatetime during \"Measurement Period\")\n\n\"Diagnostic Studies Identifying Sexual Activity\"\nor [\"Diagnostic Study, Order\": \"Diagnostic Studies During Pregnancy\"] SexualActivityDiagnostics\n  where SexualActivityDiagnostics.authorDatetime during \"Measurement Period\"\n\n\"Procedures Identifying Sexual Activity\"\n( [\"Laboratory Test, Order\": \"Pregnancy Test\"]\n  union \"Laboratory Tests Identifying Sexual Activity But Not Pregnancy\" ) AllLabOrders\n  where AllLabOrders.authorDatetime during \"Measurement Period\"","Exclusions: \nWomen who are only eligible for the initial population due to a pregnancy test and who had an x-ray or an order for a specified medication within 7 days of the pregnancy test.\nExclude patients whose hospice care overlaps the measurement period.\n\nHospice. \"Has Hospice\"\n  or ( exists ( \"Pregnancy Test Exclusion\" )\n      and not exists ( \"Diagnoses Identifying Sexual Activity\" )\n      and not exists ( \"Active Contraceptive Medications\" )\n      and not exists ( \"Laboratory Tests Identifying Sexual Activity But Not Pregnancy\" )\n      and not exists ( \"Procedures Identifying Sexual Activity\" )\n      and not exists ( \"Assessments Identifying Sexual Activity\" )\n      and not exists ( \"Ordered Contraceptive Medications\" )\n      and not exists ( \"Diagnostic Studies Identifying Sexual Activity\" ))\n\nexists ( [\"Encounter, Performed\": \"Encounter Inpatient\"] DischargeHospice\n    where ( DischargeHospice.dischargeDisposition ~ \"Discharge to home for hospice care (procedure)\"\n        or DischargeHospice.dischargeDisposition ~ \"Discharge to healthcare facility for hospice care (procedure)\")\n      and DischargeHospice.relevantPeriod ends during \"Measurement Period\")\n  or exists ( [\"Intervention, Order\": \"Hospice care ambulatory\"] HospiceOrder\n      where HospiceOrder.authorDatetime during \"Measurement Period\")\n  or exists ( [\"Intervention, Performed\": \"Hospice care ambulatory\"] HospicePerformed\n      where HospicePerformed.relevantPeriod overlaps \"Measurement Period\")\n\nor ( [\"Laboratory Test, Order\": \"Pregnancy Test\"] PregnancyTest\n    with [\"Diagnostic Study, Order\": \"X-Ray Study (all inclusive)\"] XrayOrder\n      such that XrayOrder.authorDatetime occurs 7 days or less on or after day of PregnancyTest.authorDatetime\n    where PregnancyTest.authorDatetime during \"Measurement Period\")\n  union ( [\"Laboratory Test, Order\": \"Pregnancy Test\"] PregnancyTestOrder\n      with [\"Medication, Order\": \"Isotretinoin\"] AccutaneOrder\n        such that AccutaneOrder.authorDatetime occurs 7 days or less on or after day of PregnancyTestOrder.authorDatetime\n      where PregnancyTestOrder.authorDatetime during \"Measurement Period\")","Women with at least one chlamydia test during the measurement period.\nPer the \"Measure Steward Additional Guidance\", \"Patient self-report for procedures as well as diagnostic studies should be recorded in 'Procedure, Performed' template or 'Diagnostic Study, Performed' template in QRDA-1. Patient self-report is not allowed for laboratory tests.\"","exists ( [\"Laboratory Test, Performed\": \"Chlamydia Screening\"] ChlamydiaTest\n    where Global.\"LatestOf\" ( ChlamydiaTest.relevantDatetime, ChlamydiaTest.relevantPeriod ) during \"Measurement Period\"\n      and ChlamydiaTest.result is not null)\n ","None",null,"Guidance: \nCodes to identify sexually active women include codes for: pregnancy, sexually transmitted infections, contraceptives or contraceptive devices, and infertility treatments.\n\nThe denominator exclusion does not apply to patients who qualify for the initial population (IP) based on services other than the pregnancy test alone. These other services include services for sexually transmitted infections, contraceptives or contraceptive devices and infertility treatments. For example, a patient who has both a pregnancy test and a chlamydia diagnosis, either of which would qualify them for the IP, would not be eligible for this denominator exclusion.\n\nPatient self-report for procedures as well as diagnostic studies should be recorded in 'Procedure, Performed' template or 'Diagnostic Study, Performed' template in QRDA-1. Patient self-report is not allowed for laboratory tests.\n\nThis eCQM is a patient-based measure.\n\nThis version of the eCQM uses QDM version 5.5.  Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.",null,null,null,"Positive"]
["T2-119","TIPPS","T2","Controlling High Blood Pressure","Outcome",null,"01/01/22 - 06/30/22","Numeric Data Reporting & Status Update",null,"01/01/22 - 12/31/22","Numeric Data Reporting & Status Update",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"0018","NCQA","eCQI (eCQM: CMS165v10)","https://ecqi.healthit.gov/ecqm/ep/2022/cms165v10\nhttps://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS165v10.html","Percentage of patients 18-85 years of age who had a diagnosis of essential hypertension starting before and continuing into, or starting during the first six months of the measurement period, and whose most recent blood pressure was adequately controlled (<140/90mmHg) during the measurement period","Family Medicine; Internal Medicine; Obstetrics & Gynecology; Pediatrics (Optional); Surgery","Individuals","Patients 18-85 years of age who had a visit and diagnosis of essential hypertension starting before and continuing into, or starting during the first six months of the measurement period.","\"Initial Population\"\nexists [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n  where Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) in Interval[18, 85 )\n    and exists \"Essential Hypertension Diagnosis\"\n    and ( exists AdultOutpatientEncounters.\"Qualifying Encounters\"\n        or exists ( ( [\"Encounter, Performed\": \"Telephone Visits\"]\n            union [\"Encounter, Performed\": \"Online Assessments\"] ) Telehealth\n            where Telehealth.relevantPeriod during \"Measurement Period\" )\n\n\"Essential Hypertension Diagnosis\"\n[\"Diagnosis\": \"Essential Hypertension\"] Hypertension\n  where Hypertension.prevalencePeriod overlaps Interval[start of \"Measurement Period\", start of \"Measurement Period\" + 6 months )\n\nAdultOutpatientEncounters.\"Qualifying Encounters\"\n( [\"Encounter, Performed\": \"Office Visit\"]\n  union [\"Encounter, Performed\": \"Annual Wellness Visit\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services - Established Office Visit, 18 and Up\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services-Initial Office Visit, 18 and Up\"]\n  union [\"Encounter, Performed\": \"Home Healthcare Services\"] ) ValidEncounter\n  where ValidEncounter.relevantPeriod during \"Measurement Period\"","Patients with evidence of end stage renal disease (ESRD), dialysis or renal transplant before or during the measurement period. Also exclude patients with a diagnosis of pregnancy during the measurement period.\nExclude patients whose hospice care overlaps the measurement period.\nExclude patients 66 and older who are living long term in an institution for more than 90 consecutive days during the measurement period.\nExclude patients 66 and older with advanced illness and frailty because it is unlikely that patients will benefit from the services being measured.\n\nHospice.\"Has Hospice\"\n  or exists ( \"Pregnancy Or Renal Diagnosis Exclusions\" )\n  or exists ( \"End Stage Renal Disease Procedures\" )\n  or exists ( \"End Stage Renal Disease Encounter\" )\n  or ( exists ( [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n        where Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) >= 65)\n      and ( FrailtyLTI.\"Has Long Term Care Periods Longer Than 90 Consecutive Days\" )  )\n  or FrailtyLTI.\"Advanced Illness and Frailty Exclusion Including Over Age 80\"\n  or PalliativeCare.\"Palliative Care in the Measurement Period\"\n\nexists ( [\"Encounter, Performed\": \"Encounter Inpatient\"] DischargeHospice\n    where ( DischargeHospice.dischargeDisposition ~ \"Discharge to home for hospice care (procedure)\"\n        or DischargeHospice.dischargeDisposition ~ \"Discharge to healthcare facility for hospice care (procedure)\"    )\n      and DischargeHospice.relevantPeriod ends during \"Measurement Period\" )\n  or exists ( [\"Intervention, Order\": \"Hospice care ambulatory\"] HospiceOrder\n      where HospiceOrder.authorDatetime during \"Measurement Period\"   )\n  or exists ( [\"Intervention, Performed\": \"Hospice care ambulatory\"] HospicePerformed\n      where Global.\"NormalizeInterval\" ( HospicePerformed.relevantDatetime, HospicePerformed.relevantPeriod ) overlaps \"Measurement Period\"\n\n( [\"Diagnosis\": \"Pregnancy\"]\n  union [\"Diagnosis\": \"End Stage Renal Disease\"]\n  union [\"Diagnosis\": \"Kidney Transplant Recipient\"]\n  union [\"Diagnosis\": \"Chronic Kidney Disease, Stage 5\"] ) PregnancyESRDDiagnosis\n  where PregnancyESRDDiagnosis.prevalencePeriod overlaps \"Measurement Period\"\n\n[\"Encounter, Performed\": \"ESRD Monthly Outpatient Services\"] ESRDEncounter\n  where ESRDEncounter.relevantPeriod starts on or before \n  end of \"Measurement Period\"\n \nexists ( [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n    where ( Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) in Interval[65, 79])\n      and \"Has Criteria Indicating Frailty\"\n      and ( exists \"Two Outpatient Encounters with Advanced Illness on Different Dates of Service\"\n          or exists ( \"Inpatient Encounter with Advanced Illness\" )\n          or exists \"Dementia Medications In Year Before or During Measurement Period\" ) )\n  or exists ( [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n      where ( Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) >= 80 )\n        and \"Has Criteria Indicating Frailty\"  )\n\nFrailtyLTI.Dementia Medications In Year Before or During Measurement Period\n[\"Medication, Active\": \"Dementia Medications\"] DementiaMed\n\twhere Global.\"NormalizeInterval\"(DementiaMed.relevantDatetime, DementiaMed.relevantPeriod) overlaps Interval[( start of \"Measurement Period\" - 1 year ), \n\tend of \"Measurement Period\"]\n \nFrailtyLTI.Has Criteria Indicating Frailty\nexists ( [\"Device, Order\": \"Frailty Device\"] FrailtyDeviceOrder\n    where FrailtyDeviceOrder.authorDatetime during \"Measurement Period\" )\n  or exists ( [\"Device, Applied\": \"Frailty Device\"] FrailtyDeviceApplied\n      where Global.\"NormalizeInterval\" ( FrailtyDeviceApplied.relevantDatetime, FrailtyDeviceApplied.relevantPeriod ) overlaps \"Measurement Period\"  )\n  or exists ( [\"Diagnosis\": \"Frailty Diagnosis\"] FrailtyDiagnosis\n      where FrailtyDiagnosis.prevalencePeriod overlaps \"Measurement Period\"  )\n  or exists ( [\"Encounter, Performed\": \"Frailty Encounter\"] FrailtyEncounter\n      where FrailtyEncounter.relevantPeriod overlaps \"Measurement Period\"  )\n  or exists ( [\"Symptom\": \"Frailty Symptom\"] FrailtySymptom\n      where FrailtySymptom.prevalencePeriod overlaps \"Measurement Period\" )\n \nFrailtyLTI.Has Long Term Care Periods Longer Than 90 Consecutive Days\n\"Max Long Term Care Period Length\" > 90\n \nFrailtyLTI.Inpatient Encounter with Advanced Illness\n[\"Encounter, Performed\": \"Acute Inpatient\"] InpatientEncounter\n  where exists ( InpatientEncounter.diagnoses Diagnosis\n      where Diagnosis.code in \"Advanced Illness\"  )\n    and InpatientEncounter.relevantPeriod starts 2 years or less on or before \n    end of \"Measurement Period\"\n \nFrailtyLTI.Long Term Care Adjacent Periods\nfrom \n\"Long Term Care Overlapping Periods\" LTCPeriod1,\n\"Long Term Care Overlapping Periods\" LTCPeriod2\nwhere end of LTCPeriod1 within 1 day of start of LTCPeriod2\nreturn Interval[start of LTCPeriod1, end of LTCPeriod2]\n \nFrailtyLTI.Long Term Care Overlapping Periods\ncollapse(\"Long Term Care Periods During Measurement Period\")\n \nFrailtyLTI.Long Term Care Periods During Measurement Period\n( [\"Encounter, Performed\": \"Care Services in Long-Term Residential Facility\"]\n  union [\"Encounter, Performed\": \"Nursing Facility Visit\"] ) LongTermFacilityEncounter\n  where LongTermFacilityEncounter.relevantPeriod overlaps \"Measurement Period\"\n  return LongTermFacilityEncounter.relevantPeriod\n    intersect \"Measurement Period\"\n \nFrailtyLTI.Max Long Term Care Period Length\nMax((collapse(\"Long Term Care Overlapping Periods\"\n      union \"Long Term Care Adjacent Periods\"\n  ))LTCPeriods\n    return duration in days of LTCPeriods)\n \nFrailtyLTI.Outpatient Encounters with Advanced Illness\n( [\"Encounter, Performed\": \"Outpatient\"]\n  union [\"Encounter, Performed\": \"Observation\"]\n  union [\"Encounter, Performed\": \"Emergency Department Visit\"]\n  union [\"Encounter, Performed\": \"Nonacute Inpatient\"] ) OutpatientEncounter\n  where exists ( OutpatientEncounter.diagnoses Diagnosis\n      where Diagnosis.code in \"Advanced Illness\"  )\n    and OutpatientEncounter.relevantPeriod starts 2 years or less on or before \n    end of \"Measurement Period\"\n \nFrailtyLTI.Two Outpatient Encounters with Advanced Illness on Different Dates of Service\nfrom\n  \"Outpatient Encounters with Advanced Illness\" OutpatientEncounter1,\n  \"Outpatient Encounters with Advanced Illness\" OutpatientEncounter2\n  where OutpatientEncounter2.relevantPeriod ends 1 day or more after day of \n  end of OutpatientEncounter1.relevantPeriod\n  return OutpatientEncounter1\n\nexists ( [\"Assessment, Performed\": \"Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)\"] PalliativeAssessment\n    where Global.\"NormalizeInterval\"(PalliativeAssessment.relevantDatetime, PalliativeAssessment.relevantPeriod) overlaps \"Measurement Period\" )\n  or exists ( [\"Encounter, Performed\": \"Palliative Care Encounter\"] PalliativeEncounter\n      where PalliativeEncounter.relevantPeriod overlaps \"Measurement Period\" )\n  or exists ( [\"Intervention, Performed\": \"Palliative Care Intervention\"] PalliativeIntervention\n      where Global.\"NormalizeInterval\"(PalliativeIntervention.relevantDatetime, PalliativeIntervention.relevantPeriod) overlaps \"Measurement Period\" )\n ","Patients whose most recent blood pressure is adequately controlled (systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg) during the measurement period","\"Has Diastolic Blood Pressure Less Than 90\"\n  and \"Has Systolic Blood Pressure Less Than 140\"\n\n\"Lowest Diastolic Reading on Most Recent Blood Pressure Day\".result < 90 'mm[Hg]'\n \nand \"Lowest Systolic Reading on Most Recent Blood Pressure Day\".result < 140 'mm[Hg]'","None",null,"Guidance:\nIn reference to the numerator element, only blood pressure readings performed by a clinician or a remote monitoring device are acceptable for numerator compliance with this measure. This includes blood pressures taken in person by a clinician and blood pressures measured remotely by electronic monitoring devices capable of transmitting the blood pressure data to the clinician. Blood pressure readings taken by a remote monitoring device and conveyed by the patient to the clinician are also acceptable. It is the clinician’s responsibility and discretion to confirm the remote monitoring device used to obtain the blood pressure is considered acceptable and reliable and whether the blood pressure reading is considered accurate before documenting it in the patient’s medical record.\n\nDo not include BP readings:\n-Taken during an acute inpatient stay or an ED visit\n-Taken on the same day as a diagnostic test or diagnostic or therapeutic procedure that requires a change in diet or change in medication on or one day before the day of the test or procedure, with the exception of fasting blood tests.\n-Taken by the patient using a non-digital device such as with a manual blood pressure cuff and a stethoscope.\n\nIf no blood pressure is recorded during the measurement period, the patient's blood pressure is assumed \"not controlled.\"\n\nIf there are multiple blood pressure readings on the same day, use the lowest systolic and the lowest diastolic reading as the most recent blood pressure reading.\n\nThis eCQM is a patient-based measure.\n\nThis version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.",null,null,null,"Positive"]
["T3-102","TIPPS","T3","Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Poor Control (>9.0%)","Outcome (Intermediate)",null,"01/01/22 - 06/30/22","Numeric Data Reporting & Status Update",null,"01/01/22 - 12/31/22","Numeric Data Reporting & Status Update",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"0059","NCQA","eCQI (eCQM: CMS 122v10)","https://ecqi.healthit.gov/ecqm/ep/2022/cms122v10\nhttps://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS122v10.html","Percentage of patients 18-75 years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period","Family Medicine; Internal Medicine; Pediatrics (Optional); Preventive Medicine; Dietician, Registered","Individuals","Patients 18-75 years of age with diabetes with a visit during the measurement period","\"Initial Population\"\nexists ( [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n\t\twhere Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) in Interval[18, 75 ))\n\tand exists ( AdultOutpatientEncounters.\"Qualifying Encounters\" union \"Telehealth Services\")\n\tand exists ( [\"Diagnosis\": \"Diabetes\"] Diabetes \n\t\twhere Diabetes.prevalencePeriod overlaps \"Measurement Period\")\n\nAdultOutpatientEncounters.\"Qualifying Encounters\"\n( [\"Encounter, Performed\": \"Office Visit\"]\n  union [\"Encounter, Performed\": \"Annual Wellness Visit\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services - Established Office Visit, 18 and Up\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services-Initial Office Visit, 18 and Up\"]\n  union [\"Encounter, Performed\": \"Home Healthcare Services\"] ) ValidEncounter\n  where ValidEncounter.relevantPeriod during \"Measurement Period\"\n\n\"Telehealth Services\"\n[\"Encounter, Performed\": \"Telephone Visits\"] TelehealthEncounter\n  where TelehealthEncounter.relevantPeriod during \"Measurement Period\"","Exclude patients who are in hospice care for any part of the measurement period.\nExclude patients 66 and older who are living long term in an institution for more than 90 consecutive days during the measurement period.\nExclude patients 66 and older with an indication of frailty for any part of the measurement period who meet any of the following criteria:\n- Advanced illness with two outpatient encounters during the measurement period or the year prior\n- OR advanced illness with one inpatient encounter during the measurement period or the year prior\n- OR taking dementia medications during the measurement period or the year prior\nExclude patients receiving palliative care during the measurement period.","Patients whose most recent HbA1c level (performed during the measurement period) is >9.0% or is missing, or was not performed during the measurement period.","\"Has Most Recent Elevated Hba1c\"\n\tor \"Has Most Recent HbA1c Without Result\"\n\tor \"Has No Record Of HbA1c\"\n\nLast([\"Laboratory Test, Performed\": \"HbA1c Laboratory Test\"] HighHbA1c\n\t\twhere HighHbA1c.relevantPeriod during \"Measurement Period\" and HighHbA1c.result is not null\n\t\tsort by resultDatetime).result > 9 '%'\n \nLast([\"Laboratory Test, Performed\": \"HbA1c Laboratory Test\"] HbA1cNoResult\n\t\twhere HbA1cNoResult.relevantPeriod during \"Measurement Period\"\n\t\tsort by resultDatetime).result is null\n \nnot exists [\"Laboratory Test, Performed\": \"HbA1c Laboratory Test\"] NoHbA1c\n\t\twhere NoHbA1c.relevantPeriod during \"Measurement Period\"","None",null,"If the HbA1c test result is in the medical record, the test can be used to determine numerator compliance.\nOnly patients with a diagnosis of Type 1 or Type 2 diabetes should be included in the denominator of this measure; patients with a diagnosis of secondary diabetes due to another condition should not be included.\nThis eCQM is a patient-based measure.\nThis version of the eCQM uses QDM version 5.5.  Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.\nAdditional definitions of advanced illness and fraility are available in the measure source: https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS122v9.html#d1e767.",null,null,null,"Negative"]
["T3-121","TIPPS","T3","Food Insecurity Screening","Process",null,"01/01/22 - 06/30/22","Numeric Data Reporting & Status Update",null,"01/01/22 - 12/31/22","Numeric Data Reporting & Status Update",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"NA","Texas HHSC","Texas HHSC","NA","Percentage of patients who were screened for food insecurity using the Hunger Vital Sign (HVS) 2 questions with the screening results documented during the current encounter or during the previous twelve months.","Family Medicine; Internal Medicine; Obstetrics & Gynecology; Pediatrics","Individuals","All attributed patients with an eligible encounter during the measurement period\nNOTE: Patient encounters for this measure conducted via telehealth (e.g., encounters coded with GQ, GT, 95, or POS 02 modifiers) are allowable.","All attributed patients with an eligible encounter during the measurement period. There are not any age restrictions for denominator inclusion for this measure.\nNOTE: Patient encounters for this measure conducted via telehealth (e.g., encounters coded with GQ, GT, 95, or POS 02 modifiers) are allowable.","Patient refused to participate","Patients screened for food insecurity using the Hunger Vital Sign (HVS) 2 questions with the screening results documented during the current encounter or during the previous twelve months. There are not any age restrictions for numerator inclusion for this measure. Parents, guardians, and caregivers screened using the HVS 2 questions on behalf of the patient's household may be included in the numerator. Food insecurity screening completed via telehealth services can also meet numerator performance.","The Hunger Vital Sign™ (HVS) is a validated 2-question food insecurity screening tool based on the U.S. Household Food Security Survey Module to identify households at risk of food insecurity if they answer that either or both of the following two statements is ‘Often True’ or ‘Sometimes True’ (vs. ‘Never True’).\n• “Within the past 12 months we worried whether our food would run out before we got money to buy more.” \n• “Within the past 12 months the food we bought just didn’t last and we didn’t have money to get more.” \n\nPatients (including parents, guardians, and caregivers on behalf of the patient's househould) screened for food insecurity using the HVS 2 questions with the screening results documented during the current encounter or during the previous twelve months. \n\nPerformance for this measure is not dependent on a particular result. Performance is met if the documented screening results to both questions are not null (e.g., documented as ‘Often True’, ‘Sometimes True’, or ‘Never True’).","Patients screened for food insecurity using the Hunger Vital Sign (HVS) 2 questions without the screening results documented during the current encounter or during the previous twelve months, and patients screened for food insecurity without using the HVS 2 questions.",null,"According to the sponsoring organization for the Hunger Vital Sign™, \"There is no fee or license required to use the Hunger Vital Sign™. We only ask that parties properly cite the tool as follows\":\nHager, E. R., Quigg, A. M., Black, M. M., Coleman, S. M., Heeren, T., Rose-Jacobs, R., Cook, J. T., Ettinger de Cuba, S. E., Casey, P. H., Chilton, M., Cutts, D. B., Meyers A. F., Frank, D. A. (2010). Development and Validity of a 2-Item Screen to Identify Families at Risk for Food Insecurity. Pediatrics, 126(1), 26-32. doi:10.1542/peds.2009-3146.\n\nAdditional translations of the Hunger Vital Sign™ (11 languages total): https://childrenshealthwatch.org/wp-content/uploads/Hunger-Vital-Sign_translations.pdf\n\nAdditional resources and information respective to the Hunger Vital Sign™, including academic publications, toolkits, and other technical assistance: https://childrenshealthwatch.org/public-policy/hunger-vital-sign/",null,null,null,"Positive",null,null,null,null,null,null,null,"The denominator for this measure is \"All attributed patients with an eligible encounter during the measurement period\". Given that the denominator is not restrictive, even if the TIPPS participating provider does not currently perform the numerator quality action of food insecurity screenings, the denominator is unlikely to be “zero”. Moreover, measure is a screening rate. Both positive and negative screens should be included if they meet the numerator inclusion criteria. "]
["T3-122","TIPPS","T3","Maternity Care: Post-Partum Follow-Up and Care Coordination","Process",null,"01/01/22 - 06/30/22","Numeric Data Reporting & Status Update",null,"01/01/22 - 12/31/22","Numeric Data Reporting & Status Update",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"NA","CMS","CMS QPP MIPS (#336 2021)","https://qpp.cms.gov/docs/QPP_quality_measure_specifications/CQM-Measures/2021_Measure_336_MIPSCQM.pdf","Percentage of patients, regardless of age, who gave birth during a 12-month period who were seen for postpartum care before or at 8 weeks of giving birth and received the following at a postpartum visit: breast-feeding evaluation and education, postpartum depression screening, postpartum glucose screening for gestational diabetes patients, family and contraceptive planning counseling, tobacco use screening and cessation education, healthy lifestyle behavioral advice, and an immunization review and update","Obstetrics & Gynecology","Encounters","All patients, regardless of age, who gave birth during a 12-month period and were seen for postpartum care at a visit before or at 8 weeks of giving birth","All patients, regardless of age\nAND\nPatient procedure during performance period (CPT): 59400, 59410, 59430, 59510, 59515, 59610, 59614, 59618, 59622\nAND\nPostpartum care visit before or at 8 weeks post-delivery",null,"Patients receiving the following at a postpartum visit:\n• Breast-feeding evaluation and education, including patient-reported breast-feeding\n• Postpartum depression screening\n• Postpartum glucose screening for gestational diabetes patients\n• Family and contraceptive planning counseling\n• Tobacco use screening and cessation education\n• Healthy lifestyle behavioral advice\n• Immunization review and update\n\nTo satisfactorily meet the numerator ALL components (breast-feeding evaluation and education, postpartum depression screening, postpartum glucose screening for patients with gestational diabetes, family and contraceptive planning counseling, tobacco use screening and cessation education, healthy lifestyle behavioral advice, and immunization review and update) must be performed according to the definitions provided [in the Additional Information column].","Postpartum screenings, evaluations, and education performed (G9357)","Postpartum screenings, evaluations and education, not performed (G9358)",null,"Definitions:\nBreast-Feeding Evaluation and Education – Patients who were evaluated for and educated about breast-feeding before or at 8 weeks postpartum.\nPostpartum Depression Screening – Patients who were screened for postpartum depression before or at 8 weeks postpartum. Questions may be asked either directly by a health care provider or in the form of self- completed paper- or computer-administered questionnaires, and results should be documented in the medical record. Depression screening should include a self-reported validated depression screening tool (e.g., PHQ-2, Beck Depression Inventory, Beck Depression Inventory for Primary Care, Edinburgh Postnatal Depression Scale (EPDS).\nPostpartum Glucose Screening for Gestational Diabetes – Patients who were diagnosed with gestational diabetes during pregnancy who were screened with a glucose screen before or at 8 weeks postpartum.\nFamily and Contraceptive Planning Counseling – Patients who were provided family and contraceptive planning counseling (including contraception, if necessary) before or at 8 weeks postpartum.\nTobacco Use Screening and Cessation Education: Patients who were screened for tobacco use before or at 8 weeks postpartum. Patients who used any type of tobacco who were given brief counseling (3 minutes or less) and/or pharmacotherapy.\nHealthy Lifestyle Behavioral Advice: Clinicians should use discretion to determine which patients they deem appropriate for healthy lifestyle counseling. Clinicians may take into account the number of weeks that have passed since childbirth, whether the mother is breast-feeding, the degree to which the mother’s body mass index (BMI) exceeds the normal range, whether postpartum depression is present, and the mother’s own feelings and perceptions of her body weight. Counseling should include suggestions around healthy eating and staying active.\nIf deemed necessary by the clinician, the conversation about healthy lifestyle choices could include a follow-up plan, including a referral to a specialist such as a registered dietitian nutritionist, primary care provider, or mental health professional for lifestyle/behavioral therapy, pharmacological interventions, dietary supplements, exercise counseling or nutrition counseling.\nImmunization Review and Update: Patients whose immunization records were reviewed and who were provided with indicated immunizations, including completing series initiated antepartum or postpartum, at or before 8 weeks postpartum.",null,null,null,"Positive"]
["T3-123","TIPPS","T3","Behavioral Health Risk Assessment for Pregnant Women","Process",null,"01/01/22 - 06/30/22","Numeric Data Reporting & Status Update",null,"01/01/22 - 12/31/22","Numeric Data Reporting & Status Update",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"NA","Texas HHSC","Texas HHSC (2017 CMS Medicaid Child Core Set)","https://cmit.cms.gov/CMIT_public/ViewMeasure?MeasureId=2829","Percentage of women, regardless of age, who gave birth during a 12-month period seen at least once for prenatal care who received a behavioral health screening risk assessment that includes the following screenings at the first prenatal visit: depression screening, alcohol use screening, tobacco use screening, drug use screening (illicit and prescription, over the counter), and intimate partner violence screening.","Obstetrics & Gynecology","Encounters","All patients, regardless of age, who gave birth during a 12-month period seen at least once for prenatal care.","LOGIC: \nENCOUNTER Performed, Prenatal Visit: \"2.16.840.1.113883.3.526.3.1264\"\nAND\n     PROCEDURE Performed Vaginal Delivery: \"2.16.840.1.113883.3.526.3.1341\"\n     Attribute: stop datetime Date of Delivery\n     OR \n     PROCEDURE Performed: Cesarean Section Delivery: \"2.16.840.1.113883.3.526.3.1342\"\n     Attribute: stope datetime Dat of Delivery",null,"Patients who received all behavioral health screening risk assessments at the first prenatal visit.\n","Patients who received the following behavioral health screening risk assessments at the first prenatal visit.\nDepression screening:\n• Patients who were screened for depression at the first visit. Questions may be asked either directly by a health care provider or in the form of self-completed paper- or computer-administered questionnaires and results should be documented in the medical record. Depression screening may include a self-reported validated depression screening tool [e.g., PHQ-2, Beck Depression Inventory, Beck Depression Inventory for Primary Care, Edinburgh Postnatal Depression Scale (EPDS)].\nAlcohol use screening:\n• Patients who were screened for any alcohol use at the first visit \nTobacco use screening:\n• Patients who were screened for tobacco use at the first visit \nDrug use (illicit and prescription, over the counter) screening:\n• Patients who were screened for any drug use at the first visit\nIntimate partner violence screening:\n• Patients who were screened for intimate partner violence/abuse at the first visit. Questions may be asked either directly by a health care provider or in the form of self-completed paper- or computer administered questionnaires and results should be documented in the medical record. Intimate partner violence screening may include a self-reported validated depression screening tool (e.g., Hurt, Insult, Threaten, and Scream [HITS], Woman Abuse Screening Tool [WAST], Partner Violence Screen [PVS], Abuse Assessment Screen [AAS]).\nTo satisfactorily meet the numerator, ALL screening components must be performed.\n@@@\nLOGIC:\nAll Patients Identified within the Denominator\nAND\n     RISK CATEGORY/ASSESSMENT Result; Depression Screening Tools Realted to Maternity Care: \"2.16.840.1.113883.3.526.3.1359\"\n     Attirbute: Result Value Present\n     OR\n     INTERVENTION Result; Depression Screening-Procedure: \"2.16.840.1.113883.3.526.3.1360\"\n     Attribute: Result Value Present\nAND\nRISK CATEGORY/ASSESSMENT Result; Alcohol Use Screening: \"2.16.840.1.113883.3.526.3.1361\"\nAttribute: Result Value Present\nAND\nRISK CATEGORY/ASSESSMENT Result; Tobacco Use Screening: \"2.16.840.1.113883.3.526.3.1362\"\nAttribute: Result Value Present\nAND\nRISK CATEGORY/ASSESSMENT Result; Illicit, Prescription and Over the Counter Drug Use Screening: \"2.16.840.1.113883.3.526.3.1363\"\nAttribute: Result Value Present\nAND\nRISK CATEGORY/ASSESSMENT Result, Intimate Partner Violence Screening-Tool; \"2.16.840.1.113883.3.526.3.1364\"\nAttribute: Result Value Present","NA","For TIPPS reporting purposes, the following are Allowable Exceptions. Providers should keep record of below allowable exceptions and note them in the qualitative fields when reporting baseline or performance rates. Providers must apply allowable exceptions consistently across all baseline and performance years: \n- For TIPPS reporting purposes, providers MAY include settings in addition to OB that may provide care to pregnant women. Measure is specified for prenatal visits.\n- For TIPPS reporting purposes, providers MAY determine denominator inclusion by a prenatal visit conducted during the measurement period, rather than delivery date within the measurement period. Measure is specified so that denominator inclusion is determined by a delivery during the measurement period and a prenatal visit prior to delivery.","• To satisfactorily meet the numerator, all screening components must be performed.\n• The specifications for this measure do not include upper or lower age restrictions.\n• If an eligible woman has more than one birth during the measurement year, states should count each delivery separately in the Denominator (D). To be counted toward the numerator, each delivery must have a BHRA conducted at the first prenatal visit within the specified time frame for each delivery.\n@@@\nAdditional guidance can be found in the Medicaid and Chip Child Core Set Technical Specifications and Resource Manual for Federal Fiscal Year 2017:\nhttps://www.medicaid.gov/medicaid/quality-of-care/downloads/child-core-set-archive.zip",null,null,null,"Positive"]
["T3-124","TIPPS","T3","Depression Response at Twelve Months","Outcome",null,"01/01/22 - 06/30/22","Numeric Data Reporting & Status Update",null,"01/01/22 - 12/31/22","Numeric Data Reporting & Status Update",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,1885,"MN Community Measurement","MNCM (Version 1 for 2022 Measurement Year – PRELIMINARY)","https://helpdesk.mncm.org/helpdesk/KB/View/24185684-supplemental-guide--depression-care-measures-specifications-and-calculation ","The percentage of adolescent patients (12 to 17 years of age) and adult patients (18 years of age or older) with Major Depression or Dysthymia who demonstrated a response to treatment 12 months (+/- 60 days) after an index event","Family Medicine; Internal Medicine; Pediatrics; Psychiatry; Social Worker","Individuals","The eligible population (12 years of age or older at the index event) who had index events during the denominator identification period. ","Denominator Identification Period: Patients indexed in this timeframe comprise the measure denominator.\n\nAn index event occurs when ALL the following criteria are met during an encounter*:\n• a PHQ-9 or PHQ-9M result greater than nine\n• an active diagnosis of Major Depression or Dysthymia (Major Depression or Dysthymia Value Set)\n• the patient is NOT in a prior measure assessment period\n\n* For this measure, an encounter includes but is not limited to any of the following: office visit, psychiatry or psychotherapy visit, telephone, or online encounter. PHQ-9 or PHQ-9M score greater than 9 can be documented on the same date or up to seven days prior to the encounter (index event) and this date occurs during the denominator identification measurement period. This allows for pre-visit planning and administering the PHQ-9 or PHQ-9M just prior to an encounter. \n\nAny member of the health care team can administer a PHQ-9 or PHQ-9M assessment tool to a patient. Additionally, patients can self-administer via patient portal, email, or mail.","Required Exclusions - The following exclusions must be applied to the eligible population:\n• Patient had an active diagnosis of Bipolar Disorder (Bipolar Disorder Value Set) any time prior to the end of their measure assessment period\n• Patient had an active diagnosis of Schizophrenia or Psychotic Disorder (Schizophrenia Psychotic Disorder Value Set) any time prior to the end of their measure assessment period\n\nAllowable Exclusions - The following exclusions can be applied to the eligible population:\n• Patient had an active diagnosis of Personality Disorder – Emotionally Labile\n(Personality Disorder - Emotionally Labile Value Set) any time prior to the end of their measure assessment period\n• Patient had an active diagnosis of Pervasive Developmental Disorder (Pervasive Disorder Value Set) any time prior to the end of their measure assessment period\n• Patient was a permanent nursing home resident at any time during the denominator identification period or measure assessment period\n• Patient was in hospice or receiving palliative care at any time during the denominator identification period or measure assessment period\n• Patient died prior to the end of their measure assessment period","The number of patients in the denominator who demonstrated a response to treatment, with a PHQ-9 or PHQ-9M result that is reduced by at least 50 percent since the index PHQ-9/PHQ-9M result, 12 months (+/- 60 days) after an index event.","Measure Assessment Period for Rate Calculation: For each patient, the measure assessment period begins with an index event and is 14 months (12 months + 60 days) in length. Follow-up scores obtained in this timeframe from patients in the measure denominator are evaluated for numerator compliance.\n\nAny member of the health care team can administer a PHQ-9 or PHQ-9M assessment tool to a patient. Additionally, patients can self-administer via patient portal, email, or mail.",null,"For TIPPS reporting purposes, no rounding will be accepted in calculating a percent reduction equal to or greater than 50 percent. Additionally, according to the measure steward (MNCM), the measure steward does not anticipate releasing new Value Sets until late October or early November each year, so for TIPPS reporting purposes, the value sets contained in electronic clinical quality measure (eCQM) \"Depression REMISSION at Twelve Months\" (CMS159v10) may be referenced as the value sets for T3-124: Depression RESPONSE at Twelve Months since the diagnoses and measure stewards are the same for both measures. See https://ecqi.healthit.gov/ecqm/ep/2022/cms159v10. Also, see https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS159v10.html.","TIPPS Year 2 Reporting Period 1 (data measurement period: 01/01/22-06/30/22, six months): \n• Denominator Identification Period: November 1, 2020 through October 31, 2021\n• Numerator Measure Assessment Period for Rate Calculation**: September 2, 2021 through June 30, 2022\n\nTIPPS Year 2 Reporting Period 2 (data measurement period: 01/01/22-12/31/22, 12 months):\n• Denominator Identification Period: November 1, 2020 through October 31, 2021\n• Numerator Measure Assessment Period for Rate Calculation**: September 2, 2021 through December 30, 2022\n\nDenominator Identification Period: Patients indexed in this timeframe comprise the measure denominator.\n\n**Numerator Measure Assessment Period for Rate Calculation: For each patient, the measure assessment period begins with an index event and is 14 months (12 months + 60 days) in length. Follow-up scores obtained in this timeframe from patients in the measure denominator are evaluated for numerator criteria performance met. (**The Numerator Measure Assessment Period for Rate Calculation represents the first and last possible dates of follow-up based on the denominator identification period. Due to the +/- 60-day calculation, the dates do not fall exactly on the first or last day of the month. Each patient’s individual measure assessment period is initiated with a denominator index event. Patients are assessed at 12-months [+/- 60 days] after their denominator index event. For the TIPPS Year 2 Reporting Period 2, since the data measurement period is only 01/01/22-06/30/22, the numerator measure assessment period is further limited to follow-up scores obtained from patients in the measure denominator through 06/30/22.)\n\nIdentify the 12-month (+/- 60 days) Numerator Measure Assessment Period for a qualifying denominator index event. If more than one PHQ-9/PHQ-9M score occurs during the identified Numerator Measure Assessment Period, identify the most recent (latest) PHQ-9/PHQ-9M score within the Numerator Measure Assessment Period, and use this score to assess numerator criteria performance met. \n\nPatients with no submitted PHQ-9/PHQ-9M scores within the Numerator Measure Assessment Period remain in the denominator but are not counted in the numerator.\n\nFor TIPPS reporting purposes, the following examples show how to calculate depression response.\nDepression Response = (Response Score - Index Score)/(Index Score)\n\nExample A:\n• Index Score: 16\n• Response Score: 8\n• Depression Response = (8-16)/16 = -0.50 (decrease)\n• PERFORMANCE MET (decrease in score greater than or equal to 50%)\n\nExample B: \n• Index Score of 16\n• Response Score of 10\n• Depression Response = (10-16)/16 = -0.375 (decrease)\n• PERFORMANCE NOT MET (decrease in score was not greater than or equal to 50%)\n\nExample C: \n• Index Score of 16\n• Response Score of 18; Increased\n• Depression Response = (18-16)/16 = +0.125 (increase)\n• PERFORMANCE NOT MET (increase in score)",null,null,null,"Positive"]
["T3-125","TIPPS","T3","Weight Assessment and Counseling for Nutrition and Physical Activity for Children/ Adolescents (Weight Assessment Only)","Process",null,"01/01/22 - 06/30/22","Numeric Data Reporting & Status Update",null,"01/01/22 - 12/31/22","Numeric Data Reporting & Status Update",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"0024","NCQA","eCQI (eCQM: CMS155v10)","https://ecqi.healthit.gov/ecqm/ep/2022/cms155v10\nhttps://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS155v10.html","Percentage of patients 3-17 years of age who had an outpatient visit with a Primary Care Physician (PCP) or Obstetrician/Gynecologist (OB/GYN) and who had evidence of the following during the measurement period: height, weight, and body mass index (BMI) percentile documentation. Per the \"HHSC Program Specific Modifications\", for TIPPS reporting purposes, only one rate is reported (e.g., percentage of patients with height, weight, and body mass index (BMI) percentile documentation).","Family Medicine; Pediatrics; Dietician, Registered","Individuals","Patients 3-17 years of age with at least one outpatient visit with a primary care physician (PCP) or an obstetrician/gynecologist (OB/GYN) during the measurement period","\"Initial Population\"\nexists [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n  where Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) in Interval[3, 17 )\n    and exists ( \"Qualifying Encounter\" )\n\n\"Qualifying Encounter\"\n( [\"Encounter, Performed\": \"Office Visit\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services-Individual Counseling\"]\n  union [\"Encounter, Performed\": \"Preventive Care, Established Office Visit, 0 to 17\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services, Initial Office Visit, 0 to 17\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services - Group Counseling\"]\n  union [\"Encounter, Performed\": \"Home Healthcare Services\"]\n  union [\"Encounter, Performed\": \"Telephone Visits\"] ) ValidEncounter\n  where ValidEncounter.relevantPeriod during \"Measurement Period\"","Patients who have a diagnosis of pregnancy during the measurement period.\nExclude patients who are in hospice care for any part of the measurement period.","Patients who had a height, weight and body mass index (BMI) percentile recorded during the measurement period.  \n\nPer the \"HHSC Program Specific Modifications\", for TIPPS reporting purposes, only one rate is reported (e.g., percentage of patients with height, weight, and body mass index (BMI) percentile documentation).\n\nPer the \"Measure Steward Additional Information\" ( https://www.ncqa.org/wp-content/uploads/2020/07/20200716_Summary_Table_of_Measures_Product_Line_and_Changes_UPDATED.pdf), \"Removed the exclusion of member-reported biometric values (body mass index, height and weight).","exists ( \"BMI Percentile in Measurement Period\" )\n  and exists ( \"Height in Measurement Period\" )\n  and exists ( \"Weight in Measurement Period\" )","None","For TIPPS reporting purposes, only one rate is reported (e.g., percentage of patients with height, weight, and body mass index (BMI) percentile documentation).","Removed the exclusion of member-reported biometric values (body mass index, height and weight) (https://www.ncqa.org/wp-content/uploads/2020/07/20200716_Summary_Table_of_Measures_Product_Line_and_Changes_UPDATED.pdf).\n\nGuidance:\nThe visit must be performed by a PCP or OB/GYN. \nBecause BMI norms for youth vary with age and sex, this measure evaluates whether BMI percentile, rather than an absolute BMI value, is assessed.\n\nThis eCQM is a patient-based measure.\n\nThis version of the eCQM uses QDM version 5.5.  Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.",null,null,null,"Positive"]
["C1-105","CHIRP","C1 (UHRIP)","Health Information Exchange (HIE) Participation","Structure",null,"NA","Status Update Only",null,"NA","Status Update Only",null,"NA",null,null,null,null,null,"NA","NA","NA","NA","Reporting on status with enrollment in a public HIE, including submission of ADT and CCDM data","NA","NA",null,null,null,null,null,null,null,null,null,null,null,"N/A"]
["C1-126","CHIRP","C1 (UHRIP)","Healthcare Quality Learning Collaborative Participation","Structure",null,"09/01/21 - 08/31/22","Status Update Only",null,"NA","Status Update Only",null,"NA",null,null,null,null,null,"NA","NA","NA","NA","Reporting on participation in a Healthcare Quality Learning Collaborative. A Healthcare Quality Learning Collaborative is any conference, workshop, stakeholder forum, stakeholder meeting related to improving healthcare quality. It may take place anywhere, not only in the provider’s SDA, and events may be virtual or in person.","NA","NA",null,null,null,null,null,null,null,null,null,null,null,"N/A"]
["C1-127","CHIRP","C1 (UHRIP)","Medication Reconciliation: Number of Unintentional Medication Discrepancies per Medication per Patient","Outcome",null,"01/01/22 - 06/30/22","Numeric Data Reporting & Status Update",null,"01/01/22 - 12/31/22","Numeric Data Reporting & Status Update",null,"All Payer",null,null,null,null,null,"2456","HHSC (Adapted from Brigham and Women's Hospital)","National Quality Forum (NQF)","https://www.qualityforum.org/QPS/2456","This measure assesses the actual quality of the medication reconciliation process by identifying errors in admission and discharge medication orders due to problems with the medication reconciliation process. The target population is any hospitalized patient. The time frame is the hospitalization period. At the time of admission, the admission orders are compared to the preadmission medication list (PAML) compiled by trained pharmacist (i.e., the gold standard) to look for discrepancies and identify which discrepancies were unintentional using brief medical record review. This process is repeated at the time of discharge where the discharge medication list is compared to the PAML and medications ordered during the hospitalization.","NA","Encounters","The patient denominator is the sum of the number of medications in the gold standard medication lists plus the number of unintentionally ordered additional medications in a random sample of all adults admitted to the hospital. See \"HHSC Program Specific Modifications\" for sampling specifications for CHIRP reporting purposes.",null,"Patients that are discharged or expire before a gold standard medication list can be obtained.","For each sampled inpatient in the denominator, the total number of unintentional medication discrepancies in admission orders plus the total number of unintentional medication discrepancies in discharge orders.",null,null,"For CHIRP reporting purposes, the sampling of patients should includes all admitted patients (not only adults). The denominator therefore is the sum of medications in the gold standard medication list plus the number of unintentionally ordered additional medications in a random sample of all admitted patients. A pharmacist, pharmacy resident, or a certified pharmacy technician may collect the gold standard medication history. A certified pharmacy technician would include a pharmacy technician that has earned either the ASHP Medication Reconciliation Certification or the Pharmacy Technicians Certification Board’s (PTCB) Medication History Certificate. The Gold Standard Medication History is the list of medications that the patient was taking prior to\nadmission. Within 24 hours after admission, a trained pharmacist, pharmacy resident, or certified pharmacy technician must interview each patient selected for the 6-month sample and obtain the Gold Standard Medication History. Note that this is in addition to, and separate from, any pre-admission medication list that was created as part of normal care.\n\nCHIRP SFY23 Reporting: \n• For CHIRP reporting, the minimum sample size is 38 patients per 6 months and 76 patients per 12 months. If a hospital does not have the minimum sample size of cases, they may report the data based on all the patients that are included in the denominator. \n• For example, if there were 1,000 inpatient admissions and a CHIRP participating hospital was sampling 1-2 patients per week to select for the “gold standard” medication interviews, this would result in anywhere between 52-104 patients with completed “gold standard” medication lists per measure specifications. If the CHIRP participating hospital had completed 104 “gold standard” medication interviews, then a minimum of 76 of those cases (or up to all 104 cases) must be used to report the data for this measure. If the CHIRP participating hospital had completed 52 “gold standard” medication interviews, then all 52 cases would be used to report the data for this measure.\n• For another example, for those CHIRP participating hospitals with much lower inpatient admission volume to begin with, e.g., if there were 100 inpatient admissions and the participant was sampling 2 patients per month to select for the “gold standard” medication interviews, this would result in 24 patients with completed “gold standard” medication lists per measure specifications. All 24 of these cases would be used to report the data for this measure (since 24 is less than the minimum sample size of 76).   \n\nExample of rate calculation: If among those patients sampled to receive the gold standard medication interview, there are 145 gold standard medications and 50 unintentionally ordered additional medications, and 110 unintentional discrepancies are identified, the measure outcome would be 110/195 = 0.5641 discrepancies per medication per patient for that hospital.",null,null,null,null,"Negative",null,null,null,null,null,null,null,"Helpful resources (not required to use) \n\nIdentifying Discrepancies Flowchart:  https://www.leapfroggroup.org/sites/default/files/Files/Identifying%20Discrepancies%20Flow%20Chart_0_0.pdf?token=NKOpMllV\n\nTaking a good medication history: https://www.hospitalmedicine.org/clinical-topics/clinical-topic-videos/taking-a-good-medication-history-video/\n\nMedication Reconciliation: https://www.hospitalmedicine.org/clinical-topics/medication-reconciliation/\n\nMedication Reconciliation Worksheet: https://view.officeapps.live.com/op/view.aspx?src=https%3A%2F%2Fwww.leapfroggroup.org%2Fsites%2Fdefault%2Ffiles%2FFiles%2FMedRec_Worksheet_2022.docx%3Ftoken%3D606YTZH7&wdOrigin=BROWSELINK\n\nMedication Reconciliation Workbook: https://view.officeapps.live.com/op/view.aspx?src=https%3A%2F%2Fwww.leapfroggroup.org%2Fsites%2Fdefault%2Ffiles%2FFiles%2FMedRec_Workbook_2022.xlsx%3Ftoken%3Dc2tblZFX&wdOrigin=BROWSELINK"]
["C2-103","CHIRP","C2 (ACIA Rural Hospital Best Practices)","Preventive Care and Screening: Influenza Immunization","Process",null,"01/01/22 - 06/30/22","Numeric Data Reporting & Status Update",null,"01/01/22 - 12/31/22","Numeric Data Reporting & Status Update",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"0041e","NCQA","eCQI (eCQM: CMS147v11)","https://ecqi.healthit.gov/ecqm/ep/2022/cms147v11\nhttps://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS147v11.html","Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization","Allergy & Immunology; Family Medicine; Internal Medicine; Obstetrics & Gynecology; Otolaryngology; Pediatrics; Preventive Medicine","Individuals","All patients aged 6 months and older, seen for a visit during the measurement period, and seen for a visit between October 1 and March 31\n*For DPP reporting purposes, see below.\nYear 2 Reporting Period 1 (data measurement period: 01/01/22-06/30/22, six months):\n- Report the denominator as individuals with encounters that fall within the measurement period, e.g., for the data measurement period of 01/01/22-06/30/22, the denominator would include encounters from January 2022 - March 2022. (See \"HHSC Program Specific Modifications\" cell).\n\nYear 2 Reporting Period 2 (data measurement period: 01/01/22-12/31/22, 12 months):\n- Report the denominator as individuals with encounters that fall within the measurement period, e.g., for the data measurement period of 01/01/22-12/31/22, the denominator would include encounters from January 2022 - March 2022 and October 2022 - December 2022. (See \"HHSC Program Specific Modifications\" cell).","\"Initial Population\" \nand ( exists \"Encounter During Influenza Season\"\n      or exists \"Hemodialysis During Influenza Season\"\n      or exists \"Peritoneal Dialysis During Influenza Season\" )\n\n\"Encounter During Influenza Season\"\n[\"Encounter, Performed\": \"Encounter-Influenza\"] FluEncounter\n  where FluEncounter.relevantPeriod starts during \"Influenza Season\"\n\n\"Hemodialysis During Influenza Season\"\n[\"Procedure, Performed\": \"Hemodialysis\"] FluSeasonHemodialysis\n  where FluSeasonHemodialysis.relevantPeriod overlaps \"Influenza Season\"\n\n\"Peritoneal Dialysis During Influenza Season\"\n[\"Procedure, Performed\": \"Peritoneal Dialysis\"] PeritonealDialysis\n  where PeritonealDialysis.relevantPeriod overlaps \"Measurement Period\"\n\n\"Initial Population\"\nexists ( [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n    where Global.\"CalendarAgeInMonthsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) >= 6)\n  and ( exists \"Qualifying Encounter During Measurement Period\"\n      or exists \"Hemodialysis During Measurement Period\"\n      or exists \"Peritoneal Dialysis During Measurement Period\")\n \n\"Qualifying Encounter During Measurement Period\"\n( [\"Encounter, Performed\": \"Office Visit\"]\n  union [\"Encounter, Performed\": \"Outpatient Consultation\"]\n  union [\"Encounter, Performed\": \"Care Services in Long-Term Residential Facility\"]\n  union [\"Encounter, Performed\": \"Home Healthcare Services\"]\n  union [\"Encounter, Performed\": \"Patient Provider Interaction\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services, Initial Office Visit, 0 to 17\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services-Initial Office Visit, 18 and Up\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services-Individual Counseling\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services - Group Counseling\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services - Other\"]\n  union [\"Encounter, Performed\": \"Discharge Services - Nursing Facility\"]\n  union [\"Encounter, Performed\": \"Nursing Facility Visit\"]\n  union [\"Encounter, Performed\": \"Annual Wellness Visit\"]\n  union [\"Encounter, Performed\": \"Preventive Care, Established Office Visit, 0 to 17\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services - Established Office Visit, 18 and Up\"]\n  union [\"Encounter, Performed\": \"Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal.\"]\n  union [\"Encounter, Performed\": \"Online Assessments\"]\n  union [\"Encounter, Performed\": \"Telephone Visits\"] ) QualifyingEncounter\n  where QualifyingEncounter.relevantPeriod during \"Measurement Period\"\n\n\"Hemodialysis During Measurement Period\"\n[\"Procedure, Performed\": \"Hemodialysis\"] Hemodialysis\n  where Global.\"NormalizeInterval\" ( Hemodialysis.relevantDatetime, Hemodialysis.relevantPeriod ) overlaps \"Measurement Period\"\n\n\"Peritoneal Dialysis During Measurement Period\"\n[\"Procedure, Performed\": \"Peritoneal Dialysis\"] PeritonealDialysis\n  where Global.\"NormalizeInterval\" ( PeritonealDialysis.relevantDatetime, PeritonealDialysis.relevantPeriod ) overlaps \"Measurement Period\"","Documentation of medical reason(s) for not receiving influenza immunization (e.g., patient allergy, other medical reasons).\nDocumentation of patient reason(s) for not receiving influenza immunization (e.g., patient declined, other patient reasons).\nDocumentation of system reason(s) for not receiving influenza immunization (e.g., vaccine not available, other system reasons).\n\nDenominator Exceptions\nexists \"Medical Patient or System Reason for Not Performing Influenza Vaccination\"\n  or exists \"Medical Patient or System Reason for Not Administering Influenza Vaccine\"\n  or exists \"Diagnosis of Allergy to Egg\"\n  or exists \"Egg Substance Allergy\"\n  or exists \"Diagnosis of Allergy to Influenza Vaccine\"\n  or exists \"Diagnosis of Intolerance to Influenza Vaccine\"\n  or exists \"Intolerance of Influenza Vaccination Procedure\"\n  or exists \"Allergy or Intolerance to Influenza Vaccine","Patients who received an influenza immunization OR who reported previous receipt of an influenza immunization\n\nPer \"Measure Steward Additional Information\", \"Patient self-report for procedures as well as immunizations should be recorded in 'Procedure, Performed' template or 'Immunization, Administered' template in QRDA-1.\"","exists \"Influenza Vaccination Procedure\"\n  or exists \"Influenza Immunization Administered\"\n  or exists \"Influenza Vaccine Previously Received\"\n*For DPP reporting purposes, see below.\nYear 2 Reporting Period 1 (data measurement period: 01/01/22-06/30/22, six months):\n- Report the numerator as individuals who received an influenza immunization OR who reported previous receipt of an influenza immunization within the measurement period, e.g., for denominator encounters in January 2022 – March 2022, the numerator would include influenza immunization received in August 2021 - March 2022. An Individual with multiple eligible encounters during the data measurement period only has to have the numerator met once to be counted as Numerator Performance Met. (See \"Program Specific Modifications\" cell and please note the measure steward's definition of \"Previous Receipt\" in the \"Additional Information\" cell.)\n\nYear 2 Reporting Period 2 (data measurement period: 01/01/22-12/31/22, 12 months):\n- Report the numerator as individuals who received an influenza immunization OR who reported previous receipt of an influenza immunization within the measurement period, e.g., for denominator encounters in January 2022 – March 2022, the numerator would include influenza immunization received in August 2021 - March 2022, and for denominator encounters in October 2022 - December 2022, the numerator would include influenza immunization received in August 2022 - December 2022. An Individual with multiple eligible encounters during the data measurement period only has to have the numerator met once to be counted as Numerator Performance Met. (See \"Program Specific Modifications\" cell and please note the measure steward's definition of \"Previous Receipt\" in the \"Additional Information\" cell.)","None","Please note the measure steward's definition of \"Previous Receipt\" (see the \"Additional Information\" cell).\n\nYear 2 Reporting Period 1 (data measurement period: 01/01/22-06/30/22, six months):\n- Report the denominator as individuals with encounters that fall within the measurement period, e.g., for the data measurement period of 01/01/22-06/30/22, the denominator would include encounters from January 2022 - March 2022. \n- Report the numerator as individuals who received an influenza immunization OR who reported previous receipt of an influenza immunization within the measurement period, e.g., for denominator encounters in January 2022 – March 2022, the numerator would include influenza immunization received in August 2021 - March 2022. An Individual with multiple eligible encounters during the data measurement period only has to have the numerator met once to be counted as Numerator Performance Met.\n\nYear 2 Reporting Period 2 (data measurement period: 01/01/22-12/31/22, 12 months):\n- Report the denominator as individuals with encounters that fall within the measurement period, e.g., for the data measurement period of 01/01/22-12/31/22, the denominator would include encounters from January 2022 - March 2022 and October 2022 - December 2022. \n- Report the numerator as individuals who received an influenza immunization OR who reported previous receipt of an influenza immunization within the measurement period, e.g., for denominator encounters in January 2022 – March 2022, the numerator would include influenza immunization received in August 2021 - March 2022, and for denominator encounters in October 2022 - December 2022, the numerator would include influenza immunization received in August 2022 - December 2022. An Individual with multiple eligible encounters during the data measurement period only has to have the numerator met once to be counted as Numerator Performance Met.","Patient self-report for procedures as well as immunizations should be recorded in 'Procedure, Performed' template or 'Immunization, Administered' template in QRDA-1.\n\nDefinitions: \nPrevious Receipt - receipt of the current season's influenza immunization from another provider OR from same provider prior to the visit to which the measure is applied (typically, prior vaccination would include influenza vaccine given since August 1st)",null,null,null,"Positive"]
["C2-104","CHIRP","C2 (ACIA Rural Hospital Best Practices)","Preventive Care & Screening: Tobacco Use: Screening & Cessation Intervention","Process",null,"01/01/22 - 06/30/22","Numeric Data Reporting & Status Update",null,"01/01/22 - 12/31/22","Numeric Data Reporting & Status Update",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"0028e","NCQA","eCQI (eCQM: CMS138v10)","https://ecqi.healthit.gov/ecqm/ep/2022/cms138v10\nhttps://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS138v10.html","Percentage of patients aged 18 years and older who were screened for tobacco use one or more times during the measurement period AND who received tobacco cessation intervention if identified as a tobacco user. Per the \"HHSC Program Specific Modifications\", for CHIRP reporting purposes, only one rate (Rate 3) is reported (e.g., percentage of patients aged 18 years and older who were screened for tobacco use one or more times during the measurement period AND who received tobacco cessation intervention if identified as a tobacco user).","*HHSC is determining how to align the measure specifications for this measure with CHIRP participants and will provide any measure-specific guidance to impacted CHIRP participants as needed.\n\nAllergy & Immunology; Dermatology; Family Medicine; Internal Medicine; Obstetrics & Gynecology; Ophthalmology; Orthopedic Surgery; Otolaryngology; Physical Medicine & Rehabilitation; Plastic Surgery; Pediatrics (Optional); Preventive Medicine; Psychiatry & Neurology; Neurosurgical Surgery; Surgery; Thoracic Surgery; Urology; Audiologist; Occupational Therapist; Physical Therapist; Podiatrist; Social Worker; Speech Language Pathologist; Urgent Care","Individuals","*HHSC is determining how to align the measure specifications for this measure with CHIRP participants and will provide any measure-specific guidance to impacted CHIRP participants as needed.\n\nAll patients aged 18 years and older seen for at least two visits or at least one preventive visit during the measurement period","\"Initial Population\"\nexists ( [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n    where Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) >= 18)\n  and ( Count(\"Qualifying Visit During Measurement Period\")>= 2\n      or exists \"Preventive Visit During Measurement Period\")\n\n\"Qualifying Visit During Measurement Period\"\n( [\"Encounter, Performed\": \"Health behavior intervention, individual, face-to-face; initial 30 minutes\"]\n  union [\"Encounter, Performed\": \"Health behavior assessment, or re-assessment (ie, health-focused clinical interview, behavioral observations, clinical decision making)\"]\n  union [\"Encounter, Performed\": \"Home Healthcare Services\"]\n  union [\"Encounter, Performed\": \"Occupational Therapy Evaluation\"]\n  union [\"Encounter, Performed\": \"Office Visit\"]\n  union [\"Encounter, Performed\": \"Ophthalmological Services\"]\n  union [\"Encounter, Performed\": \"Physical Therapy Evaluation\"]\n  union [\"Encounter, Performed\": \"Psych Visit - Diagnostic Evaluation\"]\n  union [\"Encounter, Performed\": \"Psych Visit - Psychotherapy\"]\n  union [\"Encounter, Performed\": \"Psychoanalysis\"]\n  union [\"Encounter, Performed\": \"Speech and Hearing Evaluation\"]\n  union [\"Encounter, Performed\": \"Telephone Visits\"]\n  union [\"Encounter, Performed\": \"Online Assessments\"] ) OfficeBasedEncounter\n  where OfficeBasedEncounter.relevantPeriod during \"Measurement Period\"\n\n\"\"Preventive Visit During Measurement Period\"\n( [\"Encounter, Performed\": \"Annual Wellness Visit\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services - Established Office Visit, 18 and Up\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services - Group Counseling\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services - Other\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services-Individual Counseling\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services-Initial Office Visit, 18 and Up\"] ) PreventiveEncounter\n  where PreventiveEncounter.relevantPeriod during \"Measurement Period\"","Documentation of medical reason(s) for not screening for tobacco use OR for not providing tobacco cessation intervention for patients identified as tobacco users (e.g., limited life expectancy, other medical reason)\n\nexists \"Medical Reason for Not Screening for Tobacco Use\"\n  or exists \"Medical Reason for Not Counseling Tobacco User\"\n  or exists \"Medical Reason for Not Ordering Tobacco Cessation Pharmacotherapy\"\n  or \"Has Limited Life Expectancy\"","Patients who were screened for tobacco use at least once during the measurement period AND who received tobacco cessation intervention if identified as a tobacco user. Per the \"HHSC Program Specific Modifications\", for CHIRP reporting purposes, only one rate (Rate 3) is reported (e.g., percentage of patients aged 18 years and older who were screened for tobacco use one or more times during the measurement period AND who received tobacco cessation intervention if identified as a tobacco user).","Criteria 3\n\"Most Recent Tobacco Use Screening Indicates Tobacco Non User\" is not null\n  or ( \"Most Recent Tobacco Use Screening Indicates Tobacco User\" is not null\n      and ( exists \"Tobacco Cessation Counseling Given\"\n          or exists \"Tobacco Cessation Pharmacotherapy Ordered\"\n          or exists \"Active Pharmacotherapy for Tobacco Cessation\"))","None","*HHSC is determining how to align the measure specifications for this measure with CHIRP participants and will provide any measure-specific guidance to impacted CHIRP participants as needed.\n\nFor CHIRP reporting purposes, only one rate (Rate 3) is reported (e.g., percentage of patients aged 18 years and older who were screened for tobacco use one or more times during the measurement period AND who received tobacco cessation intervention if identified as a tobacco user).","Definitions:\nTobacco Use - Includes any type of tobacco\nTobacco Cessation Intervention - Includes brief counseling (3 minutes or less), and/or pharmacotherapy -- Note: Concepts aligned with brief counseling (e.g., minimal and intensive advice/counseling interventions conducted both in person and over the phone) are included in the value set for the numerator. Other concepts such as written self-help materials (e.g., brochures, pamphlets) and complementary/alternative therapies are not included in the value set and do not qualify for the numerator. Brief counseling also may be of longer duration or be performed more frequently, as evidence shows there is a dose-response relationship between the intensity of counseling provided (either length or frequency) and tobacco cessation rates (U.S. Preventive Services Task Force, 2015).\n\nGuidance: \nThe requirement of two or more visits is to establish that the eligible professional or eligible clinician has an existing relationship with the patient for certain types of encounters. \n\nTo satisfy the intent of this measure, a patient must have at least one tobacco use screening during the measurement period. If a patient has multiple tobacco use screenings during the measurement period, only the most recent screening, which has a documented status of tobacco user or tobacco non-user, will be used to satisfy the measure requirements.\n\nIf a patient uses any type of tobacco (i.e., smokes or uses smokeless tobacco), the expectation is that they should receive tobacco cessation intervention: either counseling and/or pharmacotherapy.\n\nAs noted above in a recommendation statement from the USPSTF, the current evidence is insufficient to recommend electronic nicotine delivery systems (ENDS) including electronic cigarettes for tobacco cessation. Additionally, ENDS are not currently classified as tobacco in the recent evidence review to support the update of the USPSTF recommendation given that the devices do not burn or use tobacco leaves. In light of the current lack of evidence, the measure does not currently capture e-cigarette usage as either tobacco use or a cessation aid.\n\nIf tobacco use status of a patient is unknown, the patient does not meet the screening component required to be counted in the numerator and should be considered a measure failure. Instances where tobacco use status of \"unknown\" is recorded include: 1) the patient was not screened; or 2) the patient was screened and the patient (or caregiver) was unable to provide a definitive answer. If the patient does not meet the screening component of the numerator but has an allowable medical exception, then the patient should be removed from the denominator of the measure and reported as a valid exception.\n\nIn order to promote a team-based approach to patient care, the tobacco cessation intervention can be performed by another healthcare provider; therefore, the tobacco use screening and tobacco cessation intervention do not need to be performed by the same provider or clinician.   \n\nThe medical reason exception may be applied to either the screening data element OR to any of the applicable tobacco cessation intervention data elements (counseling and/or pharmacotherapy) included in the measure. \n\nIf a patient has a diagnosis of limited life expectancy, that patient has a valid denominator exception for not being screened for tobacco use or for not receiving tobacco use cessation intervention (counseling and/or pharmacotherapy) if identified as a tobacco user.\n\nThis measure contains three reporting rates which aim to identify patients who were screened for tobacco use (rate/population 1), patients who were identified as tobacco users and who received tobacco cessation intervention (rate/population 2), and a comprehensive look at the overall performance on tobacco screening and cessation intervention (rate/population 3). By separating this measure into various reporting rates, the eligible professional or eligible clinician will be able to better ascertain where gaps in performance exist, and identify opportunities for improvement. The overall rate (rate/population 3) can be utilized to compare performance to published versions of this measure prior to the 2018 performance year, when the measure had a single performance rate. For accountability reporting in the CMS MIPS program, the rate for population 2 is used for performance.\n \nThe denominator of population criteria 2 is a subset of the resulting numerator for population criteria 1, as population criteria 2 is limited to assessing if patients identified as tobacco users received an appropriate tobacco cessation intervention. For all patients, population criteria 1 and 3 are applicable, but population criteria 2 will only be applicable for those patients who are identified as tobacco users. Therefore, data for every patient that meets the initial population criteria will only be submitted for population 1 and 3, whereas data submitted for population 2 will be for a subset of patients who meet the initial population criteria, as the denominator has been further limited to those who were identified as tobacco users.\n\nThis eCQM is a patient-based measure.",null,null,null,"Positive"]
["C2-128","CHIRP","C2 (ACIA Maternal Care)","AIM Collaborative Participation","Structure",null,"NA","Status Update Only",null,"NA","Status Update Only",null,"NA",null,null,null,null,null,"NA","NA","NA","NA","Reporting on status of participating in the available Texas AIM Collaboratives. ","NA","NA",null,null,null,null,null,null,null,null,null,null,null,"N/A"]
["C2-129","CHIRP","C2 (ACIA Maternal Care)","Severe Maternal Morbidity","Outcome",null,"01/01/22 - 06/30/22","Numeric Data Reporting & Status Update",null,"01/01/22 - 12/31/22","Numeric Data Reporting & Status Update",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"NA","AIM","AIM (2021 AIM SMM Codes List: v08-09-2021)","https://safehealthcareforeverywoman.org/aim/resources/aim-data-resources/","The percentage of mothers who experience Severe Maternal Morbidity (SMM)","NA","Encounters","All mothers during their birth admission","Exclude ectopics and miscarriages ",null,"Among the denominator, all cases with any SMM code",null,null,null,"See 2021 AIM SMM Codes List: https://safehealthcareforeverywoman.org/aim/resources/aim-data-resources/\n",null,null,null,"Negative"]
["C2-130","CHIRP","C2 (ACIA Maternal Care)","PC-02 Cesarean Section","Outcome",null,"01/01/22 - 06/30/22","Numeric Data Reporting & Status Update",null,"01/01/22 - 12/31/22","Numeric Data Reporting & Status Update",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"0471","The Joint Commission","TJC (PC-02/ePC-02 2021) ","ePC-02 (E.H.R. abstracted): https://www.jointcommission.org/-/media/tjc/documents/measurement/specification-manuals/2021-reporting-period/ecqm_specifications_reportingperiod_2021.zip\nPC-02 (chart abstracted): https://manual.jointcommission.org/releases/TJC2021A/MIF0167.html","Nulliparous women with a term, singleton baby in a vertex position delivered by cesarean birth","NA","Encounters","Nulliparous patients with an ICD-10-CM Principal or Other Diagnosis Code for outcome of delivery as defined in Appendix A, Table 11.08 and with a delivery of a newborn with 37 weeks or more gestation completed or with an ICD-10-PCS Principal or Other Procedure Codes for delivery as defined in Appendix A, Tables 11.01.1.",null,"• ICD-10-CM Principal Diagnosis Code or ICD-10-CM Other Diagnosis Codes for multiple gestations and other presentations as defined in Appendix A, Table 11.09\n• Less than 8 years of age\n• Greater than or equal to 65 years of age\n• Length of Stay >120 days\n• Gestational Age < 37 weeks or UTD","Patients with cesarean births with ICD-10-PCS Principal Procedure Code or ICD-10-PCS Other Procedure Codes for cesarean birth as defined in Appendix A, Table 11.06.",null,null,"Chart abstracted measures are included in the CHIRP specifications, as well as a link to the eCQI e-measure. Hospitals may use either the chart abstracted measure or the eCQI e-measure to align with their existing TJC reporting infrastructure. Hospitals should indicate which version of the measure is utilized at the time of CHIRP reporting. ",null,null,null,null,"Negative"]
["C2-131","CHIRP","C2 (ACIA Hospital Safety)","Hospital Safety Collaborative Participation","Structure",null,"09/01/21 - 08/31/22","Status Update Only",null,"NA","Status Update Only",null,"NA",null,null,null,null,null,"NA","NA","NA","NA","Reporting on status of participating in a hospital safety collaborative. A Hospital Safety Learning Collaborative is any conference, workshop, stakeholder forum, stakeholder meeting related to improving hospital safety. It may take place anywhere, not only in the provider’s SDA, and events may be virtual or in person. ","NA","NA",null,null,null,null,null,null,null,null,null,null,null,"N/A"]
["C2-132","CHIRP","C2 (ACIA Hospital Safety)","Catheter-Associated Urinary Tract Infection (CAUTI) Outcome Measure","Outcome",null,"01/01/22 - 06/30/22","Numeric Data Reporting & Status Update",null,"01/01/22 - 12/31/22","Numeric Data Reporting & Status Update",null,"All payer",null,null,null,null,null,"0138","CDC","CDC/NHSN (January 2022)","https://www.cdc.gov/nhsn/pdfs/pscmanual/pcsmanual_current.pdf","This measure calculates the total number of healthcare-associated CAUTI among patients in bedded inpatient care locations, from the total number of indwelling urinary catheter days for each location under surveillance for CAUTI during the associated data period. This measure is risk-adjusted.","NA","Encounters","Total number of predicted healthcare-associated CAUTI among inpatient care locations under surveillance for CAUTI during the data period, based on the national CAUTI baseline Data is calculated using the facility's number of catheter days and the following significant risk factors: Acute Care Hospitals: CDC Location, Facility bed size, Medical school affiliation, and Facility type Critical Access Hospitals: Medical school affiliation Long-Term Acute Hospitals: Average length of stay, Setting type, and Location type Inpatient Rehabilitation Facilities: Setting type, Proportion of admissions with traumatic and non-traumatic spinal cord dysfunction, Proportion of admissions with stroke",null,null,"Total number of observed healthcare-associated CAUTI among patients in bedded inpatient care locations (excluding patients in Level II or III neonatal ICUs).",null,null,null,"Use the SIR – CAU Data for Hospital IQR report used for NHSN reporting, which includes only units reported to CMS. ",null,null,null,"Negative",null,null,null,null,null,null,null,"Measure is reported as a Standardized Infection Ratios (SIR), where the numerator is reported as the number of actual observed infections, and the denominator is reported as the number of predicted infections (as calculated by National Healthcare Safety Network [NHSN]). Do not report the denominator using rounding."]
["C2-133","CHIRP","C2 (ACIA Hospital Safety)","Central Line Associated Bloodstream Infection (CLABSI) Outcome Measure","Outcome",null,"01/01/22 - 06/30/22","Numeric Data Reporting & Status Update",null,"01/01/22 - 12/31/22","Numeric Data Reporting & Status Update",null,"All payer",null,null,null,null,null,"0139","CDC","CDC/NHSN (January 2022)","https://www.cdc.gov/nhsn/pdfs/pscmanual/pcsmanual_current.pdf","Standardized Infection Ratio (SIR) of healthcare-associated, central line-associated bloodstream infections (CLABSI) will be calculated among patients in bedded inpatient care locations.","NA","Encounters","Total number of predicted healthcare-associated CLABSI among patients in bedded inpatient care locations, calculated using the facility's number of central line days and the following significant risk factors: - Acute Care Hospitals: CDC location, facility bed size, medical school affiliation, facility type, birthweight category (NICU locations only) - Critical Access Hospitals: no significant risk factors, calculation based intercept only model - Inpatient Rehabilitation Facilities: Proportion of admissions with stroke, proportion of admissions in other non-specific diagnostic categories - Long Term Acute Care Hospitals: CDC location type , facility bed size, average length of stay, proportion of admissions on a ventilator, proportion of admissions on hemodialysis",null,null,"Total number of observed healthcare-associated CLABSIs among patients in bedded inpatient care locations.",null,null,null,"Use the SIR – CLAB Data for Hospital IQR report used for NHSN reporting, which includes only units reported to CMS. \n",null,null,null,"Negative",null,null,null,null,null,null,null,"Measure is reported as a Standardized Infection Ratios (SIR), where the numerator is reported as the number of actual observed infections, and the denominator is reported as the number of predicted infections (as calculated by National Healthcare Safety Network [NHSN]). Do not report the denominator using rounding."]
["C2-134","CHIRP","C2 (ACIA Hospital Safety)","Facility-wide Inpatient Hospital-onset Clostridium difficile Infection (CDI) Outcome Measure","Outcome",null,"01/01/22 - 06/30/22","Numeric Data Reporting & Status Update",null,"01/01/22 - 12/31/22","Numeric Data Reporting & Status Update",null,"All payer",null,null,null,null,null,"1717","CDC","CDC/NHSN (January 2022)","https://www.cdc.gov/nhsn/pdfs/pscmanual/pcsmanual_current.pdf","This measure calculates the total number of observed hospital-onset CDI LabID events among all inpatients in the facility, excluding well baby-nurseries and NICUs, from the total number of expected hospital-onset CDI LabID events, determined through the facility's number of inpatient days, bed size, affiliation with a medical school, microbiological test used to identify C. difficile, and community onset CDI admission prevalence rate.","NA","Encounters","Total number of predicted hospital-onset CDI LabID events, calculated using the facility's number of inpatient days, facility type, CDI event reporting from Emergency Department and 24 hour observation units, bed size, ICU bed size, affiliation with medical school, microbiological test method used to identify C. difficile, and community-onset CDI admission prevalence rate.",null,null,"Total number of observed hospital-onset CDI LabID events among all inpatients in the facility, excluding well baby-nurseries and NICUs",null,null,null,null,null,null,null,"Negative",null,null,null,null,null,null,null,"Measure is reported as a Standardized Infection Ratios (SIR), where the numerator is reported as the number of actual observed infections, and the denominator is reported as the number of predicted infections (as calculated by National Healthcare Safety Network [NHSN]). Do not report the denominator using rounding."]
["C2-135","CHIRP","C2 (ACIA Hospital Safety)","Harmonized Procedure Specific Surgical Site Infection (SSI) Outcome Measure","Outcome",null,"01/01/22 - 06/30/22","Numeric Data Reporting & Status Update",null,"01/01/22 - 12/31/22","Numeric Data Reporting & Status Update",null,"All payer",null,null,null,null,null,"0753","CDC","CDC/NHSN (January 2022)","https://www.cdc.gov/nhsn/pdfs/pscmanual/pcsmanual_current.pdf","Facility adjusted Standardized Infection Ratio (SIR) for deep incisional and organ/space Surgical Site Infections (SSI) at the primary incision site among adult patients aged >= 18 years as reported through the CDC National Health and Safety Network (NHSN).","NA","Encounters","An NHSN Operative Procedure is a procedure: that is included in the ICD-10-PCS or CPT NHSN operative procedure code mapping. And takes place during an operation where at least one incision (including laparoscopic approach and cranial Burr holes) is made through the skin or mucous membrane, or reoperation via an incision that was left open during a prior operative procedure And takes place in an operating room (OR), defined as a patient care area that met the Facilities Guidelines Institute s (FGI) or American Institute of Architects (AIA) criteria for an operating room when it was constructed or renovated. This may include an operating room, C-section room, interventional radiology room, or a cardiac catheterization lab. Exclusions: Otherwise eligible procedures that are assigned an ASA score of 6 are not eligible for NHSN SSI surveillance.",null,null,"Deep incisional primary (DIP) and organ/space SSIs during the 30-day postoperative period among patients = 18 years of age, who undergo inpatient colon surgeries or abdominal hysterectomies. SSIs will be identified before discharge from the hospital, upon readmission to the same hospital, or during outpatient care or admission to another hospital (post-discharge surveillance). Numerator Exclusion SSI events with PATOS* field = yes.",null,null,null,"Use the Complex 30 day SSI data for Hospital IQR or Hospital IPPS report from NHSN reporting.  This report is also known as the CMS model using 2015 baseline which would be for reporting hysterectomy and colon procedures.  The HHSC reporting template will ask for the number of infections observed and predicted for each of the two procedures, and then a calculator will appropriately combine them into a pooled rate.   ",null,null,null,"Negative",null,null,null,null,null,null,null,"Measure is reported as a Standardized Infection Ratios (SIR), where the numerator is reported as the number of actual observed infections for the two types of procedures (colon and hysterectomy), and the denominator is reported as the number of predicted infections for the two types of procedures (colon and hysterectomy) as calculated by National Healthcare Safety Network (NHSN). Do not report the denominator using rounding. The “Complex 30-day SSI data for Hospital IQR” or the “Hospital IPPS report from NHSN” reporting must be used to calculate the denominator; this report is also known as the “CMS model using 2015 baseline”, which would be used for reporting the colon and hysterectomy procedures."]
["C2-155","CHIRP","C2 (ACIA Pediatric)","Pediatric SSI","Outcome",null,"01/01/22 - 06/30/22","Numeric Data Reporting & Status Update",null,"01/01/22 - 12/31/22","Numeric Data Reporting & Status Update",null,"All payer",null,null,null,null,null,"NA","Children’s Hospitals’ Solutions for Patient Safety National Children’s Network","CHSPS (2021)","https://www.solutionsforpatientsafety.org/wp-content/uploads/sps-operating-definitions_November-2021-1.pdf","This measure answers the question: How often is a patient harmed due to surgical site infection following selected surgeries?","NA","Encounters","Number of designated surgical procedures during the applicable reporting period. Three surgery categories are considered for this measurement. ","All patients who experience one of the below surgical procedures:\n Spinal fusion surgeries as defined by NHSN (FUSN).\n Procedures such as growing construct placements and adjustments should be included if a facility routinely uses CPT or ICD-10 codes included in the FUSN category for such procedures.\n Neurosurgical shunt surgeries as defined by NHSN (VSHN)\n Procedures such as third ventriculostomy and external ventricular drain placement are included even though technically these are not shunt procedures.\n The CPT code 44055 (correction of malrotation) should be used only if the procedure involves a ventricular shunt.\n Cardiothoracic surgeries as defined by NHSN (CARD)","Patients with physician/advanced practice nurse/physician assistant documentation of an active infection at the time of the surgical procedure.\n Detailed criteria for an infection at time of surgery (PATOS) is available in the NHSN Manual (link above).\n Signs/symptoms of infection can include but not be limited to: fever, ","Number of SSIs related to designated surgical procedures.","Surgical Site Infection Definitions:\n\n Superficial Incisional SSI\nInfection occurs within 30 days of the operative procedure (procedure date is day\n1) AND involves only skin and subcutaneous tissue of the incision AND patient\nhas at least one of the following:\na. purulent drainage from the superficial incision.\nb. organisms identified from an aseptically-obtained specimen from the superficial incision or subcutaneous tissue by a culture or non-culture based microbiologic testing method which is performed for purposes of clinical diagnosis or treatment (for example, not Active Surveillance Culture/Testing (ASC/AST).\nc. superficial incision that is deliberately opened by a surgeon, attending physician or other designee and culture or non-culture based testing is not performed, AND patient has at least one of the following signs or symptoms: pain or tenderness; localized swelling; erythema; or heat.\nd. diagnosis of a superficial incisional SSI by the surgeon or attending physician or other designee.\nNote: The following do not meet the superficial SSI definition: Diagnosis or treatment of cellulitis (redness/warmth/swelling) by itself; stitch abscess alone (minimal inflammation and discharge confined to the points of suture penetration); localized stab wound or pin site infection\n\n Deep Incisional SSI\nInfection occurs within 90 days AND involves deep soft tissues (e.g., fascial and muscle layers) of the incision AND patient has at least one of the following:\na. purulent drainage from the deep incision.\nb. a deep incision spontaneously dehisces or is deliberately opened by a surgeon, attending physician, or other designee  and organism is identified by culture or non-culture based microbiologic testing method which is performed for purposes of clinical diagnosis or treatment or culture or non-culture based microbiologic testing method is not performed and the patient has at least one of the following signs or symptoms: fever (>38°C); localized pain or tenderness. A culture or non-culture-based test that has a negative finding does not meet this criterion.\nc. an abscess or other evidence of infection involving the deep incision that is detected on gross anatomical or histopathologic exam, or imaging test.\n\n Organ/Space SSI\nInfection occurs within 90 days after the operative procedure AND infection involves any part of the body deeper than the fascial/muscle layers that is opened or manipulated during the operative procedure AND patient has at least one of the following:\na. Purulent drainage from a drain that is placed in the organ/space (for example, closed suction drainage system, open drain, T-tube drain, CT guided drainage)\nb. organisms are identified from fluid or tissue in the organ/space by a culture or non-culture based microbiologic testing method which is performed for purposes of clinical diagnosis or treatment\nc. An abscess or other evidence of infection involving the organ/space that is detected on gross anatomical or histopathologic exam, or imaging test evidence suggestive of infection. And Meets at least one criterion for a specific organ/space infection site (listed in Table 3, NHSN Manual, http://www.cdc.gov/nhsn/PDFs/pscManual/9pscSSIcurrent.pdf)",null,null,null,null,null,null,"Negative"]
["C2-156","CHIRP","C2 (ACIA Pediatric)","Hospital Safety Collaborative Participation","Structure",null,"09/01/21 - 08/31/22","Status Update Only",null,"NA","Status Update Only",null,"NA",null,null,null,null,null,"NA","NA","NA","NA","Reporting on status of participation in a pediatric hospital safety collaborative ","NA","NA",null,null,null,null,null,null,null,null,null,null,null,"N/A"]
["C2-157","CHIRP","C2 (ACIA Pediatric)","Pediatric Adverse Drug Events","Outcome",null,"01/01/22 - 06/30/22","Numeric Data Reporting & Status Update",null,"01/01/22 - 12/31/22","Numeric Data Reporting & Status Update",null,"All payer",null,null,null,null,null,"NA","Children’s Hospitals’ Solutions for Patient Safety National Children’s Network","CHSPS (2021)","https://www.solutionsforpatientsafety.org/wp-content/uploads/sps-operating-definitions_November-2021-1.pdf","This measure answers the question: How often is a patient harmed due to failure to procure (not related to a drug shortage), store, prescribe, dispense, administer, or monitor medication as intended?","NA","Encounters","Total number patient days. ","All patients are included who are defined as inpatient or under observation at the hospital.","Enteral feeds are not counted as drug errors.\nBlood products are not counted as drug errors.","Number of adverse drug events per NCC MERP’s Index for Categorizing Medication Errors.\nNumerators will be reported as Level E and combined Level F-I as defined below.\nE = An error occurred that may have contributed to or resulted in temporary harm to the patient and required intervention\nF = An error occurred that may have contributed to or resulted in temporary harm to the patient and required initial or prolonged hospitalization\nG = An error occurred that may have contributed to or resulted in permanent patient harm\nH = An error occurred that required intervention necessary to sustain life\nI = An error occurred that contributed to or resulted in the patient’s death",null,null,null,"NCC MERP Medication Error Index: https://www.nccmerp.org/types-medication-errors",null,null,null,"Negative"]
["C2-158","CHIRP","C2 (ACIA Pediatric)","Pediatric CLABSI","Outcome",null,"01/01/22 - 06/30/22","Numeric Data Reporting & Status Update",null,"01/01/22 - 12/31/22","Numeric Data Reporting & Status Update",null,"All payer",null,null,null,null,null,"NA","Children’s Hospitals’ Solutions for Patient Safety National Children’s Network","CHSPS (2021)","https://www.solutionsforpatientsafety.org/wp-content/uploads/sps-operating-definitions_November-2021-1.pdf","This measure answers the question: How often is a patient harmed due to central line associated blood stream infections (CLABSIs)?","NA","Encounters","Total number of central line days during the time period.","All patients are included who are defined as inpatient or under observation at the hospital including one calendar day post discharge (including the CLABSIs related to Mucosal Barrier Injuries (MBIs)).","Infection must not be present on admission into the hospital as defined by NHSN. For most infections, this means that the infection does not become evident until two calendar days or more after admission, but each infection must be assessed individually.","Number of patients with a CLABSI event, as defined by CDC guidelines. For this measure, distinction is not made between an infection due to CVC/PICC insertion and one due to maintenance practices.",null,null,null,null,null,null,null,"Negative"]
["C2-159","CHIRP","C2 (ACIA Pediatric)","Pediatric CAUTI","Outcome",null,"01/01/22 - 06/30/22","Numeric Data Reporting & Status Update",null,"01/01/22 - 12/31/22","Numeric Data Reporting & Status Update",null,"All payer",null,null,null,null,null,"NA","Children’s Hospitals’ Solutions for Patient Safety National Children’s Network","CHSPS (2021)","https://www.solutionsforpatientsafety.org/wp-content/uploads/sps-operating-definitions_November-2021-1.pdf","This measure answers the question: How often are patients harmed by the occurrence of a catheter associated urinary tract infections?","NA","Encounters","Total number of indwelling urinary catheter days during the time period.","All patients admitted to an inpatient unit are included who are defined as inpatient or under observation at the hospital with an indwelling urinary catheter.","Observation patients admitted to observation units and patients admitted to neonatal intensive care units will be excluded. \n\nInfection must not be incubating at the time of the admission into the hospital. For most infections, this means that the infection does not become evident until 48 hours or more after admission, but each infection must be assessed individually. There is no minimum period of time that the catheter must be in place in order for the UTI to be considered catheter associated. ","Number of patients contracting an infection, as defined by CDC guidelines.",null,null,null,null,null,null,null,"Negative"]
["C2-160","CHIRP","C2 (ACIA Pediatric)","Engagement in Integrated Behavioral Health","Process",null,"01/01/22 - 06/30/22","Numeric Data Reporting & Status Update",null,"01/01/22 - 12/31/22","Numeric Data Reporting & Status Update",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"NA","Texas HHSC (Developed by Meadows Mental Health Policy Institute)","NA","NA","The percentage of children or youth initiating behavioral health care who received, or whose caregivers received, at least one follow-up behavioral health care or care management contact within 30 days of initiating behavioral health contact.","NA","Individuals","The unduplicated number of children and youth who were documented in the electronic health record as having had an initial behavioral health service or contact (in-person, virtual, or telephonic).","Behavioral health contact can include an assessment, a treatment session, or any other type of contact that had a behavioral health focus and that was documented in the clinical record.","Children/youth and caregivers/families who refused subsequent behavioral health care or other assistance that was offered at the initial behavioral health contact, and for whom such refusal was documented in the clinical record, should be excluded from the analysis.","The unduplicated number of children or youth who received, or whose caregivers received, a second contact (in-person, virtual, or telephonic) from a behavioral health provider, care coordinator, or care manager within 30 days of initial behavioral health contact, as documented in the electronic health record.",null,null,null,"For individuals who have multiple denominator eligible encounters, “initial encounter\" is defined as the first encounter within the measurement period.",null,null,null,"Positive"]
["C2-141","CHIRP","C2 (ACIA Psychiatric Care Transitions)","Written transition procedures that include formal MCO relationship or EDEN notification/ ADT Feed for psychiatric patients\n","Structure",null,"NA","Status Update Only",null,"NA","Status Update Only",null,"NA",null,null,null,null,null,"NA","NA","NA","NA","Reporting on status of developing and implementing standard operating policies and procedures for providing a member's managed care plan with expedient notification of admission, transfer, or discharge from hospitalization for psychiatric illness. \n\nNotification can use any format (electronic data exchange, phone call, fax, secure email, etc), the question is whether there is a standardized procedure across the organization that staff are expected to follow. If an organization uses an HIE or EHR that automatically transmits notifications to MCOs when medical data is entered into the EHR, then having standard operating procedures for entering patient data into the EHR is also considered the standardized procedure for notifying the MCO.   ","NA","NA",null,null,null,null,null,null,null,null,null,null,null,"N/A"]
["C2-142","CHIRP","C2 (ACIA Care Transitions)","Written transition procedures that include formal MCO relationship or EDEN notification/ ADT Feed for non-psychiatric patients","Structure",null,"NA","Status Update Only",null,"NA","Status Update Only",null,"NA",null,null,null,null,null,"NA","NA","NA","NA","Reporting on status of developing and implementing standard operating policies and procedures for providing a member's managed care plan with expedient notification of admission, transfer, or discharge from hospitalization. \n\nNotification can use any format (electronic data exchange, phone call, fax, secure email, etc), the question is whether there is a standardized procedure across the organization that staff are expected to follow. If an organization uses an HIE or EHR that automatically transmits notifications to MCOs when medical data is entered into the EHR, then having standard operating procedures for entering patient data into the EHR is also considered the standardized procedure for notifying the MCO.   ","NA","NA",null,null,null,null,null,null,null,null,null,null,null,"N/A"]
["R1-101","RAPPS","R1","Care team includes personnel in a care coordination role not requiring clinical licensure","Structure",null,"NA","Status Update Only",null,"NA","Status Update Only",null,"NA",null,null,null,null,null,"NA","NA","NA","NA","Reporting of care team composition, number of encounters performed by personnel in a care coordination role not requiring clinical licensure (e.g., community health workers, promotor(a)s, any social workers that are not a licensed clinical social worker, patient navigators, and medical assistants that perform care coordination)","NA","NA",null,null,null,null,null,null,null,null,null,null,null,"N/A",null,null,null,null,null,null,null,"A care coordination role typically involves functions or responsibilities to review a client’s care plan to proactively confirm that any needed appointments, specialty services, labs, tests, and community resources are being coordinated and completed. Examples of personnel not requiring clinical licensure AND who may be performing a care coordination role typically include community health workers, promotor(a)s, any social workers that are not a licensed clinical social worker, patient navigators, and medical assistants."]
["R1-143","RAPPS","R1","Telehealth to provide virtual medical appointments with a primary care or specialty care provider ","Structure",null,"NA","Status Update Only",null,"NA","Status Update Only",null,"NA",null,null,null,null,null,"NA","NA","NA","NA","Reporting on usage of telehealth to provide virtual medical appointments with a primary care or specialty care provider ","NA","NA",null,null,null,null,null,null,null,null,null,null,null,"N/A"]
["R1-144","RAPPS","R1","Use of electronic health record (EHR)","Structure",null,"NA","Status Update Only",null,"NA","Status Update Only",null,"NA",null,null,null,null,null,"NA","NA","NA","NA","Reporting on use of electronic health record (EHR)","NA","NA",null,null,null,null,null,null,null,null,null,null,null,"N/A"]
["R2-102","RAPPS","R2","Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Poor Control (>9.0%)","Outcome (Intermediate)",null,"01/01/22 - 06/30/22","Numeric Data Reporting & Status Update",null,"01/01/22 - 12/31/22","Numeric Data Reporting & Status Update",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"0059","NCQA","eCQI (eCQM: CMS 122v10)","https://ecqi.healthit.gov/ecqm/ep/2022/cms122v10\nhttps://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS122v10.html","Percentage of patients 18-75 years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period","Family Medicine; Internal Medicine; Pediatrics (Optional); Preventive Medicine; Dietician, Registered","Individuals","Patients 18-75 years of age with diabetes with a visit during the measurement period","\"Initial Population\"\nexists ( [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n\t\twhere Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) in Interval[18, 75 ))\n\tand exists ( AdultOutpatientEncounters.\"Qualifying Encounters\" union \"Telehealth Services\")\n\tand exists ( [\"Diagnosis\": \"Diabetes\"] Diabetes \n\t\twhere Diabetes.prevalencePeriod overlaps \"Measurement Period\")\n\nAdultOutpatientEncounters.\"Qualifying Encounters\"\n( [\"Encounter, Performed\": \"Office Visit\"]\n  union [\"Encounter, Performed\": \"Annual Wellness Visit\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services - Established Office Visit, 18 and Up\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services-Initial Office Visit, 18 and Up\"]\n  union [\"Encounter, Performed\": \"Home Healthcare Services\"] ) ValidEncounter\n  where ValidEncounter.relevantPeriod during \"Measurement Period\"\n\n\"Telehealth Services\"\n[\"Encounter, Performed\": \"Telephone Visits\"] TelehealthEncounter\n  where TelehealthEncounter.relevantPeriod during \"Measurement Period\"","Exclude patients who are in hospice care for any part of the measurement period.\nExclude patients 66 and older who are living long term in an institution for more than 90 consecutive days during the measurement period.\nExclude patients 66 and older with an indication of frailty for any part of the measurement period who meet any of the following criteria:\n- Advanced illness with two outpatient encounters during the measurement period or the year prior\n- OR advanced illness with one inpatient encounter during the measurement period or the year prior\n- OR taking dementia medications during the measurement period or the year prior\nExclude patients receiving palliative care during the measurement period.","Patients whose most recent HbA1c level (performed during the measurement period) is >9.0% or is missing, or was not performed during the measurement period.","\"Has Most Recent Elevated Hba1c\"\n\tor \"Has Most Recent HbA1c Without Result\"\n\tor \"Has No Record Of HbA1c\"\n\nLast([\"Laboratory Test, Performed\": \"HbA1c Laboratory Test\"] HighHbA1c\n\t\twhere HighHbA1c.relevantPeriod during \"Measurement Period\" and HighHbA1c.result is not null\n\t\tsort by resultDatetime).result > 9 '%'\n \nLast([\"Laboratory Test, Performed\": \"HbA1c Laboratory Test\"] HbA1cNoResult\n\t\twhere HbA1cNoResult.relevantPeriod during \"Measurement Period\"\n\t\tsort by resultDatetime).result is null\n \nnot exists [\"Laboratory Test, Performed\": \"HbA1c Laboratory Test\"] NoHbA1c\n\t\twhere NoHbA1c.relevantPeriod during \"Measurement Period\"","None",null,"If the HbA1c test result is in the medical record, the test can be used to determine numerator compliance.\nOnly patients with a diagnosis of Type 1 or Type 2 diabetes should be included in the denominator of this measure; patients with a diagnosis of secondary diabetes due to another condition should not be included.\nThis eCQM is a patient-based measure.\nThis version of the eCQM uses QDM version 5.5.  Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.\nAdditional definitions of advanced illness and frailty are available in the measure source: https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS122v9.html#d1e767.",null,null,null,"Negative"]
["R2-103","RAPPS","R2","Preventive Care and Screening: Influenza Immunization ","Process",null,"01/01/22 - 06/30/22","Numeric Data Reporting & Status Update",null,"01/01/22 - 12/31/22","Numeric Data Reporting & Status Update",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"0041e","NCQA","eCQI (eCQM: CMS147v11)","https://ecqi.healthit.gov/ecqm/ep/2022/cms147v11\nhttps://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS147v11.html","Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization","Allergy & Immunology; Family Medicine; Internal Medicine; Obstetrics & Gynecology; Otolaryngology; Pediatrics; Preventive Medicine","Individuals","All patients aged 6 months and older, seen for a visit during the measurement period, and seen for a visit between October 1 and March 31\n*For DPP reporting purposes, see below.\nYear 2 Reporting Period 1 (data measurement period: 01/01/22-06/30/22, six months):\n- Report the denominator as individuals with encounters that fall within the measurement period, e.g., for the data measurement period of 01/01/22-06/30/22, the denominator would include encounters from January 2022 - March 2022. (See \"HHSC Program Specific Modifications\" cell).\n\nYear 2 Reporting Period 2 (data measurement period: 01/01/22-12/31/22, 12 months):\n- Report the denominator as individuals with encounters that fall within the measurement period, e.g., for the data measurement period of 01/01/22-12/31/22, the denominator would include encounters from January 2022 - March 2022 and October 2022 - December 2022. (See \"HHSC Program Specific Modifications\" cell).","\"Initial Population\" \nand ( exists \"Encounter During Influenza Season\"\n      or exists \"Hemodialysis During Influenza Season\"\n      or exists \"Peritoneal Dialysis During Influenza Season\" )\n\n\"Encounter During Influenza Season\"\n[\"Encounter, Performed\": \"Encounter-Influenza\"] FluEncounter\n  where FluEncounter.relevantPeriod starts during \"Influenza Season\"\n\n\"Hemodialysis During Influenza Season\"\n[\"Procedure, Performed\": \"Hemodialysis\"] FluSeasonHemodialysis\n  where FluSeasonHemodialysis.relevantPeriod overlaps \"Influenza Season\"\n\n\"Peritoneal Dialysis During Influenza Season\"\n[\"Procedure, Performed\": \"Peritoneal Dialysis\"] PeritonealDialysis\n  where PeritonealDialysis.relevantPeriod overlaps \"Measurement Period\"\n\n\"Initial Population\"\nexists ( [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n    where Global.\"CalendarAgeInMonthsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) >= 6)\n  and ( exists \"Qualifying Encounter During Measurement Period\"\n      or exists \"Hemodialysis During Measurement Period\"\n      or exists \"Peritoneal Dialysis During Measurement Period\")\n \n\"Qualifying Encounter During Measurement Period\"\n( [\"Encounter, Performed\": \"Office Visit\"]\n  union [\"Encounter, Performed\": \"Outpatient Consultation\"]\n  union [\"Encounter, Performed\": \"Care Services in Long-Term Residential Facility\"]\n  union [\"Encounter, Performed\": \"Home Healthcare Services\"]\n  union [\"Encounter, Performed\": \"Patient Provider Interaction\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services, Initial Office Visit, 0 to 17\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services-Initial Office Visit, 18 and Up\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services-Individual Counseling\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services - Group Counseling\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services - Other\"]\n  union [\"Encounter, Performed\": \"Discharge Services - Nursing Facility\"]\n  union [\"Encounter, Performed\": \"Nursing Facility Visit\"]\n  union [\"Encounter, Performed\": \"Annual Wellness Visit\"]\n  union [\"Encounter, Performed\": \"Preventive Care, Established Office Visit, 0 to 17\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services - Established Office Visit, 18 and Up\"]\n  union [\"Encounter, Performed\": \"Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal.\"]\n  union [\"Encounter, Performed\": \"Online Assessments\"]\n  union [\"Encounter, Performed\": \"Telephone Visits\"] ) QualifyingEncounter\n  where QualifyingEncounter.relevantPeriod during \"Measurement Period\"\n\n\"Hemodialysis During Measurement Period\"\n[\"Procedure, Performed\": \"Hemodialysis\"] Hemodialysis\n  where Global.\"NormalizeInterval\" ( Hemodialysis.relevantDatetime, Hemodialysis.relevantPeriod ) overlaps \"Measurement Period\"\n\n\"Peritoneal Dialysis During Measurement Period\"\n[\"Procedure, Performed\": \"Peritoneal Dialysis\"] PeritonealDialysis\n  where Global.\"NormalizeInterval\" ( PeritonealDialysis.relevantDatetime, PeritonealDialysis.relevantPeriod ) overlaps \"Measurement Period\"","Documentation of medical reason(s) for not receiving influenza immunization (e.g., patient allergy, other medical reasons).\nDocumentation of patient reason(s) for not receiving influenza immunization (e.g., patient declined, other patient reasons).\nDocumentation of system reason(s) for not receiving influenza immunization (e.g., vaccine not available, other system reasons).\n\nDenominator Exceptions\nexists \"Medical Patient or System Reason for Not Performing Influenza Vaccination\"\n  or exists \"Medical Patient or System Reason for Not Administering Influenza Vaccine\"\n  or exists \"Diagnosis of Allergy to Egg\"\n  or exists \"Egg Substance Allergy\"\n  or exists \"Diagnosis of Allergy to Influenza Vaccine\"\n  or exists \"Diagnosis of Intolerance to Influenza Vaccine\"\n  or exists \"Intolerance of Influenza Vaccination Procedure\"\n  or exists \"Allergy or Intolerance to Influenza Vaccine","Patients who received an influenza immunization OR who reported previous receipt of an influenza immunization\n\nPer \"Measure Steward Additional Information\", \"Patient self-report for procedures as well as immunizations should be recorded in 'Procedure, Performed' template or 'Immunization, Administered' template in QRDA-1.\"","exists \"Influenza Vaccination Procedure\"\n  or exists \"Influenza Immunization Administered\"\n  or exists \"Influenza Vaccine Previously Received\"\n*For DPP reporting purposes, see below.\nYear 2 Reporting Period 1 (data measurement period: 01/01/22-06/30/22, six months):\n- Report the numerator as individuals who received an influenza immunization OR who reported previous receipt of an influenza immunization within the measurement period, e.g., for denominator encounters in January 2022 – March 2022, the numerator would include influenza immunization received in August 2021 - March 2022. An Individual with multiple eligible encounters during the data measurement period only has to have the numerator met once to be counted as Numerator Performance Met. (See \"Program Specific Modifications\" cell and please note the measure steward's definition of \"Previous Receipt\" in the \"Additional Information\" cell.)\n\nYear 2 Reporting Period 2 (data measurement period: 01/01/22-12/31/22, 12 months):\n- Report the numerator as individuals who received an influenza immunization OR who reported previous receipt of an influenza immunization within the measurement period, e.g., for denominator encounters in January 2022 – March 2022, the numerator would include influenza immunization received in August 2021 - March 2022, and for denominator encounters in October 2022 - December 2022, the numerator would include influenza immunization received in August 2022 - December 2022. An Individual with multiple eligible encounters during the data measurement period only has to have the numerator met once to be counted as Numerator Performance Met. (See \"Program Specific Modifications\" cell and please note the measure steward's definition of \"Previous Receipt\" in the \"Additional Information\" cell.)","None","Please note the measure steward's definition of \"Previous Receipt\" (see the \"Additional Information\" cell).\n\nYear 2 Reporting Period 1 (data measurement period: 01/01/22-06/30/22, six months):\n- Report the denominator as individuals with encounters that fall within the measurement period, e.g., for the data measurement period of 01/01/22-06/30/22, the denominator would include encounters from January 2022 - March 2022. \n- Report the numerator as individuals who received an influenza immunization OR who reported previous receipt of an influenza immunization within the measurement period, e.g., for denominator encounters in January 2022 – March 2022, the numerator would include influenza immunization received in August 2021 - March 2022. An Individual with multiple eligible encounters during the data measurement period only has to have the numerator met once to be counted as Numerator Performance Met.\n\nYear 2 Reporting Period 2 (data measurement period: 01/01/22-12/31/22, 12 months):\n- Report the denominator as individuals with encounters that fall within the measurement period, e.g., for the data measurement period of 01/01/22-12/31/22, the denominator would include encounters from January 2022 - March 2022 and October 2022 - December 2022. \n- Report the numerator as individuals who received an influenza immunization OR who reported previous receipt of an influenza immunization within the measurement period, e.g., for denominator encounters in January 2022 – March 2022, the numerator would include influenza immunization received in August 2021 - March 2022, and for denominator encounters in October 2022 - December 2022, the numerator would include influenza immunization received in August 2022 - December 2022. An Individual with multiple eligible encounters during the data measurement period only has to have the numerator met once to be counted as Numerator Performance Met.","Patient self-report for procedures as well as immunizations should be recorded in 'Procedure, Performed' template or 'Immunization, Administered' template in QRDA-1.\n\nDefinitions: \nPrevious Receipt - receipt of the current season's influenza immunization from another provider OR from same provider prior to the visit to which the measure is applied (typically, prior vaccination would include influenza vaccine given since August 1st)",null,null,null,"Positive"]
["B1-145","DPP BHS","B1","Certified Community Behavioral Health Clinic (CCBHC) Certification Status","Structure",null,"NA","Status Update Only",null,"NA","Status Update Only",null,"NA",null,null,null,null,null,"NA","NA","NA","NA","Reporting on status of CCBHC certification","NA","NA",null,null,null,null,null,null,null,null,null,null,null,"N/A"]
["B1-146","DPP BHS","B1","Provide patients with services by using remote technology including audio/video, client portals and apps for the provision of services such as telehealth, assessment collection and remote health monitoring/ screening","Structure",null,"NA","Status Update Only",null,"NA","Status Update Only",null,"NA",null,null,null,null,null,"NA","NA","NA","NA","Reporting on the use of remote technology including audio/video, client portals and apps for the provision of services such as telehealth, assessment collection and remote health monitoring/screening","NA","NA",null,null,null,null,null,null,null,null,null,null,null,"N/A"]
["B1-147","DPP BHS","B1","Provide integrated physical and behavioral health care services to children and adults with serious mental illness","Structure",null,"NA","Status Update Only",null,"NA","Status Update Only",null,"NA",null,null,null,null,null,"NA","NA","NA","NA","Reporting on integrated physical and behavioral health care services to children and adults with serious mental illness","NA","NA",null,null,null,null,null,null,null,null,null,null,null,"N/A"]
["B1-148","DPP BHS","B1","Participate in electronic exchange of clinical data with other healthcare providers/ entities","Structure",null,"NA","Status Update Only",null,"NA","Status Update Only",null,"NA",null,null,null,null,null,"NA","NA","NA","NA","Reporting on the participation in electronic exchange of clinical data with other healthcare providers/entities","NA","NA",null,null,null,null,null,null,null,null,null,null,null,"N/A"]
["B2-149","DPP BHS","B2","Preventive Care & Screening: Unhealthy Alcohol Use: Screening & Brief Counseling","Process",null,"01/01/22 - 06/30/22","Numeric Data Reporting & Status Update",null,"01/01/22 - 12/31/22","Numeric Data Reporting & Status Update",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"2152","NCQA","CMS QPP MIPS (#431 2021)","https://qpp.cms.gov/docs/QPP_quality_measure_specifications/CQM-Measures/2021_Measure_431_MIPSCQM.pdf","Percentage of patients aged 18 years and older who were screened for unhealthy alcohol use using a systematic screening method at least once within the last 12 months AND who received brief counseling if identified as an unhealthy alcohol user. Per the \"HHSC Program Specific Modifications\", for DPP BHS reporting purposes,  only one rate (Rate 3) is reported (e.g., percentage of patients aged 18 years and older who were screened for unhealthy alcohol use using a systematic screening method at least once within the last 12 months AND who received brief counseling if identified as unhealthy alcohol users).","Psychiatry, Mental/Behavioral Health","Individuals","All patients aged 18 years and older seen for at least two visits or at least one preventive visit during the measurement period\nNOTE: Patient encounters for this measure conducted via telehealth (e.g., encounters coded with GQ, GT, 95, or POS 02 modifiers) are allowable.","Patients aged ≥ 18 years\nAND\nAt least two patient encounters during the performance period (CPT or HCPCS): 90791, 90792, 90832, 90834, 90837, 90845, 96156, 96158, 97165, 97166, 97167, 97168, 97802, 97803, 97804, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, G0270, G0271\nOR\nAt least one preventive encounter during the performance period (CPT or HCPCS): 99385*, 99386*,  99387*, 99395*, 99396*, 99397*, 99401*, 99402*, 99403*, 99404*, 99411*, 99412*, 99429*, G0438, G0439\n\nNOTE: Patient encounters for this measure conducted via telehealth (e.g., encounters coded with GQ, GT, 95, or POS 02 modifiers) are allowable.","Exception: Documentation of medical reason(s) for not screening for unhealthy alcohol use (e.g., limited life expectancy, other medical reasons) (G9623)\nOR\nDocumentation of medical reason(s) for not providing brief counseling if identified as an unhealthy alcohol user (e.g., limited life expectancy, other medical reasons) (G2203) ","Patients who were screened for unhealthy alcohol use using a systematic screening method at least once within 12 months AND who received brief counseling if identified as an unhealthy alcohol user. Per the \"HHSC Program Specific Modifications\", for DPP BHS reporting purposes, only one rate (Rate 3) is reported (e.g., percentage of patients aged 18 years and older who were screened for unhealthy alcohol use using a systematic screening method at least once within the last 12 months AND who received brief counseling if identified as unhealthy alcohol users).","Patient identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method and received brief counseling (G9621)\nOR\nPatient not identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method (G9622)","Patient not screened for unhealthy alcohol use using a systematic screening method OR patient did not receive brief counseling if identified as an unhealthy alcohol user, reason not given (G9624)","For DPP BHS reporting purposes, only one rate (Rate 3) is reported (e.g., percentage of patients aged 18 years and older who were screened for unhealthy alcohol use using a systematic screening method at least once within the last 12 months AND who received brief counseling if identified as unhealthy alcohol users).","Systematic screening method – For purposes of this measure, one of the following systematic methods to\nassess unhealthy alcohol use must be utilized. \"Systematic screening methods” and thresholds for defining\nunhealthy alcohol use include:\n• AUDIT Screening Instrument (score ≥ 4) \nVersion 5.0 CPT only copyright 2020 American Medical Association. All rights reserved.\nNovember 2020 Page 3 of 18\n• AUDIT-C Screening Instrument (score ≥ 4 for men; score ≥ 3 for women)\n• Single Question Screening - How many times in the past year have you had 5 (for men) or 4(for\nwomen and all adults older than 65 years) or more drinks in a day? (response ≥ 1)\n\nTo satisfy the intent of this measure, a patient must have at least one screening for unhealthy alcohol use during the 12-month period. If a patient has multiple screenings for unhealthy alcohol use during the 12-month period, only the most recent screening, which has a documented status of unhealthy alcohol user or unhealthy alcohol non-user, will be used to satisfy the measure requirements. ",null,null,null,"Positive"]
["B2-150","DPP BHS","B2","Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk Assessment","Process",null,"01/01/22 - 06/30/22","Numeric Data Reporting & Status Update",null,"01/01/22 - 12/31/22","Numeric Data Reporting & Status Update",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"1365","Mathematica","eCQI (eCQM: CMS177v10)","https://ecqi.healthit.gov/ecqm/ep/2022/cms177v10\nhttps://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS177v10.html","Percentage of patient visits for those patients aged 6 through 17 years with a diagnosis of major depressive disorder with an assessment for suicide risk","Psychiatry, Mental/Behavioral Health","Encounters","All patient visits for those patients aged 6 through 17 years with a diagnosis of major depressive disorder","\"Initial Population\":\n\"Major Depressive Disorder Encounter\" MDDEncounter\n  with [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n    such that Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) >= 6\n      and Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) < 17\n\n\"Major Depressive Disorder Encounter\"\n( [\"Encounter, Performed\": \"Office Visit\"]\n  union [\"Encounter, Performed\": \"Outpatient Consultation\"]\n  union [\"Encounter, Performed\": \"Psych Visit - Diagnostic Evaluation\"]\n  union [\"Encounter, Performed\": \"Psych Visit - Family Psychotherapy\"]\n  union [\"Encounter, Performed\": \"Psych Visit - Psychotherapy\"]\n  union [\"Encounter, Performed\": \"Psychoanalysis\"]\n  union [\"Encounter, Performed\": \"Group Psychotherapy\"]\n  union [\"Encounter, Performed\": \"Telehealth Services\"] ) ValidEncounter\n  where exists ( ValidEncounter.diagnoses EncounterDiagnosis\n      where EncounterDiagnosis.code in \"Major Depressive Disorder-Active\")\n    and ValidEncounter.relevantPeriod during \"Measurement Period\"","None","Patient visits with an assessment for suicide risk\n\nPer \"Measure Steward Additional Information\", \"Suicide risk assessments completed via telehealth services can also meet numerator performance\".","\"Major Depressive Disorder Encounter\" MDDEncounter\n  with [\"Intervention, Performed\": \"Suicide risk assessment (procedure)\"] SuicideRiskAssessment\n    such that SuicideRiskAssessment.relevantDatetime during MDDEncounter.relevantPeriod\n\n\"Major Depressive Disorder Encounter\"\n( [\"Encounter, Performed\": \"Office Visit\"]\n  union [\"Encounter, Performed\": \"Outpatient Consultation\"]\n  union [\"Encounter, Performed\": \"Psych Visit - Diagnostic Evaluation\"]\n  union [\"Encounter, Performed\": \"Psych Visit - Family Psychotherapy\"]\n  union [\"Encounter, Performed\": \"Psych Visit - Psychotherapy\"]\n  union [\"Encounter, Performed\": \"Psychoanalysis\"]\n  union [\"Encounter, Performed\": \"Group Psychotherapy\"]\n  union [\"Encounter, Performed\": \"Telehealth Services\"] ) ValidEncounter\n  where exists ( ValidEncounter.diagnoses EncounterDiagnosis\n      where EncounterDiagnosis.code in \"Major Depressive Disorder-Active\")\n    and ValidEncounter.relevantPeriod during \"Measurement Period\"","None",null,"Definitions:\nNumerator Definition: The specific type and magnitude of the suicide risk assessment is intended to be at the discretion of the individual clinician and should be specific to the needs of the patient. At a minimum, suicide risk assessment should evaluate:\n1. Risk (e.g., age, sex, stressors, comorbid conditions, hopelessness, impulsivity) and protective factors (e.g., religious belief, concern not to hurt family) that may influence the desire to attempt suicide.\n2. Current severity of suicidality.\n3. Most severe point of suicidality in episode and lifetime.\n \nLow burden tools to track suicidal ideation and behavior such as the Columbia-Suicidal Severity Rating Scale can also be used. Because no validated assessment tool or instrument fully meets the aforementioned requirements for the suicide risk assessment, individual tools or instruments have not been explicitly included in coding.\n\nGuidance:\nThis eCQM is an episode-based measure. An episode is defined as each eligible encounter for major depressive disorder (MDD) during the measurement period. A suicide risk assessment should be performed at every visit for MDD during the measurement period.\n\nIn recognition of the growing use of integrated and team-based care, the diagnosis of depression and the assessment for suicide risk need not be performed by the same provider or clinician. \n\nSuicide risk assessments completed via telehealth services can also meet numerator performance. \n\nUse of a standardized tool(s) or instrument(s) to assess suicide risk will meet numerator performance, so long as the minimum criteria noted above is evaluated. Standardized tools can be mapped to the concept \"Intervention, Performed\": \"Suicide risk assessment (procedure)\" included in the numerator logic below, as no individual suicide risk assessment tool or instrument would satisfy the requirements alone.\n\nThis version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.",null,null,null,"Positive"]
["B2-151","DPP BHS","B2","Adult Major Depressive Disorder (MDD): Suicide Risk Assessment ","Process",null,"01/01/22 - 06/30/22","Numeric Data Reporting & Status Update",null,"01/01/22 - 12/31/22","Numeric Data Reporting & Status Update",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"0104","Mathematica","eCQI (eCQM: CMS161v10)","https://ecqi.healthit.gov/ecqm/ep/2022/cms161v10\nhttps://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS161v10.html","All patient visits during which a new diagnosis of MDD or a new diagnosis of recurrent MDD was identified for patients aged 18 years and older with a suicide risk assessment completed during the visit","Psychiatry, Mental/Behavioral Health","Encounters","Patient visits during which a new diagnosis of MDD, single or recurrent episode, was identified","\"Initial Population\":\n\"New or Recurrent Major Depressive Disorder Encounter\" NewOrRecurrentMDDEncounter\n  with [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n    such that Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) >= 17\n\n\"New or Recurrent Major Depressive Disorder Encounter\":\n\"Major Depressive Disorder Encounter\" NewOrRecurrentMDDEncounter\n  without \"Major Depressive Disorder Encounter\" PriorMDDEpisodeEncounter\n    such that PriorMDDEpisodeEncounter !~ NewOrRecurrentMDDEncounter\n      and PriorMDDEpisodeEncounter.relevantPeriod ends 104 days or less before day of start of NewOrRecurrentMDDEncounter.relevantPeriod\n  where NewOrRecurrentMDDEncounter.relevantPeriod during \"Measurement Period\"\n\n\"Major Depressive Disorder Encounter\"\n( [\"Encounter, Performed\": \"Psych Visit - Diagnostic Evaluation\"]\n  union [\"Encounter, Performed\": \"Emergency Department Visit\"]\n  union [\"Encounter, Performed\": \"Office Visit\"]\n  union [\"Encounter, Performed\": \"Outpatient Consultation\"]\n  union [\"Encounter, Performed\": \"Psych Visit - Psychotherapy\"]\n  union [\"Encounter, Performed\": \"Psychoanalysis\"]\n  union [\"Encounter, Performed\": \"Telehealth Services\"] ) ValidEncounter\n  where exists ( ValidEncounter.diagnoses EncounterDiagnosis\n      where EncounterDiagnosis.code in \"Major Depressive Disorder-Active\")","None","Patient visits during which a new diagnosis of MDD, single or recurrent episode, was identified and a suicide risk assessment was completed during the visit\n\nPer \"Measure Steward Additional Information\", \"Suicide risk assessments completed via telehealth services can also meet numerator performance\".","\"New or Recurrent Major Depressive Disorder Encounter\" NewOrRecurrentMDDEncounter\n  with [\"Intervention, Performed\": \"Suicide risk assessment (procedure)\"] SuicideRiskAssessment\n    such that Global.\"NormalizeInterval\" ( SuicideRiskAssessment.relevantDatetime, SuicideRiskAssessment.relevantPeriod ) during NewOrRecurrentMDDEncounter.relevantPeriod\n\n\"New or Recurrent Major Depressive Disorder Encounter\":\n\"Major Depressive Disorder Encounter\" NewOrRecurrentMDDEncounter\n  without \"Major Depressive Disorder Encounter\" PriorMDDEpisodeEncounter\n    such that PriorMDDEpisodeEncounter !~ NewOrRecurrentMDDEncounter\n      and PriorMDDEpisodeEncounter.relevantPeriod ends 104 days or less before day of start of NewOrRecurrentMDDEncounter.relevantPeriod\n  where NewOrRecurrentMDDEncounter.relevantPeriod during \"Measurement Period\"\n\n\"Major Depressive Disorder Encounter\"\n( [\"Encounter, Performed\": \"Psych Visit - Diagnostic Evaluation\"]\n  union [\"Encounter, Performed\": \"Emergency Department Visit\"]\n  union [\"Encounter, Performed\": \"Office Visit\"]\n  union [\"Encounter, Performed\": \"Outpatient Consultation\"]\n  union [\"Encounter, Performed\": \"Psych Visit - Psychotherapy\"]\n  union [\"Encounter, Performed\": \"Psychoanalysis\"]\n  union [\"Encounter, Performed\": \"Telehealth Services\"] ) ValidEncounter\n  where exists ( ValidEncounter.diagnoses EncounterDiagnosis\n      where EncounterDiagnosis.code in \"Major Depressive Disorder-Active\" )\n","None",null,"Definitions:\nThe specific type and magnitude of the suicide risk assessment is intended to be at the discretion of the individual clinician and should be specific to the needs of the patient. At a minimum, suicide risk assessment should evaluate:\n1) Suicidal ideation\n2) Patient's intent of initiating a suicide attempt\nAND, if either is present,\n3) Patient plans for a suicide attempt\n4) Whether the patient has means for completing suicide\n\nLow burden tools to track suicidal ideation and behavior such as the Columbia-Suicide Severity Rating Scale (C-SSRS) and the Suicide Assessment Five-Step Evaluation and Triage (SAFE-T) can also be used. Because no validated assessment tool or instrument fully meets the aforementioned requirements for the suicide risk assessment, individual tools or instruments have not been explicitly included in coding.\n\nGuidance:\nThis eCQM is an episode-based measure and should be reported for each instance of a new or recurrent episode of major depressive disorder (MDD) during the measurement period. This measure should be reported for each eligible encounter during which a new or recurrent episode of MDD is identified.\n\nAs the guidelines state, it is important to assess for additional factors which may increase or decrease suicide risk, such as presence of additional symptoms (e.g., psychosis, severe anxiety, hopelessness, severe chronic pain); presence of substance abuse, history and seriousness of previous attempts, particularly, recent suicidal behavior, current stressors and potential protective factors (e.g., positive reasons for living, strong social support), family history of suicide or mental illness or recent exposure to suicide, impulsivity and potential for risk to others, including history of violence or violent or homicidal ideas, plans, or intentions, and putting one's affairs in order (e.g., giving away possessions, writing a will). In addition, although the measure focuses on the initial visit, it is critical that suicide risk be monitored especially for the 90 days following the initial visit and throughout MDD treatment.\n\nIt is expected that a suicide risk assessment will be completed at the visit during which a new diagnosis is made or at the visit during which a recurrent episode is first identified (i.e., at the initial evaluation). For the purposes of this measure, an episode of major depressive disorder (MDD) would be considered to be recurrent if a patient has not had an MDD-related encounter in the past 105 days. If there is a gap of 105 or more days between visits for major depressive disorder (MDD), that would imply a recurrent episode. The 105-day look-back period is an operational provision and not a clinical recommendation, or definition of relapse, remission, or recurrence.\n\nIn recognition of the growing use of integrated and team-based care, the diagnosis of depression and the assessment for suicide risk need not be performed by the same provider or clinician.\n\nSuicide risk assessments completed via telehealth services can also meet numerator performance.\n\nUse of a standardized tool(s) or instrument(s) to assess suicide risk will meet numerator performance. Standardized tools can be mapped to the concept \"Intervention, Performed\": \"Suicide risk assessment (procedure)\" included in the numerator logic below.\n\nThe logic statement for the age requirement, as written, captures patients who turn 18 years old during the measurement period so that these patients are included in the measure, so long as the minimum criteria noted above is evaluated. To ensure all patients with major depressive disorder (MDD) are assessed for suicide risk, there are two clinical quality measures addressing suicide risk assessment; CMS 177 covers children and adolescents aged 6 through 17, and CMS 161 covers the adult population aged 18 years and older, as no individual suicide risk assessment tool or instrument would satisfy the requirements alone.\n\nThis version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.",null,null,null,"Positive"]
["B2-152","DPP BHS","B2","Follow-Up After Hospitalization for Mental Illness 7-Day (discharges from state hospital)","Outcome (Intermediate)",null,"01/01/22 - 06/30/22","Numeric Data Reporting & Status Update",null,"01/01/22 - 12/31/22","Numeric Data Reporting & Status Update",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"0576","NCQA","CMS QPP MIPS (#391 2021)","https://qpp.cms.gov/docs/QPP_quality_measure_specifications/CQM-Measures/2021_Measure_391_MIPSCQM.pdf","The percentage of discharges for patients 6 years of age and older who were hospitalized for treatment of selected mental illness or intentional self-harm diagnoses and who had a follow-up visit with a mental health practitioner. \n\nThe percentage of discharges for which the patient received follow-up within 7 days after discharge.","Discharges from state hospitals and Sunrise Canyon Hospital","Encounters","Patients 6 years of age and older who were discharged from an acute inpatient setting (including acute care psychiatric facilities) with a principal diagnosis of mental illness or intentional self-harm on or between January 1 and December 1 of the measurement period\n\nNOTE: Patient encounters for this measure conducted via telehealth (e.g., encounters coded with GQ, GT, 95, or POS 02 modifiers) are allowable.\n\nPer the \"HHSC Program Specific Modifications\", for DPP BHS reporting purposes, the denominator is limited to discharges from state hospitals and Sunrise Canyon Hospital.","Patients aged 6 years and older as of the date of discharge\nAND\nDiagnosis for mental illness (ICD-10-CM): F20.0, F20.1, F20.2, F20.3, F20.5, F20.81, F20.89, F20.9, F21, F22, F23, F24, F25.0, F25.1, F25.8, F25.9, F28, F29, F30.10, F30.11, F30.12, F30.13, F30.2, F30.3, F30.4, F30.8, F30.9, F31.0, F31.10, F31.11, F31.12, F31.13, F31.2, F31.30, F31.31, F31.32, F31.4, F31.5, F31.60, F31.61, F31.62, F31.63, F31.64, F31.70, F31.71, F31.72, F31.73, F31.74, F31.75, F31.76, F31.77, F31.78, F31.81, F31.89, F31.9, F32.0, F32.1, F32.2, F32.3, F32.4, F32.5, F32.8, F32.81, F32.89, F32.9, F33.0, F33.1,\nF33.2, F33.3, F33.40, F33.41, F33.42, F33.8, F33.9, F34.0, F34.1, F34.8, F34.81, F34.89, F34.9, F39, F42, F42.2, F42.3, F42.4, F42.8, F42.9, F43.0, F43.10, F43.11, F43.12, F43.20, F43.21, F43.22, F43.23, F43.24, F43.25, F43.29, F43.8, F43.9, F44.89, F53, F53.0, F53.1, F60.0, F60.1, F60.2, F60.3, F60.4, F60.5, F60.6, F60.7, F60.81, F60.89, F60.9, F63.0, F63.1, F63.2, F63.3, F63.81, F63.89, F63.9, F68.10, F68.11, F68.12, F68.13, F68.8, F68.A, F84.0, F84.2, F84.3, F84.5, F84.8, F84.9, F90.0, F90.1, F90.2, F90.8, F90.9, F91.0,\nF91.1, F91.2, F91.3, F91.8, F91.9, F93.0, F93.8, F93.9, F94.0, F94.1, F94.2, F94.8, F94.9 \nOR\nDiagnosis of intentional self-harm (ICD-10-CM): T14.91XA, T14.91XD, T14.91XS, T36.0X2A, T36.0X2D, T36.0X2S, T36.1X2A, T36.1X2D, T36.1X2S, T36.2X2A, T36.2X2D, T36.2X2S, T36.3X2A, T36.3X2D, T36.3X2S, T36.4X2A, T36.4X2D, T36.4X2S, T36.5X2A, T36.5X2D, T36.5X2S, T36.6X2A, T36.6X2D, T36.6X2S, T36.7X2A, T36.7X2D, T36.7X2S, T36.8X2A, T36.8X2D, T36.8X2S, T36.92XA, T36.92XD, T36.92XS, T37.0X2A, T37.0X2D, T37.0X2S, T37.1X2A, T37.1X2D, T37.1X2S, T37.2X2A, T37.2X2D, T37.2X2S, T37.3X2A, T37.3X2D, T37.3X2S, T37.4X2A, T37.4X2D, T37.4X2S, T37.5X2A, T37.5X2D, T37.5X2S, T37.8X2A, T37.8X2D, T37.8X2S, T37.92XA, T37.92XD, T37.92XS, T38.0X2A, T38.0X2D, T38.0X2S, T38.1X2A, T38.1X2D, T38.1X2S, T38.2X2A,T38.2X2D, T38.2X2S, T38.3X2A, T38.3X2D, T38.3X2S, T38.4X2A, T38.4X2D, T38.4X2S, T38.5X2A, T38.5X2D, T38.5X2S, T38.6X2A, T38.6X2D, T38.6X2S, T38.7X2A, T38.7X2D, T38.7X2S, T38.802A, T38.802D, T38.802S, T38.812A, T38.812D, T38.812S, T38.892A, T38.892D, T38.892S, T38.902A, T38.902D, T38.902S, T38.992A, T38.992D, T38.992S, T39.012A, T39.012D, T39.012S, T39.092A, T39.092D, T39.092S, T39.1X2A, T39.1X2D, T39.1X2S, T39.2X2A, T39.2X2D, T39.2X2S, T39.312A, T39.312D, T39.312S, T39.392A, T39.392D, T39.392S, T39.4X2A, T39.4X2D, T39.4X2S, T39.8X2A, T39.8X2D, T39.8X2S, T39.92XA, T39.92XD, T39.92XS, T40.0X2A, T40.0X2D, T40.0X2S, T40.1X2A, T40.1X2D, T40.1X2S, T40.2X2A, T40.2X2D, T40.2X2S, T40.3X2A, T40.3X2D, T40.3X2S, T40.4X2A, T40.4X2D, T40.4X2S, T40.5X2A, T40.5X2D, T40.5X2S, T40.602A, T40.602D, T40.602S, T40.692A, T40.692D, T40.692S, T40.7X2A, T40.7X2D, T40.7X2S, T40.8X2A, T40.8X2D, T40.8X2S, T40.902A, T40.902D, T40.902S, T40.992A, T40.992D, T40.992S, T41.0X2A, T41.0X2D, T41.0X2S, T41.1X2A, T41.1X2D, T41.1X2S, T41.202A, T41.202D, T41.202S, T41.292A, T41.292D, T41.292S, T41.3X2A, T41.3X2D, T41.3X2S, T41.42XA, T41.42XD, T41.42XS, T41.5X2A, T41.5X2D, T41.5X2S, T42.0X2A, T42.0X2D, T42.0X2S, T42.1X2A, T42.1X2D, T42.1X2S, T42.2X2A, T42.2X2D, T42.2X2S, T42.3X2A, T42.3X2D, T42.3X2S, T42.4X2A, T42.4X2D, T42.4X2S, T42.5X2A, T42.5X2D, T42.5X2S, T42.6X2A, T42.6X2D, T42.6X2S, T42.72XA, T42.72XD, T42.72XS, T42.8X2A, T42.8X2D, T42.8X2S, T43.012A, T43.012D, T43.012S, T43.022A, T43.022D, T43.022S, T43.1X2A, T43.1X2D, T43.1X2S, T43.202A, T43.202D, T43.202S, T43.212A, T43.212D, T43.212S, T43.222A, T43.222D, T43.222S, T43.292A, T43.292D, T43.292S, T43.3X2A, T43.3X2D, T43.3X2S, T43.4X2A, T43.4X2D, T43.4X2S, T43.502A, T43.502D, T43.502S, T43.592A, T43.592D, T43.592S, T43.602A, T43.602D, T43.602S, T43.612A, T43.612D, T43.612S, T43.622A, T43.622D, T43.622S, T43.632A, T43.632D, T43.632S, T43.642A, T43.642D, T43.642S, T43.692A, T43.692D, T43.692S, T43.8X2A, T43.8X2D, T43.8X2S, T43.92XA, T43.92XD, T43.92XS, T44.0X2A, T44.0X2D, T44.0X2S, T44.1X2A, T44.1X2D, T44.1X2S, T44.2X2A, T44.2X2D, T44.2X2S, T44.3X2A, T44.3X2D, T44.3X2S, T44.4X2A, T44.4X2D, T44.4X2S, T44.5X2A, T44.5X2D, T44.5X2S, T44.6X2A, T44.6X2D, T44.6X2S, T44.7X2A, T44.7X2D, T44.7X2S, T44.8X2A, T44.8X2D, T44.8X2S, T44.902A, T44.902D, T44.902S, T44.992A, T44.992D, T44.992S, T45.0X2A, T45.0X2D, T45.0X2S, T45.1X2A, T45.1X2D, T45.1X2S, T45.2X2A, T45.2X2D, T45.2X2S, T45.3X2A, T45.3X2D, T45.3X2S, T45.4X2A, T45.4X2D, T45.4X2S, T45.512A, T45.512D, T45.512S, T45.522A, T45.522D, T45.522S, T45.602A, T45.602D, T45.602S, T45.612A, T45.612D, T45.612S, T45.622A, T45.622D, T45.622S, T45.692A, T45.692D, T45.692S, T45.7X2A, T45.7X2D, T45.7X2S, T45.8X2A, T45.8X2D, T45.8X2S, T45.92XA, T45.92XD, T45.92XS, T46.0X2A, T46.0X2D, T46.0X2S, T46.1X2A, T46.1X2D, T46.1X2S, T46.2X2A, T46.2X2D, T46.2X2S, T46.3X2A, T46.3X2D, T46.3X2S, T46.4X2A, T46.4X2D, T46.4X2S, T46.5X2A, T46.5X2D, T46.5X2S, T46.6X2A, T46.6X2D, T46.6X2S, T46.7X2A, T46.7X2D, T46.7X2S, T46.8X2A, T46.8X2D, T46.8X2S, T46.902A, T46.902D, T46.902S, T46.992A, T46.992D, T46.992S, T47.0X2A, T47.0X2D, T47.0X2S, T47.1X2A, T47.1X2D, T47.1X2S, T47.2X2A, T47.2X2D, T47.2X2S, T47.3X2A, T47.3X2D, T47.3X2S, T47.4X2A, T47.4X2D, T47.4X2S, T47.5X2A, T47.5X2D, T47.5X2S, T47.6X2A, T47.6X2D, T47.6X2S, T47.7X2A, T47.7X2D, T47.7X2S, T47.8X2A, T47.8X2D, T47.8X2S, T47.92XA, T47.92XD, T47.92XS, T48.0X2A, T48.0X2D, T48.0X2S, T48.1X2A, T48.1X2D, T48.1X2S, T48.202A, T48.202D, T48.202S, T48.292A, T48.292D, T48.292S, T48.3X2A, T48.3X2D, T48.3X2S, T48.4X2A, T48.4X2D, T48.4X2S, T48.5X2A, T48.5X2D, T48.5X2S, T48.6X2A, T48.6X2D, T48.6X2S, T48.902A, T48.902D, T48.902S, T48.992A, T48.992D, T48.992S, T49.0X2A, T49.0X2D, T49.0X2S, T49.1X2A, T49.1X2D, T49.1X2S, T49.2X2A, T49.2X2D, T49.2X2S, T49.3X2A, T49.3X2D, T49.3X2S, T49.4X2A, T49.4X2D, T49.4X2S, T49.5X2A, T49.5X2D, T49.5X2S, T49.6X2A, T49.6X2D, T49.6X2S, T49.7X2A, T49.7X2D, T49.7X2S, T49.8X2A, T49.8X2D, T49.8X2S, T49.92XA, T49.92XD, T49.92XS, T50.0X2A, T50.0X2D, T50.0X2S, T50.1X2A, T50.1X2D, T50.1X2S, T50.2X2A, T50.2X2D, T50.2X2S, T50.3X2A, T50.3X2D, T50.3X2S, T50.4X2A, T50.4X2D, T50.4X2S, T50.5X2A, T50.5X2D, T50.5X2S, T50.6X2A, T50.6X2D, T50.6X2S, T50.7X2A, T50.7X2D, T50.7X2S, T50.8X2A, T50.8X2D, T50.8X2S, T50.902A, T50.902D, T50.902S, T50.992A, T50.992D, T50.992S, T50.A12A, T50.A12D, T50.A12S, T50.A22A, T50.A22D, T50.A22S, T50.A92A, T50.A92D, T50.A92S, T50.B12A, T50.B12D, T50.B12S, T50.B92A, T50.B92D, T50.B92S, T50.Z12A, T50.Z12D, T50.Z12S, T50.Z92A, T50.Z92D, T50.Z92S, T51.0X2A, T51.0X2D, T51.0X2S, T51.1X2A, T51.1X2D, T51.1X2S, T51.2X2A, T51.2X2D, T51.2X2S, T51.3X2A, T51.3X2D, T51.3X2S, T51.8X2A, T51.8X2D, T51.8X2S, T51.92XA, T51.92XD, T51.92XS, T52.0X2A, T52.0X2D, T52.0X2S, T52.1X2A, T52.1X2D, T52.1X2S, T52.2X2A, T52.2X2D, T52.2X2S, T52.3X2A, T52.3X2D, T52.3X2S, T52.4X2A, T52.4X2D, T52.4X2S, T52.8X2A, T52.8X2D, T52.8X2S, T52.92XA, T52.92XD, T52.92XS, T53.0X2A, T53.0X2D, T53.0X2S, T53.1X2A, T53.1X2D, T53.1X2S, T53.2X2A, T53.2X2D, T53.2X2S, T53.3X2A, T53.3X2D, T53.3X2S, T53.4X2A, T53.4X2D, T53.4X2S, T53.5X2A, T53.5X2D, T53.5X2S, T53.6X2A, T53.6X2D, T53.6X2S, T53.7X2A, T53.7X2D, T53.7X2S, T53.92XA, T53.92XD, T53.92XS, T54.0X2A, T54.0X2D, T54.0X2S, T54.1X2A, T54.1X2D, T54.1X2S, T54.2X2A, T54.2X2D, T54.2X2S, T54.3X2A, T54.3X2D, T54.3X2S, T54.92XA, T54.92XD, T54.92XS, T55.0X2A, T55.0X2D, T55.0X2S, T55.1X2A, T55.1X2D, T55.1X2S, T56.0X2A, T56.0X2D, T56.0X2S, T56.1X2A, T56.1X2D, T56.1X2S, T56.2X2A, T56.2X2D, T56.2X2S, T56.3X2A, T56.3X2D, T56.3X2S, T56.4X2A, T56.4X2D, T56.4X2S, T56.5X2A, T56.5X2D, T56.5X2S, T56.6X2A, T56.6X2D, T56.6X2S, T56.7X2A, T56.7X2D, T56.7X2S, T56.812A, T56.812D, T56.812S, T56.892A, T56.892D, T56.892S, T56.92XA, T56.92XD, T56.92XS, T57.0X2A, T57.0X2D, T57.0X2S, T57.1X2A, T57.1X2D, T57.1X2S, T57.2X2A, T57.2X2D, T57.2X2S, T57.3X2A, T57.3X2D, T57.3X2S, T57.8X2A, T57.8X2D, T57.8X2S, T57.92XA, T57.92XD, T57.92XS, T58.02XA, T58.02XD, T58.02XS, T58.12XA, T58.12XD, T58.12XS, T58.2X2A, T58.2X2D, T58.2X2S, T58.8X2A, T58.8X2D, T58.8X2S, T58.92XA, T58.92XD, T58.92XS, T59.0X2A, T59.0X2D, T59.0X2S, T59.1X2A, T59.1X2D, T59.1X2S, T59.2X2A, T59.2X2D, T59.2X2S, T59.3X2A, T59.3X2D, T59.3X2S, T59.4X2A, T59.4X2D, T59.4X2S, T59.5X2A, T59.5X2D, T59.5X2S, T59.6X2A, T59.6X2D, T59.6X2S, T59.7X2A, T59.7X2D, T59.7X2S, T59.812A, T59.812D, T59.812S, T59.892A, T59.892D, T59.892S, T59.92XA, T59.92XD, T59.92XS, T60.0X2A, T60.0X2D, T60.0X2S, T60.1X2A, T60.1X2D, T60.1X2S, T60.2X2A, T60.2X2D, T60.2X2S, T60.3X2A, T60.3X2D, T60.3X2S, T60.4X2A, T60.4X2D, T60.4X2S, T60.8X2A, T60.8X2D, T60.8X2S, T60.92XA, T60.92XD, T60.92XS, T61.02XA, T61.02XD, T61.02XS, T61.12XA, T61.12XD, T61.12XS, T61.772A, T61.772D, T61.772S, T61.782A, T61.782D, T61.782S, T61.8X2A, T61.8X2D, T61.8X2S, T61.92XA, T61.92XD, T61.92XS, T62.0X2A, T62.0X2D, T62.0X2S, T62.1X2A, T62.1X2D, T62.1X2S, T62.2X2A, T62.2X2D, T62.2X2S, T62.8X2A, T62.8X2D, T62.8X2S, T62.92XA, T62.92XD, T62.92XS, T63.002A, T63.002D, T63.002S T63.012A, T63.012D, T63.012S, T63.022A, T63.022D, T63.022S, T63.032A, T63.032D, T63.032S, T63.042A, T63.042D, T63.042S, T63.062A, T63.062D, T63.062S, T63.072A, T63.072D, T63.072S, T63.082A, T63.082D, T63.082S, T63.092A, T63.092D, T63.092S, T63.112A, T63.112D, T63.112S, T63.122A, T63.122D, T63.122S, T63.192A, T63.192D, T63.192S, T63.2X2A, T63.2X2D, T63.2X2S, T63.302A, T63.302D, T63.302S, T63.312A, T63.312D, T63.312S, T63.322A, T63.322D, T63.322S, T63.332A, T63.332D, T63.332S, T63.392A, T63.392D, T63.392S, T63.412A, T63.412D, T63.412S, T63.422A, T63.422D, T63.422S, T63.432A, T63.432D, T63.432S, T63.442A, T63.442D, T63.442S, T63.452A, T63.452D, T63.452S, T63.462A, T63.462D, T63.462S, T63.482A, T63.482D, T63.482S, T63.512A, T63.512D, T63.512S, T63.592A, T63.592D, T63.592S, T63.612A, T63.612D, T63.612S, T63.622A, T63.622D, T63.622S, T63.632A, T63.632D, T63.632S, T63.692A, T63.692D, T63.692S, T63.712A, T63.712D, T63.712S, T63.792A, T63.792D, T63.792S, T63.812A, T63.812D, T63.812S, T63.822A, T63.822D, T63.822S, T63.832A, T63.832D, T63.832S, T63.892A, T63.892D, T63.892S, T63.92XA, T63.92XD, T63.92XS, T64.02XA, T64.02XD, T64.02XS, T64.82XA, T64.82XD, T64.82XS, T65.0X2A, T65.0X2D, T65.0X2S, T65.1X2A, T65.1X2D, T65.1X2S, T65.212A, T65.212D, T65.212S, T65.222A, T65.222D, T65.222S, T65.292A, T65.292D, T65.292S, T65.3X2A, T65.3X2D, T65.3X2S, T65.4X2A, T65.4X2D, T65.4X2S, T65.5X2A, T65.5X2D, T65.5X2S, T65.6X2A, T65.6X2D, T65.6X2S, T65.812A, T65.812D, T65.812S, T65.822A, T65.822D, T65.822S, T65.832A, T65.832D, T65.832S, T65.892A, T65.892D, T65.892S, T65.92XA, T65.92XD, T65.92XS, T71.112A, T71.112D, T71.112S, T71.122A, T71.122D, T71.122S, T71.132A, T71.132D, T71.132S, T71.152A, T71.152D, T71.152S, T71.162A, T71.162D, T71.162S, T71.192A, T71.192D, T71.192S, T71.222A, T71.222D, T71.222S, T71.232A, T71.232D, T71.232S, T50.911, T50.912, T50.913, T50.914, T50.915, T50.916 \nAND\nPatient encounter during the performance period (CPT): 99221, 99222, 99223, 99231, 99232, 99233, 99238, 99239, 99291\nAND\nPatient alive at time of acute inpatient setting discharge\nAND\nPatient is discharged from an acute inpatient setting on or between January 1 and December 1 of the measurement period\nNOTE: Patient encounters for this measure conducted via telehealth (e.g., encounters coded with GQ, GT, 95, or POS 02 modifiers) are allowable.","Exclude discharges followed by readmission or direct transfer to a non-acute facility within the 7- day follow-up period, regardless of principal diagnosis for the readmission\nAND\nExclude discharges followed by readmission or direct transfer to an acute facility within the 7-day follow-up period if the principal diagnosis was for non-mental health\n\nPatients who use hospice services any time during the measurement period: G9760\n\nException: Clinician documented reason patient was not able to complete 7 day follow-up from acute inpatient setting discharge (e.g., patient death prior to follow-up visit, patient non-compliant for visit follow-up) (G9406)","A follow-up visit with a mental health practitioner within 7 days after acute inpatient discharge. Do not include visits that occur on the date of discharge. Per the \"HHSC Program Specific Modifications\", for DPP BHS reporting purposes, only one rate (Rate 2) is reported (e.g., percentage of discharges for which the patient received follow-up within 7 days after discharge).","Patient received follow-up within 7 days after discharge (G9405)","Patient did not receive follow-up within 7 days after discharge (G9407)","For DPP BHS reporting purposes, only one rate (Rate 2) is reported (e.g., percentage of discharges for which the patient received follow-up within 7 days after discharge), and the denominator is limited to state hospitals and Sunrise Canyon Hospital.\n\nFor DPP BHS reporting purposes, an eligible provider is one who delivers mental health services and meets any of the following criteria:\n• An MD or doctor of osteopathy (DO) who is certified as a psychiatrist or child psychiatrist by the American Medical Specialties Board of Psychiatry and Neurology or by the American Osteopathic Board of Neurology and Psychiatry; or, if not certified, who successfully completed an accredited program of graduate medical or osteopathic education in psychiatry or child psychiatry and is licensed to practice patient care psychiatry or child psychiatry, if required by the state of practice.\n• An individual who is licensed as a psychologist in his/her state of practice, if required by the state of practice.\n• An individual who is certified in clinical social work by the American Board of Examiners; who is listed on the National Association of Social Worker’s Clinical Register; or who has a master’s degree in social work and is licensed or certified to practice as a social worker, if required by the state of practice.\n• A registered nurse (RN) who is certified by the American Nurses Credentialing Center (a subsidiary of the American Nurses Association) as a psychiatric nurse or mental health clinical nurse specialist, or who has a master’s degree in nursing with a specialization in\npsychiatric/mental health and two years of supervised clinical experience and is licensed to practice as a psychiatric or mental health nurse, if required by the state of practice.\n• An individual (normally with a master’s or a doctoral degree in marital and family therapy and at least two years of supervised clinical experience) who is practicing as a marital and family therapist and is licensed or a certified counselor by the state of practice, or if licensure or certification is not required by the state of practice, who is eligible for clinical membership in the American Association for Marriage and Family Therapy.\n• An individual (normally with a master’s or doctoral degree in counseling and at least two years of supervised clinical experience) who is practicing as a professional counselor and who is licensed or certified to do so by the state of practice, or if licensure or certification is not required by the state of practice, is a National Certified Counselor with a Specialty Certification in Clinical Mental Health Counseling from the National Board for Certified Counselors (NBCC).\n• A certified Community Mental Health Center (CMHC), or the comparable term (e.g. behavioral health organization, mental health agency, behavioral health agency) used within the state in which it is located, or a Certified Community Behavioral Health Clinic (CCBHC).\nOnly authorized CMHCs are considered mental health providers. To be authorized as a CMHC, an entity must meet one of the following criteria:\n- The entity has been certified by CMS to meet the conditions of participation (CoPs) that community mental health centers (CMHCs) must meet in order to participate in the Medicare program, as defined in the Code of Federal Regulations Title 42. CMS defines a\nCMHC as an entity that meets applicable licensing or certification requirements for CMHCs in the State in which it is located and provides the set of services specified in section 1913(c)(1) of the Public Health Service Act (PHS Act).\n- The entity has been licensed, operated, authorized, or otherwise recognized by a state or county in which it is located.\nOnly authorized CCBHCs are considered mental health providers. To be authorized as a CCBHC, an entity must meet one of the following criteria:\n- Has been certified by a State Medicaid agency as meeting criteria established by the Secretary for participation in the Medicaid CCBHC demonstration program pursuant to Protecting Access to Medicare Act § 223(a) (42 U.S.C. § 1396a note); or as meeting\ncriteria within the State’s Medicaid Plan to be considered a CCBHC.\n- Has been recognized by the Substance Abuse and Mental Health Services Administration, through the award of grant funds or otherwise, as a CCBHC that meets the certification criteria of a Certified Community Behavioral Health Clinic",null,null,null,null,"Positive",null,null,null,null,null,null,null,"The denominator specifications are the same for measures B2-152 and B2-153. Please note the denominator specifications for B2-152 and B2-153 are limited to discharges from State Hospitals and Sunrise Canyon Hospital, and the denominator values for each respective payer type should be the same for B2-152 and B2-153. For a given payer type, the B2-153 numerator value must be equal to or greater than the numerator value for B2-152."]
["B2-153","DPP BHS","B2","Follow-Up after Hospitalization for Mental Illness 30-Day (discharges from state hospital)","Outcome (Intermediate)",null,"01/01/22 - 06/30/22","Numeric Data Reporting & Status Update",null,"01/01/22 - 12/31/22","Numeric Data Reporting & Status Update",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"0576","NCQA","CMS QPP MIPS (#391 2021)","https://qpp.cms.gov/docs/QPP_quality_measure_specifications/CQM-Measures/2021_Measure_391_MIPSCQM.pdf","The percentage of discharges for patients 6 years of age and older who were hospitalized for treatment of selected mental illness or intentional self-harm diagnoses and who had a follow-up visit with a mental health practitioner. \n\nThe percentage of discharges for which the patient received follow-up within 30 days after discharge","Discharges from state hospitals and Sunrise Canyon Hospital","Encounters","Patients 6 years of age and older who were discharged from an acute inpatient setting (including acute care psychiatric facilities) with a principal diagnosis of mental illness or intentional self-harm on or between January 1 and December 1 of the measurement period\n\nNOTE: Patient encounters for this measure conducted via telehealth (e.g., encounters coded with GQ, GT, 95, or POS 02 modifiers) are allowable.\n\nPer the \"HHSC Program Specific Modifications\", for DPP BHS reporting purposes, the denominator is limited to discharges from state hospitals and Sunrise Canyon Hospital.","Patients aged 6 years and older as of the date of discharge\nAND\nDiagnosis for mental illness (ICD-10-CM): F20.0, F20.1, F20.2, F20.3, F20.5, F20.81, F20.89, F20.9, F21, F22, F23, F24, F25.0, F25.1, F25.8, F25.9, F28, F29, F30.10, F30.11, F30.12, F30.13, F30.2, F30.3, F30.4, F30.8, F30.9, F31.0, F31.10, F31.11, F31.12, F31.13, F31.2, F31.30, F31.31, F31.32, F31.4, F31.5, F31.60, F31.61, F31.62, F31.63, F31.64, F31.70, F31.71, F31.72, F31.73, F31.74, F31.75, F31.76, F31.77, F31.78, F31.81, F31.89, F31.9, F32.0, F32.1, F32.2, F32.3, F32.4, F32.5, F32.8, F32.81, F32.89, F32.9, F33.0, F33.1,\nF33.2, F33.3, F33.40, F33.41, F33.42, F33.8, F33.9, F34.0, F34.1, F34.8, F34.81, F34.89, F34.9, F39, F42, F42.2, F42.3, F42.4, F42.8, F42.9, F43.0, F43.10, F43.11, F43.12, F43.20, F43.21, F43.22, F43.23, F43.24, F43.25, F43.29, F43.8, F43.9, F44.89, F53, F53.0, F53.1, F60.0, F60.1, F60.2, F60.3, F60.4, F60.5, F60.6, F60.7, F60.81, F60.89, F60.9, F63.0, F63.1, F63.2, F63.3, F63.81, F63.89, F63.9, F68.10, F68.11, F68.12, F68.13, F68.8, F68.A, F84.0, F84.2, F84.3, F84.5, F84.8, F84.9, F90.0, F90.1, F90.2, F90.8, F90.9, F91.0,\nF91.1, F91.2, F91.3, F91.8, F91.9, F93.0, F93.8, F93.9, F94.0, F94.1, F94.2, F94.8, F94.9 \nOR\nDiagnosis of intentional self-harm (ICD-10-CM): T14.91XA, T14.91XD, T14.91XS, T36.0X2A, T36.0X2D, T36.0X2S, T36.1X2A, T36.1X2D, T36.1X2S, T36.2X2A, T36.2X2D, T36.2X2S, T36.3X2A, T36.3X2D, T36.3X2S, T36.4X2A, T36.4X2D, T36.4X2S, T36.5X2A, T36.5X2D, T36.5X2S, T36.6X2A, T36.6X2D, T36.6X2S, T36.7X2A, T36.7X2D, T36.7X2S, T36.8X2A, T36.8X2D, T36.8X2S, T36.92XA, T36.92XD, T36.92XS, T37.0X2A, T37.0X2D, T37.0X2S, T37.1X2A, T37.1X2D, T37.1X2S, T37.2X2A, T37.2X2D, T37.2X2S, T37.3X2A, T37.3X2D, T37.3X2S, T37.4X2A, T37.4X2D, T37.4X2S, T37.5X2A, T37.5X2D, T37.5X2S, T37.8X2A, T37.8X2D, T37.8X2S, T37.92XA, T37.92XD, T37.92XS, T38.0X2A, T38.0X2D, T38.0X2S, T38.1X2A, T38.1X2D, T38.1X2S, T38.2X2A,T38.2X2D, T38.2X2S, T38.3X2A, T38.3X2D, T38.3X2S, T38.4X2A, T38.4X2D, T38.4X2S, T38.5X2A, T38.5X2D, T38.5X2S, T38.6X2A, T38.6X2D, T38.6X2S, T38.7X2A, T38.7X2D, T38.7X2S, T38.802A, T38.802D, T38.802S, T38.812A, T38.812D, T38.812S, T38.892A, T38.892D, T38.892S, T38.902A, T38.902D, T38.902S, T38.992A, T38.992D, T38.992S, T39.012A, T39.012D, T39.012S, T39.092A, T39.092D, T39.092S, T39.1X2A, T39.1X2D, T39.1X2S, T39.2X2A, T39.2X2D, T39.2X2S, T39.312A, T39.312D, T39.312S, T39.392A, T39.392D, T39.392S, T39.4X2A, T39.4X2D, T39.4X2S, T39.8X2A, T39.8X2D, T39.8X2S, T39.92XA, T39.92XD, T39.92XS, T40.0X2A, T40.0X2D, T40.0X2S, T40.1X2A, T40.1X2D, T40.1X2S, T40.2X2A, T40.2X2D, T40.2X2S, T40.3X2A, T40.3X2D, T40.3X2S, T40.4X2A, T40.4X2D, T40.4X2S, T40.5X2A, T40.5X2D, T40.5X2S, T40.602A, T40.602D, T40.602S, T40.692A, T40.692D, T40.692S, T40.7X2A, T40.7X2D, T40.7X2S, T40.8X2A, T40.8X2D, T40.8X2S, T40.902A, T40.902D, T40.902S, T40.992A, T40.992D, T40.992S, T41.0X2A, T41.0X2D, T41.0X2S, T41.1X2A, T41.1X2D, T41.1X2S, T41.202A, T41.202D, T41.202S, T41.292A, T41.292D, T41.292S, T41.3X2A, T41.3X2D, T41.3X2S, T41.42XA, T41.42XD, T41.42XS, T41.5X2A, T41.5X2D, T41.5X2S, T42.0X2A, T42.0X2D, T42.0X2S, T42.1X2A, T42.1X2D, T42.1X2S, T42.2X2A, T42.2X2D, T42.2X2S, T42.3X2A, T42.3X2D, T42.3X2S, T42.4X2A, T42.4X2D, T42.4X2S, T42.5X2A, T42.5X2D, T42.5X2S, T42.6X2A, T42.6X2D, T42.6X2S, T42.72XA, T42.72XD, T42.72XS, T42.8X2A, T42.8X2D, T42.8X2S, T43.012A, T43.012D, T43.012S, T43.022A, T43.022D, T43.022S, T43.1X2A, T43.1X2D, T43.1X2S, T43.202A, T43.202D, T43.202S, T43.212A, T43.212D, T43.212S, T43.222A, T43.222D, T43.222S, T43.292A, T43.292D, T43.292S, T43.3X2A, T43.3X2D, T43.3X2S, T43.4X2A, T43.4X2D, T43.4X2S, T43.502A, T43.502D, T43.502S, T43.592A, T43.592D, T43.592S, T43.602A, T43.602D, T43.602S, T43.612A, T43.612D, T43.612S, T43.622A, T43.622D, T43.622S, T43.632A, T43.632D, T43.632S, T43.642A, T43.642D, T43.642S, T43.692A, T43.692D, T43.692S, T43.8X2A, T43.8X2D, T43.8X2S, T43.92XA, T43.92XD, T43.92XS, T44.0X2A, T44.0X2D, T44.0X2S, T44.1X2A, T44.1X2D, T44.1X2S, T44.2X2A, T44.2X2D, T44.2X2S, T44.3X2A, T44.3X2D, T44.3X2S, T44.4X2A, T44.4X2D, T44.4X2S, T44.5X2A, T44.5X2D, T44.5X2S, T44.6X2A, T44.6X2D, T44.6X2S, T44.7X2A, T44.7X2D, T44.7X2S, T44.8X2A, T44.8X2D, T44.8X2S, T44.902A, T44.902D, T44.902S, T44.992A, T44.992D, T44.992S, T45.0X2A, T45.0X2D, T45.0X2S, T45.1X2A, T45.1X2D, T45.1X2S, T45.2X2A, T45.2X2D, T45.2X2S, T45.3X2A, T45.3X2D, T45.3X2S, T45.4X2A, T45.4X2D, T45.4X2S, T45.512A, T45.512D, T45.512S, T45.522A, T45.522D, T45.522S, T45.602A, T45.602D, T45.602S, T45.612A, T45.612D, T45.612S, T45.622A, T45.622D, T45.622S, T45.692A, T45.692D, T45.692S, T45.7X2A, T45.7X2D, T45.7X2S, T45.8X2A, T45.8X2D, T45.8X2S, T45.92XA, T45.92XD, T45.92XS, T46.0X2A, T46.0X2D, T46.0X2S, T46.1X2A, T46.1X2D, T46.1X2S, T46.2X2A, T46.2X2D, T46.2X2S, T46.3X2A, T46.3X2D, T46.3X2S, T46.4X2A, T46.4X2D, T46.4X2S, T46.5X2A, T46.5X2D, T46.5X2S, T46.6X2A, T46.6X2D, T46.6X2S, T46.7X2A, T46.7X2D, T46.7X2S, T46.8X2A, T46.8X2D, T46.8X2S, T46.902A, T46.902D, T46.902S, T46.992A, T46.992D, T46.992S, T47.0X2A, T47.0X2D, T47.0X2S, T47.1X2A, T47.1X2D, T47.1X2S, T47.2X2A, T47.2X2D, T47.2X2S, T47.3X2A, T47.3X2D, T47.3X2S, T47.4X2A, T47.4X2D, T47.4X2S, T47.5X2A, T47.5X2D, T47.5X2S, T47.6X2A, T47.6X2D, T47.6X2S, T47.7X2A, T47.7X2D, T47.7X2S, T47.8X2A, T47.8X2D, T47.8X2S, T47.92XA, T47.92XD, T47.92XS, T48.0X2A, T48.0X2D, T48.0X2S, T48.1X2A, T48.1X2D, T48.1X2S, T48.202A, T48.202D, T48.202S, T48.292A, T48.292D, T48.292S, T48.3X2A, T48.3X2D, T48.3X2S, T48.4X2A, T48.4X2D, T48.4X2S, T48.5X2A, T48.5X2D, T48.5X2S, T48.6X2A, T48.6X2D, T48.6X2S, T48.902A, T48.902D, T48.902S, T48.992A, T48.992D, T48.992S, T49.0X2A, T49.0X2D, T49.0X2S, T49.1X2A, T49.1X2D, T49.1X2S, T49.2X2A, T49.2X2D, T49.2X2S, T49.3X2A, T49.3X2D, T49.3X2S, T49.4X2A, T49.4X2D, T49.4X2S, T49.5X2A, T49.5X2D, T49.5X2S, T49.6X2A, T49.6X2D, T49.6X2S, T49.7X2A, T49.7X2D, T49.7X2S, T49.8X2A, T49.8X2D, T49.8X2S, T49.92XA, T49.92XD, T49.92XS, T50.0X2A, T50.0X2D, T50.0X2S, T50.1X2A, T50.1X2D, T50.1X2S, T50.2X2A, T50.2X2D, T50.2X2S, T50.3X2A, T50.3X2D, T50.3X2S, T50.4X2A, T50.4X2D, T50.4X2S, T50.5X2A, T50.5X2D, T50.5X2S, T50.6X2A, T50.6X2D, T50.6X2S, T50.7X2A, T50.7X2D, T50.7X2S, T50.8X2A, T50.8X2D, T50.8X2S, T50.902A, T50.902D, T50.902S, T50.992A, T50.992D, T50.992S, T50.A12A, T50.A12D, T50.A12S, T50.A22A, T50.A22D, T50.A22S, T50.A92A, T50.A92D, T50.A92S, T50.B12A, T50.B12D, T50.B12S, T50.B92A, T50.B92D, T50.B92S, T50.Z12A, T50.Z12D, T50.Z12S, T50.Z92A, T50.Z92D, T50.Z92S, T51.0X2A, T51.0X2D, T51.0X2S, T51.1X2A, T51.1X2D, T51.1X2S, T51.2X2A, T51.2X2D, T51.2X2S, T51.3X2A, T51.3X2D, T51.3X2S, T51.8X2A, T51.8X2D, T51.8X2S, T51.92XA, T51.92XD, T51.92XS, T52.0X2A, T52.0X2D, T52.0X2S, T52.1X2A, T52.1X2D, T52.1X2S, T52.2X2A, T52.2X2D, T52.2X2S, T52.3X2A, T52.3X2D, T52.3X2S, T52.4X2A, T52.4X2D, T52.4X2S, T52.8X2A, T52.8X2D, T52.8X2S, T52.92XA, T52.92XD, T52.92XS, T53.0X2A, T53.0X2D, T53.0X2S, T53.1X2A, T53.1X2D, T53.1X2S, T53.2X2A, T53.2X2D, T53.2X2S, T53.3X2A, T53.3X2D, T53.3X2S, T53.4X2A, T53.4X2D, T53.4X2S, T53.5X2A, T53.5X2D, T53.5X2S, T53.6X2A, T53.6X2D, T53.6X2S, T53.7X2A, T53.7X2D, T53.7X2S, T53.92XA, T53.92XD, T53.92XS, T54.0X2A, T54.0X2D, T54.0X2S, T54.1X2A, T54.1X2D, T54.1X2S, T54.2X2A, T54.2X2D, T54.2X2S, T54.3X2A, T54.3X2D, T54.3X2S, T54.92XA, T54.92XD, T54.92XS, T55.0X2A, T55.0X2D, T55.0X2S, T55.1X2A, T55.1X2D, T55.1X2S, T56.0X2A, T56.0X2D, T56.0X2S, T56.1X2A, T56.1X2D, T56.1X2S, T56.2X2A, T56.2X2D, T56.2X2S, T56.3X2A, T56.3X2D, T56.3X2S, T56.4X2A, T56.4X2D, T56.4X2S, T56.5X2A, T56.5X2D, T56.5X2S, T56.6X2A, T56.6X2D, T56.6X2S, T56.7X2A, T56.7X2D, T56.7X2S, T56.812A, T56.812D, T56.812S, T56.892A, T56.892D, T56.892S, T56.92XA, T56.92XD, T56.92XS, T57.0X2A, T57.0X2D, T57.0X2S, T57.1X2A, T57.1X2D, T57.1X2S, T57.2X2A, T57.2X2D, T57.2X2S, T57.3X2A, T57.3X2D, T57.3X2S, T57.8X2A, T57.8X2D, T57.8X2S, T57.92XA, T57.92XD, T57.92XS, T58.02XA, T58.02XD, T58.02XS, T58.12XA, T58.12XD, T58.12XS, T58.2X2A, T58.2X2D, T58.2X2S, T58.8X2A, T58.8X2D, T58.8X2S, T58.92XA, T58.92XD, T58.92XS, T59.0X2A, T59.0X2D, T59.0X2S, T59.1X2A, T59.1X2D, T59.1X2S, T59.2X2A, T59.2X2D, T59.2X2S, T59.3X2A, T59.3X2D, T59.3X2S, T59.4X2A, T59.4X2D, T59.4X2S, T59.5X2A, T59.5X2D, T59.5X2S, T59.6X2A, T59.6X2D, T59.6X2S, T59.7X2A, T59.7X2D, T59.7X2S, T59.812A, T59.812D, T59.812S, T59.892A, T59.892D, T59.892S, T59.92XA, T59.92XD, T59.92XS, T60.0X2A, T60.0X2D, T60.0X2S, T60.1X2A, T60.1X2D, T60.1X2S, T60.2X2A, T60.2X2D, T60.2X2S, T60.3X2A, T60.3X2D, T60.3X2S, T60.4X2A, T60.4X2D, T60.4X2S, T60.8X2A, T60.8X2D, T60.8X2S, T60.92XA, T60.92XD, T60.92XS, T61.02XA, T61.02XD, T61.02XS, T61.12XA, T61.12XD, T61.12XS, T61.772A, T61.772D, T61.772S, T61.782A, T61.782D, T61.782S, T61.8X2A, T61.8X2D, T61.8X2S, T61.92XA, T61.92XD, T61.92XS, T62.0X2A, T62.0X2D, T62.0X2S, T62.1X2A, T62.1X2D, T62.1X2S, T62.2X2A, T62.2X2D, T62.2X2S, T62.8X2A, T62.8X2D, T62.8X2S, T62.92XA, T62.92XD, T62.92XS, T63.002A, T63.002D, T63.002S T63.012A, T63.012D, T63.012S, T63.022A, T63.022D, T63.022S, T63.032A, T63.032D, T63.032S, T63.042A, T63.042D, T63.042S, T63.062A, T63.062D, T63.062S, T63.072A, T63.072D, T63.072S, T63.082A, T63.082D, T63.082S, T63.092A, T63.092D, T63.092S, T63.112A, T63.112D, T63.112S, T63.122A, T63.122D, T63.122S, T63.192A, T63.192D, T63.192S, T63.2X2A, T63.2X2D, T63.2X2S, T63.302A, T63.302D, T63.302S, T63.312A, T63.312D, T63.312S, T63.322A, T63.322D, T63.322S, T63.332A, T63.332D, T63.332S, T63.392A, T63.392D, T63.392S, T63.412A, T63.412D, T63.412S, T63.422A, T63.422D, T63.422S, T63.432A, T63.432D, T63.432S, T63.442A, T63.442D, T63.442S, T63.452A, T63.452D, T63.452S, T63.462A, T63.462D, T63.462S, T63.482A, T63.482D, T63.482S, T63.512A, T63.512D, T63.512S, T63.592A, T63.592D, T63.592S, T63.612A, T63.612D, T63.612S, T63.622A, T63.622D, T63.622S, T63.632A, T63.632D, T63.632S, T63.692A, T63.692D, T63.692S, T63.712A, T63.712D, T63.712S, T63.792A, T63.792D, T63.792S, T63.812A, T63.812D, T63.812S, T63.822A, T63.822D, T63.822S, T63.832A, T63.832D, T63.832S, T63.892A, T63.892D, T63.892S, T63.92XA, T63.92XD, T63.92XS, T64.02XA, T64.02XD, T64.02XS, T64.82XA, T64.82XD, T64.82XS, T65.0X2A, T65.0X2D, T65.0X2S, T65.1X2A, T65.1X2D, T65.1X2S, T65.212A, T65.212D, T65.212S, T65.222A, T65.222D, T65.222S, T65.292A, T65.292D, T65.292S, T65.3X2A, T65.3X2D, T65.3X2S, T65.4X2A, T65.4X2D, T65.4X2S, T65.5X2A, T65.5X2D, T65.5X2S, T65.6X2A, T65.6X2D, T65.6X2S, T65.812A, T65.812D, T65.812S, T65.822A, T65.822D, T65.822S, T65.832A, T65.832D, T65.832S, T65.892A, T65.892D, T65.892S, T65.92XA, T65.92XD, T65.92XS, T71.112A, T71.112D, T71.112S, T71.122A, T71.122D, T71.122S, T71.132A, T71.132D, T71.132S, T71.152A, T71.152D, T71.152S, T71.162A, T71.162D, T71.162S, T71.192A, T71.192D, T71.192S, T71.222A, T71.222D, T71.222S, T71.232A, T71.232D, T71.232S, T50.911, T50.912, T50.913, T50.914, T50.915, T50.916 \nAND\nPatient encounter during the performance period (CPT): 99221, 99222, 99223, 99231, 99232, 99233, 99238, 99239, 99291\nAND\nPatient alive at time of acute inpatient setting discharge\nAND\nPatient is discharged from an acute inpatient setting on or between January 1 and December 1 of the measurement period\nNOTE: Patient encounters for this measure conducted via telehealth (e.g., encounters coded with GQ, GT, 95, or POS 02 modifiers) are allowable.","Exclude discharges followed by readmission or direct transfer to a non-acute facility within the 30- day follow-up period, regardless of principal diagnosis for the readmission\nAND\nExclude discharges followed by readmission or direct transfer to an acute facility within the 30-day follow-up period if the principal diagnosis was for non-mental health\n\nPatients who use hospice services any time during the measurement period: G9760\n\nException: Clinician documented reason patient was not able to complete 30 day follow-up from acute inpatient setting discharge (e.g., patient death prior to follow-up visit, patient non-compliant for visit follow-up) (G9403)","A follow-up visit with a mental health practitioner within 30 days after acute inpatient discharge. Do not include visits that occur on the date of discharge. Per the \"HHSC Program Specific Modifications\", for DPP BHS reporting purposes, only one rate (Rate 1) is reported (e.g., percentage of discharges for which the patient received follow-up within 30 days after discharge).","Patient received follow-up within 30 days after discharge (G9402)","Patient did not receive follow-up within 30 days after discharge (G9404)","For DPP BHS reporting purposes, only one rate (Rate 1) is reported (e.g., percentage of discharges for which the patient received follow-up within 30 days after discharge), and the denominator is limited to state hospitals and Sunrise Canyon Hospital.\n\nFor DPP BHS reporting purposes, an eligible provider is one who delivers mental health services and meets any of the following criteria:\n• An MD or doctor of osteopathy (DO) who is certified as a psychiatrist or child psychiatrist by the American Medical Specialties Board of Psychiatry and Neurology or by the American Osteopathic Board of Neurology and Psychiatry; or, if not certified, who successfully completed an accredited program of graduate medical or osteopathic education in psychiatry or child psychiatry and is licensed to practice patient care psychiatry or child psychiatry, if required by the state of practice.\n• An individual who is licensed as a psychologist in his/her state of practice, if required by the state of practice.\n• An individual who is certified in clinical social work by the American Board of Examiners; who is listed on the National Association of Social Worker’s Clinical Register; or who has a master’s degree in social work and is licensed or certified to practice as a social worker, if required by the state of practice.\n• A registered nurse (RN) who is certified by the American Nurses Credentialing Center (a subsidiary of the American Nurses Association) as a psychiatric nurse or mental health clinical nurse specialist, or who has a master’s degree in nursing with a specialization in\npsychiatric/mental health and two years of supervised clinical experience and is licensed to practice as a psychiatric or mental health nurse, if required by the state of practice.\n• An individual (normally with a master’s or a doctoral degree in marital and family therapy and at least two years of supervised clinical experience) who is practicing as a marital and family therapist and is licensed or a certified counselor by the state of practice, or if licensure or certification is not required by the state of practice, who is eligible for clinical membership in the American Association for Marriage and Family Therapy.\n• An individual (normally with a master’s or doctoral degree in counseling and at least two years of supervised clinical experience) who is practicing as a professional counselor and who is licensed or certified to do so by the state of practice, or if licensure or certification is not required by the state of practice, is a National Certified Counselor with a Specialty Certification in Clinical Mental Health Counseling from the National Board for Certified Counselors (NBCC).\n• A certified Community Mental Health Center (CMHC), or the comparable term (e.g. behavioral health organization, mental health agency, behavioral health agency) used within the state in which it is located, or a Certified Community Behavioral Health Clinic (CCBHC).\nOnly authorized CMHCs are considered mental health providers. To be authorized as a CMHC, an entity must meet one of the following criteria:\n- The entity has been certified by CMS to meet the conditions of participation (CoPs) that community mental health centers (CMHCs) must meet in order to participate in the Medicare program, as defined in the Code of Federal Regulations Title 42. CMS defines a\nCMHC as an entity that meets applicable licensing or certification requirements for CMHCs in the State in which it is located and provides the set of services specified in section 1913(c)(1) of the Public Health Service Act (PHS Act).\n- The entity has been licensed, operated, authorized, or otherwise recognized by a state or county in which it is located.\nOnly authorized CCBHCs are considered mental health providers. To be authorized as a CCBHC, an entity must meet one of the following criteria:\n- Has been certified by a State Medicaid agency as meeting criteria established by the Secretary for participation in the Medicaid CCBHC demonstration program pursuant to Protecting Access to Medicare Act § 223(a) (42 U.S.C. § 1396a note); or as meeting\ncriteria within the State’s Medicaid Plan to be considered a CCBHC.\n- Has been recognized by the Substance Abuse and Mental Health Services Administration, through the award of grant funds or otherwise, as a CCBHC that meets the certification criteria of a Certified Community Behavioral Health Clinic",null,null,null,null,"Positive",null,null,null,null,null,null,null,"The denominator specifications are the same for measures B2-152 and B2-153. Please note the denominator specifications for B2-152 and B2-153 are limited to discharges from State Hospitals and Sunrise Canyon Hospital, and the denominator values for each respective payer type should be the same for B2-152 and B2-153. For a given payer type, the B2-153 numerator value must be equal to or greater than the numerator value for B2-152."]
["B2-154","DPP BHS","B2","Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up","Process",null,"01/01/22 - 06/30/22","Numeric Data Reporting & Status Update",null,"01/01/22 - 12/31/22","Numeric Data Reporting & Status Update",null,"Medicaid Managed Care, Other Medicaid, Uninsured, All Payer",null,null,null,null,null,"0421","CMS","eCQI (eCQM: CMS69v10)","https://ecqi.healthit.gov/ecqm/ep/2022/cms069v10\nhttps://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS69v10.html","Percentage of patients aged 18 years and older with a BMI documented during the current encounter or within the previous twelve months AND who had a follow-up plan documented if most recent BMI was outside of normal parameters. Normal BMI Parameters - Age 18 years and older: BMI >= 18.5 and < 25 kg/m2","Psychiatry, Mental/Behavioral Health","Individuals","All patients aged 18 and older on the date of the encounter with at least one eligible encounter during the measurement period","Patients aged ≥18 years on date of encounter\nAND\nPatient encounter during the performance period (CPT or HCPCS): 90791, 90792, 90832, 90834, 90837, 96156, 96158, 97161, 97162, 97163, 97165, 97166, 97167, 97802, 97803, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99236, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99318, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99339, 99340, 99385*, 99386*, 99387*, 99395*, 99396*, 99397*, 99401*, 99402*, D7111, D7140, D7210, D7220, D7230, D7240, D7241, D7250, D7251, G0101, G0108, G0270, G0271, G0402, G0438, G0439, G0447, G0473\nWITHOUT\nTelehealth Modifier: GQ, GT, 95, POS 02\n\nPer \"Measure Steward Additional Information\", \"Telehealth encounters are not eligible for this measure because the measure requires a clinical action that cannot be conducted via telehealth.\"","BMI not documented, documentation the patient is not eligible for BMI calculation: G8422\nOR\nBMI is documented as being outside of normal parameters, follow-up plan is not documented, documentation the patient is not eligible: G8938\n\nException: BMI not documented due to medical reason OR patient refusal of height or weight measurement (G2181) \nOR\nBMI is documented as being outside of normal parameters, follow-up plan is not completed for documented reason (G9716)\n\nNot Eligible for BMI Calculation or Follow-Up Plan (Denominator Exclusion) – A patient is not eligible if one or more of the following reasons are documented:\n•Patients receiving palliative or hospice care on the date of the current encounter or any time prior to the current encounter\n•Patients who are pregnant on the date of the current encounter or any time during the measurement period prior to the current encounter\n•Patients who refuse measurement of height and/or weight on the date of the current encounter or any time during the measurement period prior to the current encounter\n \nPatients with a documented BMI outside normal limits and a documented reason for not completing BMI follow-up plan during the current encounter or within the previous 12 months of the current encounter (Denominator Exception) –\n•Patients with a documented Medical Reason. The Medical Reason exception could include, but is not limited to, the following patients as deemed appropriate by the health care provider\n•Elderly patients (65 or older) for whom weight reduction/weight gain would complicate other underlying health conditions such as the following examples:\nillness or physical disability\noMental illness, dementia, confusion\noNutritional deficiency, such as vitamin/mineral deficiency\n•Patient is in an urgent or emergent medical situation where time\n\nException: BMI not documented due to medical reason OR patient refusal of height or weight measurement (G2181)\nOR\nBMI is documented as being outside of normal parameters, follow-up plan is not completed for documented reason (G9716)","Patients with a documented BMI during the encounter or during the previous twelve months, AND when the BMI is outside of normal parameters, a follow-up plan is documented during the encounter or during the previous twelve months of the current encounter","Performance Met: BMI is documented within normal parameters and no follow-up plan is required (G8420)\nOR\nPerformance Met: BMI is documented as above normal parameters and a follow-up plan is documented (G8417)\nOR\nPerformance Met: BMI is documented as below normal parameters and a follow-up plan is documented (G8418)\n\nPerformance Met for G8417 & G8418\n•If the provider documents a BMI and a follow-up plan at the current visit OR\n•If the patient has a documented BMI within the previous twelve months of the current encounter, the provider documents a follow-up plan at the current visit OR\n•If the patient has a documented BMI within the previous twelve months of the current encounter AND the patient has a documented follow-up plan for a BMI outside normal parameters within the previous twelve months of the current visit","Performance Not Met: BMI not documented and no reason is given (G8421)\nOR\nPerformance Not Met: BMI documented outside of normal parameters, no follow-up plan documented, no reason given (G8419)",null,"Definitions:\nNormal BMI Parameters:  Age 18 years and older BMI >= 18.5 and < 25 kg/m2\n\nBMI - Body mass index (BMI) is a number calculated using the Quetelet index: weight divided by height squared (W/H2) and is commonly used to classify weight categories. BMI can be calculated using:\n\nMetric Units:  BMI = Weight (kg) / (Height (m) x Height (m))    \nOR             \nEnglish Units:  BMI = Weight (lbs.) / (Height (in) x Height (in)) x 703\n\nFollow-Up Plan - Proposed outline of treatment to be conducted as a result of a BMI out of normal parameters. A follow-up plan may include, but is not limited to: documentation of education, referral (for example a Registered Dietitian Nutritionist (RDN), occupational therapist, physical therapist, primary care provider, exercise physiologist, mental health professional, or surgeon) for lifestyle/behavioral therapy, pharmacological interventions, dietary supplements, exercise counseling and/or nutrition counseling\n\nGuidance:\nBMI Measurement Guidance:\n*  Height and Weight - An eligible professional or their staff is required to measure both height and weight. Both height and weight must be measured within twelve months of the current encounter and may be obtained from separate encounters. Self-reported values cannot be used.\n*  The BMI may be documented in the medical record of the provider or in outside medical records obtained by the provider. \n*  If the most recent documented BMI is outside of normal parameters, then a follow-up plan is documented during the encounter or during the previous twelve months of the current encounter. \n*  If more than one BMI is reported during the measurement period, the most recent BMI will be used to determine if the performance has been met.\n*  Review the exclusions and exceptions criteria to determine those patients that BMI measurement may not be appropriate or necessary. \n\nFollow-Up Plan Guidance: \n * The documented follow-up plan must be based on the most recent documented BMI, outside of normal parameters, example: \"Patient referred to nutrition counseling for BMI above or below normal parameters.\"\n\n(See Definitions for examples of follow-up plan treatments).\n\nVariation has been noted in studies exploring optimal BMI ranges for the elderly (see Donini et al., [2012]; Holme & Tonstad [2015]; Diehr et al. [2008]). Notably however, all these studies have arrived at ranges that differ from the standard range for ages 18 and older, which is >=18.5 and < 25 kg/m2. For instance, both Donini et al. (2012) and Holme and Tonstad (2015) reported findings that suggest that higher BMI (higher than the upper end of 25kg/m2) in the elderly may be beneficial. Similarly, worse outcomes have been associated with being underweight (at a threshold higher than 18.5 kg/m2) at age 65 (Diehr et al. 2008). Because of optimal BMI range variation recommendations from these studies, no specific optimal BMI range for the elderly is used. However, it may be appropriate to exempt certain patients from a follow-up plan by applying the exception criteria. See denominator exception section for examples.\n\n*  This eCQM is a patient-based measure. This measure is to be reported a minimum of once per reporting period for patients seen during the reporting period.\n*  This measure may be reported by eligible professionals who perform the quality actions described in the measure based on the services provided at the time of the qualifying encounter and the measure-specific denominator coding. \n\nTelehealth encounters are not eligible for this measure because the measure requires a clinical action that cannot be conducted via telehealth.\n\nThis version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.",null,null,null,"Positive"]

{"sheet":"Clinical Concepts SFY23","index":11,"n_rows":132,"n_cols":22,"rows_kept":132,"cut":false,"hidden":true,"merged":[]}
[]
["Code Description",null,null,null,"Value Set Description",null,null,null,null,null,null,"Code Systems / Value Set - Version",null,null,null,"Other Information",null,null,"Internal"]
["Code","Code Descriptor - CPT","Code Descriptor - HCPCS","Code Descriptor - SNOMEDCT ","Value Set OID","Value Set Name","Value Set Type: Grouping / Individual","Purpose: Clinical Focus","Purpose: Data Element Scope","Purpose: Inclusion Criteria","Purpose: Exclusion Criteria","CPT Version","HCPCS Version","SNOMEDCT Version","Value Set Version","HCPCS Code Property","Value Set Steward","Active","Order","DPP Clinical Concept","NOTES","Medicaid Reimbursement"]
[99201,"Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family","New patient office or other outpatient visit, typically 10 minutes",null,null,null,null,null,null,null,null,2020,2020,null,null,"CPT Level I",null,"Yes",1,"Primary Care Service","Since both 99201 and 99202 represent a service described as straightforward medical decision-making (MDM), as of January 1, 2021, CPT has deleted 99201 and directs reporting 99202 in its place."]
[99202,"Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 15-29 minutes of total time is spent on the date of the encounter.","New patient outpatient visit, total time 15-29 minutes",null,"No Value Set;\n2.16.840.1.113883.3.464.1003.101.12.1001;\n2.16.840.1.113883.3.464.1003.101.12.1061","No Value Set;\nOffice Visit;\nAmbulatory/ED Visit",";\n;\nGrouping",";\n;\nThis value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.",";\n;\nThis value set may use the Quality Data Model (QDM) category related to Encounter.",";\n;\nIncludes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.",";\n;\nExcludes encounters that occurred in the inpatient setting.",2021,2021,null,";\n;\n20170504","CPT Level I","NCQA;\nNCQA;\nNCQA","Yes",2,"Primary Care Service; \nAmbulatory Encounter;\nAmbulatory Encounter"]
[99203,"Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 30-44 minutes of total time is spent on the date of the encounter.","New patient outpatient visit, total time 30-44 minutes",null,"No Value Set;\n2.16.840.1.113883.3.464.1003.101.12.1001;\n2.16.840.1.113883.3.464.1003.101.12.1061","No Value Set;\nOffice Visit;\nAmbulatory/ED Visit",";\n;\nGrouping",";\n;\nThis value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.",";\n;\nThis value set may use the Quality Data Model (QDM) category related to Encounter.",";\n;\nIncludes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.",";\n;\nExcludes encounters that occurred in the inpatient setting.",2021,2021,null,";\n;\n20170504","CPT Level I","NCQA;\nNCQA;\nNCQA","Yes",3,"Primary Care Service; \nAmbulatory Encounter;\nAmbulatory Encounter"]
[99204,"Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 45-59 minutes of total time is spent on the date of the encounter.","New patient outpatient visit, total time 45-59 minutes",null,"No Value Set;\n2.16.840.1.113883.3.464.1003.101.12.1001;\n2.16.840.1.113883.3.464.1003.101.12.1061","No Value Set;\nOffice Visit;\nAmbulatory/ED Visit",";\n;\nGrouping",";\n;\nThis value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.",";\n;\nThis value set may use the Quality Data Model (QDM) category related to Encounter.",";\n;\nIncludes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.",";\n;\nExcludes encounters that occurred in the inpatient setting.",2021,2021,null,";\n;\n20170504","CPT Level I","NCQA;\nNCQA;\nNCQA","Yes",4,"Primary Care Service; \nAmbulatory Encounter;\nAmbulatory Encounter"]
[99205,"Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 60-74 minutes of total time is spent on the date of the encounter.","New patient outpatient visit, total time 60-74 minutes",null,"No Value Set;\n2.16.840.1.113883.3.464.1003.101.12.1001;\n2.16.840.1.113883.3.464.1003.101.12.1061","No Value Set;\nOffice Visit;\nAmbulatory/ED Visit",";\n;\nGrouping",";\n;\nThis value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.",";\n;\nThis value set may use the Quality Data Model (QDM) category related to Encounter.",";\n;\nIncludes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.",";\n;\nExcludes encounters that occurred in the inpatient setting.",2021,2021,null,";\n;\n20170504","CPT Level I","NCQA;\nNCQA;\nNCQA","Yes",5,"Primary Care Service; \nAmbulatory Encounter;\nAmbulatory Encounter"]
[99211,"Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal.","Established patient outpatient visit, minimal presenting problem",null,null,null,null,null,null,null,null,2021,2021,null,null,"CPT Level I",null,"Yes",6,"Primary Care Service"]
[99212,"Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 10-19 minutes of total time is spent on the date of the encounter.","Established patient outpatient visit, total time 10-19 minutes",null,"No Value Set;\n2.16.840.1.113883.3.464.1003.101.12.1001;\n2.16.840.1.113883.3.464.1003.101.12.1061","No Value Set;\nOffice Visit;\nAmbulatory/ED Visit",";\n;\nGrouping",";\n;\nThis value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.",";\n;\nThis value set may use the Quality Data Model (QDM) category related to Encounter.",";\n;\nIncludes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. T",";\n;\nExcludes encounters that occurred in the inpatient setting.",2021,2021,null,20170504,"CPT Level I","NCQA","Yes",7,"Primary Care Service; \nAmbulatory Encounter;\nAmbulatory Encounter"]
[99213,"Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 20-29 minutes of total time is spent on the date of the encounter.","Established patient outpatient visit, total time 20-29 minutes",null,"No Value Set;\n2.16.840.1.113883.3.464.1003.101.12.1001;\n2.16.840.1.113883.3.464.1003.101.12.1061","No Value Set;\nOffice Visit;\nAmbulatory/ED Visit",";\n;\nGrouping",";\n;\nThis value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.",";\n;\nThis value set may use the Quality Data Model (QDM) category related to Encounter.",";\n;\nIncludes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. T",";\n;\nExcludes encounters that occurred in the inpatient setting.",2021,2021,null,20170504,"CPT Level I","NCQA","Yes",8,"Primary Care Service; \nAmbulatory Encounter;\nAmbulatory Encounter","SFY23 (Year 2) DPP BHS Component 2 Rate Increase: \"To align with the incentive to achieve CCBHC certification, Component 2 rate increases will be applied to the following codes: H2014, T1017, H2017, 99214, H2011, 99213, 90837, 90792, 90791, H0034, 90834, H0020, 99215, 96372, H0005\". \n\nLook into the missing codes: H2014, T1017, H2017, 99214, H2011, H0034, H0020, 96372, H0005"]
[99214,"Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 30-39 minutes of total time is spent on the date of the encounter.","Established patient outpatient visit, total time 30-39 minutes",null,"No Value Set;\n2.16.840.1.113883.3.464.1003.101.12.1001;\n2.16.840.1.113883.3.464.1003.101.12.1061","No Value Set;\nOffice Visit;\nAmbulatory/ED Visit",";\n;\nGrouping",";\n;\nThis value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.",";\n;\nThis value set may use the Quality Data Model (QDM) category related to Encounter.",";\n;\nIncludes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. T",";\n;\nExcludes encounters that occurred in the inpatient setting.",2021,2021,null,20170504,"CPT Level I","NCQA","Yes",9,"Primary Care Service; \nAmbulatory Encounter;\nAmbulatory Encounter"]
[99215,"Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.","Established patient outpatient visit, total time 40-54 minutes",null,"No Value Set;\n2.16.840.1.113883.3.464.1003.101.12.1001;\n2.16.840.1.113883.3.464.1003.101.12.1061","No Value Set;\nOffice Visit;\nAmbulatory/ED Visit",";\n;\nGrouping",";\n;\nThis value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.",";\n;\nThis value set may use the Quality Data Model (QDM) category related to Encounter.",";\n;\nIncludes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. T",";\n;\nExcludes encounters that occurred in the inpatient setting.",2021,2021,null,20170504,"CPT Level I","NCQA","Yes",10,"Primary Care Service; \nAmbulatory Encounter;\nAmbulatory Encounter","SFY23 (Year 2) DPP BHS Component 2 Rate Increase: \"To align with the incentive to achieve CCBHC certification, Component 2 rate increases will be applied to the following codes: H2014, T1017, H2017, 99214, H2011, 99213, 90837, 90792, 90791, H0034, 90834, H0020, 99215, 96372, H0005\". \n\nLook into the missing codes: H2014, T1017, H2017, 99214, H2011, H0034, H0020, 96372, H0005"]
[99304,"Initial nursing facility care, per day, for the evaluation and management of a patient, which requires these 3 key components: A detailed or comprehensive history; A detailed or comprehensive examination; and Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission are of low severity. Typically, 25 minutes are spent at the bedside and on the patient's facility floor or unit.","Initial nursing facility visit, typically 25 minutes per day",null,null,null,null,null,null,null,null,2021,2021,null,null,"CPT Level I",null,"Yes",11,"Primary Care Service"]
[99305,"Initial nursing facility care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission are of moderate severity. Typically, 35 minutes are spent at the bedside and on the patient's facility floor or unit.","Initial nursing facility visit, typically 35 minutes per day",null,null,null,null,null,null,null,null,2021,2021,null,null,"CPT Level I",null,"Yes",12,"Primary Care Service"]
[99306,"Initial nursing facility care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission are of high severity. Typically, 45 minutes are spent at the bedside and on the patient's facility floor or unit.","Initial nursing facility visit, typically 45 minutes per day",null,null,null,null,null,null,null,null,2021,2021,null,null,"CPT Level I",null,"Yes",13,"Primary Care Service"]
[99307,"Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is stable, recovering, or improving. Typically, 10 minutes are spent at the bedside and on the patient's facility floor or unit.","Subsequent nursing facility visit, typically 10 minutes per day",null,null,null,null,null,null,null,null,2021,2021,null,null,"CPT Level I",null,"Yes",14,"Primary Care Service"]
[99308,"Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Typically, 15 minutes are spent at the bedside and on the patient's facility floor or unit.","Subsequent nursing facility visit, typically 15 minutes per day",null,null,null,null,null,null,null,null,2021,2021,null,null,"CPT Level I",null,"Yes",15,"Primary Care Service"]
[99309,"Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient has developed a significant complication or a significant new problem. Typically, 25 minutes are spent at the bedside and on the patient's facility floor or unit.","Subsequent nursing facility visit, typically 25 minutes per day",null,null,null,null,null,null,null,null,2021,2021,null,null,"CPT Level I",null,"Yes",16,"Primary Care Service"]
[93310,"Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A comprehensive interval history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. The patient may be unstable or may have developed a significant new problem requiring immediate physician attention. Typically, 35 minutes are spent at the bedside and on the patient's facility floor or unit.","Subsequent nursing facility visit, typically 35 minutes per day",null,null,null,null,null,null,null,null,2021,2021,null,null,"CPT Level I",null,"Yes",17,"Primary Care Service"]
[99315,"Nursing facility discharge day management; 30 minutes or less","Nursing facility discharge day management; 30 minutes or less",null,null,null,null,null,null,null,null,2021,2021,null,null,"CPT Level I",null,"Yes",18,"Primary Care Service"]
[99316,"Nursing facility discharge day management; more than 30 minutes","Nursing facility discharge day management; more than 30 minutes",null,null,null,null,null,null,null,null,2021,2021,null,null,"CPT Level I",null,"Yes",19,"Primary Care Service"]
[99318,"Evaluation and management of a patient involving an annual nursing facility assessment, which requires these 3 key components: A detailed interval history; A comprehensive examination; and Medical decision making that is of low to moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is stable, recovering, or improving. Typically, 30 minutes are spent at the bedside and on the patient's facility floor or unit.","Nursing facility annual assessment, typically 30 minutes",null,null,null,null,null,null,null,null,2021,2021,null,null,"CPT Level I",null,"Yes",20,"Primary Care Service"]
[99324,"Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low severity. Typically, 20 minutes are spent with the patient and/or family or caregiver.","New patient assisted living visit, typically 20 minutes",null,null,null,null,null,null,null,null,2021,2021,null,null,"CPT Level I",null,"Yes",21,"Primary Care Service"]
[99325,"Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Typically, 30 minutes are spent with the patient and/or family or caregiver.","New patient assisted living visit, typically 30 minutes",null,null,null,null,null,null,null,null,2021,2021,null,null,"CPT Level I",null,"Yes",22,"Primary Care Service"]
[99326,"Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent with the patient and/or family or caregiver.","New patient assisted living visit, typically 45 minutes",null,null,null,null,null,null,null,null,2021,2021,null,null,"CPT Level I",null,"Yes",23,"Primary Care Service"]
[99327,"Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity. Typically, 60 minutes are spent with the patient and/or family or caregiver.","New patient assisted living visit, typically 60 minutes",null,null,null,null,null,null,null,null,2021,2021,null,null,"CPT Level I",null,"Yes",24,"Primary Care Service"]
[99328,"Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is unstable or has developed a significant new problem requiring immediate physician attention. Typically, 75 minutes are spent with the patient and/or family or caregiver.","New patient assisted living visit, typically 75 minutes",null,null,null,null,null,null,null,null,2021,2021,null,null,"CPT Level I",null,"Yes",25,"Primary Care Service"]
[99334,"Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self-limited or minor. Typically, 15 minutes are spent with the patient and/or family or caregiver.","Established patient assisted living visit, typically 15 minutes",null,null,null,null,null,null,null,null,2021,2021,null,null,"CPT Level I",null,"Yes",26,"Primary Care Service"]
[99335,"Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 25 minutes are spent with the patient and/or family or caregiver.","Established patient assisted living visit, typically 25 minutes",null,null,null,null,null,null,null,null,2021,2021,null,null,"CPT Level I",null,"Yes",27,"Primary Care Service"]
[99336,"Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 40 minutes are spent with the patient and/or family or caregiver.","Established patient assisted living visit, typically 40 minutes",null,null,null,null,null,null,null,null,2021,2021,null,null,"CPT Level I",null,"Yes",28,"Primary Care Service"]
[99337,"Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive interval history; A comprehensive examination; Medical decision making of moderate to high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. The patient may be unstable or may have developed a significant new problem requiring immediate physician attention. Typically, 60 minutes are spent with the patient and/or family or caregiver.","Established patient assisted living visit, typically 60 minutes",null,null,null,null,null,null,null,null,2021,2021,null,null,"CPT Level I",null,"Yes",29,"Primary Care Service"]
[99339,"Individual physician supervision of a patient (patient not present) in home, domiciliary or rest home (eg, assisted living facility) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of related laboratory and other studies, communication (including telephone calls) for purposes of assessment or care decisions with health care professional(s), family member(s), surrogate decision maker(s) (eg, legal guardian) and/or key caregiver(s) involved in patient's care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month; 15-29 minutes","Physician supervision of patient care at home or assisted living facility, 15-29 minutes in one month",null,null,null,null,null,null,null,null,2021,2021,null,null,"CPT Level I",null,"Yes",30,"Primary Care Service"]
[99340,"Individual physician supervision of a patient (patient not present) in home, domiciliary or rest home (eg, assisted living facility) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of related laboratory and other studies, communication (including telephone calls) for purposes of assessment or care decisions with health care professional(s), family member(s), surrogate decision maker(s) (eg, legal guardian) and/or key caregiver(s) involved in patient's care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month; 30 minutes or more","Physician supervision of patient care at home or assisted living facility, 30 minutes or more in one month",null,null,null,null,null,null,null,null,2021,2021,null,null,"CPT Level I",null,"Yes",31,"Primary Care Service"]
[99341,"Home visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low severity. Typically, 20 minutes are spent face-to-face with the patient and/or family.","New patient home visit, typically 20 minutes",null,"2.16.840.1.113883.3.464.1003.101.12.1061","Ambulatory/ED Visit","Grouping","This value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.","This value set may use the Quality Data Model (QDM) category related to Encounter.","Includes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.","Excludes encounters that occurred in the inpatient setting.",2021,2021,null,20170504,"CPT Level I","NCQA","Yes",39,"Primary Care Service; \nAmbulatory Encounter"]
[99342,"Home visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Typically, 30 minutes are spent face-to-face with the patient and/or family.","New patient home visit, typically 30 minutes",null,"2.16.840.1.113883.3.464.1003.101.12.1061","Ambulatory/ED Visit","Grouping","This value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.","This value set may use the Quality Data Model (QDM) category related to Encounter.","Includes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.","Excludes encounters that occurred in the inpatient setting.",2021,2021,null,20170504,"CPT Level I","NCQA","Yes",39,"Primary Care Service; \nAmbulatory Encounter"]
[99343,"Home visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent face-to-face with the patient and/or family.\t","New patient home visit, typically 45 minutes",null,"2.16.840.1.113883.3.464.1003.101.12.1061","Ambulatory/ED Visit","Grouping","This value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.","This value set may use the Quality Data Model (QDM) category related to Encounter.","Includes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.","Excludes encounters that occurred in the inpatient setting.",2021,2021,null,20170504,"CPT Level I","NCQA","Yes",39,"Primary Care Service; \nAmbulatory Encounter"]
[99344,"Home visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity. Typically, 60 minutes are spent face-to-face with the patient and/or family.","New patient home visit, typically 60 minutes",null,"2.16.840.1.113883.3.464.1003.101.12.1061","Ambulatory/ED Visit","Grouping","This value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.","This value set may use the Quality Data Model (QDM) category related to Encounter.","Includes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.","Excludes encounters that occurred in the inpatient setting.",2021,2021,null,20170504,"CPT Level I","NCQA","Yes",39,"Primary Care Service; \nAmbulatory Encounter"]
[99345,"Home visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is unstable or has developed a significant new problem requiring immediate physician attention. Typically, 75 minutes are spent face-to-face with the patient and/or family.","New patient home visit, typically 75 minutes",null,"2.16.840.1.113883.3.464.1003.101.12.1061","Ambulatory/ED Visit","Grouping","This value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.","This value set may use the Quality Data Model (QDM) category related to Encounter.","Includes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.","Excludes encounters that occurred in the inpatient setting.",2021,2021,null,20170504,"CPT Level I","NCQA","Yes",39,"Primary Care Service; \nAmbulatory Encounter"]
[99347,"Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 15 minutes are spent face-to-face with the patient and/or family.","Established patient home visit, typically 15 minutes",null,"2.16.840.1.113883.3.464.1003.101.12.1061","Ambulatory/ED Visit","Grouping","This value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.","This value set may use the Quality Data Model (QDM) category related to Encounter.","Includes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.","Excludes encounters that occurred in the inpatient setting.",2021,2021,null,20170504,"CPT Level I","NCQA","Yes",39,"Primary Care Service; \nAmbulatory Encounter"]
[99348,"Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 25 minutes are spent face-to-face with the patient and/or family.","Established patient home visit, typically 25 minutes",null,"2.16.840.1.113883.3.464.1003.101.12.1061","Ambulatory/ED Visit","Grouping","This value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.","This value set may use the Quality Data Model (QDM) category related to Encounter.","Includes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.","Excludes encounters that occurred in the inpatient setting.",2021,2021,null,20170504,"CPT Level I","NCQA","Yes",39,"Primary Care Service; \nAmbulatory Encounter"]
[99349,"Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are moderate to high severity. Typically, 40 minutes are spent face-to-face with the patient and/or family.","Established patient home visit, typically 40 minutes",null,"2.16.840.1.113883.3.464.1003.101.12.1061","Ambulatory/ED Visit","Grouping","This value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.","This value set may use the Quality Data Model (QDM) category related to Encounter.","Includes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.","Excludes encounters that occurred in the inpatient setting.",2021,2021,null,20170504,"CPT Level I","NCQA","Yes",39,"Primary Care Service; \nAmbulatory Encounter"]
[99350,"Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive interval history; A comprehensive examination; Medical decision making of moderate to high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. The patient may be unstable or may have developed a significant new problem requiring immediate physician attention. Typically, 60 minutes are spent face-to-face with the patient and/or family.","Established patient home visit, typically 60 minutes",null,"2.16.840.1.113883.3.464.1003.101.12.1061","Ambulatory/ED Visit","Grouping","This value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.","This value set may use the Quality Data Model (QDM) category related to Encounter.","Includes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.","Excludes encounters that occurred in the inpatient setting.",2021,2021,null,20170504,"CPT Level I","NCQA","Yes",40,"Primary Care Service;\nAmbulatory Encounter"]
["G0438",null,"Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit",null,"2.16.840.1.113883.3.526.2.1363","Annual Wellness Visit",null,null,null,null,null,null,2021,null,null,"CPT Level II","NCQA","Yes",41,"Preventive Care Service"]
["G0439",null,"Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit",null,"2.16.840.1.113883.3.526.2.1363","Annual Wellness Visit",null,null,null,null,null,null,2021,null,null,"CPT Level II","NCQA","Yes",42,"Preventive Care Service"]
[99381,"Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; infant (age younger than 1 year)","Initial new patient preventive medicine evaluation infant younger than 1 year",null,"2.16.840.1.113883.3.464.1003.101.12.1023;\n2.16.840.1.113883.3.464.1003.101.12.1061","Preventive Care Services Initial Office Visit, 18 and Up;\nAmbulatory/ED Visit",";\nGrouping",";\nThis value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.",";\nThis value set may use the Quality Data Model (QDM) category related to Encounter.",";\nIncludes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.",";\nExcludes encounters that occurred in the inpatient setting.",2021,2021,null,";\n20170504","CPT Level I","NCQA;\nNCQA","Yes",43,"Preventive Care Service;\nAmbulatory Encounter"]
[99382,"Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; early childhood (age 1 through 4 years)","Initial new patient preventive medicine evaluation, age 1 through 4 years",null,"2.16.840.1.113883.3.464.1003.101.12.1023;\n2.16.840.1.113883.3.464.1003.101.12.1061","Preventive Care Services Initial Office Visit, 18 and Up;\nAmbulatory/ED Visit",";\nGrouping",";\nThis value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.",";\nThis value set may use the Quality Data Model (QDM) category related to Encounter.",";\nIncludes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.",";\nExcludes encounters that occurred in the inpatient setting.",2021,2021,null,";\n20170504","CPT Level I","NCQA;\nNCQA","Yes",44,"Preventive Care Service;\nAmbulatory Encounter"]
[99383,"Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; late childhood (age 5 through 11 years)","Initial new patient preventive medicine evaluation, age 5 through 11 years",null,"2.16.840.1.113883.3.464.1003.101.12.1023;\n2.16.840.1.113883.3.464.1003.101.12.1061","Preventive Care Services Initial Office Visit, 18 and Up;\nAmbulatory/ED Visit",";\nGrouping",";\nThis value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.",";\nThis value set may use the Quality Data Model (QDM) category related to Encounter.",";\nIncludes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.",";\nExcludes encounters that occurred in the inpatient setting.",2021,2021,null,";\n20170504","CPT Level I","NCQA;\nNCQA","Yes",45,"Preventive Care Service;\nAmbulatory Encounter"]
[99384,"Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; adolescent (age 12 through 17 years)","Initial new patient preventive medicine evaluation, age 12 through 17 years",null,"2.16.840.1.113883.3.464.1003.101.12.1023;\n2.16.840.1.113883.3.464.1003.101.12.1061","Preventive Care Services Initial Office Visit, 18 and Up;\nAmbulatory/ED Visit",";\nGrouping",";\nThis value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.",";\nThis value set may use the Quality Data Model (QDM) category related to Encounter.",";\nIncludes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.",";\nExcludes encounters that occurred in the inpatient setting.",2021,2021,null,";\n20170504","CPT Level I","NCQA;\nNCQA","Yes",46,"Preventive Care Service;\nAmbulatory Encounter"]
[99391,"Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; infant (age younger than 1 year)","Established patient periodic preventive medicine examination infant younger than 1 year",null,"2.16.840.1.113883.3.464.1003.101.12.1025;\n2.16.840.1.113883.3.464.1003.101.12.1061","Preventive Care Services Established Office Visit, 18 and Up;\nAmbulatory/ED Visit",";\nGrouping",";\nThis value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.",";\nThis value set may use the Quality Data Model (QDM) category related to Encounter.",";\nIncludes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.",";\nExcludes encounters that occurred in the inpatient setting.",2021,2021,null,";\n20170504","CPT Level I","NCQA;\nNCQA","Yes",47,"Preventive Care Service;\nAmbulatory Encounter"]
[99392,"Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; early childhood (age 1 through 4 years)","Established patient periodic preventive medicine examination, age 1 through 4 years",null,"2.16.840.1.113883.3.464.1003.101.12.1025;\n2.16.840.1.113883.3.464.1003.101.12.1061","Preventive Care Services Established Office Visit, 18 and Up;\nAmbulatory/ED Visit",";\nGrouping",";\nThis value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.",";\nThis value set may use the Quality Data Model (QDM) category related to Encounter.",";\nIncludes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.",";\nExcludes encounters that occurred in the inpatient setting.",2021,2021,null,";\n20170504","CPT Level I","NCQA;\nNCQA","Yes",48,"Preventive Care Service;\nAmbulatory Encounter"]
[99393,"Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; late childhood (age 5 through 11 years)","Established patient periodic preventive medicine examination, age 5 through 11 years",null,"2.16.840.1.113883.3.464.1003.101.12.1025;\n2.16.840.1.113883.3.464.1003.101.12.1061","Preventive Care Services Established Office Visit, 18 and Up;\nAmbulatory/ED Visit",";\nGrouping",";\nThis value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.",";\nThis value set may use the Quality Data Model (QDM) category related to Encounter.",";\nIncludes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.",";\nExcludes encounters that occurred in the inpatient setting.",2021,2021,null,";\n20170504","CPT Level I","NCQA;\nNCQA","Yes",49,"Preventive Care Service;\nAmbulatory Encounter"]
[99394,"Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; adolescent (age 12 through 17 years)","Established patient periodic preventive medicine examination, age 12 through 17 years",null,"2.16.840.1.113883.3.464.1003.101.12.1025;\n2.16.840.1.113883.3.464.1003.101.12.1061","Preventive Care Services Established Office Visit, 18 and Up;\nAmbulatory/ED Visit",";\nGrouping",";\nThis value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.",";\nThis value set may use the Quality Data Model (QDM) category related to Encounter.",";\nIncludes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.",";\nExcludes encounters that occurred in the inpatient setting.",2021,2021,null,";\n20170504","CPT Level I","NCQA;\nNCQA","Yes",50,"Preventive Care Service;\nAmbulatory Encounter"]
[99385,"Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 18-39 years","Initial new patient preventive medicine evaluation age 18-39 years",null,"2.16.840.1.113883.3.464.1003.101.12.1023;\n2.16.840.1.113883.3.464.1003.101.12.1061","Preventive Care Services Initial Office Visit, 18 and Up;\nAmbulatory/ED Visit",";\nGrouping",";\nThis value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.",";\nThis value set may use the Quality Data Model (QDM) category related to Encounter.",";\nIncludes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.",";\nExcludes encounters that occurred in the inpatient setting.",2021,2021,null,";\n20170504","CPT Level I","NCQA;\nNCQA","Yes",51,"Preventive Care Service;\nAmbulatory Encounter"]
[99386,"Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 40-64 years","Initial new patient preventive medicine evaluation age 40-64 years",null,"2.16.840.1.113883.3.464.1003.101.12.1023;\n2.16.840.1.113883.3.464.1003.101.12.1061","Preventive Care Services Initial Office Visit, 18 and Up;\nAmbulatory/ED Visit",";\nGrouping",";\nThis value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.",";\nThis value set may use the Quality Data Model (QDM) category related to Encounter.",";\nIncludes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.",";\nExcludes encounters that occurred in the inpatient setting.",2021,2021,null,";\n20170504","CPT Level I","NCQA;\nNCQA","Yes",52,"Preventive Care Service;\nAmbulatory Encounter"]
[99387,"Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 65 years and older","Initial new patient preventive medicine evaluation, age 65 years and older",null,"2.16.840.1.113883.3.464.1003.101.12.1023;\n2.16.840.1.113883.3.464.1003.101.12.1061","Preventive Care Services Initial Office Visit, 18 and Up;\nAmbulatory/ED Visit",";\nGrouping",";\nThis value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.",";\nThis value set may use the Quality Data Model (QDM) category related to Encounter.",";\nIncludes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.",";\nExcludes encounters that occurred in the inpatient setting.",2021,2021,null,";\n20170504","CPT Level I","NCQA;\nNCQA","Yes",53,"Preventive Care Service;\nAmbulatory Encounter"]
[99395,"Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 18-39 years","Established patient periodic preventive medicine examination age 18-39 years",null,"2.16.840.1.113883.3.464.1003.101.12.1025;\n2.16.840.1.113883.3.464.1003.101.12.1061","Preventive Care Services Established Office Visit, 18 and Up;\nAmbulatory/ED Visit",";\nGrouping",";\nThis value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.",";\nThis value set may use the Quality Data Model (QDM) category related to Encounter.",";\nIncludes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.",";\nExcludes encounters that occurred in the inpatient setting.",2021,2021,null,";\n20170504","CPT Level I","NCQA;\nNCQA","Yes",54,"Preventive Care Service;\nAmbulatory Encounter"]
[99396,"Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 40-64 years","Established patient periodic preventive medicine examination age 40-64 years",null,"2.16.840.1.113883.3.464.1003.101.12.1025;\n2.16.840.1.113883.3.464.1003.101.12.1061","Preventive Care Services Established Office Visit, 18 and Up;\nAmbulatory/ED Visit",";\nGrouping",";\nThis value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.",";\nThis value set may use the Quality Data Model (QDM) category related to Encounter.",";\nIncludes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.",";\nExcludes encounters that occurred in the inpatient setting.",2021,2021,null,";\n20170504","CPT Level I","NCQA;\nNCQA","Yes",55,"Preventive Care Service;\nAmbulatory Encounter"]
[99397,"Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 65 years and older","Established patient periodic preventive medicine examination, age 65 years and older",null,"2.16.840.1.113883.3.464.1003.101.12.1025;\n2.16.840.1.113883.3.464.1003.101.12.1061","Preventive Care Services Established Office Visit, 18 and Up;\nAmbulatory/ED Visit",";\nGrouping",";\nThis value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.",";\nThis value set may use the Quality Data Model (QDM) category related to Encounter.",";\nIncludes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.",";\nExcludes encounters that occurred in the inpatient setting.",2021,2021,null,";\n20170504","CPT Level I","NCQA;\nNCQA","Yes",56,"Preventive Care Service;\nAmbulatory Encounter"]
[99401,"Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes","Preventive medicine counseling, approximately 15 minutes",null,"2.16.840.1.113883.3.464.1003.101.12.1026;\n2.16.840.1.113883.3.464.1003.101.12.1061","Preventive Care Services Individual Counseling;\nAmbulatory/ED Visit",";\nGrouping",";\nThis value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.",";\nThis value set may use the Quality Data Model (QDM) category related to Encounter.",";\nIncludes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. Thi",";\nExcludes encounters that occurred in the inpatient setting.",2021,2021,null,";\n20170504","CPT Level I","NCQA;\nNCQA","Yes",57,"Preventive Care Service;\nAmbulatory Encounter"]
[99402,"Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 30 minutes","Preventive medicine counseling, approximately 30 minutes",null,"2.16.840.1.113883.3.464.1003.101.12.1026;\n2.16.840.1.113883.3.464.1003.101.12.1061","Preventive Care Services Individual Counseling;\nAmbulatory/ED Visit",";\nGrouping",";\nThis value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.",";\nThis value set may use the Quality Data Model (QDM) category related to Encounter.",";\nIncludes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. Thi",";\nExcludes encounters that occurred in the inpatient setting.",2021,2021,null,";\n20170504","CPT Level I","NCQA;\nNCQA","Yes",58,"Preventive Care Service;\nAmbulatory Encounter"]
[99403,"Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 45 minutes","Preventive medicine counseling, approximately 45 minutes",null,"2.16.840.1.113883.3.464.1003.101.12.1026;\n2.16.840.1.113883.3.464.1003.101.12.1061","Preventive Care Services Individual Counseling;\nAmbulatory/ED Visit",";\nGrouping",";\nThis value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.",";\nThis value set may use the Quality Data Model (QDM) category related to Encounter.",";\nIncludes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. Thi",";\nExcludes encounters that occurred in the inpatient setting.",2021,2021,null,";\n20170504","CPT Level I","NCQA;\nNCQA","Yes",59,"Preventive Care Service;\nAmbulatory Encounter"]
[99404,"Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 60 minutes","Preventive medicine counseling, approximately 60 minutes",null,"2.16.840.1.113883.3.464.1003.101.12.1026;\n2.16.840.1.113883.3.464.1003.101.12.1061","Preventive Care Services Individual Counseling;\nAmbulatory/ED Visit",";\nGrouping",";\nThis value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.",";\nThis value set may use the Quality Data Model (QDM) category related to Encounter.",";\nIncludes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. Thi",";\nExcludes encounters that occurred in the inpatient setting.",2021,2021,null,";\n20170504","CPT Level I","NCQA;\nNCQA","Yes",60,"Preventive Care Service;\nAmbulatory Encounter"]
[185463005,null,null,"Visit out of hours (procedure)","2.16.840.1.113883.3.464.1003.101.12.1001;\n2.16.840.1.113883.3.464.1003.101.12.1048;\n2.16.840.1.113883.3.464.1003.101.12.1061","Office Visit;\nFace-to-Face Interaction;\nAmbulatory/ED Visit",";\n;\nGrouping",";\n;\nThis value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.",";\n;\nThis value set may use the Quality Data Model (QDM) category related to Encounter.",";\n;\nIncludes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.",";\n;\nExcludes encounters that occurred in the inpatient setting.",null,null,"2021-09",";\n;\n20170504",null,"NCQA;\nNCQA;\nNCQA","Yes",61,"Ambulatory Encounter;\nAmbulatory Encounter;\nAmbulatory Encounter"]
[185464004,null,null,"Out of hours visit - not night visit (procedure)","2.16.840.1.113883.3.464.1003.101.12.1001","Office Visit",null,null,null,null,null,null,null,"2021-09",null,null,"NCQA","Yes",62,"Ambulatory Encounter"]
[185465003,null,null,"Weekend visit (procedure)","2.16.840.1.113883.3.464.1003.101.12.1001;\n2.16.840.1.113883.3.464.1003.101.12.1048;\n2.16.840.1.113883.3.464.1003.101.12.1061","Office Visit;\nFace-to-Face Interaction;\nAmbulatory/ED Visit",";\n;\nGrouping",";\n;\nThis value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.",";\n;\nThis value set may use the Quality Data Model (QDM) category related to Encounter.",";\n;\nIncludes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.",";\n;\nExcludes encounters that occurred in the inpatient setting.",null,null,"2021-09",";\n;\n20170504",null,"NCQA;\nNCQA;\nNCQA","Yes",63,"Ambulatory Encounter;\nAmbulatory Encounter;\nAmbulatory Encounter"]
[3391000175108,null,null,"Office visit for pediatric care and assessment (procedure)","2.16.840.1.113883.3.464.1003.101.12.1001","Office Visit",null,null,null,null,null,null,null,"2021-09",null,null,"NCQA","Yes",64,"Ambulatory Encounter"]
[439740005,null,null,"Postoperative follow-up visit (procedure)","2.16.840.1.113883.3.464.1003.101.12.1001","Office Visit",null,null,null,null,null,null,null,"2021-09",null,null,"NCQA","Yes",65,"Ambulatory Encounter"]
[12843005,null,null,"Subsequent hospital visit by physician (procedure)","2.16.840.1.113883.3.464.1003.101.12.1048;\n2.16.840.1.113883.3.464.1003.101.12.1061","Face-to-Face Interaction;\nAmbulatory/ED Visit",";\nGrouping",";\nThis value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.",";\nThis value set may use the Quality Data Model (QDM) category related to Encounter.",";\nIncludes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.",";\nExcludes encounters that occurred in the inpatient setting.",null,null,"2021-09",";\n20170504",null,"NCQA;\nNCQA","Yes",66,"Ambulatory Encounter;\nAmbulatory Encounter"]
[18170008,null,null,"Subsequent nursing facility visit (procedure)","2.16.840.1.113883.3.464.1003.101.12.1048;\n2.16.840.1.113883.3.464.1003.101.12.1061","Face-to-Face Interaction;\nAmbulatory/ED Visit",";\nGrouping",";\nThis value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.",";\nThis value set may use the Quality Data Model (QDM) category related to Encounter.",";\nIncludes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.",";\nExcludes encounters that occurred in the inpatient setting.",null,null,"2021-09",";\n20170504",null,"NCQA;\nNCQA","Yes",66,"Ambulatory Encounter;\nAmbulatory Encounter"]
[185349003,null,null,"Encounter for check up (procedure)","2.16.840.1.113883.3.464.1003.101.12.1048;\n2.16.840.1.113883.3.464.1003.101.12.1061","Face-to-Face Interaction;\nAmbulatory/ED Visit",";\nGrouping",";\nThis value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.",";\nThis value set may use the Quality Data Model (QDM) category related to Encounter.",";\nIncludes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.",";\nExcludes encounters that occurred in the inpatient setting.",null,null,"2021-09",";\n20170504",null,"NCQA;\nNCQA","Yes",66,"Ambulatory Encounter;\nAmbulatory Encounter"]
[19681004,null,null,"Nursing evaluation of patient and report (procedure)","2.16.840.1.113883.3.464.1003.101.12.1048;\n2.16.840.1.113883.3.464.1003.101.12.1061","Face-to-Face Interaction;\nAmbulatory/ED Visit",";\nGrouping",";\nThis value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.",";\nThis value set may use the Quality Data Model (QDM) category related to Encounter.",";\nIncludes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.",";\nExcludes encounters that occurred in the inpatient setting.",null,null,"2021-09",";\n20170504",null,"NCQA;\nNCQA","Yes",66,"Ambulatory Encounter;\nAmbulatory Encounter"]
[207195004,null,null,"History and physical examination with evaluation and management of nursing facility patient (procedure)","2.16.840.1.113883.3.464.1003.101.12.1048;\n2.16.840.1.113883.3.464.1003.101.12.1061","Face-to-Face Interaction;\nAmbulatory/ED Visit",";\nGrouping",";\nThis value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.",";\nThis value set may use the Quality Data Model (QDM) category related to Encounter.",";\nIncludes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.",";\nExcludes encounters that occurred in the inpatient setting.",null,null,"2021-09",";\n20170504",null,"NCQA;\nNCQA","Yes",66,"Ambulatory Encounter;\nAmbulatory Encounter"]
[270427003,null,null,"Patient-initiated encounter (procedure)","2.16.840.1.113883.3.464.1003.101.12.1048;\n2.16.840.1.113883.3.464.1003.101.12.1061","Face-to-Face Interaction;\nAmbulatory/ED Visit",";\nGrouping",";\nThis value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.",";\nThis value set may use the Quality Data Model (QDM) category related to Encounter.",";\nIncludes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.",";\nExcludes encounters that occurred in the inpatient setting.",null,null,"2021-09",";\n20170504",null,"NCQA;\nNCQA","Yes",66,"Ambulatory Encounter;\nAmbulatory Encounter"]
[270430005,null,null,"Provider-initiated encounter (procedure)","2.16.840.1.113883.3.464.1003.101.12.1048;\n2.16.840.1.113883.3.464.1003.101.12.1061","Face-to-Face Interaction;\nAmbulatory/ED Visit",";\nGrouping",";\nThis value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.",";\nThis value set may use the Quality Data Model (QDM) category related to Encounter.",";\nIncludes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.",";\nExcludes encounters that occurred in the inpatient setting.",null,null,"2021-09",";\n20170504",null,"NCQA;\nNCQA","Yes",66,"Ambulatory Encounter;\nAmbulatory Encounter"]
[308335008,null,null,"Patient encounter procedure (procedure)","2.16.840.1.113883.3.464.1003.101.12.1048;\n2.16.840.1.113883.3.464.1003.101.12.1061","Face-to-Face Interaction;\nAmbulatory/ED Visit",";\nGrouping",";\nThis value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.",";\nThis value set may use the Quality Data Model (QDM) category related to Encounter.",";\nIncludes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.",";\nExcludes encounters that occurred in the inpatient setting.",null,null,"2021-09",";\n20170504",null,"NCQA;\nNCQA","Yes",66,"Ambulatory Encounter;\nAmbulatory Encounter"]
[390906007,null,null,"Follow-up encounter (procedure)","2.16.840.1.113883.3.464.1003.101.12.1048;\n2.16.840.1.113883.3.464.1003.101.12.1061","Face-to-Face Interaction;\nAmbulatory/ED Visit",";\nGrouping",";\nThis value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.",";\nThis value set may use the Quality Data Model (QDM) category related to Encounter.",";\nIncludes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.",";\nExcludes encounters that occurred in the inpatient setting.",null,null,"2021-09",";\n20170504",null,"NCQA;\nNCQA","Yes",66,"Ambulatory Encounter;\nAmbulatory Encounter"]
[406547006,null,null,"Urgent follow-up (procedure)","2.16.840.1.113883.3.464.1003.101.12.1048;\n2.16.840.1.113883.3.464.1003.101.12.1061","Face-to-Face Interaction;\nAmbulatory/ED Visit",";\nGrouping",";\nThis value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.",";\nThis value set may use the Quality Data Model (QDM) category related to Encounter.",";\nIncludes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.",";\nExcludes encounters that occurred in the inpatient setting.",null,null,"2021-09",";\n20170504",null,"NCQA;\nNCQA","Yes",66,"Ambulatory Encounter;\nAmbulatory Encounter"]
[439708006,null,null,"Home visit (procedure)","2.16.840.1.113883.3.464.1003.101.12.1048;\n2.16.840.1.113883.3.464.1003.101.12.1061","Face-to-Face Interaction;\nAmbulatory/ED Visit",";\nGrouping",";\nThis value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.",";\nThis value set may use the Quality Data Model (QDM) category related to Encounter.",";\nIncludes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.",";\nExcludes encounters that occurred in the inpatient setting.",null,null,"2021-09",";\n20170504",null,"NCQA;\nNCQA","Yes",66,"Ambulatory Encounter;\nAmbulatory Encounter"]
[87790002,null,null,"Follow-up inpatient consultation visit","2.16.840.1.113883.3.464.1003.101.12.1048;\n2.16.840.1.113883.3.464.1003.101.12.1061","Face-to-Face Interaction;\nAmbulatory/ED Visit",";\nGrouping",";\nThis value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.",";\nThis value set may use the Quality Data Model (QDM) category related to Encounter.",";\nIncludes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.",";\nExcludes encounters that occurred in the inpatient setting.",null,null,"2021-09",";\n20170504",null,"NCQA;\nNCQA","Yes",66,"Ambulatory Encounter;\nAmbulatory Encounter"]
[90526000,null,null,"Initial evaluation and management of healthy individual (procedure)","2.16.840.1.113883.3.464.1003.101.12.1048;\n2.16.840.1.113883.3.464.1003.101.12.1061","Face-to-Face Interaction;\nAmbulatory/ED Visit",";\nGrouping",";\nThis value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.",";\nThis value set may use the Quality Data Model (QDM) category related to Encounter.",";\nIncludes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.",";\nExcludes encounters that occurred in the inpatient setting.",null,null,"2021-09",";\n20170504",null,"NCQA;\nNCQA","Yes",66,"Ambulatory Encounter;\nAmbulatory Encounter"]
[92002,"Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; intermediate, new patient","Eye and medical examination for diagnosis and treatment, new patient",null,"2.16.840.1.113883.3.526.3.1285","Ophthalmological Services",null,null,null,null,null,2021,2021,null,null,"CPT Level I","American Academy of Ophthalmology","Yes",79,"Ambulatory Encounter"]
[92004,"Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient, 1 or more visits","Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits",null,"2.16.840.1.113883.3.526.3.1285","Ophthalmological Services",null,null,null,null,null,2021,2021,null,null,"CPT Level I","American Academy of Ophthalmology","Yes",80,"Ambulatory Encounter"]
[92012,"Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient","Eye and medical examination for diagnosis and treatment, established patient",null,"2.16.840.1.113883.3.526.3.1285","Ophthalmological Services",null,null,null,null,null,2021,2021,null,null,"CPT Level I","American Academy of Ophthalmology","Yes",81,"Ambulatory Encounter"]
[92014,"Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; comprehensive, established patient, 1 or more visits","Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits",null,"2.16.840.1.113883.3.526.3.1285","Ophthalmological Services",null,null,null,null,null,2021,2021,null,null,"CPT Level I","American Academy of Ophthalmology","Yes",82,"Ambulatory Encounter"]
[359960003,null,null,"Ophthalmologic examination and evaluation under general anesthesia, limited (procedure)","2.16.840.1.113883.3.526.3.1285","Ophthalmological Services",null,null,null,null,null,null,null,"2021-09",null,null,"American Academy of Ophthalmology","Yes",83,"Ambulatory Encounter"]
[36228007,null,null,"Ophthalmic examination and evaluation (procedure)","2.16.840.1.113883.3.526.3.1285","Ophthalmological Services",null,null,null,null,null,null,null,"2021-09",null,null,"American Academy of Ophthalmology","Yes",84,"Ambulatory Encounter"]
[66902005,null,null,"Ophthalmic examination and evaluation, follow-up (procedure)","2.16.840.1.113883.3.526.3.1285","Ophthalmological Services",null,null,null,null,null,null,null,"2021-09",null,null,"American Academy of Ophthalmology","Yes",85,"Ambulatory Encounter"]
[78831002,null,null,"Comprehensive eye examination (procedure)","2.16.840.1.113883.3.526.3.1285","Ophthalmological Services",null,null,null,null,null,null,null,"2021-09",null,null,"American Academy of Ophthalmology","Yes",86,"Ambulatory Encounter"]
["99241","Office consultation for a new or established patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 15 minutes are spent face-to-face with the patient and/or family.","Patient office consultation, typically 15 minutes",null,"2.16.840.1.113883.3.464.1003.101.12.1008;\n2.16.840.1.113883.3.464.1003.101.12.1061","Outpatient Consultation;\nAmbulatory/ED Visit",";\nGrouping","The purpose of this value set is to represent concepts for encounters for outpatient interactions with a member of the medical care team.;\nThis value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.","This value set may use a model element related to Encounter.;\nThis value set may use the Quality Data Model (QDM) category related to Encounter.","Includes concepts that represent an encounter for the comprehensive history, evaluation, and management of a patient presenting with minor to high severity problems.;\nIncludes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.","No exclusions.;\nExcludes encounters that occurred in the inpatient setting.",2021,2021,null,"20180310;\n20170504","CPT Level I","NCQA;\nNCQA","Yes",null,"Ambulatory Encounter;\nAmbulatory Encounter"]
["99242","Office consultation for a new or established patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low severity. Typically, 30 minutes are spent face-to-face with the patient and/or family.","Patient office consultation, typically 30 minutes",null,"2.16.840.1.113883.3.464.1003.101.12.1008;\n2.16.840.1.113883.3.464.1003.101.12.1061","Outpatient Consultation;\nAmbulatory/ED Visit",";\nGrouping","The purpose of this value set is to represent concepts for encounters for outpatient interactions with a member of the medical care team.;\nThis value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.","This value set may use a model element related to Encounter.;\nThis value set may use the Quality Data Model (QDM) category related to Encounter.","Includes concepts that represent an encounter for the comprehensive history, evaluation, and management of a patient presenting with minor to high severity problems.;\nIncludes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.","No exclusions.;\nExcludes encounters that occurred in the inpatient setting.",2021,2021,null,"20180310;\n20170504","CPT Level I","NCQA;\nNCQA","Yes",null,"Ambulatory Encounter;\nAmbulatory Encounter"]
["99243","Office consultation for a new or established patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Typically, 40 minutes are spent face-to-face with the patient and/or family.","Patient office consultation, typically 40 minutes",null,"2.16.840.1.113883.3.464.1003.101.12.1008;\n2.16.840.1.113883.3.464.1003.101.12.1061","Outpatient Consultation;\nAmbulatory/ED Visit",";\nGrouping","The purpose of this value set is to represent concepts for encounters for outpatient interactions with a member of the medical care team.;\nThis value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.","This value set may use a model element related to Encounter.;\nThis value set may use the Quality Data Model (QDM) category related to Encounter.","Includes concepts that represent an encounter for the comprehensive history, evaluation, and management of a patient presenting with minor to high severity problems.;\nIncludes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.","No exclusions.;\nExcludes encounters that occurred in the inpatient setting.",2021,2021,null,"20180310;\n20170504","CPT Level I","NCQA;\nNCQA","Yes",null,"Ambulatory Encounter;\nAmbulatory Encounter"]
["99244","Office consultation for a new or established patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 60 minutes are spent face-to-face with the patient and/or family.","Patient office consultation, typically 60 minutes",null,"2.16.840.1.113883.3.464.1003.101.12.1008;\n2.16.840.1.113883.3.464.1003.101.12.1061","Outpatient Consultation;\nAmbulatory/ED Visit",";\nGrouping","The purpose of this value set is to represent concepts for encounters for outpatient interactions with a member of the medical care team.;\nThis value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.","This value set may use a model element related to Encounter.;\nThis value set may use the Quality Data Model (QDM) category related to Encounter.","Includes concepts that represent an encounter for the comprehensive history, evaluation, and management of a patient presenting with minor to high severity problems.;\nIncludes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.","No exclusions.;\nExcludes encounters that occurred in the inpatient setting.",2021,2021,null,"20180310;\n20170504","CPT Level I","NCQA;\nNCQA","Yes",null,"Ambulatory Encounter;\nAmbulatory Encounter"]
["99245","Office consultation for a new or established patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 80 minutes are spent face-to-face with the patient and/or family.","Patient office consultation, typically 80 minutes",null,"2.16.840.1.113883.3.464.1003.101.12.1008;\n2.16.840.1.113883.3.464.1003.101.12.1061","Outpatient Consultation;\nAmbulatory/ED Visit",";\nGrouping","The purpose of this value set is to represent concepts for encounters for outpatient interactions with a member of the medical care team.;\nThis value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.","This value set may use a model element related to Encounter.;\nThis value set may use the Quality Data Model (QDM) category related to Encounter.","Includes concepts that represent an encounter for the comprehensive history, evaluation, and management of a patient presenting with minor to high severity problems.;\nIncludes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.","No exclusions.;\nExcludes encounters that occurred in the inpatient setting.",2021,2021,null,"20180310;\n20170504","CPT Level I","NCQA;\nNCQA","Yes",null,"Ambulatory Encounter;\nAmbulatory Encounter"]
["281036007",null,null,"Follow-up consultation (procedure)","2.16.840.1.113883.3.464.1003.101.12.1008","Outpatient Consultation",null,"The purpose of this value set is to represent concepts for encounters for outpatient interactions with a member of the medical care team.","This value set may use a model element related to Encounter.","Includes concepts that represent an encounter for the comprehensive history, evaluation, and management of a patient presenting with minor to high severity problems.","No exclusions.",null,null,"2021-09",20180310,null,"NCQA","Yes",null,"Ambulatory Encounter"]
["77406008",null,null,"Confirmatory medical consultation (procedure)","2.16.840.1.113883.3.464.1003.101.12.1008","Outpatient Consultation",null,"The purpose of this value set is to represent concepts for encounters for outpatient interactions with a member of the medical care team.","This value set may use a model element related to Encounter.","Includes concepts that represent an encounter for the comprehensive history, evaluation, and management of a patient presenting with minor to high severity problems.","No exclusions.",null,null,"2021-09",20180310,null,"NCQA","Yes",null,"Ambulatory Encounter"]
["90832","Psychotherapy, 30 minutes with patient","Psychotherapy, 30 minutes",null,"2.16.840.1.113883.3.526.3.1496","Psych Visit Psychotherapy",null,"The purpose of this value set is to represent concepts for encounters for psychotherapy visits.","This value set may use a model element related to Encounter.","Includes concepts that represent an encounter for individual psychotherapy services.","Excludes concepts that represent an encounter for group psychotherapy or family psychotherapy visits.",2021,2021,null,20190315,"CPT Level I","NCQA","Yes",null,"Ambulatory Encounter"]
["90834","Psychotherapy, 45 minutes with patient","Psychotherapy, 45 minutes",null,"2.16.840.1.113883.3.526.3.1496","Psych Visit Psychotherapy",null,"The purpose of this value set is to represent concepts for encounters for psychotherapy visits.","This value set may use a model element related to Encounter.","Includes concepts that represent an encounter for individual psychotherapy services.","Excludes concepts that represent an encounter for group psychotherapy or family psychotherapy visits.",2021,2021,null,20190315,"CPT Level I","NCQA","Yes",null,"Ambulatory Encounter","SFY23 (Year 2) DPP BHS Component 2 Rate Increase: \"To align with the incentive to achieve CCBHC certification, Component 2 rate increases will be applied to the following codes: H2014, T1017, H2017, 99214, H2011, 99213, 90837, 90792, 90791, H0034, 90834, H0020, 99215, 96372, H0005\". \n\nLook into the missing codes: H2014, T1017, H2017, 99214, H2011, H0034, H0020, 96372, H0005"]
["90837","Psychotherapy, 60 minutes with patient","Psychotherapy, 60 minutes",null,"2.16.840.1.113883.3.526.3.1496","Psych Visit Psychotherapy",null,"The purpose of this value set is to represent concepts for encounters for psychotherapy visits.","This value set may use a model element related to Encounter.","Includes concepts that represent an encounter for individual psychotherapy services.","Excludes concepts that represent an encounter for group psychotherapy or family psychotherapy visits.",2021,2021,null,20190315,"CPT Level I","NCQA","Yes",null,"Ambulatory Encounter","SFY23 (Year 2) DPP BHS Component 2 Rate Increase: \"To align with the incentive to achieve CCBHC certification, Component 2 rate increases will be applied to the following codes: H2014, T1017, H2017, 99214, H2011, 99213, 90837, 90792, 90791, H0034, 90834, H0020, 99215, 96372, H0005\". \n\nLook into the missing codes: H2014, T1017, H2017, 99214, H2011, H0034, H0020, 96372, H0005"]
["183381005",null,null,"General psychotherapy (regime/therapy)","2.16.840.1.113883.3.526.3.1496","Psych Visit Psychotherapy",null,"The purpose of this value set is to represent concepts for encounters for psychotherapy visits.","This value set may use a model element related to Encounter.","Includes concepts that represent an encounter for individual psychotherapy services.","Excludes concepts that represent an encounter for group psychotherapy or family psychotherapy visits.",null,null,"2021-09",20190315,null,"NCQA","Yes",null,"Ambulatory Encounter"]
["183382003",null,null,"Psychotherapy - behavioral (regime/therapy)","2.16.840.1.113883.3.526.3.1496","Psych Visit Psychotherapy",null,"The purpose of this value set is to represent concepts for encounters for psychotherapy visits.","This value set may use a model element related to Encounter.","Includes concepts that represent an encounter for individual psychotherapy services.","Excludes concepts that represent an encounter for group psychotherapy or family psychotherapy visits.",null,null,"2021-09",20190315,null,"NCQA","Yes",null,"Ambulatory Encounter"]
["183383008",null,null,"Psychotherapy - cognitive (regime/therapy)","2.16.840.1.113883.3.526.3.1496","Psych Visit Psychotherapy",null,"The purpose of this value set is to represent concepts for encounters for psychotherapy visits.","This value set may use a model element related to Encounter.","Includes concepts that represent an encounter for individual psychotherapy services.","Excludes concepts that represent an encounter for group psychotherapy or family psychotherapy visits.",null,null,"2021-09",20190315,null,"NCQA","Yes",null,"Ambulatory Encounter"]
["18512000",null,null,"Individual psychotherapy (regime/therapy)","2.16.840.1.113883.3.526.3.1496","Psych Visit Psychotherapy",null,"The purpose of this value set is to represent concepts for encounters for psychotherapy visits.","This value set may use a model element related to Encounter.","Includes concepts that represent an encounter for individual psychotherapy services.","Excludes concepts that represent an encounter for group psychotherapy or family psychotherapy visits.",null,null,"2021-09",20190315,null,"NCQA","Yes",null,"Ambulatory Encounter"]
["302242004",null,null,"Long-term psychodynamic psychotherapy (regime/therapy)","2.16.840.1.113883.3.526.3.1496","Psych Visit Psychotherapy",null,"The purpose of this value set is to represent concepts for encounters for psychotherapy visits.","This value set may use a model element related to Encounter.","Includes concepts that represent an encounter for individual psychotherapy services.","Excludes concepts that represent an encounter for group psychotherapy or family psychotherapy visits.",null,null,"2021-09",20190315,null,"NCQA","Yes",null,"Ambulatory Encounter"]
["304820009",null,null,"Developmental psychodynamic psychotherapy (regime/therapy)","2.16.840.1.113883.3.526.3.1496","Psych Visit Psychotherapy",null,"The purpose of this value set is to represent concepts for encounters for psychotherapy visits.","This value set may use a model element related to Encounter.","Includes concepts that represent an encounter for individual psychotherapy services.","Excludes concepts that represent an encounter for group psychotherapy or family psychotherapy visits.",null,null,"2021-09",20190315,null,"NCQA","Yes",null,"Ambulatory Encounter"]
["304822001",null,null,"Psychodynamic-interpersonal psychotherapy (regime/therapy)","2.16.840.1.113883.3.526.3.1496","Psych Visit Psychotherapy",null,"The purpose of this value set is to represent concepts for encounters for psychotherapy visits.","This value set may use a model element related to Encounter.","Includes concepts that represent an encounter for individual psychotherapy services.","Excludes concepts that represent an encounter for group psychotherapy or family psychotherapy visits.",null,null,"2021-09",20190315,null,"NCQA","Yes",null,"Ambulatory Encounter"]
["314034001",null,null,"Psychodynamic psychotherapy (regime/therapy)","2.16.840.1.113883.3.526.3.1496","Psych Visit Psychotherapy",null,"The purpose of this value set is to represent concepts for encounters for psychotherapy visits.","This value set may use a model element related to Encounter.","Includes concepts that represent an encounter for individual psychotherapy services.","Excludes concepts that represent an encounter for group psychotherapy or family psychotherapy visits.",null,null,"2021-09",20190315,null,"NCQA","Yes",null,"Ambulatory Encounter"]
["38678006",null,null,"Client-centered psychotherapy (regime/therapy)","2.16.840.1.113883.3.526.3.1496","Psych Visit Psychotherapy",null,"The purpose of this value set is to represent concepts for encounters for psychotherapy visits.","This value set may use a model element related to Encounter.","Includes concepts that represent an encounter for individual psychotherapy services.","Excludes concepts that represent an encounter for group psychotherapy or family psychotherapy visits.",null,null,"2021-09",20190315,null,"NCQA","Yes",null,"Ambulatory Encounter"]
["401157001",null,null,"Brief solution focused psychotherapy (regime/therapy)","2.16.840.1.113883.3.526.3.1496","Psych Visit Psychotherapy",null,"The purpose of this value set is to represent concepts for encounters for psychotherapy visits.","This value set may use a model element related to Encounter.","Includes concepts that represent an encounter for individual psychotherapy services.","Excludes concepts that represent an encounter for group psychotherapy or family psychotherapy visits.",null,null,"2021-09",20190315,null,"NCQA","Yes",null,"Ambulatory Encounter"]
["443730003",null,null,"Interpersonal psychotherapy (regime/therapy)","2.16.840.1.113883.3.526.3.1496","Psych Visit Psychotherapy",null,"The purpose of this value set is to represent concepts for encounters for psychotherapy visits.","This value set may use a model element related to Encounter.","Includes concepts that represent an encounter for individual psychotherapy services.","Excludes concepts that represent an encounter for group psychotherapy or family psychotherapy visits.",null,null,"2021-09",20190315,null,"NCQA","Yes",null,"Ambulatory Encounter"]
["75516001",null,null,"Psychotherapy (regime/therapy)","2.16.840.1.113883.3.526.3.1496","Psych Visit Psychotherapy",null,"The purpose of this value set is to represent concepts for encounters for psychotherapy visits.","This value set may use a model element related to Encounter.","Includes concepts that represent an encounter for individual psychotherapy services.","Excludes concepts that represent an encounter for group psychotherapy or family psychotherapy visits.",null,null,"2021-09",20190315,null,"NCQA","Yes",null,"Ambulatory Encounter"]
["90102008",null,null,"Social psychotherapy (regime/therapy)","2.16.840.1.113883.3.526.3.1496","Psych Visit Psychotherapy",null,"The purpose of this value set is to represent concepts for encounters for psychotherapy visits.","This value set may use a model element related to Encounter.","Includes concepts that represent an encounter for individual psychotherapy services.","Excludes concepts that represent an encounter for group psychotherapy or family psychotherapy visits.",null,null,"2021-09",20190315,null,"NCQA","Yes",null,"Ambulatory Encounter"]
["99217","Observation care discharge day management (This code is to be utilized to report all services provided to a patient on discharge from outpatient hospital \"observation status\" if the discharge is on other than the initial date of \"observation status.\" To report services to a patient designated as \"observation status\" or \"inpatient status\" and discharged on the same date, use the codes for Observation or Inpatient Care Services [including Admission and Discharge Services, 99234-99236 as appropriate.])",null,null,"2.16.840.1.113883.3.464.1003.101.12.1061","Ambulatory/ED Visit","Grouping","This value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.","This value set may use the Quality Data Model (QDM) category related to Encounter.","Includes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.","Excludes encounters that occurred in the inpatient setting.",null,null,null,20170504,null,"NCQA","Yes",null,"Ambulatory Encounter"]
["99218","Initial observation care, per day, for the evaluation and management of a patient which requires these 3 key components: A detailed or comprehensive history; A detailed or comprehensive examination; and Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission to outpatient hospital \"observation status\" are of low severity. Typically, 30 minutes are spent at the bedside and on the patient's hospital floor or unit.",null,null,"2.16.840.1.113883.3.464.1003.101.12.1061","Ambulatory/ED Visit","Grouping","This value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.","This value set may use the Quality Data Model (QDM) category related to Encounter.","Includes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.","Excludes encounters that occurred in the inpatient setting.",null,null,null,20170504,null,"NCQA","Yes",null,"Ambulatory Encounter"]
["99219","Initial observation care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission to outpatient hospital \"observation status\" are of moderate severity. Typically, 50 minutes are spent at the bedside and on the patient's hospital floor or unit.",null,null,"2.16.840.1.113883.3.464.1003.101.12.1061","Ambulatory/ED Visit","Grouping","This value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.","This value set may use the Quality Data Model (QDM) category related to Encounter.","Includes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.","Excludes encounters that occurred in the inpatient setting.",null,null,null,20170504,null,"NCQA","Yes",null,"Ambulatory Encounter"]
["99220","Initial observation care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission to outpatient hospital \"observation status\" are of high severity. Typically, 70 minutes are spent at the bedside and on the patient's hospital floor or unit.",null,null,"2.16.840.1.113883.3.464.1003.101.12.1061","Ambulatory/ED Visit","Grouping","This value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.","This value set may use the Quality Data Model (QDM) category related to Encounter.","Includes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.","Excludes encounters that occurred in the inpatient setting.",null,null,null,20170504,null,"NCQA","Yes",null,"Ambulatory Encounter"]
["99281","Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor.",null,null,"2.16.840.1.113883.3.464.1003.101.12.1061","Ambulatory/ED Visit","Grouping","This value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.","This value set may use the Quality Data Model (QDM) category related to Encounter.","Includes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.","Excludes encounters that occurred in the inpatient setting.",null,null,null,20170504,null,"NCQA","Yes",null,"Ambulatory Encounter"]
["99282","Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity.",null,null,"2.16.840.1.113883.3.464.1003.101.12.1061","Ambulatory/ED Visit","Grouping","This value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.","This value set may use the Quality Data Model (QDM) category related to Encounter.","Includes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.","Excludes encounters that occurred in the inpatient setting.",null,null,null,20170504,null,"NCQA","Yes",null,"Ambulatory Encounter"]
["99283","Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity.",null,null,"2.16.840.1.113883.3.464.1003.101.12.1061","Ambulatory/ED Visit","Grouping","This value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.","This value set may use the Quality Data Model (QDM) category related to Encounter.","Includes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.","Excludes encounters that occurred in the inpatient setting.",null,null,null,20170504,null,"NCQA","Yes",null,"Ambulatory Encounter"]
["99284","Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity, and require urgent evaluation by the physician, or other qualified health care professionals but do not pose an immediate significant threat to life or physiologic function.",null,null,"2.16.840.1.113883.3.464.1003.101.12.1061","Ambulatory/ED Visit","Grouping","This value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.","This value set may use the Quality Data Model (QDM) category related to Encounter.","Includes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.","Excludes encounters that occurred in the inpatient setting.",null,null,null,20170504,null,"NCQA","Yes",null,"Ambulatory Encounter"]
["99285","Emergency department visit for the evaluation and management of a patient, which requires these 3 key components within the constraints imposed by the urgency of the patient's clinical condition and/or mental status: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity and pose an immediate significant threat to life or physiologic function.",null,null,"2.16.840.1.113883.3.464.1003.101.12.1061","Ambulatory/ED Visit","Grouping","This value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.","This value set may use the Quality Data Model (QDM) category related to Encounter.","Includes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.","Excludes encounters that occurred in the inpatient setting.",null,null,null,20170504,null,"NCQA","Yes",null,"Ambulatory Encounter"]
["99411","Preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure); approximately 30 minutes",null,null,"2.16.840.1.113883.3.464.1003.101.12.1061","Ambulatory/ED Visit","Grouping","This value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.","This value set may use the Quality Data Model (QDM) category related to Encounter.","Includes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.","Excludes encounters that occurred in the inpatient setting.",null,null,null,20170504,null,"NCQA","Yes",null,"Ambulatory Encounter"]
["99412","Preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure); approximately 60 minutes",null,null,"2.16.840.1.113883.3.464.1003.101.12.1061","Ambulatory/ED Visit","Grouping","This value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.","This value set may use the Quality Data Model (QDM) category related to Encounter.","Includes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.","Excludes encounters that occurred in the inpatient setting.",null,null,null,20170504,null,"NCQA","Yes",null,"Ambulatory Encounter"]
["99429","Unlisted preventive medicine service",null,null,"2.16.840.1.113883.3.464.1003.101.12.1061","Ambulatory/ED Visit","Grouping","This value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.","This value set may use the Quality Data Model (QDM) category related to Encounter.","Includes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.","Excludes encounters that occurred in the inpatient setting.",null,null,null,20170504,null,"NCQA","Yes",null,"Ambulatory Encounter"]
["99455","Work related or medical disability examination by the treating physician that includes: Completion of a medical history commensurate with the patient's condition; Performance of an examination commensurate with the patient's condition; Formulation of a diagnosis, assessment of capabilities and stability, and calculation of impairment; Development of future medical treatment plan; and Completion of necessary documentation/certificates and report.",null,null,"2.16.840.1.113883.3.464.1003.101.12.1061","Ambulatory/ED Visit","Grouping","This value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.","This value set may use the Quality Data Model (QDM) category related to Encounter.","Includes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.","Excludes encounters that occurred in the inpatient setting.",null,null,null,20170504,null,"NCQA","Yes",null,"Ambulatory Encounter"]
["99456","Work related or medical disability examination by other than the treating physician that includes: Completion of a medical history commensurate with the patient's condition; Performance of an examination commensurate with the patient's condition; Formulation of a diagnosis, assessment of capabilities and stability, and calculation of impairment; Development of future medical treatment plan; and Completion of necessary documentation/certificates and report.",null,null,"2.16.840.1.113883.3.464.1003.101.12.1061","Ambulatory/ED Visit","Grouping","This value set contains concepts that represent patients who have had an interaction with a member of their medical care team in the emergency department or an ambulatory care setting.","This value set may use the Quality Data Model (QDM) category related to Encounter.","Includes only relevant concepts associated with care provided to new and established patients in the emergency department or ambulatory care setting. Includes only relevant concepts associated with ED, home health, in-office, and observation visits. This is a value set grouping that contains CPT and SNOMED CT codes.","Excludes encounters that occurred in the inpatient setting.",null,null,null,20170504,null,"NCQA","Yes",null,"Ambulatory Encounter"]
["90791","Psychiatric diagnostic evaluation","Psychiatric diagnostic evaluation",null,"2.16.840.1.113883.3.526.3.1492","Psych Visit Diagnostic Evaluation","Grouping","The purpose of this value set is to represent concepts for encounters for diagnostic psychiatric evaluations.","This value set may use a model element related to Encounter.","Includes concepts that represent an encounter for psychiatric diagnostic evaluations.","Excludes concepts that represent an encounter for group psychotherapy or family psychotherapy visits.",2021,2021,null,20190315,"CPT Level I","NCQA","Yes",null,"Ambulatory Encounter","SFY23 (Year 2) DPP BHS Component 2 Rate Increase: \"To align with the incentive to achieve CCBHC certification, Component 2 rate increases will be applied to the following codes: H2014, T1017, H2017, 99214, H2011, 99213, 90837, 90792, 90791, H0034, 90834, H0020, 99215, 96372, H0005\". \n\nLook into the missing codes: H2014, T1017, H2017, 99214, H2011, H0034, H0020, 96372, H0005"]
["90792","Psychiatric diagnostic evaluation with medical services","Psychiatric diagnostic evaluation with medical services",null,"2.16.840.1.113883.3.526.3.1492","Psych Visit Diagnostic Evaluation","Grouping","The purpose of this value set is to represent concepts for encounters for diagnostic psychiatric evaluations.","This value set may use a model element related to Encounter.","Includes concepts that represent an encounter for psychiatric diagnostic evaluations.","Excludes concepts that represent an encounter for group psychotherapy or family psychotherapy visits.",2021,2021,null,20190315,"CPT Level I","NCQA","Yes",null,"Ambulatory Encounter","SFY23 (Year 2) DPP BHS Component 2 Rate Increase: \"To align with the incentive to achieve CCBHC certification, Component 2 rate increases will be applied to the following codes: H2014, T1017, H2017, 99214, H2011, 99213, 90837, 90792, 90791, H0034, 90834, H0020, 99215, 96372, H0005\". \n\nLook into the missing codes: H2014, T1017, H2017, 99214, H2011, H0034, H0020, 96372, H0005"]
["10197000",null,null,"Psychiatric interview and evaluation (procedure)","2.16.840.1.113883.3.526.3.1492","Psych Visit Diagnostic Evaluation","Grouping","The purpose of this value set is to represent concepts for encounters for diagnostic psychiatric evaluations.","This value set may use a model element related to Encounter.","Includes concepts that represent an encounter for psychiatric diagnostic evaluations.","Excludes concepts that represent an encounter for group psychotherapy or family psychotherapy visits.",null,null,"2021-09",20190315,null,"NCQA","Yes",null,"Ambulatory Encounter"]
["165172002",null,null,"Diagnostic psychiatric interview (procedure)","2.16.840.1.113883.3.526.3.1492","Psych Visit Diagnostic Evaluation","Grouping","The purpose of this value set is to represent concepts for encounters for diagnostic psychiatric evaluations.","This value set may use a model element related to Encounter.","Includes concepts that represent an encounter for psychiatric diagnostic evaluations.","Excludes concepts that represent an encounter for group psychotherapy or family psychotherapy visits.",null,null,"2021-09",20190315,null,"NCQA","Yes",null,"Ambulatory Encounter"]
["68338001",null,null,"Interactive medical psychiatric diagnostic interview (procedure)","2.16.840.1.113883.3.526.3.1492","Psych Visit Diagnostic Evaluation","Grouping","The purpose of this value set is to represent concepts for encounters for diagnostic psychiatric evaluations.","This value set may use a model element related to Encounter.","Includes concepts that represent an encounter for psychiatric diagnostic evaluations.","Excludes concepts that represent an encounter for group psychotherapy or family psychotherapy visits.",null,null,"2021-09",20190315,null,"NCQA","Yes",null,"Ambulatory Encounter"]
["79094001",null,null,"Initial psychiatric interview with mental status and evaluation (procedure)","2.16.840.1.113883.3.526.3.1492","Psych Visit Diagnostic Evaluation","Grouping","The purpose of this value set is to represent concepts for encounters for diagnostic psychiatric evaluations.","This value set may use a model element related to Encounter.","Includes concepts that represent an encounter for psychiatric diagnostic evaluations.","Excludes concepts that represent an encounter for group psychotherapy or family psychotherapy visits.",null,null,"2021-09",20190315,null,"NCQA","Yes",null,"Ambulatory Encounter"]

{"sheet":"Specifications SFY22_OLD","index":12,"n_rows":60,"n_cols":50,"rows_kept":60,"cut":false,"hidden":true,"merged":[]}
["Draft Measure ID","Final Measure ID","Summary of Changes","Program Shorthand","Program Component","Measure Name","Measure Type","Reported in Q1 October 2021 (Y/N)","Q1 Data Measurement Period","Q1 Performance Requirements","Q1 Reporting Impacted Payment Period","Reported in Q2 January 2022 (Y/N)","Q2 Measurement Period","Q2 Performance Requirements","Q2 Reporting Payment Impact Period","Reported in Q3 April 2022 (Y/N)","Q3 Measurement Period","Q3 Performance Requirements","Q3 Reporting Payment Impact Period","Reported in Q4 (Y/N) July 2022","Q4 Measurement Period","Q4 Performance Requirements","Q4 Reporting Payment Impact Period","Achievement Payer Type (for P4P)","Reporting Payer Type Stratification","P4P Goal Calcluation Type","National Benchmark Source","25th Percentile National Benchmark","50th Percentile National Benchmark","Reporting Data Source","NQF #","Measure Steward","Measure Specs Source","Link to specifications source","Measure Description","Eligible Physician Specialties and Other Clinicians for Outpatient Measures (DELETE - this is old for review only)","Eligible Physician Specialties and Other Clinicians","Eligible Physician Subspecialties (NUCC Area of Specialization - DELETE unless team wants to keep)","Denominator Unit of Measurement","Denominator Description","Denominator Inclusions","Denominator Exclusions","Numerator Description","Numerator Inclusion (Performance Met) ","Numerator Exclusion (Performance Not Met) ","Program Specific Modifications","Additional Information","DSRIP DY7 - 10 Measure ID","DSRIP Best Practices Workgroup Key Measure","Other Medicaid or CMS Program Alignment"]
["T1-101","T1-101",null,"TIPPS","T1 - PMPM","Patient-Centered Medical Home (PCMH) Accreditation or Recognition Status","Structure","Y","NA","Status Update","Monthly payment Nov 21-Apr 22. Presumptive eligibility - monthly payment Sep-Oct 21.","N",null,null,null,"Y","NA","Status Update","Monthly payment May-Oct 22.","N",null,null,null,"NA","NA","NA","NA","NA","NA","Physician Practice Group attestation","NA","NA","NA",null,"Reporting PCMH accreditation or recognition status or steps to obtain accreditation or recognition","NA","NA",null,"NA",null,null,null,null,null,null,null,null,"NA",null,"NA"]
["T1-103","T1-102",null,"TIPPS","T1 - PMPM","Same-day, walk-in, or after-hours appointments in the outpatient setting","Structure","Y","NA","Status Update","Monthly payment Nov 21-Apr 22. Presumptive eligibility - monthly payment Sep-Oct 21.","N",null,null,null,"Y","NA","Status Update","Monthly payment May-Oct 22.","N",null,null,null,"NA","NA","NA","NA","NA","NA","Physician Practice Group attestation","NA","NA","NA",null,"Reporting of availability of same-day, walk-in, or after-hours appointments","NA","NA",null,"NA",null,null,null,null,null,null,null,null,"NA",null,"NA"]
["T1-104","T1-103",null,"TIPPS","T1 - PMPM","Care team includes personnel in a care coordination role not requiring clinical licensure","Structure","Y","NA","Status Update","Monthly payment Nov 21-Apr 22. Presumptive eligibility - monthly payment Sep-Oct 21.","N",null,null,null,"Y","NA","Status Update","Monthly payment May-Oct 22.","N",null,null,null,"NA","NA","NA","NA","NA","NA","Physician Practice Group attestation","NA","NA","NA",null,"Reporting of care team composition, number of encounters performed by CHW/SW","NA","NA",null,"NA",null,null,null,null,null,null,null,null,"NA",null,"NA"]
["T1-105","T1-104",null,"TIPPS","T1 - PMPM","Pre-visit planning and/or standing order protocols","Structure","Y","NA","Status Update","Monthly payment Nov 21-Apr 22. Presumptive eligibility - monthly payment Sep-Oct 21.","N",null,null,null,"Y","NA","Status Update","Monthly payment May-Oct 22.","N",null,null,null,"NA","NA","NA","NA","NA","NA","Physician Practice Group attestation","NA","NA","NA",null,"Reporting of processes in place for pre-visit planning and/or standing order protocols ","NA","NA",null,"NA",null,null,null,null,null,null,null,null,"NA",null,"NA"]
["T1-106","T1-105",null,"TIPPS","T1 - PMPM","Patient education focused on disease self-management","Structure","Y","NA","Status Update","Monthly payment Nov 21-Apr 22. Presumptive eligibility - monthly payment Sep-Oct 21.","N",null,null,null,"Y","NA","Status Update","Monthly payment May-Oct 22.","N",null,null,null,"NA","NA","NA","NA","NA","NA","Physician Practice Group attestation","NA","NA","NA",null,"Reporting of availability of self-management education, number of patients with completed education/classes","NA","NA",null,"NA",null,null,null,null,null,null,null,null,"NA",null,"NA"]
["T1-108","T1-106",null,"TIPPS","T1 - PMPM","Identification of pregnant women at-risk for Hypertension, Preeclampsia, or Eclampsia; treatment based on best practices; and follow-up with postpartum women diagnosed with Hypertension, Preeclampsia, or Eclampsia ","Structure","Y","NA","Status Update","Monthly payment Nov 21-Apr 22. Presumptive eligibility - monthly payment Sep-Oct 21.","N",null,null,null,"Y","NA","Status Update","Monthly payment May-Oct 22.","N",null,null,null,"NA","NA","NA","NA","NA","NA","Physician Practice Group attestation","NA","NA","NA",null,"Reporting of processes in place to Identify, treat, and provide follow-up for pregnant women at-risk for Hypertension, Preeclampsia, or Eclampsia","NA","NA",null,"NA",null,null,null,null,null,null,null,null,"NA",null,"NA"]
["T1-109","T1-107",null,"TIPPS","T1 - PMPM","Health Information Exchange (HIE) Participation","Structure","Y","NA","Status Update","Monthly payment Nov 21-Apr 22. Presumptive eligibility - monthly payment Sep-Oct 21.","N",null,null,null,"Y","NA","Status Update","Monthly payment May-Oct 22.","N",null,null,null,"NA","NA","NA","NA","NA","NA","Physician Practice Group attestation","NA","NA","NA",null,"Reporting on status with enrollment in a public HIE","NA","NA",null,"NA",null,null,null,null,null,null,null,null,"NA",null,"NA"]
["T1-110","T1-108","Modified","TIPPS","T1 - PMPM","Telehealth to provide virtual medical appointments and/or consultations for specialty services, including both physical health and behavioral health services","Structure","Y","NA","Status Update","Monthly payment Nov 21-Apr 22. Presumptive eligibility - monthly payment Sep-Oct 21.","N",null,null,null,"Y","NA","Status Update","Monthly payment May-Oct 22.","N",null,null,null,"NA","NA","NA","NA","NA","NA","Physician Practice Group attestation","NA","NA","NA",null,"Reporting of availability of telehealth for specialty services and in what setting","NA","NA",null,"NA",null,null,null,null,null,null,null,null,"NA",null,"NA"]
["T2-111","T2-109",null,"TIPPS","T2 - P4P","Preventive Care & Screening: Tobacco Use: Screening & Cessation Intervention","Process","Y","01/01/21 - 06/30/21","Data Reporting & Status Update","Lump sum payment in November or December 2021","N",null,null,null,"Y","01/01/21 - 12/31/21","Data Reporting & Status Update","Lump sum payment in May or June 2022","N",null,null,null,"Medicaid","Medicaid, Uninsured, Other","IOS","NA","NA","NA","Physician Practice Group","0028","PCPI","eCQM - CMS138v9","https://ecqi.healthit.gov/ecqm/ep/2021/cms138v9","Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 12 months AND who received tobacco cessation intervention if identified as a tobacco user\n\nOnly one rate is reported:\nPercentage of patients aged 18 years and older who were screened for tobacco use one or more times within 12 months AND who received tobacco cessation intervention if identified as a tobacco user","General Practice, Family Practice, Internal Medicine, Obstetrics/Gynecology, Geriatric Medicine, Pyschiatry, Mental/Behavioral Health, Allergy/Immunology, Cardiology, Gastro-enterology, Dermatology, Ophthalmology, Orthopedic Surgery, Otolaryngology, Physical Medicine, Plastic Surgery, Preventive Medicine, Neurology, Vascular Surgery, General Surgery, Thoracic Surgery, Urology, Oncology, Rheumatology, Neurosurgical, Podiatry, Physical Therapy/Occupational Therapy, Urgent Care, Endocrinology, Pulmonology, Clinical Social Work, Audiology, Speech Language Pathology","Allergy & Immunology; Dermatology; Family Medicine; Internal Medicine; Obstetrics & Gynecology; Ophthalmology; Orthopaedic Surgery; Otolaryngology; Physicial Medicine & Rehabilitation; Plastic Surgery; Preventive Medicine; Psychiatry & Neurology; Neurosurgical Surgery; Surgery; Thoracic Surgery; Urology; Audiologist; Occupational Therapist; Physical Therapist; Podiatrist; Social Worker; Speech Language Pathologist; Urgent Care","Cardiology; Endocrinology; Gastroenterology; Oncology; Pulmonology; Rheumatology; Vascular Surgery","Individuals","All patients aged 18 years and older seen for at least two visits or at least one preventive visit during the measurement period","\"Initial Population\"\n\nexists ( [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n    where Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) >= 18)\n  and ( Count(\"Office Based Visit During Measurement Period\")>= 2\n      or exists \"Preventive Visit During Measurement Period\")","Documentation of medical reason(s) for not screening for tobacco use OR for not providing tobacco cessation intervention for patients identified as tobacco users (e.g., limited life expectancy, other medical reason)\n\nexists \"Medical Reason for Not Screening for Tobacco Use\"\n  or exists \"Medical Reason for Not Counseling Tobacco User\"\n  or exists \"Medical Reason for Not Ordering Tobacco Cessation Pharmacotherapy\"\n  or \"Has Limited Life Expectancy\"\n\n[\"Assessment, Not Performed\": \"Tobacco Use Screening\"] NoTobaccoUseScreening\n  where NoTobaccoUseScreening.authorDatetime during \"Measurement Period\"\n    and NoTobaccoUseScreening.negationRationale in \"Medical Reason\"\n\nor [\"Intervention, Not Performed\": \"Tobacco Use Cessation Counseling\"] NoTobaccoCessationCounseling\n  where NoTobaccoCessationCounseling.authorDatetime during \"Measurement Period\"\n    and NoTobaccoCessationCounseling.negationRationale in \"Medical Reason\"\n\nor [\"Medication, Not Ordered\": \"Tobacco Use Cessation Pharmacotherapy\"] NoCessationPharmacotherapyOrdered\n  where NoCessationPharmacotherapyOrdered.authorDatetime during \"Measurement Period\"\n    and NoCessationPharmacotherapyOrdered.negationRationale in \"Medical Reason\"\n\nor exists ( [\"Diagnosis\": \"Limited Life Expectancy\"] LimitedLifeExpectancy\n    where LimitedLifeExpectancy.prevalencePeriod overlaps after \"Measurement Period\")","Patients who were screened for tobacco use at least once within 12 months AND who received tobacco cessation intervention if identified as a tobacco user","Criteria 1\n\"Most Recent Tobacco Use Screening Indicates Tobacco Non User\" is not null\n  or \"Most Recent Tobacco Use Screening Indicates Tobacco User\" is not null\n\n(Last([\"Assessment, Performed\": \"Tobacco Use Screening\"] TobaccoUseScreening\n    where TobaccoUseScreening.relevantDatetime during \"Measurement Period\"\n    sort by relevantDatetime)) MostRecentTobaccoUseScreening\n  where MostRecentTobaccoUseScreening.result in \"Tobacco Non-User\"\n \n(Last([\"Assessment, Performed\": \"Tobacco Use Screening\"] TobaccoUseScreening\n    where TobaccoUseScreening.relevantDatetime during \"Measurement Period\"\n    sort by relevantDatetime)) MostRecentTobaccoUseScreening\n  where MostRecentTobaccoUseScreening.result in \"Tobacco User\"\n\nCriteria 2\nexists \"Tobacco Cessation Counseling Given\"\n  or exists \"Tobacco Cessation Pharmacotherapy Ordered\"\n  or exists \"Active Pharmacotherapy for Tobacco Cessation\n\n[\"Intervention, Performed\": \"Tobacco Use Cessation Counseling\"] TobaccoCessationCounseling\n  where TobaccoCessationCounseling.relevantDatetime during \"Measurement Period\"\n\n[\"Medication, Order\": \"Tobacco Use Cessation Pharmacotherapy\"] CessationPharmacotherapyOrdered\n  where CessationPharmacotherapyOrdered.authorDatetime during \"Measurement Period\"\n\n[\"Medication, Active\": \"Tobacco Use Cessation Pharmacotherapy\"] TakingCessationPharmacotherapy\n  where TakingCessationPharmacotherapy.relevantPeriod overlaps after \"Measurement Period\"\n\nCriteria 3\n\"Most Recent Tobacco Use Screening Indicates Tobacco Non User\" is not null\n  or ( \"Most Recent Tobacco Use Screening Indicates Tobacco User\" is not null\n      and ( exists \"Tobacco Cessation Counseling Given\"\n          or exists \"Tobacco Cessation Pharmacotherapy Ordered\"\n          or exists \"Active Pharmacotherapy for Tobacco Cessation\"))\n\n(Last([\"Assessment, Performed\": \"Tobacco Use Screening\"] TobaccoUseScreening\n    where TobaccoUseScreening.relevantDatetime during \"Measurement Period\"\n    sort by relevantDatetime)) MostRecentTobaccoUseScreening\n  where MostRecentTobaccoUseScreening.result in \"Tobacco Non-User\"\n \n(Last([\"Assessment, Performed\": \"Tobacco Use Screening\"] TobaccoUseScreening\n    where TobaccoUseScreening.relevantDatetime during \"Measurement Period\"\n    sort by relevantDatetime)) MostRecentTobaccoUseScreening\n  where MostRecentTobaccoUseScreening.result in \"Tobacco User\"\n\n[\"Intervention, Performed\": \"Tobacco Use Cessation Counseling\"] TobaccoCessationCounseling\n  where TobaccoCessationCounseling.relevantDatetime during \"Measurement Period\"\n\n[\"Medication, Order\": \"Tobacco Use Cessation Pharmacotherapy\"] CessationPharmacotherapyOrdered\n  where CessationPharmacotherapyOrdered.authorDatetime during \"Measurement Period\"\n\n[\"Medication, Active\": \"Tobacco Use Cessation Pharmacotherapy\"] TakingCessationPharmacotherapy\n  where TakingCessationPharmacotherapy.relevantPeriod overlaps after \"Measurement Period\"","None","Only one rate is reported. If using the E.H.R. version of the specifications, the denominator is all individiuals that meet the initial population (Criteria 1) and the numerator is all individuals from the denominator that meet all applicable criteria (for example, meet numerator criteria 1 if included only in denominator criteria 1, or meet numerator criteria 1, 2, and 3, if included in denominator criteria 1, 2, and 3). ","Definitions:\nTobacco Use - Includes any type of tobacco\nTobacco Cessation Intervention - Includes brief counseling (3 minutes or less), and/or pharmacotherapy -- Note: Concepts aligned with brief counseling (e.g., minimal and intensive advice/counseling interventions conducted both in person and over the phone) are included in the value set for the numerator. Other concepts such as written self-help materials (e.g., brochures, pamphlets) and complementary/alternative therapies are not included in the value set and do not qualify for the numerator. Brief counseling also may be of longer duration or be performed more frequently, as evidence shows there is a dose-response relationship between the intensity of counseling provided (either length or frequency) and tobacco cessation rates (U.S. Preventive Services Task Force, 2015).\n\n\nGuidance: \nThe requirement of two or more visits is to establish that the eligible professional or eligible clinician has an existing relationship with the patient for certain types of encounters. \n\nTo satisfy the intent of this measure, a patient must have at least one tobacco use screening during the 12-month period. If a patient has multiple tobacco use screenings during the 12-month period, only the most recent screening, which has a documented status of tobacco user or tobacco non-user, will be used to satisfy the measure requirements.\n\nIf a patient uses any type of tobacco (i.e., smokes or uses smokeless tobacco), the expectation is that they should receive tobacco cessation intervention: either counseling and/or pharmacotherapy.\n\nAs noted above in a recommendation statement from the USPSTF, the current evidence is insufficient to recommend electronic nicotine delivery systems (ENDS) including electronic cigarettes for tobacco cessation. Additionally, ENDS are not currently classified as tobacco in the recent evidence review to support the update of the USPSTF recommendation given that the devices do not burn or use tobacco leaves. In light of the current lack of evidence, the measure does not currently capture e-cigarette usage as either tobacco use or a cessation aid.\n\nIf tobacco use status of a patient is unknown, the patient does not meet the screening component required to be counted in the numerator and should be considered a measure failure. Instances where tobacco use status of \"unknown\" is recorded include: 1) the patient was not screened; or 2) the patient was screened and the patient (or caregiver) was unable to provide a definitive answer. If the patient does not meet the screening component of the numerator but has an allowable medical exception, then the patient should be removed from the denominator of the measure and reported as a valid exception.\n\nIn order to promote a team-based approach to patient care, the tobacco cessation intervention can be performed by another healthcare provider; therefore, the tobacco use screening and tobacco cessation intervention do not need to be performed by the same provider or clinician.   \n\nThe medical reason exception may be applied to either the screening data element OR to any of the applicable tobacco cessation intervention data elements (counseling and/or pharmacotherapy) included in the measure. \n\nIf a patient has a diagnosis of limited life expectancy, that patient has a valid denominator exception for not being screened for tobacco use or for not receiving tobacco use cessation intervention (counseling and/or pharmacotherapy) if identified as a tobacco user.\n\nThis measure contains three reporting rates which aim to identify patients who were screened for tobacco use (rate/population 1), patients who were identified as tobacco users and who received tobacco cessation intervention (rate/population 2), and a comprehensive look at the overall performance on tobacco screening and cessation intervention (rate/population 3). By separating this measure into various reporting rates, the eligible professional or eligible clinician will be able to better ascertain where gaps in performance exist, and identify opportunities for improvement. The overall rate (rate/population 3) can be utilized to compare performance to published versions of this measure prior to the 2018 performance year, when the measure had a single performance rate. For accountability reporting in the CMS MIPS program, the rate for population 2 is used for performance.\n \nThe denominator of population criteria 2 is a subset of the resulting numerator for population criteria 1, as population criteria 2 is limited to assessing if patients identified as tobacco users received an appropriate tobacco cessation intervention. For all patients, population criteria 1 and 3 are applicable, but population criteria 2 will only be applicable for those patients who are identified as tobacco users. Therefore, data for every patient that meets the initial population criteria will only be submitted for population 1 and 3, whereas data submitted for population 2 will be for a subset of patients who meet the initial population criteria, as the denominator has been further limited to those who were identified as tobacco users.\n\nThis eCQM is a patient-based measure.\n\nThis version of the eCQM uses QDM version 5.5.  Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.","C1-105","Yes","MIPS, Medicare ACOs, Medicare Million Hearts; NQF CQMC Consensus Core Set: Behavioral Health, Cardiology, & ACO/PCMH/Primary Care"]
["T2-112","T2-110",null,"TIPPS","T2 - P4P","Cervical Cancer Screening","Process","Y","01/01/21 - 06/30/21","Data Reporting & Status Update","Lump sum payment in November or December 2021","N",null,null,null,"Y","01/01/21 - 12/31/21","P4P - Benchmark & Status Update","Lump sum payment in May or June 2022","N",null,null,null,"Medicaid","Medicaid, Uninsured, Other","Benchmark","NCQA Quality Compas HEDIS 2020 (2019)","NA",61.31,"Physician Practice Group","0032","NCQA","eCQM - CMS124v9","https://ecqi.healthit.gov/ecqm/ep/2021/cms124v9","Percentage of women 21-64 years of age who were screened for cervical cancer using either of the following criteria:\n-Women age 21-64 who had cervical cytology performed within the last 3 years\n-Women age 30-64 who had cervical human papillomavirus (HPV) testing performed within the last 5 years","General Practice, Family Practice, Internal Medicine, Obstetrics/Gynecology","Family Medicine; Internal Medicine; Obstetrics & Gynecology",null,"Individuals","Women 23-64 years of age with a visit during the measurement period","\"Initial Population\"\n\nexists ( [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n    where Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) in Interval[23, 64))\n  and exists ( [\"Patient Characteristic Sex\": \"Female\"] )\n  and exists \"Qualifying Encounters\"\n\n( [\"Encounter, Performed\": \"Office Visit\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services - Established Office Visit, 18 and Up\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services-Initial Office Visit, 18 and Up\"]\n  union [\"Encounter, Performed\": \"Home Healthcare Services\"] ) ValidEncounter\n  where ValidEncounter.relevantPeriod during \"Measurement Period\"","Women who had a hysterectomy with no residual cervix or a congenital absence of cervix.\nExclude patients whose hospice care overlaps the measurement period.\n\nHospice. \"Has Hospice\"\n  or exists \"Absence of Cervix\"\n\nexists ( [\"Encounter, Performed\": \"Encounter Inpatient\"] DischargeHospice\n    where ( DischargeHospice.dischargeDisposition ~ \"Discharge to home for hospice care (procedure)\"\n        or DischargeHospice.dischargeDisposition ~ \"Discharge to healthcare facility for hospice care (procedure)\")\n      and DischargeHospice.relevantPeriod ends during \"Measurement Period\")\n  or exists ( [\"Intervention, Order\": \"Hospice care ambulatory\"] HospiceOrder\n      where HospiceOrder.authorDatetime during \"Measurement Period\")\n  or exists ( [\"Intervention, Performed\": \"Hospice care ambulatory\"] HospicePerformed\n      where HospicePerformed.relevantPeriod overlaps \"Measurement Period\")\n\n( [\"Procedure, Performed\": \"Hysterectomy with No Residual Cervix\"] NoCervixProcedure\n    where NoCervixProcedure.relevantPeriod ends on or before \n    end of \"Measurement Period\")\n  union ( [\"Diagnosis\": \"Congenital absence of cervix (disorder)\"] NoCervixDiagnosis\n      where NoCervixDiagnosis.prevalencePeriod starts on or before \n      end of \"Measurement Period\")","Women with one or more screenings for cervical cancer. Appropriate screenings are defined by any one of the following criteria:\n-Cervical cytology performed during the measurement period or the two years prior to the measurement period for women who are at least 21 years old at the time of the test\n-Cervical human papillomavirus (HPV) testing performed during the measurement period or the four years prior to the measurement period for women who are 30 years or older at the time of the test","exists \"Cervical Cytology Within 3 Years\"\n  or exists \"HPV Test Within 5 Years for Women Age 30 and Older\"\n\n[\"Laboratory Test, Performed\": \"Pap Test\"] CervicalCytology\n  where CervicalCytology.relevantDatetime 3 years or less on or before \n  end of \"Measurement Period\"\n    and CervicalCytology.result is not null\n\n[\"Laboratory Test, Performed\": \"HPV Test\"] HPVTest\n  with [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n    such that Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, HPVTest.relevantDatetime ) >= 30\n  where HPVTest.relevantDatetime 5 years or less on or before \n  end of \"Measurement Period\"\n    and HPVTest.result is not null","None",null,"Guidance\t\nTo ensure the measure is only looking for a cervical cytology test only after a woman turns 21 years of age, the youngest age in the initial population is 23.\n\nPatient self-report for procedures as well as diagnostic studies should be recorded in 'Procedure, Performed' template or 'Diagnostic Study, Performed' template in QRDA-1.\n\nInclude only cytology and HPV \"co-testing\"; in co-testing, both cytology and HPV tests are performed (i.e., the samples are collected and both tests are ordered, regardless of the cytology result) on the same date of service. Do not include reflex testing. In addition, if the medical record indicates the HPV test was performed only after determining the cytology result, this is considered reflex testing and does not meet criteria for the measure.","C2-106","Yes","Medicaid MCO P4Q; MIPS; CMS Adult Core Set; NQF CQMC Consensus Core Set: Obstetrics and Gynecology & ACO/PCMH/Primary Care"]
["T2-113","T2-111",null,"TIPPS","T2 - P4P","Childhood Immunization Status","Process","Y","01/01/21 - 06/30/21","Data Reporting & Status Update","Lump sum payment in November or December 2021","N",null,null,null,"Y","01/01/21 - 12/31/21","P4P - Benchmark & Status Update","Lump sum payment in May or June 2022","N",null,null,null,"Medicaid","Medicaid, Uninsured, Other","Benchmark","NCQA Quality Compas HEDIS 2020 (2019)","NA",37.47,"Physician Practice Group","0038","NCQA","eCQM - CMS117v9","https://ecqi.healthit.gov/ecqm/ep/2021/cms117v9","Percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV), one measles, mumps and rubella (MMR); three or four H influenza type B (Hib); three hepatitis B (Hep B); one chicken pox (VZV); four pneumococcal conjugate (PCV); one hepatitis A (Hep A); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday","Pediatric Medicine","Family Medicine; Pediatrics",null,"Individuals","Children who turn 2 years of age during the measurement period and who have a visit during the measurement period","\"Initial Population\"\n\nexists ( [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n    where Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) >= 1\n      and Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, \n      end of \"Measurement Period\" ) = 2)\n  and exists ( \"Qualifying Encounter\" )\n\n( [\"Encounter, Performed\": \"Office Visit\"]\n  union [\"Encounter, Performed\": \"Home Healthcare Services\"]\n  union [\"Encounter, Performed\": \"Preventive Care, Established Office Visit, 0 to 17\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services, Initial Office Visit, 0 to 17\"] ) ValidEncounter\n  where ValidEncounter.relevantPeriod during \"Measurement Period\"","Exclude patients whose hospice care overlaps the measurement period\n\nHospice. \"Has Hospice\"\nexists ( [\"Encounter, Performed\": \"Encounter Inpatient\"] DischargeHospice\n    where ( DischargeHospice.dischargeDisposition ~ \"Discharge to home for hospice care (procedure)\"\n        or DischargeHospice.dischargeDisposition ~ \"Discharge to healthcare facility for hospice care (procedure)\")\n      and DischargeHospice.relevantPeriod ends during \"Measurement Period\")\n  or exists ( [\"Intervention, Order\": \"Hospice care ambulatory\"] HospiceOrder\n      where HospiceOrder.authorDatetime during \"Measurement Period\")\n  or exists ( [\"Intervention, Performed\": \"Hospice care ambulatory\"] HospicePerformed\n      where HospicePerformed.relevantPeriod overlaps \"Measurement Period\")","Children who have evidence showing they received recommended vaccines, had documented history of the illness, had a seropositive test result, or had an allergic reaction to the vaccine by their second birthday","( exists ( \"Four DTaP Vaccinations\" )\n    or exists ( \"DTaP Numerator Inclusion Conditions\" ))\n  and ( exists ( \"Three Polio Vaccinations\" )\n      or exists ( \"Polio Numerator Inclusion Conditions\" ))\n  and ( exists ( \"One MMR Vaccination\" )\n      or exists ( \"MMR Numerator Inclusion Conditions\" )\n      or ( exists ( \"Measles Indicators\" )\n          and exists ( \"Mumps Indicators\" )\n          and exists ( \"Rubella Indicators\" )))\n  and ( \"Has Appropriate Number of Hib Immunizations\"\n      or exists ( \"Hib Numerator Inclusion Conditions\" ))\n  and ( exists ( \"Three Hepatitis B Vaccinations\" )\n      or exists ( \"Hepatitis B Numerator Inclusion Conditions\" ))\n  and ( exists ( \"One Chicken Pox Vaccination\" )\n      or exists ( \"Varicella Zoster Numerator Inclusion Conditions\" ))\n  and ( exists ( \"Four Pneumococcal Conjugate Vaccinations\" )\n      or exists ( \"Pneumococcal Conjugate Numerator Inclusion Conditions\" ))\n  and ( exists ( \"One Hepatitis A Vaccinations\" )\n      or exists ( \"Hepatitis A Numerator Inclusion Conditions\" ))\n  and ( \"Has Appropriate Number of Rotavirus Immunizations\"\n      or exists ( \"Rotavirus Numerator Inclusion Conditions\" ))\n  and ( exists ( \"Two Influenza Vaccinations\" )\n      or exists ( \"Influenza Numerator Inclusion Conditions\" ))\n\nfrom\n  \"DTaP Immunizations or Procedures\" DTaPVaccination1,\n  \"DTaP Immunizations or Procedures\" DTaPVaccination2,\n  \"DTaP Immunizations or Procedures\" DTaPVaccination3,\n  \"DTaP Immunizations or Procedures\" DTaPVaccination4\n  where DTaPVaccination2.relevantDatetime 1 day or more after day of DTaPVaccination1.relevantDatetime\n    and DTaPVaccination3.relevantDatetime 1 day or more after day of DTaPVaccination2.relevantDatetime\n    and DTaPVaccination4.relevantDatetime 1 day or more after day of DTaPVaccination3.relevantDatetime\n  return DTaPVaccination1\n\n( [\"Diagnosis\": \"Anaphylactic Reaction to DTaP Vaccine\"]\n  union [\"Diagnosis\": \"Encephalopathy due to Childhood Vaccination\"] ) DTaPConditions\n  where ( start of DTaPConditions.prevalencePeriod during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])\n\nfrom\n  \"Polio Immunizations or Procedures\" PolioVaccination1,\n  \"Polio Immunizations or Procedures\" PolioVaccination2,\n  \"Polio Immunizations or Procedures\" PolioVaccination3\n  where PolioVaccination2.relevantDatetime 1 day or more after day of PolioVaccination1.relevantDatetime\n    and PolioVaccination3.relevantDatetime 1 day or more after day of PolioVaccination2.relevantDatetime\n  return PolioVaccination1\n\n( [\"Diagnosis\": \"Poliomyelitis vaccine adverse reaction (disorder)\"]\n  union [\"Diagnosis\": \"Streptomycin adverse reaction (disorder)\"]\n  union [\"Diagnosis\": \"Polymyxin B adverse reaction (disorder)\"]\n  union [\"Diagnosis\": \"Neomycin adverse reaction (disorder)\"] ) PolioConditions\n  where ( start of PolioConditions.prevalencePeriod during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])\n\n( ( [\"Immunization, Administered\": \"Measles, Mumps and Rubella (MMR) Vaccine\"]\n    union [\"Procedure, Performed\": \"Measles, Mumps and Rubella (MMR) Vaccine Administered\"] ) MMRVaccination\n    where MMRVaccination.relevantDatetime during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])\n\n( [\"Diagnosis\": \"Disorders of the Immune System\"]\n  union [\"Diagnosis\": \"HIV\"]\n  union [\"Diagnosis\": \"Malignant Neoplasm of Lymphatic and Hematopoietic Tissue\"]\n  union [\"Diagnosis\": \"Neomycin adverse reaction (disorder)\"] ) MMRConditions\n  where ( start of MMRConditions.prevalencePeriod during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])\n\n( ( [\"Laboratory Test, Performed\": \"Measles Antibody Test (IgG Antibody Titer)\"] MeaslesTiter\n    where MeaslesTiter.result >= 1.10)\n  union ( [\"Laboratory Test, Performed\": \"Measles Antibody Test (IgG Antibody presence)\"] MeaslesIgGPresence\n      where MeaslesIgGPresence.result as Code in \"Positive Finding”)\n  union ( [\"Diagnosis\": \"Measles\"] MeaslesDiagnosis\n      return \"Laboratory Test, Performed\" { relevantDatetime: start of MeaslesDiagnosis.prevalencePeriod }) ) Measles\n  where ( Measles.relevantDatetime during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])\n\n( ( [\"Laboratory Test, Performed\": \"Mumps Antibody Test (IgG Antibody Titer)\"] MumpsTiter\n    where MumpsTiter.result >= 1.10)\n  union ( [\"Laboratory Test, Performed\": \"Mumps Antibody Test (IgG Antibody presence)\"] MumpsIgGPresence\n      where MumpsIgGPresence.result as Code in \"Positive Finding\")\n  union ( [\"Diagnosis\": \"Mumps\"] MumpsDiagnosis\n      return \"Laboratory Test, Performed\" { relevantDatetime: start of MumpsDiagnosis.prevalencePeriod }) ) Mumps\n  where ( Mumps.relevantDatetime during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])\n\n( ( [\"Laboratory Test, Performed\": \"Rubella Antibody Test (IgG Antibody Titer)\"] RubellaTiter\n    where RubellaTiter.result >= 1.10)\n  union ( [\"Laboratory Test, Performed\": \"Rubella Antibody Test (IgG Antibody presence)\"] RubellaIgGPresence\n      where RubellaIgGPresence.result as Code in \"Positive Finding\")\n  union ( [\"Diagnosis\": \"Rubella\"] RubellaDiagnosis\n      return \"Laboratory Test, Performed\" { relevantDatetime: start of RubellaDiagnosis.prevalencePeriod }) ) Rubella\n  where ( Rubella.relevantDatetime during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])\n\nexists ( \"All Hib Vaccinations\" HibImmunization //union of 3 and 4 dose immunizations\n//4 dose test\n    let has_4_dose: Count(\"Hib 4 Dose Immunizations or Procedures\")> 0\n    where ( has_4_dose //if pt had at least one 4 dose code\n        and Count(distinct(\"All Hib Vaccinations\" HibVaccinations\n              return HibVaccinations.relevantDatetime)\n        )>= 4 //pt must have 4 regimens (e.g., 3,3,4,4 or 4,3,4,4))\n      or ( has_4_dose is false //if pt did not have at least one 4 dose code\n          and Count(distinct(\"All Hib Vaccinations\" HibVaccinations\n                return HibVaccinations.relevantDatetime))>= 3 //pt must have 3 regimens of 3 dose codes))\n\n[\"Diagnosis\": \"Anaphylaxis due to Haemophilus influenzae type b vaccine (disorder)\"] HibReaction\n  where ( start of HibReaction.prevalencePeriod during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])\n\nfrom\n  \"Hepatitis B Immunizations or Procedures\" HepatitisBVaccination1,\n  \"Hepatitis B Immunizations or Procedures\" HepatitisBVaccination2,\n  \"Hepatitis B Immunizations or Procedures\" HepatitisBVaccination3\n  where HepatitisBVaccination2.relevantDatetime 1 day or more after day of HepatitisBVaccination1.relevantDatetime\n    and HepatitisBVaccination3.relevantDatetime 1 day or more after day of HepatitisBVaccination2.relevantDatetime\n  return HepatitisBVaccination1\n \n( ( [\"Laboratory Test, Performed\": \"Anti Hepatitis A IgG Antigen Test\"] HepatitisAAntigenTest\n    where HepatitisAAntigenTest.result as Code in \"Positive Finding\")\n  union ( [\"Diagnosis\": \"Anaphylactic Reaction to Hepatitis A Vaccine\"] HepatitisAReaction\n      return \"Laboratory Test, Performed\" { relevantDatetime: start of HepatitisAReaction.prevalencePeriod })\n  union ( [\"Diagnosis\": \"Hepatitis A\"] HepatitisADiagnosis\n      return \"Laboratory Test, Performed\" { relevantDatetime: start of HepatitisADiagnosis.prevalencePeriod }) ) HepatitisAConditions\n  where ( HepatitisAConditions.relevantDatetime during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])\n\n( ( [\"Immunization, Administered\": \"Varicella Zoster Vaccine (VZV)\"]\n    union [\"Procedure, Performed\": \"Varicella Zoster Vaccine (VZV) Administered\"] ) ChickenPoxVaccination\n    where ChickenPoxVaccination.relevantDatetime during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])\n\n( ( [\"Laboratory Test, Performed\": \"Varicella Zoster Antibody Test (IgG Antibody Titer)\"] ChickenPoxTiter\n    where ChickenPoxTiter.result >= 1.10)\n  union ( [\"Laboratory Test, Performed\": \"Varicella Zoster Antibody Test (IgG Antibody Presence)\"] ChickenPoxIgGPresence\n      where ChickenPoxIgGPresence.result as Code in \"Positive Finding\")\n  union ( [\"Diagnosis\": \"Disorders of the Immune System\"] ImmuneDisorder\n      return \"Laboratory Test, Performed\" { relevantDatetime: start of ImmuneDisorder.prevalencePeriod })\n  union ( [\"Diagnosis\": \"HIV\"] HIV\n      return \"Laboratory Test, Performed\" { relevantDatetime: start of HIV.prevalencePeriod })\n  union ( [\"Diagnosis\": \"Malignant Neoplasm of Lymphatic and Hematopoietic Tissue\"] LymphaticMalignantNeoplasm\n      return \"Laboratory Test, Performed\" { relevantDatetime: start of LymphaticMalignantNeoplasm.prevalencePeriod })\n  union ( [\"Diagnosis\": \"Neomycin adverse reaction (disorder)\"] NeomycinReaction\n      return \"Laboratory Test, Performed\" { relevantDatetime: start of NeomycinReaction.prevalencePeriod })\n  union ( [\"Diagnosis\": \"Varicella Zoster\"] VaricellaZoster\n      return \"Laboratory Test, Performed\" { relevantDatetime: start of VaricellaZoster.prevalencePeriod }) ) VaricellaZosterConditions\n  where ( VaricellaZosterConditions.relevantDatetime during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])\n\nfrom\n  \"Pneumococcal Conjugate Immunizations or Procedures\" PneumococcalVaccination1,\n  \"Pneumococcal Conjugate Immunizations or Procedures\" PneumococcalVaccination2,\n  \"Pneumococcal Conjugate Immunizations or Procedures\" PneumococcalVaccination3,\n  \"Pneumococcal Conjugate Immunizations or Procedures\" PneumococcalVaccination4\n  where PneumococcalVaccination2.relevantDatetime 1 day or more after day of PneumococcalVaccination1.relevantDatetime\n    and PneumococcalVaccination3.relevantDatetime 1 day or more after day of PneumococcalVaccination2.relevantDatetime\n    and PneumococcalVaccination4.relevantDatetime 1 day or more after day of PneumococcalVaccination3.relevantDatetime\n  return PneumococcalVaccination1\n \n[\"Diagnosis\": \"Pneumococcal vaccine adverse reaction (disorder)\"] PneumococcalReaction\n  where ( start of PneumococcalReaction.prevalencePeriod during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])\n\n( ( [\"Immunization, Administered\": \"Hepatitis A Vaccine\"]\n    union [\"Procedure, Performed\": \"Hepatitis A Vaccine Administered\"] ) HepatitisAVaccination\n    where HepatitisAVaccination.relevantDatetime during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])\n\n( ( [\"Laboratory Test, Performed\": \"Anti Hepatitis A IgG Antigen Test\"] HepatitisAAntigenTest\n    where HepatitisAAntigenTest.result as Code in \"Positive Finding\")\n  union ( [\"Diagnosis\": \"Anaphylactic Reaction to Hepatitis A Vaccine\"] HepatitisAReaction\n      return \"Laboratory Test, Performed\" { relevantDatetime: start of HepatitisAReaction.prevalencePeriod })\n  union ( [\"Diagnosis\": \"Hepatitis A\"] HepatitisADiagnosis\n      return \"Laboratory Test, Performed\" { relevantDatetime: start of HepatitisADiagnosis.prevalencePeriod }) ) HepatitisAConditions\n  where ( HepatitisAConditions.relevantDatetime during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])\n\nexists ( \"All Rotavirus Vaccinations\" RotavirusImmunization\n    let has_3_dose: Count(\"Rotavirus 3 Dose Immunizations or Procedures\")> 0\n    where ( has_3_dose\n        and Count(distinct(\"All Rotavirus Vaccinations\" RotavirusVaccinations\n              return RotavirusVaccinations.relevantDatetime))>= 3)\n      or ( has_3_dose is false\n          and Count(distinct(\"All Rotavirus Vaccinations\" RotavirusVaccinations\n                return RotavirusVaccinations.relevantDatetime))>= 2))\n\n( ( [\"Diagnosis\": \"Anaphylaxis due to rotavirus vaccine (disorder)\"]\n    union [\"Diagnosis\": \"Severe Combined Immunodeficiency\"]\n    union [\"Diagnosis\": \"Intussusception\"] ) RotavirusConditions\n    where ( start of RotavirusConditions.prevalencePeriod during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years]))\n\nfrom\n  \"Influenza Immunizations or Procedures\" FluVaccination1,\n  \"Influenza Immunizations or Procedures\" FluVaccination2\n  where FluVaccination2.relevantDatetime 1 day or more after day of FluVaccination1.relevantDatetime\n  return FluVaccination1\n\n( [\"Diagnosis\": \"Influenza virus vaccine adverse reaction (disorder)\"]\n  union [\"Diagnosis\": \"Malignant Neoplasm of Lymphatic and Hematopoietic Tissue\"]\n  union [\"Diagnosis\": \"Neomycin adverse reaction (disorder)\"]\n  union [\"Diagnosis\": \"HIV\"]\n  union [\"Diagnosis\": \"Disorders of the Immune System\"] ) InfluenzaConditions\n  where ( start of InfluenzaConditions.prevalencePeriod during Interval[Patient.birthDatetime, Patient.birthDatetime + 2 years])","None",null,"Definitions:\nRecommended vaccines: Vaccines and the schedule of vaccines as recommended by the Advisory Committee on Immunization Practices (ACIP) for children two years of age. The measure may differ slightly from the ACIP recommendations because the measure focuses on immunizations that are appropriate by age 2. Also, there may be small differences when there are shortages for a particular vaccine.\n\nFor the MMR, hepatitis B, VZV and hepatitis A vaccines, numerator inclusion criteria include: evidence of receipt of the recommended vaccine; documented history of the illness; or, a seropositive test result for the antigen. For the DTaP, IPV, Hib, pneumococcal, rotavirus, and influenza vaccines, numerator inclusion criteria include only evidence of receipt of the recommended vaccine. \n\nPatients may be included in the numerator for a particular antigen if they had an anaphylactic reaction to the vaccine. Patients may be included in the numerator for the DTaP vaccine if they have encephalopathy. Patients may be included in the numerator for the IPV vaccine if they have had an anaphylactic reaction to streptomycin, polymyxin B, or neomycin. Patients may be included in the numerator for the influenza, MMR, or varicella vaccines if they have cancer of lymphoreticular or histiocytic tissue, multiple myeloma, leukemia, have had an anaphylactic reaction to neomycin, have immunodeficiency, or have HIV. Patients may be included in the numerator for the hepatitis B vaccine if they have had an anaphylactic reaction to common baker's yeast.\nThe measure allows a grace period by measuring compliance with these recommendations between birth and age two.\nThis eCQM is a patient-based measure.\nThis version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.\n\nRecommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States 2019 (Centers for Disease Control and Prevention, 2019)\n\nHepatitis B (HepB)\n\"(minimum age: birth)\nBirth dose (monovalent HepB vaccine only)\n-- Mother is HBsAg-negative: 1 dose within 24 hours of birth for all medically stable infants ?2,000 grams. Infants <2,000 grams: administer 1 dose at chronological age 1 month or hospital discharge.\n-- Mother is HBsAg-positive:\n- Administer HepB vaccine and 0.5 mL of hepatitis B immune globulin (HBIG) (at separate anatomic sites) within 12 hours of birth, regardless of birth weight. For infants <2,000 grams, administer 3 additional doses of vaccine (total of 4 doses) beginning at age 1 month.\n- Test for HBsAg and anti-HBs at age 9–12 months. If HepB series is delayed, test 1–2 months after final dose.\n-- Mother’s HBsAg status is unknown:\n- Administer HepB vaccine within 12 hours of birth, regardless of birth weight.\n- For infants <2,000 grams, administer 0.5 mL of HBIG in addition to HepB vaccine within 12 hours of birth. Administer 3 additional doses of vaccine (total of 4 doses) beginning at age 1 month.\n- Determine mother’s HBsAg status as soon as possible. If mother is HBsAg-positive, administer 0.5 mL of HBIG to infants ?2,000 grams as soon as possible, but no later than 7 days of age.\nRoutine series\n-- 3-dose series at 0, 1–2, 6–18 months (use monovalent HepB vaccine for doses administered before age 6 weeks)\n-- Infants who did not receive a birth dose should begin the series as soon as feasible (see Table 2).\n-- Administration of 4 doses is permitted when a combination vaccine containing HepB is used after the birth dose.\n-- Minimum age for the final (3rd or 4th ) dose: 24 weeks\n-- Minimum intervals: dose 1 to dose 2: 4 weeks / dose 2 to\ndose 3: 8 weeks / dose 1 to dose 3: 16 weeks (when 4 doses are administered, substitute \"dose 4\" for \"dose 3\" in these calculations) \"\n\nDiphtheria, tetanus, acellular pertussis vaccinations (DTap)\n\"(minimum age: 6 weeks [4 years for Kinrix or Quadracel])\nRoutine vaccination\n-- 5-dose series at 2, 4, 6, 15–18 months, 4–6 years\n- Prospectively: Dose 4 may be given as early as age 12 months if at least 6 months have elapsed since dose 3.\n- Retrospectively: A 4th dose that was inadvertently given as early as 12 months may be counted if at least 4 months have elapsed since dose 3.\"\n\nHaemophilus influenzae type b (Hib)\n\"(minimum age: 6 weeks)\nRoutine vaccination\n-- ActHIB, Hiberix, or Pentacel: 4-dose series at 2, 4, 6, 12–15 months\n-- PedvaxHIB: 3-dose series at 2, 4, 12–15 months\"\n\nPoliovirus (inactivated) (IPV)\n\" (minimum age: 6 weeks)\nRoutine vaccination\n-- 4-dose series at ages 2, 4, 6–18 months, 4–6 years; administer the final dose on or after the 4th birthday and at least 6 months after the previous dose.\n-- 4 or more doses of IPV can be administered before the 4th birthday when a combination vaccine containing IPV is used. However, a dose is still recommended after the 4th birthday and at least 6 months after the previous dose.\"\n\nMeasles, mumps, and rubella (MMR)\n\"(minimum age: 12 months for routine vaccination)\nRoutine vaccination\n-- 2-dose series at 12–15 months, 4–6 years\n Dose 2 may be administered as early as 4 weeks after dose 1\"\n\nPneumococcal\n\"(minimum age: 6 weeks [PCV13], 2 years [PPSV23])\nRoutine vaccination with PCV13\n-- 4-dose series at 2, 4, 6, 12–15 months\"\n\nVaricella (VAR) \n\"(minimum age: 12 months)\nRoutine vaccination\n-- 2-dose series: 12–15 months, 4–6 years\n-- Dose 2 may be administered as early as 3 months after dose 1 (a dose administered after a 4-week interval may be counted).\"\n\nHepatitis A (HepA)\n\"(minimum age: 12 months for routine vaccination)\nRoutine vaccination\n-- 2-dose series (Havrix 6–12 months apart or Vaqta 6–18 months apart, minimum interval 6 months); a series begun before the 2nd birthday should be completed even if the child turns 2 before the second dose is administered.\"\n\nRotavirus (RV) \n\"(minimum age: 6 weeks)\nRoutine vaccination\n-- Rotarix: 2-dose series at 2 and 4 months.\n-- RotaTeq: 3-dose series at 2, 4, and 6 months.\nIf any dose in the series is either RotaTeq or unknown, default to 3-dose series.\"\n\nInfluenza (inactivated)  influenza vaccine (IIV) \n\"(minimum age: 6 months [IIV], 2 years [LAIV  ], 18 years [RIV])\nRoutine vaccination\n-- 1 dose any influenza vaccine appropriate for age and health status annually (2 doses separated by at least 4 weeks for children 6 months–8 years who did not receive at least 2 doses of influenza vaccine before July 1, 2018)\"","D1-108","Yes","Medicaid MCO P4Q; MIPS; CMS Medicaid Child Core Set"]
["T2-114","T2-112",null,"TIPPS","T2 - P4P","Immunization for Adolescents","Process","Y","01/01/21 - 06/30/21","Data Reporting & Status Update","Lump sum payment in November or December 2021","N",null,null,null,"Y","01/01/21 - 12/31/21","P4P - Benchmark & Status Update","Lump sum payment in May or June 2022","N",null,null,null,"Medicaid","Medicaid, Uninsured, Other","Benchmark","NCQA Quality Compas HEDIS 2020 (2019)","NA",36.69,"Physician Practice Group",1407,"NCQA","CMS MIPS #394 2020","https://qpp-cm-prod-content.s3.amazonaws.com/uploads/786/2020+CQM+Specifications+and+Supporting+Docs.zip","The percentage of adolescents 13 years of age who had the recommended immunizations by their 13th birthday. \nOnly one rate is reported: All patients who are compliant for Meningococcal, Tdap and HPV during the specified timeframes","General Practice, Family Practice, Pediatric Medicine","Family Medicine; Pediatrics",null,"Individuals","Adolescents who turn 13 years of age during the measurement period ","Patients who turn 13 years of age during the measurement period\n\nAND\n\nPatient encounter during the performance period (CPT or HCPCS): 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0402","Meningococcal, Tdap and/or HPV vaccine contraindicated OR patient allergic to the meningococcal, Tdap, and/or HPV vaccine\n\nOR\n\nEncephalopathy due to Tdap vaccine\n\nOR\n\nPatients who use hospice services any time during the measurement period: G9761","All patients who are numerator compliant for Meningococcal, Tdap and HPV during the specified timeframes","Patient had one dose of meningococcal vaccine (serogroups A, C, W, Y) on or between the patient’s 11th and 13th birthdays (G9414) \nAND\nPatient had one tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap) on or between the patient’s 10th and 13th birthdays (G9416) \nAND\nPatient had at least two HPV vaccines (with at least 146 days between the two) OR three HPV vaccines on or between the patient’s 9th and 13th birthdays (G9762)\n","Patient did not have one dose of meningococcal vaccine on or between the patient’s 11th and 13th birthdays (G9415) \nOR\nPatient did not have one tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap) on or between the patient’s 10th and 13th birthdays (G9417) \nOR\nPatient did not have at least two HPV vaccines (with at least 146 days between the two) OR three HPV vaccines on or between the patient’s 9th and 13th birthdays (G9763)","Under CMS MIPS specifications, measure is reported as 4 rates but only one rate is reported in TIPPS (criteria 4: adolescents who are numerator compliant for Rates 1, 2 and 3).",null,"D1-271","Yes","Medicaid MCO P4Q; MIPS; CMS Medicaid Child Core Set; NQF CQMC Consensus Core Set: Pediatrics"]
["T2-115","T2-113",null,"TIPPS","T2 - P4P","Preventive Care and Screening: Screening for Depression and Follow-Up Plan","Process","Y","01/01/21 - 06/30/21","Data Reporting & Status Update","Lump sum payment in November or December 2021","N",null,null,null,"Y","01/01/21 - 12/31/21","Data Reporting & Status Update","Lump sum payment in May or June 2022","N",null,null,null,"Medicaid","Medicaid, Uninsured, Other","IOS","NA",null,"NA","Physician Practice Group","0418","CMS","eCQM - CMS2v10","https://ecqi.healthit.gov/ecqm/ep/2021/cms002v10"," Percentage of patients aged 12 years and older screened for depression on the date of the encounter or up to 14 days prior to the date of the encounter using an age-appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the eligible encounter","General Practice, Family Practice, Internal Medicine, Pediatric Medicine, Geriatric Medicine, Pyschiatry, Mental/Behavioral Health, Orthopedic Surgery, Preventive Medicine, Neurology, Physical Therapy/Occupational Therapy, Endocrinology, Clinical Social Work","Family Medicine; Internal Medicine; Orthopedic Surgery; Pediatrics; Preventive Medicine; Psychiatry & Neurology; Audiologist; Occupational Therapist; Physical Therapist; Social Worker","Endocrinology","Individuals","All patients aged 12 years and older at the beginning of the measurement period with at least one eligible encounter during the measurement period","\"Initial Population\"\n\n\"Patient Age 12 Years or Older at Start of Measurement Period\"\n  and exists ( \"Qualifying Encounter During Measurement Period\" )\n\nexists [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n  where Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) >= 12\n\n( [\"Encounter, Performed\": \"Encounter to Screen for Depression\"]\n  union [\"Encounter, Performed\": \"Physical Therapy Evaluation\"] ) ValidEncounter\n  where ValidEncounter.relevantPeriod during \"Measurement Period\"","Patient Reason(s)\nPatient refuses to participate \nOR\nMedical Reason(s) \nDocumentation of medical reason for not screening patient for depression (e.g., cognitive, functional, or motivational limitations that may impact accuracy of results; patient is in an urgent or emergent situation where time is of the essence and to delay treatment would jeopardize the patient's health status)\n\nPatients who have been diagnosed with depression or with bipolar disorder\nexists \"History of Bipolar or Depression Diagnosis Before Qualifying Encounter\"\n\n( [\"Diagnosis\": \"Bipolar Diagnosis\"]\n  union [\"Diagnosis\": \"Depression Diagnosis\"] ) DiagnosisBipolarorDepression\n  with \"Qualifying Encounter During Measurement Period\" QualifyingEncounter\n    such that DiagnosisBipolarorDepression.prevalencePeriod starts before QualifyingEncounter.relevantPeriod\n\nDenominator Exceptions\n( exists \"Medical or Patient Reason for Not Screening Adolescent for Depression\"\n    and not \"Has Adolescent Depression Screening\")\n  or ( exists \"Medical or Patient Reason for Not Screening Adult for Depression\"\n      and not \"Has Adult Depression Screening\")\n\n[\"Assessment, Not Performed\": \"Adolescent depression screening assessment\"] NoAdolescentScreen\n  with \"Qualifying Encounter During Measurement Period\" QualifyingEncounter\n    such that NoAdolescentScreen.authorDatetime during QualifyingEncounter.relevantPeriod\n  where ( NoAdolescentScreen.negationRationale in \"Patient Declined\"\n      or NoAdolescentScreen.negationRationale in \"Medical Reason\")\n\nand not exists ( [\"Assessment, Performed\": \"Adolescent depression screening assessment\"] AdolescentScreening\n    with \"Qualifying Encounter During Measurement Period\" QualifyingEncounter\n      such that AdolescentScreening.relevantDatetime 14 days or less on or before day of start of QualifyingEncounter.relevantPeriod\n        and AdolescentScreening.result is not null)\n\nor [\"Assessment, Not Performed\": \"Adult depression screening assessment\"] NoAdultScreen\n  with \"Qualifying Encounter During Measurement Period\" QualifyingEncounter\n    such that NoAdultScreen.authorDatetime during QualifyingEncounter.relevantPeriod\n  where ( NoAdultScreen.negationRationale in \"Patient Declined\"\n      or NoAdultScreen.negationRationale in \"Medical Reason\")\n\nand not exists ( [\"Assessment, Performed\": \"Adult depression screening assessment\"] AdultScreening\n    with \"Qualifying Encounter During Measurement Period\" QualifyingEncounter\n      such that AdultScreening.relevantDatetime 14 days or less on or before day of start of QualifyingEncounter.relevantPeriod\n        and AdultScreening.result is not null)","Patients screened for depression on the date of the encounter or up to 14 days prior to the date of the encounter using an age-appropriate standardized tool AND if positive, a follow-up plan is documented on the date of the eligible encounter","( \"Patient Age 12 to 16 Years at Start of Measurement Period\"\n    and ( \"Has Most Recent Adolescent Screening Negative\"\n        or exists \"Most Recent Adolescent Screening Positive and Follow Up Provided\"))\n  or ( \"Patient Age 17 Years at Start of Measurement Period\"\n      and ( \"Has Most Recent Adolescent Screening Negative\"\n          or exists \"Most Recent Adolescent Screening Positive and Follow Up Provided\"\n          or \"Has Most Recent Adult Screening Negative\"\n          or exists \"Most Recent Adult Depression Screening Positive and Follow Up Provided\"))\n  or ( \"Patient Age 18 Years or Older at Start of Measurement Period\"\n      and ( \"Has Most Recent Adult Screening Negative\"\n          or exists \"Most Recent Adult Depression Screening Positive and Follow Up Provided\"))\n \nexists [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n  where Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) < 17\n\nand ( \"Most Recent Adolescent Depression Screening\" AdolescentScreen\n    where AdolescentScreen.result in \"Negative Depression Screening\") is not null\n\nor from\n  \"Most Recent Adolescent Depression Screening\" LastAdolescentScreen,\n  \"Follow Up For Positive Adolescent Depression Screening\" FollowUpPositiveAdolescentScreen,\n  \"Qualifying Encounter During Measurement Period\" QualifyingEncounter\n  where LastAdolescentScreen.relevantDatetime 14 days or less on or before day of start of QualifyingEncounter.relevantPeriod\n    and LastAdolescentScreen.result in \"Positive Depression Screening\"\n    and ( FollowUpPositiveAdolescentScreen.authorDatetime same day as \n      end of QualifyingEncounter.relevantPeriod\n        or FollowUpPositiveAdolescentScreen.relevantDatetime same day as \n        end of QualifyingEncounter.relevantPeriod)\n\nor exists [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n  where Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) = 17\n\nand ( \"Most Recent Adolescent Depression Screening\" AdolescentScreen\n    where AdolescentScreen.result in \"Negative Depression Screening\") is not null\n\nor from\n  \"Most Recent Adolescent Depression Screening\" LastAdolescentScreen,\n  \"Follow Up For Positive Adolescent Depression Screening\" FollowUpPositiveAdolescentScreen,\n  \"Qualifying Encounter During Measurement Period\" QualifyingEncounter\n  where LastAdolescentScreen.relevantDatetime 14 days or less on or before day of start of QualifyingEncounter.relevantPeriod\n    and LastAdolescentScreen.result in \"Positive Depression Screening\"\n    and ( FollowUpPositiveAdolescentScreen.authorDatetime same day as \n      end of QualifyingEncounter.relevantPeriod\n        or FollowUpPositiveAdolescentScreen.relevantDatetime same day as \n        end of QualifyingEncounter.relevantPeriod)\n\nor ( \"Most Recent Adult Depression Screening\" AdultScreen\n    where AdultScreen.result in \"Negative Depression Screening\") is not null\n\nand from\n  \"Most Recent Adult Depression Screening\" LastAdultScreen,\n  \"Follow Up for Positive Adult Depression Screening\" FollowUpPositiveAdultScreen,\n  \"Qualifying Encounter During Measurement Period\" QualifyingEncounter\n  where LastAdultScreen.relevantDatetime 14 days or less on or before day of start of QualifyingEncounter.relevantPeriod\n    and LastAdultScreen.result in \"Positive Depression Screening\"\n    and ( FollowUpPositiveAdultScreen.authorDatetime same day as \n      end of QualifyingEncounter.relevantPeriod\n        or FollowUpPositiveAdultScreen.relevantDatetime same day as \n        end of QualifyingEncounter.relevantPeriod)\n\nor exists [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n  where Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) >= 18\n\nand ( \"Most Recent Adult Depression Screening\" AdultScreen\n    where AdultScreen.result in \"Negative Depression Screening\") is not null\n\nor from\n  \"Most Recent Adult Depression Screening\" LastAdultScreen,\n  \"Follow Up for Positive Adult Depression Screening\" FollowUpPositiveAdultScreen,\n  \"Qualifying Encounter During Measurement Period\" QualifyingEncounter\n  where LastAdultScreen.relevantDatetime 14 days or less on or before day of start of QualifyingEncounter.relevantPeriod\n    and LastAdultScreen.result in \"Positive Depression Screening\"\n    and ( FollowUpPositiveAdultScreen.authorDatetime same day as \n      end of QualifyingEncounter.relevantPeriod\n        or FollowUpPositiveAdultScreen.relevantDatetime same day as \n        end of QualifyingEncounter.relevantPeriod)","None",null,"Definitions:\n\t\nScreening:\nCompletion of a clinical or diagnostic tool used to identify people at risk of developing or having a certain disease or condition, even in the absence of symptoms.  \n\nStandardized Depression Screening Tool: A normalized and validated depression screening tool developed for the patient population in which it is being utilized.\n\nExamples of standardized depression screening tools include but are not limited to: \n*  Adolescent Screening Tools (12-17 years) \n   *  Patient Health Questionnaire for Adolescents (PHQ-A)\n   *  Beck Depression Inventory-Primary Care Version (BDI-PC)\n   *  Mood Feeling Questionnaire (MFQ)\n   *  Center for Epidemiologic Studies Depression Scale (CES-D)\n   *  Patient Health Questionnaire (PHQ-9)\n   *  Pediatric Symptom Checklist (PSC-17)\n   *  PRIME MD-PHQ2 \n*  Adult Screening Tools (18 years and older) \n   *  Patient Health Questionnaire (PHQ9)\n   *  Beck Depression Inventory (BDI or BDI-II)\n   *  Center for Epidemiologic Studies Depression Scale (CES-D)\n   *  Depression Scale (DEPS)\n   *  Duke Anxiety-Depression Scale (DADS)\n   *  Geriatric Depression Scale (GDS)\n   *  Cornell Scale for Depression in Dementia (CSDD)\n   *  PRIME MD-PHQ2 \n   *  Hamilton Rating Scale for Depression (HAM-D)\n   *  Quick Inventory of Depressive Symptomatology Self-Report (QID-SR)\n   *  Computerized Adaptive Testing Depression Inventory (CAT-DI)\n   *  Computerized Adaptive Diagnostic Screener (CAD-MDD)\n* Perinatal Screening Tools\n   *  Edinburgh Postnatal Depression Scale\n   *  Postpartum Depression Screening Scale\n   *  Patient Health Questionnaire 9 (PHQ-9)\n   *  Beck Depression Inventory\n   *  Beck Depression Inventory-II\n   *  Center for Epidemiologic Studies Depression Scale\n   *  Zung Self-rating Depression Scale\n   \nFollow-Up Plan: \nDocumented follow-up for a positive depression screening must include one or more of the following:\n *  Referral to a practitioner who is qualified to diagnose and treat depression\n *  Pharmacological interventions\n *  Other interventions or follow-up for the diagnosis or treatment of depression\n\n\n\nGuidance\t\nA depression screen is completed on the date of the encounter or up to 14 days prior to the date of the encounter using an age-appropriate standardized depression screening tool AND if positive, a follow-up plan must be documented on the date of the encounter, such as referral to a practitioner who is qualified to treat depression, pharmacological interventions or other interventions for the treatment of depression.\n\nThis eCQM is a patient-based measure. Depression screening is required once per measurement period, not at all encounters.\n\nThe intent of the measure is to screen for depression in patients who have never had a diagnosis of depression or bipolar disorder prior to the eligible encounter used to evaluate the numerator. Patients who have ever been diagnosed with depression or bipolar disorder will be excluded from the measure.\n\nScreening Tools:\n *  An age-appropriate, standardized, and validated depression screening tool must be used for numerator compliance.\n *  The name of the age-appropriate standardized depression screening tool utilized must be documented in the medical record.\n *  The depression screening must be reviewed and addressed in the office of the provider, filing the code, on the date of the encounter. Positive pre-screening results indicating a patient is at high risk for self-harm should receive more urgent intervention as determined by the provider practice.\n *  The screening should occur during a qualifying encounter or up to 14 days prior to the date of the qualifying encounter.\n *  The measure assesses the most recent depression screening completed either during the eligible encounter or within the 14 days prior to that encounter. Therefore, a clinician would not be able to complete another screening at the time of the encounter to count towards a follow-up, because that would serve as the most recent screening. In order to satisfy the follow-up requirement for a patient screening positively, the eligible clinician would need to provide one of the aforementioned follow-up actions, which does not include use of a standardized depression screening tool.\n\nFollow-Up Plan:\n\nThe follow-up plan must be related to a positive depression screening, for example: \"Patient referred for psychiatric evaluation due to positive depression screening.\"\n\nExamples of a follow-up plan include but are not limited to: \n *  Referral to a practitioner or program for further evaluation for depression, for example, referral to a psychiatrist, psychologist, social worker, mental health counselor, or other mental health service such as family or group therapy, support group, depression management program, or other service for treatment of depression\n *  Other interventions designed to treat depression such as behavioral health evaluation, psychotherapy, pharmacological interventions, or additional treatment options\n\nShould a patient screen positive for depression, a clinician should opt to complete a suicide risk assessment when appropriate and based on individual patient characteristics. However, for the purposes of this measure, a suicide risk assessment or additional screening using a standardized tool will not qualify as a follow-up plan.\n\nThis version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.","H1-146","Yes","MIPS; CMS Medicaid Adult Core Set; NQF CQMC Consensus Core Set: Behavioral Health, Obstetrics and Gynecology, ACO/PCMH/Primary Care & Pediatrics"]
["T2-116","T2-114",null,"TIPPS","T2 - P4P","Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) testing","Process","Y","01/01/21 - 06/30/21","Data Reporting & Status Update","Lump sum payment in November or December 2021","N",null,null,null,"Y","01/01/21 - 12/31/21","P4P - Benchmark & Status Update","Lump sum payment in May or June 2022","N",null,null,null,"Medicaid","Medicaid, Uninsured, Other","Benchmark","NCQA Quality Compas HEDIS 2020 (2019)","NA",88.77,"Physician Practice Group","0057","NCQA","CMS Adult Core Set 2019","https://www.medicaid.gov/medicaid/quality-of-care/performance-measurement/adult-and-child-health-care-quality-measures/adult-core-set-reporting-resources/index.html","Percentage of patients ages 18 to 75 with diabetes (type 1 and type 2) who had a hemoglobin A1c (HbA1c) test.","General Practice, Family Practice, Internal Medicine, Geriatric Medicine, Preventive Medicine, Nephrology, Endocrinology, Nutrition/Dietician","Family Medicine; Internal Medicine; Preventive Medicine; Dietician, Registered","Endocrinology; Nephrology ","Individuals","Ages 18 to 75 as of December 31 of the measurement year.",{"$cut":{"chars":31097,"head":"Diabetes Value Set: \n[E10.10] Type 1 diabetes mellitus with ketoacidosis without coma\n[E10.11] Type 1 diabetes mellitus with ketoacidosis with coma\n[E10.21] Type 1 diabetes mellitus with diabetic nephropathy\n[E10.22] Type 1 diabetes mellitus with diabetic chronic kidney disease\n[E10.29] Type 1 diabetes mellitus with other diabetic kidney complication\n[E10.311] Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edema\n[E10.319] Type 1 diabetes mellitus with unspecified diabetic retinopathy without macular edema\n[E10.321] Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema\n[E10.3211] Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye\n[E10.3212] Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye\n[E10.3213] Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral\n[E10.3219] Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye\n[E10.329] Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema\n[E10.3291] Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye\n[E10.3292] Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye\n[E10.3293] Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral\n[E10.3299] Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye\n[E10.331] Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema\n[E10.3311] Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye\n[E10.3312] Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye\n[E10.3313] Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral\n[E10.3319] Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye\n[E10.339] Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema\n[E10.3391] Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye\n[E10.3392] Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye\n[E10.3393] Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral\n[E10.3399] Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye\n[E10.341] Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema\n[E10.3411] Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye\n[E10.3412] Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye\n[E10.3413] Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral\n[E10.3419] Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye\n[E10.349] Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema\n[E10.3491] Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye\n[E10.3492] Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye\n[E10.3493] Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral\n[E10.3499] Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye\n[E10.351] Type 1 diabetes mellitus with proliferative diabetic retinopath"}},{"$cut":{"chars":24867,"head":"Exclusions: Patients who do not have a diagnosis of diabetes (Diabetes Value Set), in any setting, during the measurement year or year prior to the measurement year and who had a diagnosis of gestational diabetes or steroid-induced diabetes (Diabetes Exclusions Value Set), in any setting, during the measurement year or the year prior to the measurement year. If the patient was included in this measure based on claim or encounter data, as described in the event/diagnosis criteria, the optional exclusions do not apply because the patient had a diagnosis of diabetes\n\nDiabetes Exclusions Value Set:\n[E08.00] Diabetes mellitus due to underlying condition with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC)\n[E08.01] Diabetes mellitus due to underlying condition with hyperosmolarity with coma\n[E08.10] Diabetes mellitus due to underlying condition with ketoacidosis without coma\n[E08.11] Diabetes mellitus due to underlying condition with ketoacidosis with coma\n[E08.21] Diabetes mellitus due to underlying condition with diabetic nephropathy\n[E08.22] Diabetes mellitus due to underlying condition with diabetic chronic kidney disease\n[E08.29] Diabetes mellitus due to underlying condition with other diabetic kidney complication\n[E08.311] Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema\n[E08.319] Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy without macular edema\n[E08.321] Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema\n[E08.3211] Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, right eye\n[E08.3212] Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, left eye\n[E08.3213] Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, bilateral\n[E08.3219] Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye\n[E08.329] Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema\n[E08.3291] Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, right eye\n[E08.3292] Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, left eye\n[E08.3293] Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, bilateral\n[E08.3299] Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye\n[E08.331] Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema\n[E08.3311] Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, right eye\n[E08.3312] Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, left eye\n[E08.3313] Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, bilateral\n[E08.3319] Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye\n[E08.339] Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema\n[E08.3391] Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, right eye\n[E08.3392] Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, left eye\n[E08.3393] Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, bilateral\n[E08.3399] Di"}},"An HbA1c test (HbA1c Tests Value Set) performed during the measurement year, as identified by claim/encounter or automated laboratory data. ","HbA1c Test Value Set: \n\nCPT: \n83036\n83037 \n\nLOINC: \n17856-6 Hemoglobin A1c/Hemoglobin.total in Blood by HPLC\n4548-4 Hemoglobin A1c/Hemoglobin.total in Blood\n4549-2 Hemoglobin A1c/Hemoglobin.total in Blood by Electrophoresis \n\nSNOMED CT US Edition:\n43396009 Hemoglobin A1c measurement (procedure) \n313835008 Hemoglobin A1c measurement aligned to the Diabetes Control and Complications Trial (procedure) \n",null,"For TIPPS reporting purposes, the word \"beneficiary\" has been replaced with \"patient.\" ","Value sets adapted from Medicaid Adult Core Set 2020 Adult HEDIS codes ","C1-113",null,"CMS Medicaid Adult Core Set; NQF CQMC Consensus Core Set: ACO/PCMH/Primary Care"]
["T2-117","T2-115",null,"TIPPS","T2 - P4P","Preventive Care and Screening: Influenza Immunization","Process","Y","01/01/21 - 06/30/21","Data Reporting & Status Update","Lump sum payment in November or December 2021","N",null,null,null,"Y","01/01/21 - 12/31/21","Data Reporting & Status Update","Lump sum payment in May or June 2022","N",null,null,null,"Medicaid","Medicaid, Uninsured, Other","IOS","NA",null,"NA","Physician Practice Group","0041","AMA-PCPI","eCQM - CMS147v10","https://ecqi.healthit.gov/ecqm/ep/2021/cms147v10","Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization","General Practice, Family Practice, Internal Medicine, Obstetrics/Gynecology, Pediatric Medicine, Geriatric Medicine, Preventive Medicine, Otolaryngology,  Allergy/Immunology, Oncology, Rheumatology, Nephrology, Infectious Disease","Allergy & Immunology; Family Medicine; Internal Medicine; Obstetrics & Gynecology; Otolaryngology; Pediatrics; Preventive Medicine","Geriatrics; Infectious Disease; Nephrology; Oncology; Rheumatology","Individuals","All patients aged 6 months and older seen for a visit during the measurement period, and seen for a visit between October 1 and March 31","\"Initial Population\"\n  and ( exists \"Encounter During Influenza Season\"\n      or exists \"Hemodialysis During Influenza Season\"\n      or exists \"Peritoneal Dialysis During Influenza Season\")\n\n[\"Encounter, Performed\": \"Encounter-Influenza\"] FluEncounter\n  where FluEncounter.relevantPeriod starts during \"Influenza Season\"\n\n[\"Procedure, Performed\": \"Hemodialysis\"] FluSeasonHemodialysis\n  where FluSeasonHemodialysis.relevantPeriod overlaps \"Influenza Season\"\n\n[\"Procedure, Performed\": \"Peritoneal Dialysis\"] PeritonealDialysis\n  where PeritonealDialysis.relevantPeriod overlaps \"Measurement Period\"","Documentation of medical reason(s) for not receiving influenza immunization (e.g., patient allergy, other medical reasons).\nDocumentation of patient reason(s) for not receiving influenza immunization (e.g., patient declined, other patient reasons).\nDocumentation of system reason(s) for not receiving influenza immunization (e.g., vaccine not available, other system reasons).\n\nDenominator Exceptions\nexists \"Medical Patient or System Reason for Not Performing Influenza Vaccination\"\n  or exists \"Medical Patient or System Reason for Not Administering Influenza Vaccine\"\n  or exists \"Diagnosis of Allergy to Egg\"\n  or exists \"Egg Substance Allergy\"\n  or exists \"Diagnosis of Allergy to Influenza Vaccine\"\n  or exists \"Diagnosis of Intolerance to Influenza Vaccine\"\n  or exists \"Intolerance of Influenza Vaccination Procedure\"\n  or exists \"Allergy or Intolerance to Influenza Vaccine\n\n[\"Procedure, Not Performed\": \"Influenza Vaccination\"] NoFluVaccination\n  where NoFluVaccination.authorDatetime during \"Influenza Season Including August and September of the Prior Year\"\n    and ( NoFluVaccination.negationRationale in \"Medical Reason\"\n        or NoFluVaccination.negationRationale in \"Patient Reason\"\n        or NoFluVaccination.negationRationale in \"System Reason\"\n        or NoFluVaccination.negationRationale in \"Influenza Vaccination Declined\")\n\nor [\"Immunization, Not Administered\": \"Influenza Vaccine\"] NoFluVaccine\n  where NoFluVaccine.authorDatetime during \"Influenza Season Including August and September of the Prior Year\"\n    and ( NoFluVaccine.negationRationale in \"Medical Reason\"\n        or NoFluVaccine.negationRationale in \"Patient Reason\"\n        or NoFluVaccine.negationRationale in \"System Reason\"\n        or NoFluVaccine.negationRationale in \"Influenza Vaccination Declined\") \n\nor [\"Diagnosis\": \"Allergy to Eggs\"] EggAllergy\n  where EggAllergy.prevalencePeriod overlaps after \"Influenza Season\"\n\nor [\"Allergy/Intolerance\": \"Egg Substance\"] AllergyEggSubstance\n  where AllergyEggSubstance.prevalencePeriod overlaps after \"Influenza Season\"\n\nor [\"Diagnosis\": \"Allergy to Influenza Vaccine\"] FluVaccineAllergyDiagnosis\n  where FluVaccineAllergyDiagnosis.prevalencePeriod overlaps after \"Influenza Season\"\n\nor [\"Diagnosis\": \"Intolerance to Influenza Vaccine\"] FluVaccineIntoleranceDiagnosis\n  where FluVaccineIntoleranceDiagnosis.prevalencePeriod overlaps after \"Influenza Season\"\n\nor [\"Allergy/Intolerance\": \"Influenza Vaccination\"] FluVaccinationIntolerance\n  where FluVaccinationIntolerance.prevalencePeriod overlaps after \"Influenza Season\"\n\nor [\"Allergy/Intolerance\": \"Influenza Vaccine\"] FluVaccineAllergyIntolerance\n  where FluVaccineAllergyIntolerance.prevalencePeriod overlaps after \"Influenza Season\"","Patients who received an influenza immunization OR who reported previous receipt of an influenza immunization","exists \"Influenza Vaccination Procedure\"\n  or exists \"Influenza Immunization Administered\"\n  or exists \"Influenza Vaccine Previously Received\"\n\n[\"Procedure, Performed\": \"Influenza Vaccination\"] FluVaccination\n  where FluVaccination.relevantDatetime during \"Influenza Season Including August and September of the Prior Year\"\n\nor [\"Immunization, Administered\": \"Influenza Vaccine\"] AdministeredFluVaccine\n  where AdministeredFluVaccine.relevantDatetime during \"Influenza Season Including August and September of the Prior Year\"\n\nor [\"Assessment, Performed\": \"Previous Receipt of Influenza Vaccine\"] PreviousReceiptFluVaccine\n  where PreviousReceiptFluVaccine.relevantDatetime during \"Influenza Season Including August and September of the Prior Year\"","None","For TIPPS reporting purposes, report denominator encounters that fall within the measurement period. For example, for CY2021, the denominator would include encounters from January - March 2021 and October - December 2021.","Definitions: \nPrevious Receipt - receipt of the current season's influenza immunization from another provider OR from same provider prior to the visit to which the measure is applied (typically, prior vaccination would include influenza vaccine given since August 1st)\n\n\nGuidance:\n\t\nThe timeframe for the visit during the \"Encounter, Performed\": \"Encounter-Influenza\" or \"Procedure, Performed\": \"Peritoneal Dialysis\" or \"Procedure, Performed\": \"Hemodialysis\" in the Population Criteria-Denominator, refers to the influenza season defined by the measure: October through March (October 1 for the year prior to the start of the reporting period through March 31 during the reporting period). The \"Encounter-Influenza\" Grouping OID detailed in the data criteria section below is comprised of several individual OIDs of different encounter types. The individual OIDs are included in the value set and should be reviewed to determine that an applicable visit occurred during the timeframe for \"Encounter, Performed\": \"Encounter-Influenza\" as specified in the denominator.\n\nTo enable reporting of this measure at the close of the reporting period, this measure will only assess the influenza season that ends in March of the reporting period. The subsequent influenza season (ending March of the following year) will be measured and reported in the following year.\n\nDue to the changing stance of the CDC/ACIP recommendations regarding the live attenuated influenza vaccine (LAIV) for a particular flu season, this measure will not include the administration of this specific formulation of the flu vaccination. Given the variance of the timeframes for the annual update cycles, program implementation, and publication of revised recommendations from the CDC/ACIP, it has been determined that the coding for this measure will specifically exclude this formulation, so as not to inappropriately include this form of the vaccine for flu seasons when CDC/ACIP explicitly advise against it. However, it is recommended that all eligible professionals or eligible clinicians to review the guidelines for each flu season to determine appropriateness of the LAIV and other formulations of the flu vaccine. Should the LAIV be recommended for administration for a particular flu season, eligible professional or clinician may consider one of the following options: 1) satisfy the numerator by reporting either previous receipt or using the CVX 88 for unspecified formulation, 2) report a denominator exception, either as a patient reason (e.g., for patient preference) or a system reason (e.g., the institution only carries LAIV).\n\nThis eCQM is a patient-based measure.\n\nThis version of the eCQM uses QDM version 5.5.  Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.","C1-269","Yes","CMS Medicaid Adult Core Set"]
["T2-118","T2-116",null,"TIPPS","T2 - P4P","Tobacco Use and Help with Quitting Among Adolescents","Process","Y","01/01/21 - 06/30/21","Data Reporting & Status Update","Lump sum payment in November or December 2021","N",null,null,null,"Y","01/01/21 - 12/31/21","Data Reporting & Status Update","Lump sum payment in May or June 2022","N",null,null,null,"Medicaid","Medicaid, Uninsured, Other","IOS","NA",null,"NA","Physician Practice Group","2803","NCQA","CMS MIPS #402 2020","https://qpp-cm-prod-content.s3.amazonaws.com/uploads/786/2020+CQM+Specifications+and+Supporting+Docs.zip","The percentage of adolescents 12 to 20 years of age with a primary care visit during the measurement year for whom tobacco use status was documented and received help with quitting if identified as a tobacco user","General Practice, Family Practice, Internal Medicine, Obstetrics/Gynecology, Pediatric Medicine, Pyschiatry, Mental/Behavioral Health, Allergy/Immunology, Cardiology, Gastro-enterology, Dermatology, Orthopedic Surgery, Otolaryngology, Physical Medicine, Preventive Medicine, Neurology, Vascular Surgery, General Surgery, Thoracic Surgery, Oncology, Rheumatology, Urgent Care, Clinical Social Work","Allergy & Immunology;  Dermatology; Family Medicine; Internal Medicine; Obstetrics & Gynecology; Orthopaedic Surgery; Otolaryngology; Pediatrics; Physicial Medicine & Rehabilitation; Preventive Medicine; Psychiatry & Neurology;   Surgery; Thoracic Surgery; Social Worker; Urgent Care","Cardiology; Gastroenterology; Oncology; Rheumatology;  Vascular Sugery ","Individuals","All patients aged 12-20 years with a visit during the measurement period","Patients aged 12-20 years on date of encounter\n\nAND\n\nPatient encounter during the performance period (CPT or HCPCS): 90791, 90792, 90832, 90834, 90837, 90839, 90845, 92002, 92004, 92012, 92014, 96156, 96158, 97165, 97166, 97167, 97168, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99406, 99407, G0438, G0439, 99383, 99384, 99385, 99393, 99394, 99395",null,"Patients who were screened for tobacco use at least once within 18 months (during the measurement period or the six months prior to the measurement period) AND who received tobacco cessation counseling intervention if identified as a tobacco user","Patient documented as tobacco user AND received tobacco cessation intervention (must include at least one of the following: advice given to quit smoking or tobacco use, counseling on the benefits of quitting smoking or tobacco use, assistance with or referral to external smoking or tobacco cessation support programs, or current enrollment in smoking or tobacco use cessation program) if identified as a tobacco user (G9458)\n\nOR\n\nCurrently a tobacco non-user (G9459)","Tobacco assessment OR tobacco cessation intervention not performed, reason not given (G9460)","Providers should include Texas Health Steps medical checkup codes 99383, 99384, 99385, 99393, 99394, 99395. ",null,"D1-400","Yes","MIPS"]
["T2-119","T2-117",null,"TIPPS","T2 - P4P","Chlamydia Screening in Women","Process","Y","01/01/21 - 06/30/21","Data Reporting & Status Update","Lump sum payment in November or December 2021","N",null,null,null,"Y","01/01/21 - 12/31/21","P4P - Benchmark & Status Update","Lump sum payment in May or June 2022","N",null,null,null,"Medicaid","Medicaid, Uninsured, Other","Benchmark","NCQA Quality Compas HEDIS 2020 (2019)","NA",58.06,"Physician Practice Group","0033","NCQA","eCQM - CMS153v9","https://ecqi.healthit.gov/ecqm/ep/2021/cms153v9","Percentage of women 16-24 years of age who were identified as sexually active and who had at least one test for chlamydia during the measurement period","General Practice, Family Practice, Internal Medicine, Obstetrics/Gynecology, Pediatric Medicine, Preventive Medicine","Family Medicine; Obstetrics & Gynecology; Pediatrics",null,"Individuals","Women 16 to 24 years of age who are sexually active and who had a visit in the measurement period","\"Initial Population\"\n\nexists ( [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n    where Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) in Interval[16, 24))\n  and exists ( [\"Patient Characteristic Sex\": \"Female\"] )\n  and exists ( \"Qualifying Encounters\" )\n  and ( exists ( \"Assessments Identifying Sexual Activity\" )\n      or exists ( \"Diagnoses Identifying Sexual Activity\" )\n      or exists ( \"Active Contraceptive Medications\" )\n      or exists ( \"Ordered Contraceptive Medications\" )\n      or exists ( \"Laboratory Tests Identifying Sexual Activity\" )\n      or exists ( \"Diagnostic Studies Identifying Sexual Activity\" )\n      or exists ( \"Procedures Identifying Sexual Activity\" ))\n\nand ( [\"Encounter, Performed\": \"Office Visit\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services - Established Office Visit, 18 and Up\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services-Initial Office Visit, 18 and Up\"]\n  union [\"Encounter, Performed\": \"Preventive Care- Initial Office Visit, 0 to 17\"]\n  union [\"Encounter, Performed\": \"Preventive Care - Established Office Visit, 0 to 17\"]\n  union [\"Encounter, Performed\": \"Home Healthcare Services\"] ) ValidEncounter\n  where ValidEncounter.relevantPeriod during \"Measurement Period\"\n\nand ( [\"Assessment, Performed\": \"Sexually Active\"] SexualActivityAssessment\n    where SexualActivityAssessment.result ~ \"Yes (qualifier value)\"\n      and SexualActivityAssessment.relevantDatetime before \n      end of \"Measurement Period\")\n\nor ( ( [\"Diagnosis\": \"Other Female Reproductive Conditions\"]\n    union [\"Diagnosis\": \"Genital Herpes\"]\n    union [\"Diagnosis\": \"Gonococcal Infections and Venereal Diseases\"]\n    union [\"Diagnosis\": \"Inflammatory Diseases of Female Reproductive Organs\"]\n    union [\"Diagnosis\": \"Chlamydia\"]\n    union [\"Diagnosis\": \"HIV\"]\n    union [\"Diagnosis\": \"Syphilis\"]\n    union [\"Diagnosis\": \"Carrier of Predominantly Sexually Transmitted Infection\"]\n    union [\"Diagnosis\": \"Complications of Pregnancy, Childbirth and the Puerperium\"] ) SexualActivityDiagnosis\n    where SexualActivityDiagnosis.prevalencePeriod overlaps \"Measurement Period\")\n\nor [\"Medication, Active\": \"Contraceptive Medications\"] ActiveContraceptives\n  where ActiveContraceptives.relevantPeriod overlaps \"Measurement Period\"\n\nor [\"Medication, Order\": \"Contraceptive Medications\"] OrderedContraceptives\n  where OrderedContraceptives.authorDatetime during \"Measurement Period\"\n\nor ( [\"Laboratory Test, Order\": \"Pap Test\"]\n  union [\"Laboratory Test, Order\": \"Lab Tests During Pregnancy\"]\n  union [\"Laboratory Test, Order\": \"Lab Tests for Sexually Transmitted Infections\"] ) LabOrders\n  where LabOrders.authorDatetime during \"Measurement Period\"\n\nor [\"Diagnostic Study, Order\": \"Diagnostic Studies During Pregnancy\"] SexualActivityDiagnostics\n  where SexualActivityDiagnostics.authorDatetime during \"Measurement Period\"\n\nor ( [\"Procedure, Performed\": \"Delivery Live Births\"]\n  union [\"Procedure, Performed\": \"Procedures During Pregnancy\"]\n  union [\"Procedure, Performed\": \"Procedures Involving Contraceptive Devices\"] ) ProceduresForSexualActivity\n  where ProceduresForSexualActivity.relevantDatetime during \"Measurement Period\"","Exclusions: \nWomen who are only eligible for the initial population due to a pregnancy test and who had an x-ray or an order for a specified medication within 7 days of the pregnancy test.\nExclude patients whose hospice care overlaps the measurement period.\n\nHospice. \"Has Hospice\"\n  or ( exists ( \"Pregnancy Test Exclusion\" )\n      and not exists ( \"Diagnoses Identifying Sexual Activity\" )\n      and not exists ( \"Active Contraceptive Medications\" )\n      and not exists ( \"Laboratory Tests Identifying Sexual Activity But Not Pregnancy\" )\n      and not exists ( \"Procedures Identifying Sexual Activity\" )\n      and not exists ( \"Assessments Identifying Sexual Activity\" )\n      and not exists ( \"Ordered Contraceptive Medications\" )\n      and not exists ( \"Diagnostic Studies Identifying Sexual Activity\" ))\n\nexists ( [\"Encounter, Performed\": \"Encounter Inpatient\"] DischargeHospice\n    where ( DischargeHospice.dischargeDisposition ~ \"Discharge to home for hospice care (procedure)\"\n        or DischargeHospice.dischargeDisposition ~ \"Discharge to healthcare facility for hospice care (procedure)\")\n      and DischargeHospice.relevantPeriod ends during \"Measurement Period\")\n  or exists ( [\"Intervention, Order\": \"Hospice care ambulatory\"] HospiceOrder\n      where HospiceOrder.authorDatetime during \"Measurement Period\")\n  or exists ( [\"Intervention, Performed\": \"Hospice care ambulatory\"] HospicePerformed\n      where HospicePerformed.relevantPeriod overlaps \"Measurement Period\")\n\nor ( [\"Laboratory Test, Order\": \"Pregnancy Test\"] PregnancyTest\n    with [\"Diagnostic Study, Order\": \"X-Ray Study (all inclusive)\"] XrayOrder\n      such that XrayOrder.authorDatetime occurs 7 days or less on or after day of PregnancyTest.authorDatetime\n    where PregnancyTest.authorDatetime during \"Measurement Period\")\n  union ( [\"Laboratory Test, Order\": \"Pregnancy Test\"] PregnancyTestOrder\n      with [\"Medication, Order\": \"Isotretinoin\"] AccutaneOrder\n        such that AccutaneOrder.authorDatetime occurs 7 days or less on or after day of PregnancyTestOrder.authorDatetime\n      where PregnancyTestOrder.authorDatetime during \"Measurement Period\")\n\nand not ( ( [\"Diagnosis\": \"Other Female Reproductive Conditions\"]\n    union [\"Diagnosis\": \"Genital Herpes\"]\n    union [\"Diagnosis\": \"Gonococcal Infections and Venereal Diseases\"]\n    union [\"Diagnosis\": \"Inflammatory Diseases of Female Reproductive Organs\"]\n    union [\"Diagnosis\": \"Chlamydia\"]\n    union [\"Diagnosis\": \"HIV\"]\n    union [\"Diagnosis\": \"Syphilis\"]\n    union [\"Diagnosis\": \"Carrier of Predominantly Sexually Transmitted Infection\"]\n    union [\"Diagnosis\": \"Complications of Pregnancy, Childbirth and the Puerperium\"] ) SexualActivityDiagnosis\n    where SexualActivityDiagnosis.prevalencePeriod overlaps \"Measurement Period\")\n\nand not [\"Medication, Active\": \"Contraceptive Medications\"] ActiveContraceptives\n  where ActiveContraceptives.relevantPeriod overlaps \"Measurement Period\"\n\nand not ( [\"Laboratory Test, Order\": \"Pap Test\"]\n  union [\"Laboratory Test, Order\": \"Lab Tests During Pregnancy\"]\n  union [\"Laboratory Test, Order\": \"Lab Tests for Sexually Transmitted Infections\"] ) LabOrders\n  where LabOrders.authorDatetime during \"Measurement Period\"\n\nand not ( [\"Procedure, Performed\": \"Delivery Live Births\"]\n  union [\"Procedure, Performed\": \"Procedures During Pregnancy\"]\n  union [\"Procedure, Performed\": \"Procedures Involving Contraceptive Devices\"] ) ProceduresForSexualActivity\n  where ProceduresForSexualActivity.relevantDatetime during \"Measurement Period\"\n\nand not ( [\"Assessment, Performed\": \"Sexually Active\"] SexualActivityAssessment\n    where SexualActivityAssessment.result ~ \"Yes (qualifier value)\"\n      and SexualActivityAssessment.relevantDatetime before \n      end of \"Measurement Period\")\n\nand not [\"Medication, Order\": \"Contraceptive Medications\"] OrderedContraceptives\n  where OrderedContraceptives.authorDatetime during \"Measurement Period\"\n\nand not [\"Diagnostic Study, Order\": \"Diagnostic Studies During Pregnancy\"] SexualActivityDiagnostics\n  where SexualActivityDiagnostics.authorDatetime during \"Measurement Period\"","Women with at least one chlamydia test during the measurement period","exists ( [\"Laboratory Test, Performed\": \"Chlamydia Screening\"] ChlamydiaTest\n    where ChlamydiaTest.result is not null\n      and ChlamydiaTest.relevantDatetime during \"Measurement Period\")","None",null,"Guidance: \n\nCodes to identify sexually active women include codes for: pregnancy, sexually transmitted infections, contraceptives or contraceptive devices, and infertility treatments.\n\nThe denominator exclusion does not apply to patients who qualify for the initial population (IP) based on services other than the pregnancy test alone. These other services include services for sexually transmitted infections, contraceptives or contraceptive devices and infertility treatments. For example, a patient who has both a pregnancy test and a chlamydia diagnosis, either of which would qualify them for the IP, would not be eligible for this denominator exclusion.\n\nPatient self-report for procedures as well as diagnostic studies should be recorded in 'Procedure, Performed' template or 'Diagnostic Study, Performed' template in QRDA-1. Patient self-report is not allowed for laboratory tests.\n\nThis eCQM is a patient-based measure.\n\nThis version of the eCQM uses QDM version 5.5.  Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.","C1-280",null,"CMS Medicaid Child Core Set;  NQF CQMC Consensus Core Set: Obstetrics and Gynecology; NQF CQMC Consensus Core Set: Pediatrics"]
["T2-120","T2-118",null,"TIPPS","T2 - P4P","Controlling High Blood Pressure","Outcome","Y","01/01/21 - 06/30/21","Data Reporting & Status Update","Lump sum payment in November or December 2021","N",null,null,null,"Y","01/01/21 - 12/31/21","P4P - Benchmark & Status Update","Lump sum payment in May or June 2022","N",null,null,null,"Medicaid","Medicaid, Uninsured, Other","Benchmark","NCQA Quality Compas HEDIS 2020 (2019)","NA",61.8,"Physician Practice Group","0018","NCQA","eCQM - CMS165v9","https://ecqi.healthit.gov/ecqm/ep/2021/cms165v9","Percentage of patients 18-85 years of age who had a diagnosis of hypertension overlapping the measurement period or the year prior to the measurement period, and whose most recent blood pressure was adequately controlled (<140/90mmHg) during the measurement period","General Practice, Family Practice, Internal Medicine, Obstetrics/Gynecology, Geriatric Medicine, Cardiology, Vascular Surgery, Rheumatology, Endocrinology, Pulmonology","Family Medicine; Internal Medicine; Obstetrics & Gynecology; Surgery","Cardiology; Endocrinology; Pulmonology; Rheumatology; Vascular Surgery","Individuals","Patients 18-85 years of age who had a visit and diagnosis of essential hypertension overlapping the measurement period or the year prior to the measurement period","\"Initial Population\"\n\nexists [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n  where Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) in Interval[18, 85 )\n    and exists \"Essential Hypertension Diagnosis\"\n    and exists AdultOutpatientEncounters.\"Qualifying Encounters\"\n\n[\"Diagnosis\": \"Essential Hypertension\"] Hypertension\n  where Hypertension.prevalencePeriod overlaps Interval[start of \"Measurement Period\" - 1 year, \n  end of \"Measurement Period\"]\n\nand ( [\"Encounter, Performed\": \"Office Visit\"]\n union [\"Encounter, Performed\": \"Annual Wellness Visit\"]\n union [\"Encounter, Performed\": \"Preventive Care Services - Established Office Visit, 18 and Up\"]\n union [\"Encounter, Performed\": \"Preventive Care Services-Initial Office Visit, 18 and Up\"]\n union [\"Encounter, Performed\": \"Home Healthcare Services\"] ) ValidEncounter\n where ValidEncounter.relevantPeriod during \"Measurement Period\"","Patients with evidence of end stage renal disease (ESRD), dialysis or renal transplant before or during the measurement period. Also exclude patients with a diagnosis of pregnancy during the measurement period.\nExclude patients whose hospice care overlaps the measurement period.\nExclude patients 66 and older who are living long term in an institution for more than 90 consecutive days during the measurement period.\nExclude patients 66 and older with advanced illness and frailty because it is unlikely that patients will benefit from the services being measured.\n\nHospice. \"Has Hospice\"\n  or exists ( \"Pregnancy Or Renal Diagnosis Exclusions\" )\n  or ( exists ( \"End Stage Renal Disease Procedures\" )\n      or exists ( \"End Stage Renal Disease Encounter\" ))\n  or ( exists ( [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n        where Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) >= 65)\n      and ( FrailtyLTI.\"Long Term Care Periods Longer Than 90 Consecutive Days\" ))\n  or FrailtyLTI.\"Advanced Illness and Frailty Exclusion Including Over Age 80\"\n\nexists ( [\"Encounter, Performed\": \"Encounter Inpatient\"] DischargeHospice\n    where ( DischargeHospice.dischargeDisposition ~ \"Discharge to home for hospice care (procedure)\"\n        or DischargeHospice.dischargeDisposition ~ \"Discharge to healthcare facility for hospice care (procedure)\")\n      and DischargeHospice.relevantPeriod ends during \"Measurement Period\")\n  or exists ( [\"Intervention, Order\": \"Hospice care ambulatory\"] HospiceOrder\n      where HospiceOrder.authorDatetime during \"Measurement Period\")\n  or exists ( [\"Intervention, Performed\": \"Hospice care ambulatory\"] HospicePerformed\n      where HospicePerformed.relevantPeriod overlaps \"Measurement Period\")\n\nor ( [\"Diagnosis\": \"Pregnancy\"]\n  union [\"Diagnosis\": \"End Stage Renal Disease\"]\n  union [\"Diagnosis\": \"Kidney Transplant Recipient\"]\n  union [\"Diagnosis\": \"Chronic Kidney Disease, Stage 5\"] ) PregnancyESRDDiagnosis\n  where PregnancyESRDDiagnosis.prevalencePeriod overlaps \"Measurement Period\"\n\nor ( [\"Procedure, Performed\": \"Vascular Access for Dialysis\"]\n  union [\"Procedure, Performed\": \"Kidney Transplant\"]\n  union [\"Procedure, Performed\": \"Dialysis Services\"] ) ESRDProcedure\n  where ESRDProcedure.relevantPeriod starts before \n  end of \"Measurement Period\"\n\nor [\"Encounter, Performed\": \"ESRD Monthly Outpatient Services\"] ESRDEncounter\n  where ESRDEncounter.relevantPeriod starts before \n  end of \"Measurement Period\"\n\nand exists ( \"Long Term Care Periods During Measurement Period\" LongTermCareDuringMP\n    where duration in days of LongTermCareDuringMP > 90)\n\nor //If the measure includes populations age 80 and older, then use this logic:\nexists ( [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n  where ( Global.\"CalendarAgeInYearsAt\"(BirthDate.birthDatetime, start of \"Measurement Period\")in Interval[66, 80])\n   and \"Has Criteria Indicating Frailty\"\n   and ( Count(\"Outpatient Encounters with Advanced Illness\")>= 2\n     or exists ( \"Inpatient Encounter with Advanced Illness\" )\n     or exists \"Dementia Medications In Year Before or During Measurement Period\"))\n or exists ( [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n   where ( Global.\"CalendarAgeInYearsAt\"(BirthDate.birthDatetime, start of \"Measurement Period\")>= 81 )\n    and \"Has Criteria Indicating Frailty\")","Patients whose most recent blood pressure is adequately controlled (systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg) during the measurement period","\"Has Diastolic Blood Pressure Less Than 90\"\n  and \"Has Systolic Blood Pressure Less Than 140\"\n\n\"Lowest Diastolic Reading on Most Recent Blood Pressure Day\".result < 90 'mm[Hg]'\n \nand \"Lowest Systolic Reading on Most Recent Blood Pressure Day\".result < 140 'mm[Hg]'","None",null,"Guidance:\n\nIn reference to the numerator element, only blood pressure readings performed by a clinician or a remote monitoring device are acceptable for numerator compliance with this measure. \n\nDo not include BP readings:\n-Taken during an acute inpatient stay or an ED visit\n-Taken on the same day as a diagnostic test or diagnostic or therapeutic procedure that requires a change in diet or change in medication on or one day before the day of the test or procedure, with the exception of fasting blood tests.\n-Reported by or taken by the member\n\nIf no blood pressure is recorded during the measurement period, the patient's blood pressure is assumed \"not controlled.\"\n\nIf there are multiple blood pressure readings on the same day, use the lowest systolic and the lowest diastolic reading as the most recent blood pressure reading.\n\nThis eCQM is a patient-based measure.\n\nThis version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.","A2-103","Yes","Medicaid MCO P4Q; CMS Medicaid Adult Core Set; MIPS; Medicare ACOs; Medicare Million Hearts; NQF CQMC Consensus Core Set: ACO/PCMH/Primary Care"]
["T3-121","T3-119",null,"TIPPS","T3 - P4P","Food Insecurity Screening","Process","Y","NA","Status Update","Percentage increase paid on actual utilization of 9 CPT codes, Nov 21 - April 2022. Presumptive eligibilty Sep-Oct 21.","N",null,null,null,"Y","01/01/2022 - 02/28/2022","Data Reporting & Status Update","Percentage increase paid on actual utilization of 9 CPT codes, May-Oct 2022","N",null,null,null,"Medicaid","Medicaid, Uninsured, Other","IOS","NA","NA","NA","Physician Practice Group","NA","Texas HHSC","Texas HHSC","NA","Percentage of patients who were screened for food insecurity using the Hunger Vital Sign (HVS) 2 questions with the screening results documented during the current encounter or during the previous twelve months.","General Practice, Family Practice, Internal Medicine, Obstetrics/Gynecology, Pediatric Medicine, Geriatric Medicine, Preventive Medicine","Family Medicine, Internal Medicine, Obstetrics & Gynecology, Pediatrics",null,"Individuals","All attributed patients with an eligible encounter during the measurement period","All attributed patients with an eligible encounter during the measurement period. There are not any age restrictions for denominator inclusion for this measure.","Patient refused to participate","Patients screened for food insecurity using the Hunger Vital Sign (HVS) 2 questions with the screening results documented during the current encounter or during the previous twelve months.\n\nThere are not any age restrictions for numerator inclusion for this measure. Parents, guardians, and caregivers screened using the HVS 2 questions on behalf of the patient's household may be included in the numerator.","The Hunger Vital Sign™ (HVS) is a validated 2-question food insecurity screening tool based on the U.S. Household Food Security Survey Module to identify households at risk of food insecurity if they answer that either or both of the following two statements is ‘Often True’ or ‘Sometimes True’ (vs. ‘Never True’).\n• “Within the past 12 months we worried whether our food would run out before we got money to buy more.” \n• “Within the past 12 months the food we bought just didn’t last and we didn’t have money to get more.” \n\nPatients (including parents, guardians, and caregivers on behalf of the patient's househould) screened for food insecurity using the HVS 2 questions with the screening results documented during the current encounter or during the previous twelve months. \n\nPerformance for this measure is not dependent on a particular result. Performance is met if the documented screening results to both questions are not null (e.g., documented as ‘Often True’, ‘Sometimes True’, or ‘Never True’).","Patients screened for food insecurity using the Hunger Vital Sign (HVS) 2 questions without the screening results documented during the current encounter or during the previous twelve months, and patients screened for food insecurity without using the HVS 2 questions.","None","According to the sponsoring organization for the Hunger Vital Sign™, \"There is no fee or license required to use the Hunger Vital Sign™. We only ask that parties properly cite the tool as follows\":\nHager, E. R., Quigg, A. M., Black, M. M., Coleman, S. M., Heeren, T., Rose-Jacobs, R., Cook, J. T., Ettinger de Cuba, S. E., Casey, P. H., Chilton, M., Cutts, D. B., Meyers A. F., Frank, D. A. (2010). Development and Validity of a 2-Item Screen to Identify Families at Risk for Food Insecurity. Pediatrics, 126(1), 26-32. doi:10.1542/peds.2009-3146.\n\nAdditional translations of the Hunger Vital Sign™ (11 languages total): https://childrenshealthwatch.org/wp-content/uploads/Hunger-Vital-Sign_translations.pdf\n\nAdditional resources and information respective to the Hunger Vital Sign™, including academic publications, toolkits, and other technical assistance: https://childrenshealthwatch.org/public-policy/hunger-vital-sign/","NA","Yes","NA"]
["T3-122","T3-120",null,"TIPPS","T3 - P4P","Maternity Care: Post-Partum Follow-Up and Care Coordination","Process","Y","01/01/21 - 06/30/21","Data Reporting & Status Update","Percentage increase paid on actual utilization of 9 CPT codes, Nov 21 - April 2022. Presumptive eligibilty Sep-Oct 21.","N",null,null,null,"Y","01/01/21 - 12/31/21","Data Reporting & Status Update","Percentage increase paid on actual utilization of 9 CPT codes, May-Oct 2022","N",null,null,null,"Medicaid","Medicaid, Uninsured, Other","IOS","NA","NA","NA","Physician Practice Group","NA","CMS","CMS MIPS #336 2020","https://qpp-cm-prod-content.s3.amazonaws.com/uploads/786/2020+CQM+Specifications+and+Supporting+Docs.zip","Percentage of patients, regardless of age, who gave birth during a 12-month period who were seen for postpartum care within 8 weeks of giving birth and who received a breast-feeding evaluation and education, postpartum depression screening, postpartum glucose screening for gestational diabetes patients, family and contraceptive planning counseling, tobacco use screening and cessation education, healthy lifestyle behavioral advice, and an immunization review and update","Obstetrics/Gynecology","Obstetrics & Gynecology",null,"Encounters","All patients, regardless of age, who gave birth during a 12-month period seen for postpartum care visit before or at 8 weeks of giving birth","All patients, regardless of age\nAND\nPatient procedure during performance period (CPT): 59400, 59410, 59430, 59510, 59515, 59610, 59614, 59618, 59622\nAND\nPostpartum care visit before or at 8 weeks post-delivery",null,"Patients receiving the following at a postpartum visit:\n• Breast-feeding evaluation and education, including patient-reported breast-feeding\n• Postpartum depression screening\n• Postpartum glucose screening for gestational diabetes patients\n• Family and contraceptive planning counseling\n• Tobacco use screening and cessation education\n• Healthy lifestyle behavioral advice\n• Immunization review and update","Postpartum screenings, evaluations, and education performed (G9357)","Postpartum screenings, evaluations and education, not performed (G9358)",null,"Definitions:\nBreast-Feeding Evaluation and Education – Patients who were evaluated for breast-feeding before or at 8 weeks postpartum.\nPostpartum Depression Screening – Patients who were screened for postpartum depression before or at 8 weeks postpartum. Questions may be asked either directly by a health care provider or in the form of self- completed paper- or computer-administered questionnaires, and results should be documented in the medical record. Depression screening should include a self-reported validated depression screening tool (e.g., PHQ-2, Beck Depression Inventory, Beck Depression Inventory for Primary Care, Edinburgh Postnatal Depression Scale (EPDS).\nPostpartum Glucose Screening for Gestational Diabetes – Patients who were diagnosed with gestational diabetes during pregnancy who were screened with a glucose screen before or at 8 weeks postpartum.\nFamily and Contraceptive Planning Counseling – Patients who were provided family and contraceptive planning counseling and education (including contraception, if necessary) before or at 8 weeks postpartum.\nTobacco Use Screening and Cessation Education: Patients who were screened for tobacco use before or at 8 weeks postpartum. Patients who used any type of tobacco who were given brief counseling (3 minutes or less) and/or pharmacotherapy.\nHealthy Lifestyle Behavioral Advice: Clinicians should use discretion to determine which patients they deem appropriate for healthy lifestyle counseling. Clinicians may take into account the number of weeks that have passed since childbirth, whether the mother is breast-feeding, the degree to which the mother’s body mass index (BMI) exceeds the normal range, whether postpartum depression is present, and the mother’s own feelings and perceptions of her body weight. Counseling should include suggestions around healthy eating and staying active.\nIf deemed necessary by the clinician, the conversation about healthy lifestyle choices could include a follow-up plan, including a referral to a specialist such as a registered dietitian nutritionist, primary care provider, or mental health professional for lifestyle/behavioral therapy, pharmacological interventions, dietary supplements, exercise counseling or nutrition counseling.\nImmunization Review and Update: Patients whose immunization records were reviewed and who were provided with indicated immunizations, including completing series initiated antepartum or postpartum, at or before 8 weeks postpartum.","E1-235","Yes","MIPS;  NQF CQMC Consensus Core Set: Obstetrics and Gynecology"]
["T3-123","T3-121",null,"TIPPS","T3 - P4P","Behavioral Health Risk Assessment for Pregnant Women","Process","Y","01/01/21 - 06/30/21","Data Reporting & Status Update","Percentage increase paid on actual utilization of 9 CPT codes, Nov 21 - April 2022. Presumptive eligibilty Sep-Oct 21.","N",null,null,null,"Y","01/01/21 - 12/31/21","Data Reporting & Status Update","Percentage increase paid on actual utilization of 9 CPT codes, May-Oct 2022","N",null,null,null,"Medicaid","Medicaid, Uninsured, Other","IOS","NA","NA","NA","Physician Practice Group","NA","CMS (retired)","Texas HHSC (based on 2017 Medicaid child core set)","NA","Percentage of women, regardless of age, who gave birth during a 12-month period seen at least once for prenatal care who received a behavioral health screening risk assessment that includes the following screenings at the first prenatal visit: depression screening, alcohol use screening, tobacco use screening, drug use screening (illicit and prescription, over the counter), and intimate partner violence screening.","Obstetrics/Gynecology","Obstetrics & Gynecology",null,"Encounters","All patients, regardless of age, who gave birth during a 12-month period seen at least once for prenatal care.","LOGIC: \nENCOUNTER Performed, Prenatal Visit: \"2.16.840.1.113883.3.526.3.1264\"\nAND\n     PROCEDURE Performed Vaginal Delivery: \"2.16.840.1.113883.3.526.3.1341\"\n     Attribute: stop datetime Date of Delivery\n     OR \n     PROCEDURE Performed: Cesarean Section Delivery: \"2.16.840.1.113883.3.526.3.1342\"\n     Attribute: stope datetime Dat of Delivery",null,"Patients who received all behavioral health screening risk assessments at the first prenatal visit.\n","Patients who received the following behavioral health screening risk assessments at the first prenatal visit.\nDepression screening:\n• Patients who were screened for depression at the first visit. Questions may be asked either directly by a health care provider or in the form of self-completed paper- or computer-administered questionnaires and results should be documented in the medical record. Depression screening may include a self-reported validated depression screening tool [e.g., PHQ-2, Beck Depression Inventory, Beck Depression Inventory for Primary Care, Edinburgh Postnatal Depression Scale (EPDS)].\nAlcohol use screening:\n• Patients who were screened for any alcohol use at the first visit \nTobacco use screening:\n• Patients who were screened for tobacco use at the first visit \nDrug use (illicit and prescription, over the counter) screening:\n• Patients who were screened for any drug use at the first visit\nIntimate partner violence screening:\n• Patients who were screened for intimate partner violence/abuse at the first visit. Questions may be asked either directly by a health care provider or in the form of self-completed paper- or computer administered questionnaires and results should be documented in the medical record. Intimate partner violence screening may include a self-reported validated depression screening tool (e.g., Hurt, Insult, Threaten, and Scream [HITS], Woman Abuse Screening Tool [WAST], Partner Violence Screen [PVS], Abuse Assessment Screen [AAS]).\nTo satisfactorily meet the numerator, ALL screening components must be performed.\n@@@\nLOGIC:\nAll Patients Identified within the Denominator\nAND\n     RISK CATEGORY/ASSESSMENT Result; Depression Screening Tools Realted to Maternity Care: \"2.16.840.1.113883.3.526.3.1359\"\n     Attirbute: Result Value Present\n     OR\n     INTERVENTION Result; Depression Screening-Procedure: \"2.16.840.1.113883.3.526.3.1360\"\n     Attribute: Result Value Present\nAND\nRISK CATEGORY/ASSESSMENT Result; Alcohol Use Screening: \"2.16.840.1.113883.3.526.3.1361\"\nAttribute: Result Value Present\nAND\nRISK CATEGORY/ASSESSMENT Result; Tobacco Use Screening: \"2.16.840.1.113883.3.526.3.1362\"\nAttribute: Result Value Present\nAND\nRISK CATEGORY/ASSESSMENT Result; Illicit, Prescription and Over the Counter Drug Use Screening: \"2.16.840.1.113883.3.526.3.1363\"\nAttribute: Result Value Present\nAND\nRISK CATEGORY/ASSESSMENT Result, Intimate Partner Violence Screening-Tool; \"2.16.840.1.113883.3.526.3.1364\"\nAttribute: Result Value Present","NA",null,"• To satisfactorily meet the numerator, all screening components must be performed.\n• The specifications for this measure do not include upper or lower age restrictions.\n• If an eligible woman has more than one birth during the measurement year, states should count each delivery separately in the Denominator (D). To be counted toward the numerator, each delivery must have a BHRA conducted at the first prenatal visit within the specified time frame for each delivery.\n@@@\nAdditional guidance can be found in the Medicaid and Chip Child Core Set Technical Specifications and Resource Manual for Federal Fiscal Year 2017\nhttps://www.medicaid.gov/medicaid/quality-of-care/downloads/medicaid-and-chip-child-core-set-manual.pdf \n@@@\nAllowable Exceptions: \n- Measure is specified for prenatal visits. For TIPPS reporting purposes, providers MAY include settings in addition to OB that may provide care to pregnant women.  \n- Measure is specified so that denominator inclusion is determined by a delivery during the measurement period and a prenatal visit prior to delivery. For TIPPS reporting purposes, providers MAY determine denominator inclusion by a prenatal visit conducted during the measurement period, rather than delivery date within the measurement period. \nProviders should keep record of above exceptions and note them in the qualitative fields when reporting baseline or performance rates. Providers must apply exceptions consistently across all baseline and performance years. ","E1-300","Yes","MIPS"]
["T3-124","T3-122",null,"TIPPS","T3 - P4P","Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Poor Control (>9.0%)","Outcome","Y","01/01/21 - 06/30/21","Data Reporting & Status Update","Percentage increase paid on actual utilization of 9 CPT codes, Nov 21 - April 2022. Presumptive eligibilty Sep-Oct 21.","N",null,null,null,"Y","01/01/21 - 12/31/21","P4P - Benchmark & Status Update","Percentage increase paid on actual utilization of 9 CPT codes, May-Oct 2022","N",null,null,null,"Medicaid","Medicaid, Uninsured, Other","Benchmark","NCQA Quality Compas HEDIS 2020 (2019)",44.77,"NA","Physician Practice Group","0059","NCQA","eCQM - CMS 122v9","https://ecqi.healthit.gov/ecqm/ep/2021/cms122v9","Percentage of patients 18-75 years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period","General Practice, Family Practice, Internal Medicine, Geriatric Medicine, Preventive Medicine, Nephrology, Endocrinology, Nutrition/Dietician","Family Medicine; Internal Medicine; Preventive Medicine; Dietician, Registered","Endocrinology; Nephrology ","Individuals","Patients 18-75 years of age with diabetes with a visit during the measurement period","\"Initial Population\"\n\nexists ( [\"Patient Characteristic Birthdate\"] Birthdate\n\t\twhere Global.\"CalendarAgeInYearsAt\"(Birthdate.birthDatetime, start of \"Measurement Period\")in Interval[18, 75 ))\n\tand exists ( AdultOutpatientEncounters.\"Qualifying Encounters\" )\n\tand exists ( [\"Diagnosis\": \"Diabetes\"] Diabetes\n\t\t\twhere Diabetes.prevalencePeriod overlaps \"Measurement Period\")\n\n( [\"Encounter, Performed\": \"Office Visit\"]\n\tunion [\"Encounter, Performed\": \"Annual Wellness Visit\"]\n\tunion [\"Encounter, Performed\": \"Preventive Care Services - Established Office Visit, 18 and Up\"]\n\tunion [\"Encounter, Performed\": \"Preventive Care Services-Initial Office Visit, 18 and Up\"]\n\tunion [\"Encounter, Performed\": \"Home Healthcare Services\"] ) ValidEncounter\n\twhere ValidEncounter.relevantPeriod during \"Measurement Period\"","Exclude patients whose hospice care overlaps the measurement period.\n\nExclude patients 66 and older who are living long term in an institution for more than 90 consecutive days during the measurement period.\n\nExclude patients 66 and older with advanced illness and frailty because it is unlikely that patients will benefit from the services being measured.\n\nHospice.\"Has Hospice\"\n  or FrailtyLTI.\"Advanced Illness and Frailty Exclusion Not Including Over Age 80\"\n  or ( exists [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n      where ( Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) >= 65 )\n        and FrailtyLTI.\"Long Term Care Periods Longer Than 90 Consecutive Days\")\n \n\nHospice. \"Has Hospice\"\n\nexists ( [\"Encounter, Performed\": \"Encounter Inpatient\"] DischargeHospice\n\t\twhere (DischargeHospice.dischargeDisposition as Code ~ \"Discharge to home for hospice care (procedure)\"\n\t\t\t\tor DischargeHospice.dischargeDisposition as Code ~ \"Discharge to healthcare facility for hospice care (procedure)\")\n\t\t\tand DischargeHospice.relevantPeriod ends during \"Measurement Period\")\n\tor exists ( [\"Intervention, Order\": \"Hospice care ambulatory\"] HospiceOrder\n\t\t\twhere HospiceOrder.authorDatetime during \"Measurement Period\")\n\tor exists ( [\"Intervention, Performed\": \"Hospice care ambulatory\"] HospicePerformed\n\t\t\twhere HospicePerformed.relevantPeriod overlaps \"Measurement Period\")","Patients whose most recent HbA1c level (performed during the measurement period) is >9.0%","\"Has Most Recent Elevated Hba1c\"\n\tor \"Has Most Recent HbA1c Without Result\"\n\tor \"Has No Record Of HbA1c\"\n\nLast([\"Laboratory Test, Performed\": \"HbA1c Laboratory Test\"] HighHbA1c\n\t\twhere HighHbA1c.relevantPeriod during \"Measurement Period\"\n\t\t\tand HighHbA1c.result is not null\n\t\tsort by resultDatetime\n).result > 9 '%'\n \nLast([\"Laboratory Test, Performed\": \"HbA1c Laboratory Test\"] HbA1cNoResult\n\t\twhere HbA1cNoResult.relevantPeriod during \"Measurement Period\"\n\t\tsort by resultDatetime\n).result is null\n \nnot exists [\"Laboratory Test, Performed\": \"HbA1c Laboratory Test\"] NoHbA1c\n\twhere NoHbA1c.relevantPeriod during \"Measurement Period\"","None",null,"Additional definitinos of advanced illness and fraility are available in the measure source: https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS122v9.html#d1e767.\n\nPatient is numerator compliant if most recent HbA1c level >9%, the most recent HbA1c result is missing, or if there are no HbA1c tests performed and results documented during the measurement period. If the HbA1c test result is in the medical record, the test can be used to determine numerator compliance.\n\nOnly patients with a diagnosis of Type 1 or Type 2 diabetes should be included in the denominator of this measure; patients with a diagnosis of secondary diabetes due to another condition should not be included.\n\nThis eCQM is a patient-based measure.\n\nThis version of the eCQM uses QDM version 5.5.  Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.","A1-115","Yes","Medicare Shared Savings Program, MIPS, CMS Medicaid Adult Core Set, Medicare E.H.R. Incentive Program; NQF CQMC Consensus Core Set: ACO/PCMH/Primary Care"]
["T3-125","T2-123",null,"TIPPS","T3 - P4P","Depression Response at Twelve Months","Outcome","Y","01/01/21 - 06/30/21","Data Reporting & Status Update","Percentage increase paid on actual utilization of 9 CPT codes, Nov 21 - April 2022. Presumptive eligibilty Sep-Oct 21.","N",null,null,null,"Y","01/01/21 - 12/31/21","Data Reporting & Status Update","Percentage increase paid on actual utilization of 9 CPT codes, May-Oct 2022","N",null,null,null,"Medicaid","Medicaid, Uninsured, Other","IOS","NA","NA","NA","Physician Practice Group",1885,"MN Community Measurement","MN Community Measurement","https://helpdesk.mncm.org/helpdesk/KB/View/24185684-supplemental-guide--depression-care-measures-specifications-and-calculation ","The percentage of adolescent patients (12 to 17 years of age) and adult patients (18 years of age or older) with Major Depression or Dysthymia who demonstrated a response to treatment 12 months (+/- 60 days) after an index event","General Practice, Family Practice, Internal Medicine, Pediatric Medicine, Psychiatry, Mental/Behavioral Health","Family Medicine; Internal Medicine; Pediatrics; Psychiatry; Social Worker","Geriatrics","Individuals","The eligible population (12 years of age or older at the index event) who had index events during the denominator identification period. ","Denominator Identification Period: Patients indexed in this timeframe comprise the measure denominator.\n\nAn index event occurs when ALL the following criteria are met during an encounter*:\n• a PHQ-9 or PHQ-9M result greater than nine\n• an active diagnosis of Major Depression or Dysthymia (Major Depression or Dysthymia Value Set)\n• the patient is NOT in a prior measure assessment period\n\n* For this measure, an encounter includes but is not limited to any of the following: office visit, psychiatry or psychotherapy visit, telephone, or online encounter. PHQ-9 or PHQ-9M score greater than 9 can be documented on the same date or up to seven days prior to the encounter (index event) and this date occurs during the denominator identification measurement period. This allows for pre-visit planning and administering the PHQ-9 or PHQ-9M just prior to an encounter. \n\nAny member of the health care team can administer a PHQ-9 or PHQ-9M assessment tool to a patient. Additionally, patients can self-administer via patient portal, email, or mail","Required Exclusions - The following exclusions must be applied to the eligible population:\n• Patient had an active diagnosis of Bipolar Disorder (Bipolar Disorder Value Set) any time prior to the end of their measure assessment period\n• Patient had an active diagnosis of Schizophrenia or Psychotic Disorder (Schizophrenia Psychotic Disorder Value Set) any time prior to the end of their measure assessment period\n\nAllowable Exclusions - The following exclusions can be applied to the eligible population:\n• Patient had an active diagnosis of Personality Disorder – Emotionally Labile\n(Personality Disorder - Emotionally Labile Value Set) any time prior to the end of their measure assessment period\n• Patient had an active diagnosis of Pervasive Developmental Disorder (Pervasive Disorder Value Set) any time prior to the end of their measure assessment period\n• Patient was a permanent nursing home resident at any time during the denominator identification period or measure assessment period\n• Patient was in hospice or receiving palliative care at any time during the denominator identification period or measure assessment period\n• Patient died prior to the end of their measure assessment period","The number of patients in the denominator who demonstrated a response to treatment, with a PHQ-9 or PHQ-9M result that is reduced by at least 50 percent since the index PHQ-9/PHQ-9M result, 12 months (+/- 60 days) after an index event.","Measure Assessment Period for Rate Calculation: For each patient, the measure assessment period begins with an index event and is 14 months (12 months + 60 days) in length. Follow-up scores obtained in this timeframe from patients in the measure denominator are evaluated for numerator compliance.",null,"For TIPPS reporting purposes, no rounding will be accepted in calculating a percent reduction equal to or greater than 50 percent.","Denominator Identification Period: Patients indexed in this timeframe comprise the measure denominator.\n• TIPPS CY2021 (Baseline): November 1, 2019 through October 31, 2020\n\nMeasure Assessment Period for Rate Calculation: For each patient, the measure assessment period begins with an index event and is 14 months (12 months + 60 days) in length. Follow-up scores obtained in this timeframe from patients in the measure denominator are evaluated for numerator compliance.\n• TIPPS CY2021 (Baseline)*: September 2, 2020 through December 30, 2021\n\n*The overall measure assessment period represents the first and last possible dates of follow-up based on the denominator identification period. Due to the +/- 60-day calculation, the dates do not fall exactly on the first or last day of the month. Each patient’s individual measure assessment period is initiated with an index event. Patients are assessed at 12-months (+/- 60 days) after their index event.\n\nFor TIPPS reporting purposes, the following examples show how to calculate depression response.\nDepression Response = (Response Score - Index Score)/(Index Score)\n\nExample A:\n• Index Score: 16\n• Response Score: 8\n• Depression Response = (8-16)/16 = -0.50 (decrease)\n• PERFORMANCE MET (decrease in score greater than or equal to 50%)\n\nExample B: \n• Index Score of 16\n• Response Score of 10\n• Depression Response = (10-16)/16 = -0.375 (decrease)\n• PERFORMANCE NOT MET (decrease in score was not greater than or equal to 50%)\n\nExample C: \n• Index Score of 16\n• Response Score of 18; Increased\n• Depression Response = (18-16)/16 = +0.125 (increase)\n• PERFORMANCE NOT MET (increase in score)","M1-165",null,"Remission  measure: Merit-Based Incentive Payment System (MIPS) Program, Medicaid Promoting Interoperability Program for Eligible Professionals; NQF CQMC Consensus Core Set: Behavioral Health"]
[null,"T2-124","Added","TIPPS","T3 - P4P","Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (Weight Assessment Only)","Process","Y","01/01/21 - 06/30/21","Data Reporting & Status Update","Percentage increase paid on actual utilization, Nov 21 - April 2022","N",null,null,null,"Y","01/01/21 - 12/31/21","Data Reporting & Status Update",null,"N",null,null,null,"Medicaid","Medicaid, Uninsured, Other","Benchmark","NA",71.290000000000006,"NA","Physician Practice Group","0024","NCQA","eCQM - CMS155v9","https://ecqi.healthit.gov/ecqm/ep/2021/cms155v9","Percentage of patients 3-17 years of age who had an outpatient visit with a Primary Care Physician (PCP) or Obstetrician/Gynecologist (OB/GYN) and who had evidence of the following during the measurement period. Only one rate is reported:\nPercentage of patients with height, weight, and body mass index (BMI) percentile documentation",null,"Family Medicine; Pediatrics; Dietician, Registered",null,"Individuals","Patients 3-17 years of age with at least one outpatient visit with a primary care physician (PCP) or an obstetrician/gynecologist (OB/GYN) during the measurement period","exists [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n  where Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) in Interval[3, 17 )\n    and exists ( \"Qualifying Encounter\" )\n\n( [\"Encounter, Performed\": \"Office Visit\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services-Individual Counseling\"]\n  union [\"Encounter, Performed\": \"Preventive Care, Established Office Visit, 0 to 17\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services, Initial Office Visit, 0 to 17\"]\n  union [\"Encounter, Performed\": \"Preventive Care Services - Group Counseling\"]\n  union [\"Encounter, Performed\": \"Home Healthcare Services\"] ) ValidEncounter\n  where ValidEncounter.relevantPeriod during \"Measurement Period\"","Patients who have a diagnosis of pregnancy during the measurement period.\n\nExclude patients whose hospice care overlaps the measurement period.\n\nHospice.\"Has Hospice\"\n  or exists ( \"Pregnancy Diagnosis Which Overlaps Measurement Period\" )\n ","Patients who had a height, weight and body mass index (BMI) percentile recorded during the measurement period","exists ( \"BMI Percentile in Measurement Period\" )\n  and exists ( \"Height in Measurement Period\" )\n  and exists ( \"Weight in Measurement Period\" )","None","Only rate 1 of the measure is being reported: Percentage of patients with height, weight, and body mass index (BMI) percentile documentation.","Guidance:\nThe visit must be performed by a PCP or OB/GYN. \nBecause BMI norms for youth vary with age and sex, this measure evaluates whether BMI percentile, rather than an absolute BMI value, is assessed.\n\nThis eCQM is a patient-based measure.\n\nThis version of the eCQM uses QDM version 5.5.  Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.\n","D1-211"]
["C1-101","C1-101",null,"CHIRP","C1 - UHRIP","HIE Participation","Structure","Y","NA","Status Update",null,"Y","NA","Status Update",null,"Y","NA","Status Update",null,"Y","NA","Status Update",null,"NA","NA","NA","NA","NA","NA","Hospital Attestation","NA","NA","NA",null,"Reporting on status with enrollment in a public HIE, including submission of ADT and CCDM data","NA","NA",null,"NA",null,null,null,null,null,null,null,null,"NA",null,"NA"]
["C1-103","C1-102",null,"CHIRP","C1 - UHRIP","SDA Learning Collaborative Participation","Structure","Y","NA","Status Update",null,"Y","NA","Status Update",null,"Y","NA","Status Update",null,"Y","NA","Status Update",null,"NA","NA","NA","NA","NA","NA","Hospital Attestation","NA","NA","NA",null,"Reporting on participation in a learning collaborative hosted by a regional anchor entity","NA","NA",null,"NA",null,null,null,null,null,null,null,null,"NA",null,"NA"]
["C2-104","C2-103",null,"CHIRP","C2 - ACIA Maternal Care","AIM Collaborative Participation","Structure","Y","NA","Status Update",null,"Y","NA","Status Update",null,"Y","NA","Status Update",null,"Y","NA","Status Update",null,"NA","NA","NA","NA","NA","NA","Hospital Attestation","NA","NA","NA",null,"Reporting on status of participating in the available Texas AIM Collaboratives. ","NA","NA",null,"NA",null,null,null,null,null,null,null,null,"NA",null,"NA"]
["C2-105","C2-104",null,"CHIRP","C2 - ACIA Maternal Care","Severe Maternal Morbidity","Outcome","Y","01/01/21 - 06/30/21","Data Reporting & Status Update",null,"N",null,null,null,"Y","01/01/21 - 12/31/21","Data Reporting & Status Update",null,"N",null,null,null,"NA","Medicaid, Uninsured, Other","NA","NA","NA","NA","Hospital","NA","AIM","AIM","https://safehealthcareforeverywoman.org/aim/resources/aim-data-resources/","The percentage of mothers who experience Severe Maternal Morbidity (SMM)","NA","NA",null,"Encounters","All mothers during their birth admission","Exclude ectopics and miscarriages ",null,"Among the denominator, all cases with any SMM code",null,null,null,"see AIM SMM Codes List:\nhttp://safehealthcareforeverywoman.org/aim-program/aim-data/\n","NA",null,"TEXAS AIM Collaborative"]
["C2-106","C2-105",null,"CHIRP","C2 - ACIA Maternal Care","PC-02 Cesarean Section","Outcome","Y","01/01/21 - 06/30/21","Data Reporting & Status Update",null,"N",null,null,null,"Y","01/01/21 - 12/31/21","Data Reporting & Status Update",null,"N",null,null,null,"NA","Medicaid, Uninsured, Other","NA","NA","NA","NA","Hospital","0471","The Joint Commission","The Joint Commission","https://manual.jointcommission.org/releases/TJC2021A/MIF0167.html","Nulliparous women with a term, singleton baby in a vertex position delivered by cesarean birth","NA","NA",null,"Encounters","Nulliparous patients with an ICD-10-CM Principal or Other Diagnosis Code for outcome of delivery as defined in Appendix A, Table 11.08 and with a delivery of a newborn with 37 weeks or more gestation completed or with an ICD-10-PCS Principal or Other Procedure Codes for delivery as defined in Appendix A, Tables 11.01.1.",null,"• ICD-10-CM Principal Diagnosis Code or ICD-10-CM Other Diagnosis Codes for multiple gestations and other presentations as defined in Appendix A, Table 11.09\n• Less than 8 years of age\n• Greater than or equal to 65 years of age\n• Length of Stay >120 days\n• Gestational Age < 37 weeks or UTD","Patients with cesarean births with ICD-10-PCS Principal Procedure Code or ICD-10-PCS Other Procedure Codes for cesarean birth as defined in Appendix A, Table 11.06.",null,null,null,"Joint Commission Appendix A, Table Number 11.01.1: https://manual.jointcommission.org/releases/TJC2021A1/AppendixATJC.html#Table_Number_11.01.1:_Delivery\nJoint Commission Appendix A, Table Number 11.06: https://manual.jointcommission.org/releases/TJC2021A1/AppendixATJC.html#Table_Number_11.06:_Cesarean_Birth\nJoint Commission Appendix A, Table Number 11.08: https://manual.jointcommission.org/releases/TJC2021A1/AppendixATJC.html#Table_Number_11.08:_Outcome_of_Delivery\nJoint Commission Appendix A, Table Number 11.09: https://manual.jointcommission.org/releases/TJC2021A1/AppendixATJC.html#Table_Number_11.09:_Multiple_Gestations_and_Other_Presentations","E2-150","Yes","CMS Medicaid Maternity Core Set;  NQF CQMC Consensus Core Set: Obstetrics and Gynecology"]
["C2-108","C2-106",null,"CHIRP","C2 - ACIA Hospital Safety","Hospital Safety Collaborative Participation","Structure","Y","NA","Status Update",null,"Y","NA","Status Update",null,"Y","NA","Status Update",null,"Y","NA","Status Update",null,"NA","NA","NA","NA","NA","NA","Hospital Attestation","NA","NA","NA",null,"Reporting on status of participating in a hospital safety collaborative","NA","NA",null,"NA",null,null,null,null,null,null,null,null,"NA",null,"NA"]
["C2-109","C2-107",null,"CHIRP","C2 - ACIA Hospital Safety","Catheter-Associated Urinary Tract Infection (CAUTI) Outcome Measure","Outcome","Y","01/01/21 - 06/30/21","Data Reporting & Status Update",null,"N",null,null,null,"Y","01/01/21 - 12/31/21","Data Reporting & Status Update",null,"N",null,null,null,"NA","All-payer","NA","NA","NA","NA","Hospital","0138","CDC","CDC/NHSN","https://www.cdc.gov/nhsn/enrolled-facilities/index.html","This measure calculates the total number of healthcare-associated CAUTI among patients in bedded inpatient care locations, from the total number of indwelling urinary catheter days for each location under surveillance for CAUTI during the associated data period. This measure is risk-ad","NA","NA",null,"Encounters","Total number of predicted healthcare-associated CAUTI among inpatient care locations under surveillance for CAUTI during the data period, based on the national CAUTI baseline Data is calculated using the facility's number of catheter days and the following significant risk factors: Acute Care Hospitals: CDC Location, Facility bed size, Medical school affiliation, and Facility type Critical Access Hospitals: Medical school affiliation Long-Term Acute Hospitals: Average length of stay, Setting type, and Location type Inpatient Rehabilitation Facilities: Setting type, Proportion of admissions with traumatic and non-traumatic spinal cord dysfunction, Proportion of admissions with stroke",null,null,"Total number of observed healthcare-associated CAUTI among patients in bedded inpatient care locations (excluding patients in Level II or III neonatal ICUs).",null,null,null,null,"J1-219",null,"Hospital Acquired Condition Reduction Program (Active)\nInpatient Rehabilitation Facility Quality Reporting (Active)\nLong-Term Care Hospital Quality Reporting (Active)\nProspective Payment System-Exempt Cancer Hospital Quality Reporting (Active)"]
["C2-110","C2-108",null,"CHIRP","C2 - ACIA Hospital Safety","Central Line Associated Bloodstream Infection (CLABSI) Outcome Measure","Outcome","Y","01/01/21 - 06/30/21","Data Reporting & Status Update",null,"N",null,null,null,"Y","01/01/21 - 12/31/21","Data Reporting & Status Update",null,"N",null,null,null,"NA","All-payer","NA","NA","NA","NA","Hospital","0139","CDC","CDC/NHSN","https://www.cdc.gov/nhsn/enrolled-facilities/index.html","Standardized Infection Ratio (SIR) and Adjusted Ranking Metric (ARM) of healthcare-associated, central line-associated bloodstream infections (CLABSI) will be calculated among patients in bedded inpatient care locations.","NA","NA",null,"Encounters","Total number of predicted healthcare-associated CLABSI among patients in bedded inpatient care locations, calculated using the facility's number of central line days and the following significant risk factors: - Acute Care Hospitals: CDC location, facility bed size, medical school affiliation, facility type, birthweight category (NICU locations only) - Critical Access Hospitals: no significant risk factors, calculation based intercept only model - Inpatient Rehabilitation Facilities: Proportion of admissions with stroke, proportion of admissions in other non-specific diagnostic categories - Long Term Acute Care Hospitals: CDC location type , facility bed size, average length of stay, proportion of admissions on a ventilator, proportion of admissions on hemodialysis",null,null,"Total number of observed healthcare-associated CLABSIs among patients in bedded inpatient care locations.",null,null,null,null,"J1-218",null,"Hospital Acquired Condition Reduction Program (Active)\nLong-Term Care Hospital Quality Reporting (Active)\nProspective Payment System-Exempt Cancer Hospital Quality Reporting (Active)\n"]
["C2-111","C2-109",null,"CHIRP","C2 - ACIA Hospital Safety","Facility-wide Inpatient Hospital-onset Clostridium difficile Infection (CDI) Outcome Measure","Outcome","Y","01/01/21 - 06/30/21","Data Reporting & Status Update",null,"N",null,null,null,"Y","01/01/21 - 12/31/21","Data Reporting & Status Update",null,"N",null,null,null,"NA","All-payer","NA","NA","NA","NA","Hospital","1717","CDC","CDC/NHSN","https://www.cdc.gov/nhsn/enrolled-facilities/index.html","This measure calculates the total number of observed hospital-onset CDI LabID events among all inpatients in the facility, excluding well baby-nurseries and NICUs, from the total number of expected hospital-onset CDI LabID events, determined through the facility's number of inpatient days, bed size, affiliation with a medical school, microbiological test used to identify C. difficile, and community onset CDI admission prevalence rate.","NA","NA",null,"Encounters","Total number of predicted hospital-onset CDI LabID events, calculated using the facility's number of inpatient days, facility type, CDI event reporting from Emergency Department and 24 hour observation units, bed size, ICU bed size, affiliation with medical school, microbiological test method used to identify C. difficile, and community-onset CDI admission prevalence rate.",null,null,"Total number of observed hospital-onset CDI LabID events among all inpatients in the facility, excluding well baby-nurseries and NICUs",null,null,null,null,"NA",null,"Hospital Acquired Condition Reduction Program\nInpatient Rehabilitation Facility Quality Reporting\nLong-Term Care Hospital Quality Reporting\nProspective Payment System-Exempt Cancer Hospital Quality Reporting\n\n\n\n"]
["C2-112","C2-110",null,"CHIRP","C2 - ACIA Hospital Safety","Harmonized Procedure Specific Surgical Site Infection (SSI) Outcome Measure","Outcome","Y","01/01/21 - 06/30/21","Data Reporting & Status Update",null,"N",null,null,null,"Y","01/01/21 - 12/31/21","Data Reporting & Status Update",null,"N",null,null,null,"NA","All-payer","NA","NA","NA","NA","Hospital","0753","CDC","CDC/NHSN","https://www.cdc.gov/nhsn/enrolled-facilities/index.html","Facility adjusted Standardized Infection Ratio (SIR) and Adjusted Ranking Metric (ARM) for deep incisional and organ/space Surgical Site Infections (SSI) at the primary incision site among adult patients aged >= 18 years as reported through the CDC National Health and Safety Network (NHSN).","NA","NA",null,"Encounters","An NHSN Operative Procedure is a procedure: that is included in the ICD-10-PCS or CPT NHSN operative procedure code mapping. And takes place during an operation where at least one incision (including laparoscopic approach and cranial Burr holes) is made through the skin or mucous membrane, or reoperation via an incision that was left open during a prior operative procedure And takes place in an operating room (OR), defined as a patient care area that met the Facilities Guidelines Institute s (FGI) or American Institute of Architects (AIA) criteria for an operating room when it was constructed or renovated. This may include an operating room, C-section room, interventional radiology room, or a cardiac catheterization lab. Exclusions: Otherwise eligible procedures that are assigned an ASA score of 6 are not eligible for NHSN SSI surveillance.",null,null,"Deep incisional primary (DIP) and organ/space SSIs during the 30-day postoperative period among patients = 18 years of age, who undergo inpatient colon surgeries or abdominal hysterectomies. SSIs will be identified before discharge from the hospital, upon readmission to the same hospital, or during outpatient care or admission to another hospital (post-discharge surveillance). Numerator Exclusion SSI events with PATOS* field = yes.",null,null,null,null,"NA",null,"Hospital Value-Based Purchasing\nHospital Acquired Condition Reduction Program\nProspective Payment System-Exempt Cancer Hospital Quality Reporting (Active)\n\n"]
["C2-113","C2-111",null,"CHIRP","C2 - ACIA Pediatric","Hospital Safety Collaborative Participation","Structure","Y","NA","Status Update",null,"Y","NA","Status Update",null,"Y","NA","Status Update",null,"Y","NA","Status Update",null,"NA","NA","NA","NA","NA","NA","Hospital Attestation","NA","NA","NA",null,"Reporting on status of participation in a pediatric hospital safety collaborative ","NA","NA",null,"NA",null,null,null,null,null,null,null,null,"NA",null,"NA"]
["C2-114","C2-112",null,"CHIRP","C2 - ACIA Pediatric","Pediatric Adverse Drug Events","Outcome","Y","01/01/21 - 06/30/21","Data Reporting & Status Update",null,"N",null,null,null,"Y","01/01/21 - 12/31/21","Data Reporting & Status Update",null,"N",null,null,null,"NA","All-payer","NA","NA","NA","NA","Hospital","NA","Children’s Hospitals’ Solutions for Patient Safety National Children’s Network","CHSPS","https://www.solutionsforpatientsafety.org/wp-content/uploads/sps-operating-definitions_MAY-2020.pdf","This measure answers the question: How often is a patient harmed due to failure to procure (not related to a drug shortage), store, prescribe, dispense, administer, or monitor medication as intended?","NA","NA",null,"Encounters","Total number patient days. ","All patients are included who are defined as inpatient or under observation at the hospital.","Enteral feeds are not counted as drug errors.\nBlood products are not counted as drug errors.","Number of adverse drug events per NCC MERP’s Index for Categorizing Medication Errors.\nNumerators will be reported as Level E and combined Level F-I as defined below.\nE = An error occurred that may have contributed to or resulted in temporary harm to the patient and required intervention\nF = An error occurred that may have contributed to or resulted in temporary harm to the patient and required initial or prolonged hospitalization\nG = An error occurred that may have contributed to or resulted in permanent patient harm\nH = An error occurred that required intervention necessary to sustain life\nI = An error occurred that contributed to or resulted in the patient’s death",null,null,null,"NCC MERP Medication Error Index: https://www.nccmerp.org/types-medication-errors","D3-334",null,"Children’s Hospitals’ Solutions for Patient Safety National Children’s Network"]
["C2-115","C2-113",null,"CHIRP","C2 - ACIA Pediatric","Pediatric CLABSI","Outcome","Y","01/01/21 - 06/30/21","Data Reporting & Status Update",null,"N",null,null,null,"Y","01/01/21 - 12/31/21","Data Reporting & Status Update",null,"N",null,null,null,"NA","All-payer","NA","NA","NA","NA","Hospital","NA","Children’s Hospitals’ Solutions for Patient Safety National Children’s Network","CHSPS","https://www.solutionsforpatientsafety.org/wp-content/uploads/sps-operating-definitions_MAY-2020.pdf","This measure answers the question: How often is a patient harmed due to central line associated blood stream infections (CLABSIs)?","NA","NA",null,"Encounters","Total number of central line days during the time period.","All patients are included who are defined as inpatient or under observation at the hospital including one calendar day post discharge (including the CLABSIs related to Mucosal Barrier Injuries (MBIs)).","Infection must not be present on admission into the hospital as defined by NHSN. For most infections, this means that the infection does not become evident until two calendar days or more after admission, but each infection must be assessed individually.","Number of patients with a CLABSI event, as defined by CDC guidelines. For this measure, distinction is not made between an infection due to CVC/PICC insertion and one due to maintenance practices.",null,null,null,null,"D3-330",null,"Children’s Hospitals’ Solutions for Patient Safety National Children’s Network"]
["C2-116","C2-114",null,"CHIRP","C2 - ACIA Pediatric","Pediatric CAUTI","Outcome","Y","01/01/21 - 06/30/21","Data Reporting & Status Update",null,"N",null,null,null,"Y","01/01/21 - 12/31/21","Data Reporting & Status Update",null,"N",null,null,null,"NA","All-payer","NA","NA","NA","NA","Hospital","NA","Children’s Hospitals’ Solutions for Patient Safety National Children’s Network","CHSPS","https://www.solutionsforpatientsafety.org/wp-content/uploads/sps-operating-definitions_MAY-2020.pdf","This measure answers the question: How often are patients harmed by the occurrence of a catheter associated urinary tract infections?","NA","NA",null,"Encounters","Total number of indwelling urinary catheter days during the time period.","All patients admitted to an inpatient unit are included who are defined as inpatient or under observation at the hospital with an indwelling urinary catheter.","Observation patients admitted to observation units and patients admitted to neonatal intensive care units will be excluded. \n\nInfection must not be incubating at the time of the admission into the hospital. For most infections, this means that the infection does not become evident until 48 hours or more after admission, but each infection must be assessed individually. There is no minimum period of time that the catheter must be in place in order for the UTI to be considered catheter associated. ","Number of patients contracting an infection, as defined by CDC guidelines.",null,null,null,null,"D3-331",null,"Children’s Hospitals’ Solutions for Patient Safety National Children’s Network"]
["C2-117","C2-115",null,"CHIRP","C2 - ACIA Pediatric","Pediatric SSI","Outcome","Y","01/01/21 - 06/30/21","Data Reporting & Status Update",null,"N",null,null,null,"Y","01/01/21 - 12/31/21","Data Reporting & Status Update",null,"N",null,null,null,"NA","All-payer","NA","NA","NA","NA","Hospital","NA","Children’s Hospitals’ Solutions for Patient Safety National Children’s Network","CHSPS","https://www.solutionsforpatientsafety.org/wp-content/uploads/sps-operating-definitions_MAY-2020.pdf","This measure answers the question: How often is a patient harmed due to surgical site infection following selected surgeries?","NA","NA",null,"Encounters","Number of designated surgical procedures during the applicable reporting period. Three surgery categories are considered for this measurement. ","All patients who experience one of the below surgical procedures:\n Spinal fusion surgeries as defined by NHSN (FUSN).\n Procedures such as growing construct placements and adjustments should be included if a facility routinely uses CPT or ICD-10 codes included in the FUSN category for such procedures.\n Neurosurgical shunt surgeries as defined by NHSN (VSHN)\n Procedures such as third ventriculostomy and external ventricular drain placement are included even though technically these are not shunt procedures.\n The CPT code 44055 (correction of malrotation) should be used only if the procedure involves a ventricular shunt.\n Cardiothoracic surgeries as defined by NHSN (CARD)","Patients with physician/advanced practice nurse/physician assistant documentation of an active infection at the time of the surgical procedure.\n Detailed criteria for an infection at time of surgery (PATOS) is available in the NHSN Manual (link above).\n Signs/symptoms of infection can include but not be limited to: fever, ","Number of SSIs related to designated surgical procedures.","Surgical Site Infection Definitions:\n\n Superficial Incisional SSI\nInfection occurs within 30 days of the operative procedure (procedure date is day\n1) AND involves only skin and subcutaneous tissue of the incision AND patient\nhas at least one of the following:\na. purulent drainage from the superficial incision.\nb. organisms identified from an aseptically-obtained specimen from the superficial incision or subcutaneous tissue by a culture or non-culture based microbiologic testing method which is performed for purposes of clinical diagnosis or treatment (for example, not Active Surveillance Culture/Testing (ASC/AST).\nc. superficial incision that is deliberately opened by a surgeon, attending physician or other designee and culture or non-culture based testing is not performed, AND patient has at least one of the following signs or symptoms: pain or tenderness; localized swelling; erythema; or heat.\nd. diagnosis of a superficial incisional SSI by the surgeon or attending physician or other designee.\nNote: The following do not meet the superficial SSI definition: Diagnosis or treatment of cellulitis (redness/warmth/swelling) by itself; stitch abscess alone (minimal inflammation and discharge confined to the points of suture penetration); localized stab wound or pin site infection\n\n Deep Incisional SSI\nInfection occurs within 90 days AND involves deep soft tissues (e.g., fascial and muscle layers) of the incision AND patient has at least one of the following:\na. purulent drainage from the deep incision.\nb. a deep incision spontaneously dehisces or is deliberately opened by a surgeon, attending physician, or other designee  and organism is identified by culture or non-culture based microbiologic testing method which is performed for purposes of clinical diagnosis or treatment or culture or non-culture based microbiologic testing method is not performed and the patient has at least one of the following signs or symptoms: fever (>38°C); localized pain or tenderness. A culture or non-culture-based test that has a negative finding does not meet this criterion.\nc. an abscess or other evidence of infection involving the deep incision that is detected on gross anatomical or histopathologic exam, or imaging test.\n\n Organ/Space SSI\nInfection occurs within 90 days after the operative procedure AND infection involves any part of the body deeper than the fascial/muscle layers that is opened or manipulated during the operative procedure AND patient has at least one of the following:\na. Purulent drainage from a drain that is placed in the organ/space (for example, closed suction drainage system, open drain, T-tube drain, CT guided drainage)\nb. organisms are identified from fluid or tissue in the organ/space by a culture or non-culture based microbiologic testing method which is performed for purposes of clinical diagnosis or treatment\nc. An abscess or other evidence of infection involving the organ/space that is detected on gross anatomical or histopathologic exam, or imaging test evidence suggestive of infection. And Meets at least one criterion for a specific organ/space infection site (listed in Table 3, NHSN Manual, http://www.cdc.gov/nhsn/PDFs/pscManual/9pscSSIcurrent.pdf)",null,null,null,"D3-333",null,"Children’s Hospitals’ Solutions for Patient Safety National Children’s Network"]
[null,"C2-116","Added","CHIRP","C2 - ACIA Pediatric","Engagement in Integrated Behavioral Health","Process","Y","01/01/21 - 06/30/21","Data Reporting & Status Update",null,"N",null,null,null,"Y","01/01/21 - 12/31/21","Data Reporting & Status Update",null,"N",null,null,null,"NA","Medicaid, Uninsured, Other","NA","NA","NA","NA","Hospital","NA","Meadows Mental Health Policy Institute","NA","NA","The percentage of children or youth initiating behavioral health care who received, or whose caregivers received, at least one follow-up behavioral health care or care management contact within 30 days of initiating behavioral health contact.",null,"???",null,"Individuals","The unduplicated number of children and youth who were documented in the electronic health record as having had an initial behavioral health service or contact (in-person, virtual, or telephonic).","Behavioral health contact can include an assessment, a treatment session, or any other type of contact that had a behavioral health focus and that was documented in the clinical record.","Children/youth and caregivers/families who refused subsequent behavioral health care or other assistance that was offered at the initial behavioral health contact, and for whom such refusal was documented in the clinical record, should be excluded from the analysis.","The unduplicated number of children or youth who received, or whose caregivers received, a second contact (in-person, virtual, or telephonic) from a behavioral health provider, care coordinator, or care manager within 30 days of initial behavioral health contact, as documented in the electronic health record.",null,null,null,null,"H1-T04"]
["C2-118","C2-117",null,"CHIRP","C2 - ACIA Psychiatric Care Transitions","Written transition procedures that include formal MCO relationship or EDEN notification/ADT Feed for psychiatric patients\n","Structure","Y","NA","Status Update",null,"Y","NA","Status Update",null,"Y","NA","Status Update",null,"Y","NA","Status Update",null,"NA","NA","NA","NA","NA","NA","Hospital Attestation","NA","NA","NA",null,"Reporting on status of developing and implementing policies and procedures for providing a members managed care plan with expedient notification of hospitalization for psychiatric illness. ","NA","NA",null,"NA",null,null,null,null,null,null,null,null,"NA",null,"NA"]
["C2-122","C2-118",null,"CHIRP","C2 - ACIA Care Transitions","Written transition procedures that include formal MCO relationship or EDEN notification/ADT Feed for non-psychiatric patients","Structure","Y","NA","Status Update",null,"Y","NA","Status Update",null,"Y","NA","Status Update",null,"Y","NA","Status Update",null,"NA","NA","NA","NA","NA","NA","Hospital Attestation","NA","NA","NA",null,"Reporting on status of developing and implementing policies and procedures for providing a members managed care plan with timely notification of hospitalization. ","NA","NA",null,"NA",null,null,null,null,null,null,null,null,"NA",null,"NA"]
["C2-131","C2-119",null,"CHIRP","C2 - ACIA Rural Hospital Best Practices","Preventive Care & Screening: Tobacco Use: Screening & Cessation Intervention","Process","Y","01/01/21 - 06/30/21","Data Reporting & Status Update",null,"N",null,null,null,"Y","01/01/21 - 12/31/21","Data Reporting & Status Update",null,"N",null,null,null,"NA","Medicaid, Uninsured, Other","NA","NA","NA","NA","Hospital","0028","NCQA","eCQM - CMS138v9","https://ecqi.healthit.gov/ecqm/ep/2021/cms138v9","Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 12 months AND who received tobacco cessation intervention if identified as a tobacco user\n\nThree rates are reported:\n\na. Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 12 months\n\nb. Percentage of patients aged 18 years and older who were identified as a tobacco user who received tobacco cessation intervention\n\nc. Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 12 months AND who received tobacco cessation intervention if identified as a tobacco user","General Practice, Family Practice, Internal Medicine, Obstetrics/Gynecology, Geriatric Medicine, Pyschiatry, Mental/Behavioral Health, Allergy/Immunology, Cardiology, Gastro-enterology, Dermatology, Ophthalmology, Orthopedic Surgery, Otolaryngology, Physical Medicine, Plastic Surgery, Preventive Medicine, Neurology, Vascular Surgery, General Surgery, Thoracic Surgery, Urology, Oncology, Rheumatology, Neurosurgical, Podiatry, Physical Therapy/Occupational Therapy, Urgent Care, Endocrinology, Pulmonology, Clinical Social Work, Audiology, Speech Language Pathology","Allergy & Immunology; Dermatology; Family Medicine; Internal Medicine; Obstetrics & Gynecology; Ophthalmology; Orthopaedic Surgery; Otolaryngology; Physicial Medicine & Rehabilitation; Plastic Surgery; Preventive Medicine; Psychiatry & Neurology; Neurosurgical Surgery; Surgery; Thoracic Surgery; Urology; Audiologist; Occupational Therapist; Physical Therapist; Podiatrist; Social Worker; Speech Language Pathologist; Urgent Care","Cardiology; Endocrinology; Gastroenterology; Oncology; Pulmonology; Rheumatology; Vascular Surgery","Individuals","Population 1:\nAll patients aged 18 years and older seen for at least two visits or at least one preventive visit during the measurement period\n\nPopulation 2:\nAll patients aged 18 years and older seen for at least two visits or at least one preventive visit during the measurement period, who were screened for tobacco use and identified as a tobacco user\n\nPopulation 3:\nAll patients aged 18 years and older seen for at least two visits or at least one preventive visit during the measurement period","Population 1:\n\"Initial Population\"\n\nexists ( [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n    where Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) >= 18)\n  and ( Count(\"Office Based Visit During Measurement Period\")>= 2\n      or exists \"Preventive Visit During Measurement Period\")\n\nPopulation 2:\n\"Initial Population\"\n  and \"Most Recent Tobacco Use Screening Indicates Tobacco User\" is not null\n\nexists ( [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n    where Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) >= 18)\n  and ( Count(\"Office Based Visit During Measurement Period\")>= 2\n      or exists \"Preventive Visit During Measurement Period\")\n\n( Last([\"Assessment, Performed\": \"Tobacco Use Screening\"] TobaccoUseScreening\n    where TobaccoUseScreening.relevantDatetime during \"Measurement Period\"\n    sort by relevantDatetime)) MostRecentTobaccoUseScreening\n  where MostRecentTobaccoUseScreening.result in \"Tobacco User\"\n\nPopulation 3:\n\"Initial Population\"\n\nexists ( [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n    where Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) >= 18)\n  and ( Count(\"Office Based Visit During Measurement Period\")>= 2\n      or exists \"Preventive Visit During Measurement Period\")","Population 1:\nexists \"Medical Reason for Not Screening for Tobacco Use\"\n  or \"Has Limited Life Expectancy\"\n\n[\"Assessment, Not Performed\": \"Tobacco Use Screening\"] NoTobaccoUseScreening\n  where NoTobaccoUseScreening.authorDatetime during \"Measurement Period\"\n    and NoTobaccoUseScreening.negationRationale in \"Medical Reason\"\n\nexists ( [\"Diagnosis\": \"Limited Life Expectancy\"] LimitedLifeExpectancy\n    where LimitedLifeExpectancy.prevalencePeriod overlaps after \"Measurement Period\")\n\nPopulation 2:\nexists \"Medical Reason for Not Counseling Tobacco User\"\n  or exists \"Medical Reason for Not Ordering Tobacco Cessation Pharmacotherapy\"\n  or \"Has Limited Life Expectancy\"\n\n[\"Intervention, Not Performed\": \"Tobacco Use Cessation Counseling\"] NoTobaccoCessationCounseling\n  where NoTobaccoCessationCounseling.authorDatetime during \"Measurement Period\"\n    and NoTobaccoCessationCounseling.negationRationale in \"Medical Reason\n\n[\"Medication, Not Ordered\": \"Tobacco Use Cessation Pharmacotherapy\"] NoCessationPharmacotherapyOrdered\n  where NoCessationPharmacotherapyOrdered.authorDatetime during \"Measurement Period\"\n    and NoCessationPharmacotherapyOrdered.negationRationale in \"Medical Reason\"\n\nexists ( [\"Diagnosis\": \"Limited Life Expectancy\"] LimitedLifeExpectancy\n    where LimitedLifeExpectancy.prevalencePeriod overlaps after \"Measurement Period\")\n\nPopulation 3:\nexists \"Medical Reason for Not Screening for Tobacco Use\"\n  or exists \"Medical Reason for Not Counseling Tobacco User\"\n  or exists \"Medical Reason for Not Ordering Tobacco Cessation Pharmacotherapy\"\n  or \"Has Limited Life Expectancy\"\n\n[\"Assessment, Not Performed\": \"Tobacco Use Screening\"] NoTobaccoUseScreening\n  where NoTobaccoUseScreening.authorDatetime during \"Measurement Period\"\n    and NoTobaccoUseScreening.negationRationale in \"Medical Reason\"\n\n[\"Intervention, Not Performed\": \"Tobacco Use Cessation Counseling\"] NoTobaccoCessationCounseling\n  where NoTobaccoCessationCounseling.authorDatetime during \"Measurement Period\"\n    and NoTobaccoCessationCounseling.negationRationale in \"Medical Reason\"\n\n[\"Medication, Not Ordered\": \"Tobacco Use Cessation Pharmacotherapy\"] NoCessationPharmacotherapyOrdered\n  where NoCessationPharmacotherapyOrdered.authorDatetime during \"Measurement Period\"\n    and NoCessationPharmacotherapyOrdered.negationRationale in \"Medical Reason\"\n\nexists ( [\"Diagnosis\": \"Limited Life Expectancy\"] LimitedLifeExpectancy\n    where LimitedLifeExpectancy.prevalencePeriod overlaps after \"Measurement Period\")","Population 1:\nPatients who were screened for tobacco use at least once within 12 months \n\nPopulation 2:\nPatients who received tobacco cessation intervention\n\nPopulation 3:\nPatients who were screened for tobacco use at least once within 12 months AND who received tobacco cessation intervention if identified as a tobacco user","Population 1:\n\"Most Recent Tobacco Use Screening Indicates Tobacco Non User\" is not null\n  or \"Most Recent Tobacco Use Screening Indicates Tobacco User\" is not null\n\n( Last([\"Assessment, Performed\": \"Tobacco Use Screening\"] TobaccoUseScreening\n    where TobaccoUseScreening.relevantDatetime during \"Measurement Period\"\n    sort by relevantDatetime)) MostRecentTobaccoUseScreening\n  where MostRecentTobaccoUseScreening.result in \"Tobacco Non-User\"\n \n( Last([\"Assessment, Performed\": \"Tobacco Use Screening\"] TobaccoUseScreening\n    where TobaccoUseScreening.relevantDatetime during \"Measurement Period\"\n    sort by relevantDatetime)) MostRecentTobaccoUseScreening\n  where MostRecentTobaccoUseScreening.result in \"Tobacco User\"\n\nPopulation 2:\nexists \"Tobacco Cessation Counseling Given\"\n  or exists \"Tobacco Cessation Pharmacotherapy Ordered\"\n  or exists \"Active Pharmacotherapy for Tobacco Cessation\"\n\n[\"Intervention, Performed\": \"Tobacco Use Cessation Counseling\"] TobaccoCessationCounseling\n  where TobaccoCessationCounseling.relevantDatetime during \"Measurement Period\"\n \n[\"Medication, Order\": \"Tobacco Use Cessation Pharmacotherapy\"] CessationPharmacotherapyOrdered\n  where CessationPharmacotherapyOrdered.authorDatetime during \"Measurement Period\"\n\n[\"Medication, Active\": \"Tobacco Use Cessation Pharmacotherapy\"] TakingCessationPharmacotherapy\n  where TakingCessationPharmacotherapy.relevantPeriod overlaps after \"Measurement Period\n\nPopulation 3:\n\"Most Recent Tobacco Use Screening Indicates Tobacco Non User\" is not null\n  or ( \"Most Recent Tobacco Use Screening Indicates Tobacco User\" is not null\n      and ( exists \"Tobacco Cessation Counseling Given\"\n          or exists \"Tobacco Cessation Pharmacotherapy Ordered\"\n          or exists \"Active Pharmacotherapy for Tobacco Cessation\"))\n\n( Last([\"Assessment, Performed\": \"Tobacco Use Screening\"] TobaccoUseScreening\n    where TobaccoUseScreening.relevantDatetime during \"Measurement Period\"\n    sort by relevantDatetime)) MostRecentTobaccoUseScreening\n  where MostRecentTobaccoUseScreening.result in \"Tobacco Non-User\"\n \n( Last([\"Assessment, Performed\": \"Tobacco Use Screening\"] TobaccoUseScreening\n    where TobaccoUseScreening.relevantDatetime during \"Measurement Period\"\n    sort by relevantDatetime)) MostRecentTobaccoUseScreening\n  where MostRecentTobaccoUseScreening.result in \"Tobacco User\"\n\n[\"Intervention, Performed\": \"Tobacco Use Cessation Counseling\"] TobaccoCessationCounseling\n  where TobaccoCessationCounseling.relevantDatetime during \"Measurement Period\"\n \n[\"Medication, Order\": \"Tobacco Use Cessation Pharmacotherapy\"] CessationPharmacotherapyOrdered\n  where CessationPharmacotherapyOrdered.authorDatetime during \"Measurement Period\"\n\n[\"Medication, Active\": \"Tobacco Use Cessation Pharmacotherapy\"] TakingCessationPharmacotherapy\n  where TakingCessationPharmacotherapy.relevantPeriod overlaps after \"Measurement Period","None",null,"Definitions:\nTobacco Use - Includes any type of tobacco\nTobacco Cessation Intervention - Includes brief counseling (3 minutes or less), and/or pharmacotherapy -- Note: Concepts aligned with brief counseling (e.g., minimal and intensive advice/counseling interventions conducted both in person and over the phone) are included in the value set for the numerator. Other concepts such as written self-help materials (e.g., brochures, pamphlets) and complementary/alternative therapies are not included in the value set and do not qualify for the numerator. Brief counseling also may be of longer duration or be performed more frequently, as evidence shows there is a dose-response relationship between the intensity of counseling provided (either length or frequency) and tobacco cessation rates (U.S. Preventive Services Task Force, 2015).\n\n\nGuidance: \nThe requirement of two or more visits is to establish that the eligible professional or eligible clinician has an existing relationship with the patient for certain types of encounters. \n\nTo satisfy the intent of this measure, a patient must have at least one tobacco use screening during the 12-month period. If a patient has multiple tobacco use screenings during the 12-month period, only the most recent screening, which has a documented status of tobacco user or tobacco non-user, will be used to satisfy the measure requirements.\n\nIf a patient uses any type of tobacco (i.e., smokes or uses smokeless tobacco), the expectation is that they should receive tobacco cessation intervention: either counseling and/or pharmacotherapy.\n\nAs noted above in a recommendation statement from the USPSTF, the current evidence is insufficient to recommend electronic nicotine delivery systems (ENDS) including electronic cigarettes for tobacco cessation. Additionally, ENDS are not currently classified as tobacco in the recent evidence review to support the update of the USPSTF recommendation given that the devices do not burn or use tobacco leaves. In light of the current lack of evidence, the measure does not currently capture e-cigarette usage as either tobacco use or a cessation aid.\n\nIf tobacco use status of a patient is unknown, the patient does not meet the screening component required to be counted in the numerator and should be considered a measure failure. Instances where tobacco use status of \"unknown\" is recorded include: 1) the patient was not screened; or 2) the patient was screened and the patient (or caregiver) was unable to provide a definitive answer. If the patient does not meet the screening component of the numerator but has an allowable medical exception, then the patient should be removed from the denominator of the measure and reported as a valid exception.\n\nIn order to promote a team-based approach to patient care, the tobacco cessation intervention can be performed by another healthcare provider; therefore, the tobacco use screening and tobacco cessation intervention do not need to be performed by the same provider or clinician.   \n\nThe medical reason exception may be applied to either the screening data element OR to any of the applicable tobacco cessation intervention data elements (counseling and/or pharmacotherapy) included in the measure. \n\nIf a patient has a diagnosis of limited life expectancy, that patient has a valid denominator exception for not being screened for tobacco use or for not receiving tobacco use cessation intervention (counseling and/or pharmacotherapy) if identified as a tobacco user.\n\nThis measure contains three reporting rates which aim to identify patients who were screened for tobacco use (rate/population 1), patients who were identified as tobacco users and who received tobacco cessation intervention (rate/population 2), and a comprehensive look at the overall performance on tobacco screening and cessation intervention (rate/population 3). By separating this measure into various reporting rates, the eligible professional or eligible clinician will be able to better ascertain where gaps in performance exist, and identify opportunities for improvement. The overall rate (rate/population 3) can be utilized to compare performance to published versions of this measure prior to the 2018 performance year, when the measure had a single performance rate. For accountability reporting in the CMS MIPS program, the rate for population 2 is used for performance.\n \nThe denominator of population criteria 2 is a subset of the resulting numerator for population criteria 1, as population criteria 2 is limited to assessing if patients identified as tobacco users received an appropriate tobacco cessation intervention. For all patients, population criteria 1 and 3 are applicable, but population criteria 2 will only be applicable for those patients who are identified as tobacco users. Therefore, data for every patient that meets the initial population criteria will only be submitted for population 1 and 3, whereas data submitted for population 2 will be for a subset of patients who meet the initial population criteria, as the denominator has been further limited to those who were identified as tobacco users.\n\nThis eCQM is a patient-based measure.\n\nThis version of the eCQM uses QDM version 5.5.  Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.","K1-105","Yes","MIPS, Medicare ACOs, Medicare Million Hearts; NQF CQMC Consensus Core Set: Behavioral Health, Cardiology, & ACO/PCMH/Primary Care"]
["C2-133","C2-120",null,"CHIRP","C2 - ACIA Rural Hospital Best Practices","Preventive Care and Screening: Influenza Immunization","Process","Y","01/01/21 - 06/30/21","Data Reporting & Status Update",null,"N",null,null,null,"Y","01/01/21 - 12/31/21","Data Reporting & Status Update",null,"N",null,null,null,"NA","Medicaid, Uninsured, Other","NA","NA","NA","NA","Hospital","0041","AMA-PCPI","eCQM - CMS147v10","https://ecqi.healthit.gov/ecqm/ep/2021/cms147v10","Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization","General Practice, Family Practice, Internal Medicine, Obstetrics/Gynecology, Pediatric Medicine, Geriatric Medicine, Preventive Medicine, Otolaryngology, Allergy/Immunology, Oncology, Rheumatology, Nephrology, Infectious Disease","Allergy & Immunology; Family Medicine; Internal Medicine; Obstetrics & Gynecology; Otolaryngology; Pediatrics; Preventive Medicine","Geriatrics; Infectious Disease; Nephrology; Oncology; Rheumatology","Individuals","All patients aged 6 months and older seen for a visit during the measurement period, and seen for a visit between October 1 and March 31","\"Initial Population\"\n  and ( exists \"Encounter During Influenza Season\"\n      or exists \"Hemodialysis During Influenza Season\"\n      or exists \"Peritoneal Dialysis During Influenza Season\")\n\n[\"Encounter, Performed\": \"Encounter-Influenza\"] FluEncounter\n  where FluEncounter.relevantPeriod starts during \"Influenza Season\"\n\n[\"Procedure, Performed\": \"Hemodialysis\"] FluSeasonHemodialysis\n  where FluSeasonHemodialysis.relevantPeriod overlaps \"Influenza Season\"\n\n[\"Procedure, Performed\": \"Peritoneal Dialysis\"] PeritonealDialysis\n  where PeritonealDialysis.relevantPeriod overlaps \"Measurement Period\"","Documentation of medical reason(s) for not receiving influenza immunization (e.g., patient allergy, other medical reasons).\nDocumentation of patient reason(s) for not receiving influenza immunization (e.g., patient declined, other patient reasons).\nDocumentation of system reason(s) for not receiving influenza immunization (e.g., vaccine not available, other system reasons).\n\nDenominator Exceptions\nexists \"Medical Patient or System Reason for Not Performing Influenza Vaccination\"\n  or exists \"Medical Patient or System Reason for Not Administering Influenza Vaccine\"\n  or exists \"Diagnosis of Allergy to Egg\"\n  or exists \"Egg Substance Allergy\"\n  or exists \"Diagnosis of Allergy to Influenza Vaccine\"\n  or exists \"Diagnosis of Intolerance to Influenza Vaccine\"\n  or exists \"Intolerance of Influenza Vaccination Procedure\"\n  or exists \"Allergy or Intolerance to Influenza Vaccine\n\n[\"Procedure, Not Performed\": \"Influenza Vaccination\"] NoFluVaccination\n  where NoFluVaccination.authorDatetime during \"Influenza Season Including August and September of the Prior Year\"\n    and ( NoFluVaccination.negationRationale in \"Medical Reason\"\n        or NoFluVaccination.negationRationale in \"Patient Reason\"\n        or NoFluVaccination.negationRationale in \"System Reason\"\n        or NoFluVaccination.negationRationale in \"Influenza Vaccination Declined\")\n\nor [\"Immunization, Not Administered\": \"Influenza Vaccine\"] NoFluVaccine\n  where NoFluVaccine.authorDatetime during \"Influenza Season Including August and September of the Prior Year\"\n    and ( NoFluVaccine.negationRationale in \"Medical Reason\"\n        or NoFluVaccine.negationRationale in \"Patient Reason\"\n        or NoFluVaccine.negationRationale in \"System Reason\"\n        or NoFluVaccine.negationRationale in \"Influenza Vaccination Declined\") \n\nor [\"Diagnosis\": \"Allergy to Eggs\"] EggAllergy\n  where EggAllergy.prevalencePeriod overlaps after \"Influenza Season\"\n\nor [\"Allergy/Intolerance\": \"Egg Substance\"] AllergyEggSubstance\n  where AllergyEggSubstance.prevalencePeriod overlaps after \"Influenza Season\"\n\nor [\"Diagnosis\": \"Allergy to Influenza Vaccine\"] FluVaccineAllergyDiagnosis\n  where FluVaccineAllergyDiagnosis.prevalencePeriod overlaps after \"Influenza Season\"\n\nor [\"Diagnosis\": \"Intolerance to Influenza Vaccine\"] FluVaccineIntoleranceDiagnosis\n  where FluVaccineIntoleranceDiagnosis.prevalencePeriod overlaps after \"Influenza Season\"\n\nor [\"Allergy/Intolerance\": \"Influenza Vaccination\"] FluVaccinationIntolerance\n  where FluVaccinationIntolerance.prevalencePeriod overlaps after \"Influenza Season\"\n\nor [\"Allergy/Intolerance\": \"Influenza Vaccine\"] FluVaccineAllergyIntolerance\n  where FluVaccineAllergyIntolerance.prevalencePeriod overlaps after \"Influenza Season\"","Patients who received an influenza immunization OR who reported previous receipt of an influenza immunization","exists \"Influenza Vaccination Procedure\"\n  or exists \"Influenza Immunization Administered\"\n  or exists \"Influenza Vaccine Previously Received\"\n\n[\"Procedure, Performed\": \"Influenza Vaccination\"] FluVaccination\n  where FluVaccination.relevantDatetime during \"Influenza Season Including August and September of the Prior Year\"\n\nor [\"Immunization, Administered\": \"Influenza Vaccine\"] AdministeredFluVaccine\n  where AdministeredFluVaccine.relevantDatetime during \"Influenza Season Including August and September of the Prior Year\"\n\nor [\"Assessment, Performed\": \"Previous Receipt of Influenza Vaccine\"] PreviousReceiptFluVaccine\n  where PreviousReceiptFluVaccine.relevantDatetime during \"Influenza Season Including August and September of the Prior Year\"",null,"For CHIRP reporting purposes, report denominator encounters that fall within the measurement period. For example, for CY2021, the denominator would include encounters from January - March 2021 and October - December 2021.","Definitions: \nPrevious Receipt - receipt of the current season's influenza immunization from another provider OR from same provider prior to the visit to which the measure is applied (typically, prior vaccination would include influenza vaccine given since August 1st)\n\n\nGuidance:\n\t\nThe timeframe for the visit during the \"Encounter, Performed\": \"Encounter-Influenza\" or \"Procedure, Performed\": \"Peritoneal Dialysis\" or \"Procedure, Performed\": \"Hemodialysis\" in the Population Criteria-Denominator, refers to the influenza season defined by the measure: October through March (October 1 for the year prior to the start of the reporting period through March 31 during the reporting period). The \"Encounter-Influenza\" Grouping OID detailed in the data criteria section below is comprised of several individual OIDs of different encounter types. The individual OIDs are included in the value set and should be reviewed to determine that an applicable visit occurred during the timeframe for \"Encounter, Performed\": \"Encounter-Influenza\" as specified in the denominator.\n\nTo enable reporting of this measure at the close of the reporting period, this measure will only assess the influenza season that ends in March of the reporting period. The subsequent influenza season (ending March of the following year) will be measured and reported in the following year.\n\nDue to the changing stance of the CDC/ACIP recommendations regarding the live attenuated influenza vaccine (LAIV) for a particular flu season, this measure will not include the administration of this specific formulation of the flu vaccination. Given the variance of the timeframes for the annual update cycles, program implementation, and publication of revised recommendations from the CDC/ACIP, it has been determined that the coding for this measure will specifically exclude this formulation, so as not to inappropriately include this form of the vaccine for flu seasons when CDC/ACIP explicitly advise against it. However, it is recommended that all eligible professionals or eligible clinicians to review the guidelines for each flu season to determine appropriateness of the LAIV and other formulations of the flu vaccine. Should the LAIV be recommended for administration for a particular flu season, eligible professional or clinician may consider one of the following options: 1) satisfy the numerator by reporting either previous receipt or using the CVX 88 for unspecified formulation, 2) report a denominator exception, either as a patient reason (e.g., for patient preference) or a system reason (e.g., the institution only carries LAIV).\n\nThis eCQM is a patient-based measure.\n\nThis version of the eCQM uses QDM version 5.5.  Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.","K1-269","Yes","Merit-Based Incentive Payment System (MIPS) Program, Medicaid Promoting Interoperability Program for Eligible Professionals"]
["B1-101","B1-101",null,"DPP for BHS","B1 - Dollar Increase","Certified Community Behavioral Health Clinic (CCBHC) Certification Status","Structure","Y","NA","Status Update","PMPM Nov 21 - April 22","N",null,null,null,"Y","NA","Status Update",null,"N",null,null,null,"NA","NA","NA","NA","NA","NA","CMHC Attestation","NA","NA","NA",null,"Reporting on status of CCBHC certification","NA","NA",null,"NA",null,null,null,null,null,null,null,null,"NA",null,"NA"]
["B1-102","B1-102",null,"DPP for BHS","B1 - Dollar Increase","Provide patients with services by using remote technology  including audio/video, client portals and apps for the provision of services such as telehealth, assessment collection and remote health monitoring/screening","Structure","Y","NA","Status Update","PMPM Nov 21 - April 22","N",null,null,null,"Y","NA","Status Update",null,"N",null,null,null,"NA","NA","NA","NA","NA","NA","CMHC Attestation","NA","NA","NA",null,"Reporting on the use of remote technology including audio/video, client portals and apps for the provision of services such as telehealth, assessment collection and remote health monitoring/screening","NA","NA",null,"NA",null,null,null,null,null,null,null,null,"NA",null,"NA"]
["B1-103","B1-103",null,"DPP for BHS","B1 - Dollar Increase","Provide integrated physical and behavioral health care services to children and adults with serious mental illness","Structure","Y","NA","Status Update","PMPM Nov 21 - April 22","N",null,null,null,"Y","NA","Status Update",null,"N",null,null,null,"NA","NA","NA","NA","NA","NA","CMHC Attestation","NA","NA","NA",null,"Reporting on integrated physical and behavioral health care services to children and adults with serious mental illness","NA","NA",null,"NA",null,null,null,null,null,null,null,null,"NA",null,"NA"]
["B1-104","B1-104",null,"DPP for BHS","B1 - Dollar Increase","Participate in electronic exchange of clinical data with other healthcare providers/entities","Structure","Y","NA","Status Update","PMPM Nov 21 - April 22","N",null,null,null,"Y","NA","Status Update",null,"N",null,null,null,"NA","NA","NA","NA","NA","NA","CMHC Attestation","NA","NA","NA",null,"Reporting on the participation in electronic exchange of clinical data with other healthcare providers/entities","NA","NA",null,"NA",null,null,null,null,null,null,null,null,"NA",null,"NA"]
["B2-105","B2-105",null,"DPP for BHS","B2 - Percent Increase","Preventive Care & Screening: Unhealthy Alcohol Use: Screening & Brief Counseling","Process","Y","01/01/21 - 06/30/21","Data Reporting & Status Update","Precentage increase Nov 21 - April 22","N",null,null,null,"Y","01/01/21 - 12/31/21","Data Reporting & Status Update",null,"N",null,null,null,"Medicaid","Medicaid, Uninsured, Other","IOS","NA","NA","NA","CMHC","2152","AMA-PCPI","CMS MIPS #431 2020","https://qpp-cm-prod-content.s3.amazonaws.com/uploads/786/2020+CQM+Specifications+and+Supporting+Docs.zip","Percentage of patients aged 18 years and older who were screened for unhealthy alcohol use using a systematic screening method at least once within the last 24 months AND who received brief counseling if identified as an unhealthy alcohol user","Pyschiatry, Mental/Behavioral Health","Pyschiatry, Mental/Behavioral Health",null,"Individuals","All patients aged 18 years and older seen for at least two visits or at least one preventive visit during the measurement period","Denominator Criteria (Eligible Cases):\nPatients aged ≥ 18 years\nAND\nAt least two patient encounters during the performance period (CPT or HCPCS): 90791, 90792,\n90832, 90834, 90837, 90845, 96150, 96151, 96152, 97165, 97166, 97167, 97168, 97802, 97803, 97804,\n99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, G0270, G0271\nWITHOUT\nTelehealth Modifier: GQ, GT, 95, POS 02\nOR\nAt Least One Preventive Visit during the performance period (CPT or HCPCS): 96160, 96161, 99385*,\n99386*, 99387*, 99395*, 99396*, 99397*, 99401*, 99402*, 99403*, 99404*, 99411*, 99412*, 99429*,\nG0438, G0439\nWITHOUT\nTelehealth Modifier: GQ, GT, 95, POS 02","Exception: Documentation of medical reason(s) for not screening for unhealthy alcohol use (e.g., limited life expectancy, other medical reasons) (G9623)","Patients who were screened for unhealthy alcohol use using a systematic screening method at least once within the last 24 months AND who received brief counseling if identified as an unhealthy alcohol user","Patient identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method and received brief counseling (G9621)\n\nOR\n\nPatient not identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method (G9622)","Patient not screened for unhealthy alcohol use using a systematic screening method OR patient did not receive brief counseling if identified as an unhealthy alcohol user, reason not given (G9624)",null,"Definitions:\nSystematic screening method – For purposes of this measure, one of the following systematic methods to assess unhealthy alcohol use must be utilized. Systematic screening methods and thresholds for defining unhealthy alcohol use include:\n\n• AUDIT Screening Instrument (score ≥ 8)\n• AUDIT-C Screening Instrument (score ≥ 4 for men; score ≥ 3 for women)\n• Single Question Screening - How many times in the past year have you had 5 (for men) or 4 (for women and all adults older than 65 years) or more drinks in a day? (response ≥ 2)\n\nBrief counseling – Brief counseling for unhealthy alcohol use refers to one or more counseling sessions, a minimum of 5-15 minutes, which may include: feedback on alcohol use and harms; identification of high risk situations for drinking and coping strategies; increased motivation and the development of a personal plan to reduce drinking.","M1-317",null,"Medicare Physician Quality Reporting System, Physician Feedback/Quality Resource Use Report, Physician Value-Based Payment Modifier, Merit-Based Incentive Payment System (MIPS) Program; NQF CQMC Consensus Core Set: Behavioral Health, Cardiology, & ACO/PCMH/Primary Care"]
["B2-106","B2-106",null,"DPP for BHS","B2 - Percent Increase","Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk Assessment","Process","Y","01/01/21 - 06/30/21","Data Reporting & Status Update","Precentage increase Nov 21 - April 22","N",null,null,null,"Y","01/01/21 - 12/31/21","Data Reporting & Status Update",null,"N",null,null,null,"Medicaid","Medicaid, Uninsured, Other","IOS","NA","NA","NA","CMHC","1365","AMA-PCPI","eCQM - CMS177v9","https://ecqi.healthit.gov/ecqm/ep/2021/cms177v9","Percentage of patient visits for those patients aged 6 through 17 years with a diagnosis of major depressive disorder with an assessment for suicide risk","Pyschiatry, Mental/Behavioral Health","Pyschiatry, Mental/Behavioral Health",null,"Encounters","All patient visits for those patients aged 6 through 17 years with a diagnosis of major depressive disorder","\"Initial Population\"\n\n\"Major Depressive Disorder Encounter\" MDDEncounter\n  with [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n    such that Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) >= 6\n      and Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) < 17\n\n( [\"Encounter, Performed\": \"Office Visit\"]\n  union [\"Encounter, Performed\": \"Outpatient Consultation\"]\n  union [\"Encounter, Performed\": \"Psych Visit - Diagnostic Evaluation\"]\n  union [\"Encounter, Performed\": \"Psych Visit - Family Psychotherapy\"]\n  union [\"Encounter, Performed\": \"Psych Visit - Psychotherapy\"]\n  union [\"Encounter, Performed\": \"Psychoanalysis\"]\n  union [\"Encounter, Performed\": \"Group Psychotherapy\"]\n  union [\"Encounter, Performed\": \"Telehealth Services\"] ) ValidEncounter\n  where exists ( ValidEncounter.diagnoses EncounterDiagnosis\n      where EncounterDiagnosis.code in \"Major Depressive Disorder-Active\")\n    and ValidEncounter.relevantPeriod during \"Measurement Period\"","None","Patient visits with an assessment for suicide risk","\"Major Depressive Disorder Encounter\" MDDEncounter\n  with [\"Intervention, Performed\": \"Suicide risk assessment (procedure)\"] SuicideRiskAssessment\n    such that SuicideRiskAssessment.relevantDatetime during MDDEncounter.relevantPeriod\n\n( [\"Encounter, Performed\": \"Office Visit\"]\n  union [\"Encounter, Performed\": \"Outpatient Consultation\"]\n  union [\"Encounter, Performed\": \"Psych Visit - Diagnostic Evaluation\"]\n  union [\"Encounter, Performed\": \"Psych Visit - Family Psychotherapy\"]\n  union [\"Encounter, Performed\": \"Psych Visit - Psychotherapy\"]\n  union [\"Encounter, Performed\": \"Psychoanalysis\"]\n  union [\"Encounter, Performed\": \"Group Psychotherapy\"]\n  union [\"Encounter, Performed\": \"Telehealth Services\"] ) ValidEncounter\n  where exists ( ValidEncounter.diagnoses EncounterDiagnosis\n      where EncounterDiagnosis.code in \"Major Depressive Disorder-Active\")\n    and ValidEncounter.relevantPeriod during \"Measurement Period\"","None",null,"Definitions:\nNumerator Definition: The specific type and magnitude of the suicide risk assessment is intended to be at the discretion of the individual clinician and should be specific to the needs of the patient. At a minimum, suicide risk assessment should evaluate:\n1. Risk (e.g., age, sex, stressors, comorbid conditions, hopelessness, impulsivity) and protective factors (e.g., religious belief, concern not to hurt family) that may influence the desire to attempt suicide.\n2. Current severity of suicidality.\n3. Most severe point of suicidality in episode and lifetime.\n \nLow burden tools to track suicidal ideation and behavior such as the Columbia-Suicidal Severity Rating Scale can also be used. Because no validated assessment tool or instrument fully meets the aforementioned requirements for the suicide risk assessment, individual tools or instruments have not been explicitly included in coding.\n\n\nGuidance:\nThis eCQM is an episode-based measure. A suicide risk assessment should be performed at every visit for major depressive disorder during the measurement period. \n\nIn recognition of the growing use of integrated and team-based care, the diagnosis of depression and the assessment for suicide risk need not be performed by the same provider or clinician. \n\nSuicide risk assessments completed via telehealth services can also meet numerator performance. \n\nThis measure is an episode-of-care measure; the level of analysis for this measure is every visit for major depressive disorder during the measurement period. For example, at every visit for MDD, the patient should have a suicide risk assessment.\n\nUse of a standardized tool(s) or instrument(s) to assess suicide risk will meet numerator performance, so long as the minimum criteria noted above is evaluated. Standardized tools can be mapped to the concept \"Intervention, Performed\": \"Suicide risk assessment (procedure)\" included in the numerator logic below, as no individual suicide risk assessment tool or instrument would satisfy the requirements alone.\n\nThis version of the eCQM uses QDM version 5.5.  Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.","M1-305","Yes","Medicare and Medicaid Electronic Health Record Incentive Program for Eligible Professionals (Unknown), Merit-Based Incentive Payment System (MIPS) Program (Active), Medicaid (Inactive)"]
["B2-107","B2-107",null,"DPP for BHS","B2 - Percent Increase","Adult Major Depressive Disorder (MDD): Suicide Risk Assessment ","Process","Y","01/01/21 - 06/30/21","Data Reporting & Status Update","Precentage increase Nov 21 - April 22","N",null,null,null,"Y","01/01/21 - 12/31/21","Data Reporting & Status Update",null,"N",null,null,null,"Medicaid","Medicaid, Uninsured, Other","IOS","NA","NA","NA","CMHC","0104","AMA-PCPI","eCQM - CMS161v9","https://ecqi.healthit.gov/ecqm/ep/2021/cms161v9","All patient visits during which a new diagnosis of MDD or a new diagnosis of recurrent MDD was identified for patients aged 18 years and older with a suicide risk assessment completed during the visit","Pyschiatry, Mental/Behavioral Health","Pyschiatry, Mental/Behavioral Health",null,"Encounters","Patient visits during which a new diagnosis of MDD, single or recurrent episode, was identified","\"Initial Population\"\n\n\"New or Recurrent Major Depressive Disorder Encounter\" NewOrRecurrentMDDEncounter\n  with [\"Patient Characteristic Birthdate\": \"Birth date\"] BirthDate\n    such that Global.\"CalendarAgeInYearsAt\" ( BirthDate.birthDatetime, start of \"Measurement Period\" ) >= 17\n\n\"Major Depressive Disorder Encounter\" NewOrRecurrentMDDEncounter\n  without \"Major Depressive Disorder Encounter\" PriorMDDEpisodeEncounter\n    such that PriorMDDEpisodeEncounter !~ NewOrRecurrentMDDEncounter\n      and PriorMDDEpisodeEncounter.relevantPeriod ends 104 days or less before day of start of NewOrRecurrentMDDEncounter.relevantPeriod\n  where NewOrRecurrentMDDEncounter.relevantPeriod during \"Measurement Period\"\n\n( [\"Encounter, Performed\": \"Psych Visit - Diagnostic Evaluation\"]\n  union [\"Encounter, Performed\": \"Emergency Department Visit\"]\n  union [\"Encounter, Performed\": \"Office Visit\"]\n  union [\"Encounter, Performed\": \"Outpatient Consultation\"]\n  union [\"Encounter, Performed\": \"Psych Visit - Psychotherapy\"]\n  union [\"Encounter, Performed\": \"Psychoanalysis\"]\n  union [\"Encounter, Performed\": \"Telehealth Services\"] ) ValidEncounter\n  where exists ( ValidEncounter.diagnoses EncounterDiagnosis\n      where EncounterDiagnosis.code in \"Major Depressive Disorder-Active\")","None","Patient visits during which a new diagnosis of MDD, single or recurrent episode, was identified and a suicide risk assessment was completed during the visit","\"New or Recurrent Major Depressive Disorder Encounter\" NewOrRecurrentMDDEncounter\n  with [\"Intervention, Performed\": \"Suicide risk assessment (procedure)\"] SuicideRiskAssessment\n    such that SuicideRiskAssessment.relevantDatetime during NewOrRecurrentMDDEncounter.relevantPeriod\n\n\"Major Depressive Disorder Encounter\" NewOrRecurrentMDDEncounter\n  without \"Major Depressive Disorder Encounter\" PriorMDDEpisodeEncounter\n    such that PriorMDDEpisodeEncounter !~ NewOrRecurrentMDDEncounter\n      and PriorMDDEpisodeEncounter.relevantPeriod ends 104 days or less before day of start of NewOrRecurrentMDDEncounter.relevantPeriod\n  where NewOrRecurrentMDDEncounter.relevantPeriod during \"Measurement Period\"\n\n( [\"Encounter, Performed\": \"Psych Visit - Diagnostic Evaluation\"]\n  union [\"Encounter, Performed\": \"Emergency Department Visit\"]\n  union [\"Encounter, Performed\": \"Office Visit\"]\n  union [\"Encounter, Performed\": \"Outpatient Consultation\"]\n  union [\"Encounter, Performed\": \"Psych Visit - Psychotherapy\"]\n  union [\"Encounter, Performed\": \"Psychoanalysis\"]\n  union [\"Encounter, Performed\": \"Telehealth Services\"] ) ValidEncounter\n  where exists ( ValidEncounter.diagnoses EncounterDiagnosis\n      where EncounterDiagnosis.code in \"Major Depressive Disorder-Active\")","None",null,"Definitions:\nThe specific type and magnitude of the suicide risk assessment is intended to be at the discretion of the individual clinician and should be specific to the needs of the patient. At a minimum, suicide risk assessment should evaluate:\n1) Suicidal ideation\n2) Patient's intent of initiating a suicide attempt\nAND, if either is present,\n3) Patient plans for a suicide attempt\n4) Whether the patient has means for completing suicide\n\nLow burden tools to track suicidal ideation and behavior such as the Columbia-Suicide Severity Rating Scale (C-SSRS) and the Suicide Assessment Five-Step Evaluation and Triage (SAFE-T) can also be used. Because no validated assessment tool or instrument fully meets the aforementioned requirements for the suicide risk assessment, individual tools or instruments have not been explicitly included in coding.\n\n\nGuidance:\nThis eCQM is an episode-of-care measure and should be reported for each instance of a new or recurrent episode of major depressive disorder (MDD); every new or recurrent episode will count separately in the Initial Population.\n\nAs the guidelines state, it is important to assess for additional factors which may increase or decrease suicide risk, such as presence of additional symptoms (e.g., psychosis, severe anxiety, hopelessness, severe chronic pain); presence of substance abuse, history and seriousness of previous attempts, particularly, recent suicidal behavior, current stressors and potential protective factors (e.g., positive reasons for living, strong social support), family history of suicide or mental illness or recent exposure to suicide, impulsivity and potential for risk to others, including history of violence or violent or homicidal ideas, plans, or intentions, and putting one's affairs in order (e.g., giving away possessions, writing a will). In addition, although the measure focuses on the initial visit, it is critical that suicide risk be monitored especially for the 90 days following the initial visit and throughout MDD treatment.\n\nIt is expected that a suicide risk assessment will be completed at the visit during which a new diagnosis is made or at the visit during which a recurrent episode is first identified (i.e., at the initial evaluation). For the purposes of this measure, an episode of major depressive disorder (MDD) would be considered to be recurrent if a patient has not had an MDD-related encounter in the past 105 days. If there is a gap of 105 or more days between visits for major depressive disorder (MDD), that would imply a recurrent episode. The 105-day look-back period is an operational provision and not a clinical recommendation, or definition of relapse, remission, or recurrence.\n\nIn recognition of the growing use of integrated and team-based care, the diagnosis of depression and the assessment for suicide risk need not be performed by the same provider or clinician.\n\nSuicide risk assessments completed via telehealth services can also meet numerator performance.\n\nUse of a standardized tool(s) or instrument(s) to assess suicide risk will meet numerator performance. Standardized tools can be mapped to the concept \"Intervention, Performed\": \"Suicide risk assessment (procedure)\" included in the numerator logic below.\n\nThe logic statement for the age requirement, as written, captures patients who turn 18 years old during the measurement period so that these patients are included in the measure, so long as the minimum criteria noted above is evaluated. To ensure all patients with major depressive disorder (MDD) are assessed for suicide risk, there are two clinical quality measures addressing suicide risk assessment; CMS 177 covers children and adolescents aged 6 through 17, and CMS 161 covers the adult population aged 18 years and older, as no individual suicide risk assessment tool or instrument would satisfy the requirements alone.\n\nThis version of the eCQM uses QDM version 5.5.  Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.","M1-319","Yes","MIPS, Medicaid Promoting Interoperability Program for Eligible Professionals, Medicare Electronic Health Records Incentive Program"]
["B2-108","B2-108",null,"DPP for BHS","B2 - Percent Increase","Follow-Up After Hospitalization for Mental Illness 7-Day (discharges from state hospital)","Outcome","Y","01/01/21 - 06/30/21","Data Reporting & Status Update","Precentage increase Nov 21 - April 22","N",null,null,null,"Y","01/01/21 - 12/31/21","Data Reporting & Status Update",null,"N",null,null,null,"Medicaid","Medicaid, Uninsured, Other","Benchmark","NCQA Quality Compass HEDIS 2020 (2019)","NA",59.38,"CMHC","0576","NCQA","CMS MIPS #391 2020","https://qpp-cm-prod-content.s3.amazonaws.com/uploads/786/2020+CQM+Specifications+and+Supporting+Docs.zip","The percentage of discharges for patients 6 years of age and older who were hospitalized for treatment of selected mental illness or intentional self-harm diagnoses and who had a follow-up visit. The percentage of discharges for which the patient received follow-up within 7 days after discharge.","Discharges from state hospitals","Discharges from state hospitals",null,"Encounters","Patients 6 years of age and older who were discharged from an acute inpatient setting (including acute care psychiatric facilities) with a principal diagnosis of mental illness or intentional self-harm on or between January 1 and December 1 of the measurement period","Patients aged 6 years and older as of the date of discharge\nAND\nDiagnosis for mental illness (ICD-10-CM): F20.0, F20.1, F20.2, F20.3, F20.5, F20.81, F20.89, F20.9, F21, F22, F23, F24, F25.0, F25.1, F25.8, F25.9, F28, F29, F30.10, F30.11, F30.12, F30.13, F30.2, F30.3, F30.4, F30.8, F30.9, F31.0, F31.10, F31.11, F31.12, F31.13, F31.2, F31.30, F31.31, F31.32, F31.4, F31.5, F31.60, F31.61, F31.62, F31.63, F31.64, F31.70, F31.71, F31.72, F31.73, F31.74, F31.75, F31.76, F31.77, F31.78, F31.81, F31.89, F31.9, F32.0, F32.1, F32.2, F32.3, F32.4, F32.5, F32.8, F32.81, F32.89, F32.9, F33.0, F33.1,\nF33.2, F33.3, F33.40, F33.41, F33.42, F33.8, F33.9, F34.0, F34.1, F34.8, F34.81, F34.89, F34.9, F39, F42, F42.2, F42.3, F42.4, F42.8, F42.9, F43.0, F43.10, F43.11, F43.12, F43.20, F43.21, F43.22, F43.23, F43.24, F43.25, F43.29, F43.8, F43.9, F44.89, F53, F53.0, F53.1, F60.0, F60.1, F60.2, F60.3, F60.4, F60.5, F60.6, F60.7, F60.81, F60.89, F60.9, F63.0, F63.1, F63.2, F63.3, F63.81, F63.89, F63.9, F68.10, F68.11, F68.12, F68.13, F68.8, F68.A, F84.0, F84.2, F84.3, F84.5, F84.8, F84.9, F90.0, F90.1, F90.2, F90.8, F90.9, F91.0,\nF91.1, F91.2, F91.3, F91.8, F91.9, F93.0, F93.8, F93.9, F94.0, F94.1, F94.2, F94.8, F94.9 \nOR\nDiagnosis of intentional self-harm (ICD-10-CM): T14.91XA, T14.91XD, T14.91XS, T36.0X2A, T36.0X2D, T36.0X2S, T36.1X2A, T36.1X2D, T36.1X2S, T36.2X2A, T36.2X2D, T36.2X2S, T36.3X2A, T36.3X2D, T36.3X2S, T36.4X2A, T36.4X2D, T36.4X2S, T36.5X2A, T36.5X2D, T36.5X2S, T36.6X2A, T36.6X2D, T36.6X2S, T36.7X2A, T36.7X2D, T36.7X2S, T36.8X2A, T36.8X2D, T36.8X2S, T36.92XA, T36.92XD, T36.92XS, T37.0X2A, T37.0X2D, T37.0X2S, T37.1X2A, T37.1X2D, T37.1X2S, T37.2X2A, T37.2X2D, T37.2X2S, T37.3X2A, T37.3X2D, T37.3X2S, T37.4X2A, T37.4X2D, T37.4X2S, T37.5X2A, T37.5X2D, T37.5X2S, T37.8X2A, T37.8X2D, T37.8X2S, T37.92XA, T37.92XD, T37.92XS, T38.0X2A, T38.0X2D, T38.0X2S, T38.1X2A, T38.1X2D, T38.1X2S, T38.2X2A,T38.2X2D, T38.2X2S, T38.3X2A, T38.3X2D, T38.3X2S, T38.4X2A, T38.4X2D, T38.4X2S, T38.5X2A, T38.5X2D, T38.5X2S, T38.6X2A, T38.6X2D, T38.6X2S, T38.7X2A, T38.7X2D, T38.7X2S, T38.802A, T38.802D, T38.802S, T38.812A, T38.812D, T38.812S, T38.892A, T38.892D, T38.892S, T38.902A, T38.902D, T38.902S, T38.992A, T38.992D, T38.992S, T39.012A, T39.012D, T39.012S, T39.092A, T39.092D, T39.092S, T39.1X2A, T39.1X2D, T39.1X2S, T39.2X2A, T39.2X2D, T39.2X2S, T39.312A, T39.312D, T39.312S, T39.392A, T39.392D, T39.392S, T39.4X2A, T39.4X2D, T39.4X2S, T39.8X2A, T39.8X2D, T39.8X2S, T39.92XA, T39.92XD, T39.92XS, T40.0X2A, T40.0X2D, T40.0X2S, T40.1X2A, T40.1X2D, T40.1X2S, T40.2X2A, T40.2X2D, T40.2X2S, T40.3X2A, T40.3X2D, T40.3X2S, T40.4X2A, T40.4X2D, T40.4X2S, T40.5X2A, T40.5X2D, T40.5X2S, T40.602A, T40.602D, T40.602S, T40.692A, T40.692D, T40.692S, T40.7X2A, T40.7X2D, T40.7X2S, T40.8X2A, T40.8X2D, T40.8X2S, T40.902A, T40.902D, T40.902S, T40.992A, T40.992D, T40.992S, T41.0X2A, T41.0X2D, T41.0X2S, T41.1X2A, T41.1X2D, T41.1X2S, T41.202A, T41.202D, T41.202S, T41.292A, T41.292D, T41.292S, T41.3X2A, T41.3X2D, T41.3X2S, T41.42XA, T41.42XD, T41.42XS, T41.5X2A, T41.5X2D, T41.5X2S, T42.0X2A, T42.0X2D, T42.0X2S, T42.1X2A, T42.1X2D, T42.1X2S, T42.2X2A, T42.2X2D, T42.2X2S, T42.3X2A, T42.3X2D, T42.3X2S, T42.4X2A, T42.4X2D, T42.4X2S, T42.5X2A, T42.5X2D, T42.5X2S, T42.6X2A, T42.6X2D, T42.6X2S, T42.72XA, T42.72XD, T42.72XS, T42.8X2A, T42.8X2D, T42.8X2S, T43.012A, T43.012D, T43.012S, T43.022A, T43.022D, T43.022S, T43.1X2A, T43.1X2D, T43.1X2S, T43.202A, T43.202D, T43.202S, T43.212A, T43.212D, T43.212S, T43.222A, T43.222D, T43.222S, T43.292A, T43.292D, T43.292S, T43.3X2A, T43.3X2D, T43.3X2S, T43.4X2A, T43.4X2D, T43.4X2S, T43.502A, T43.502D, T43.502S, T43.592A, T43.592D, T43.592S, T43.602A, T43.602D, T43.602S, T43.612A, T43.612D, T43.612S, T43.622A, T43.622D, T43.622S, T43.632A, T43.632D, T43.632S, T43.642A, T43.642D, T43.642S, T43.692A, T43.692D, T43.692S, T43.8X2A, T43.8X2D, T43.8X2S, T43.92XA, T43.92XD, T43.92XS, T44.0X2A, T44.0X2D, T44.0X2S, T44.1X2A, T44.1X2D, T44.1X2S, T44.2X2A, T44.2X2D, T44.2X2S, T44.3X2A, T44.3X2D, T44.3X2S, T44.4X2A, T44.4X2D, T44.4X2S, T44.5X2A, T44.5X2D, T44.5X2S, T44.6X2A, T44.6X2D, T44.6X2S, T44.7X2A, T44.7X2D, T44.7X2S, T44.8X2A, T44.8X2D, T44.8X2S, T44.902A, T44.902D, T44.902S, T44.992A, T44.992D, T44.992S, T45.0X2A, T45.0X2D, T45.0X2S, T45.1X2A, T45.1X2D, T45.1X2S, T45.2X2A, T45.2X2D, T45.2X2S, T45.3X2A, T45.3X2D, T45.3X2S, T45.4X2A, T45.4X2D, T45.4X2S, T45.512A, T45.512D, T45.512S, T45.522A, T45.522D, T45.522S, T45.602A, T45.602D, T45.602S, T45.612A, T45.612D, T45.612S, T45.622A, T45.622D, T45.622S, T45.692A, T45.692D, T45.692S, T45.7X2A, T45.7X2D, T45.7X2S, T45.8X2A, T45.8X2D, T45.8X2S, T45.92XA, T45.92XD, T45.92XS, T46.0X2A, T46.0X2D, T46.0X2S, T46.1X2A, T46.1X2D, T46.1X2S, T46.2X2A, T46.2X2D, T46.2X2S, T46.3X2A, T46.3X2D, T46.3X2S, T46.4X2A, T46.4X2D, T46.4X2S, T46.5X2A, T46.5X2D, T46.5X2S, T46.6X2A, T46.6X2D, T46.6X2S, T46.7X2A, T46.7X2D, T46.7X2S, T46.8X2A, T46.8X2D, T46.8X2S, T46.902A, T46.902D, T46.902S, T46.992A, T46.992D, T46.992S, T47.0X2A, T47.0X2D, T47.0X2S, T47.1X2A, T47.1X2D, T47.1X2S, T47.2X2A, T47.2X2D, T47.2X2S, T47.3X2A, T47.3X2D, T47.3X2S, T47.4X2A, T47.4X2D, T47.4X2S, T47.5X2A, T47.5X2D, T47.5X2S, T47.6X2A, T47.6X2D, T47.6X2S, T47.7X2A, T47.7X2D, T47.7X2S, T47.8X2A, T47.8X2D, T47.8X2S, T47.92XA, T47.92XD, T47.92XS, T48.0X2A, T48.0X2D, T48.0X2S, T48.1X2A, T48.1X2D, T48.1X2S, T48.202A, T48.202D, T48.202S, T48.292A, T48.292D, T48.292S, T48.3X2A, T48.3X2D, T48.3X2S, T48.4X2A, T48.4X2D, T48.4X2S, T48.5X2A, T48.5X2D, T48.5X2S, T48.6X2A, T48.6X2D, T48.6X2S, T48.902A, T48.902D, T48.902S, T48.992A, T48.992D, T48.992S, T49.0X2A, T49.0X2D, T49.0X2S, T49.1X2A, T49.1X2D, T49.1X2S, T49.2X2A, T49.2X2D, T49.2X2S, T49.3X2A, T49.3X2D, T49.3X2S, T49.4X2A, T49.4X2D, T49.4X2S, T49.5X2A, T49.5X2D, T49.5X2S, T49.6X2A, T49.6X2D, T49.6X2S, T49.7X2A, T49.7X2D, T49.7X2S, T49.8X2A, T49.8X2D, T49.8X2S, T49.92XA, T49.92XD, T49.92XS, T50.0X2A, T50.0X2D, T50.0X2S, T50.1X2A, T50.1X2D, T50.1X2S, T50.2X2A, T50.2X2D, T50.2X2S, T50.3X2A, T50.3X2D, T50.3X2S, T50.4X2A, T50.4X2D, T50.4X2S, T50.5X2A, T50.5X2D, T50.5X2S, T50.6X2A, T50.6X2D, T50.6X2S, T50.7X2A, T50.7X2D, T50.7X2S, T50.8X2A, T50.8X2D, T50.8X2S, T50.902A, T50.902D, T50.902S, T50.992A, T50.992D, T50.992S, T50.A12A, T50.A12D, T50.A12S, T50.A22A, T50.A22D, T50.A22S, T50.A92A, T50.A92D, T50.A92S, T50.B12A, T50.B12D, T50.B12S, T50.B92A, T50.B92D, T50.B92S, T50.Z12A, T50.Z12D, T50.Z12S, T50.Z92A, T50.Z92D, T50.Z92S, T51.0X2A, T51.0X2D, T51.0X2S, T51.1X2A, T51.1X2D, T51.1X2S, T51.2X2A, T51.2X2D, T51.2X2S, T51.3X2A, T51.3X2D, T51.3X2S, T51.8X2A, T51.8X2D, T51.8X2S, T51.92XA, T51.92XD, T51.92XS, T52.0X2A, T52.0X2D, T52.0X2S, T52.1X2A, T52.1X2D, T52.1X2S, T52.2X2A, T52.2X2D, T52.2X2S, T52.3X2A, T52.3X2D, T52.3X2S, T52.4X2A, T52.4X2D, T52.4X2S, T52.8X2A, T52.8X2D, T52.8X2S, T52.92XA, T52.92XD, T52.92XS, T53.0X2A, T53.0X2D, T53.0X2S, T53.1X2A, T53.1X2D, T53.1X2S, T53.2X2A, T53.2X2D, T53.2X2S, T53.3X2A, T53.3X2D, T53.3X2S, T53.4X2A, T53.4X2D, T53.4X2S, T53.5X2A, T53.5X2D, T53.5X2S, T53.6X2A, T53.6X2D, T53.6X2S, T53.7X2A, T53.7X2D, T53.7X2S, T53.92XA, T53.92XD, T53.92XS, T54.0X2A, T54.0X2D, T54.0X2S, T54.1X2A, T54.1X2D, T54.1X2S, T54.2X2A, T54.2X2D, T54.2X2S, T54.3X2A, T54.3X2D, T54.3X2S, T54.92XA, T54.92XD, T54.92XS, T55.0X2A, T55.0X2D, T55.0X2S, T55.1X2A, T55.1X2D, T55.1X2S, T56.0X2A, T56.0X2D, T56.0X2S, T56.1X2A, T56.1X2D, T56.1X2S, T56.2X2A, T56.2X2D, T56.2X2S, T56.3X2A, T56.3X2D, T56.3X2S, T56.4X2A, T56.4X2D, T56.4X2S, T56.5X2A, T56.5X2D, T56.5X2S, T56.6X2A, T56.6X2D, T56.6X2S, T56.7X2A, T56.7X2D, T56.7X2S, T56.812A, T56.812D, T56.812S, T56.892A, T56.892D, T56.892S, T56.92XA, T56.92XD, T56.92XS, T57.0X2A, T57.0X2D, T57.0X2S, T57.1X2A, T57.1X2D, T57.1X2S, T57.2X2A, T57.2X2D, T57.2X2S, T57.3X2A, T57.3X2D, T57.3X2S, T57.8X2A, T57.8X2D, T57.8X2S, T57.92XA, T57.92XD, T57.92XS, T58.02XA, T58.02XD, T58.02XS, T58.12XA, T58.12XD, T58.12XS, T58.2X2A, T58.2X2D, T58.2X2S, T58.8X2A, T58.8X2D, T58.8X2S, T58.92XA, T58.92XD, T58.92XS, T59.0X2A, T59.0X2D, T59.0X2S, T59.1X2A, T59.1X2D, T59.1X2S, T59.2X2A, T59.2X2D, T59.2X2S, T59.3X2A, T59.3X2D, T59.3X2S, T59.4X2A, T59.4X2D, T59.4X2S, T59.5X2A, T59.5X2D, T59.5X2S, T59.6X2A, T59.6X2D, T59.6X2S, T59.7X2A, T59.7X2D, T59.7X2S, T59.812A, T59.812D, T59.812S, T59.892A, T59.892D, T59.892S, T59.92XA, T59.92XD, T59.92XS, T60.0X2A, T60.0X2D, T60.0X2S, T60.1X2A, T60.1X2D, T60.1X2S, T60.2X2A, T60.2X2D, T60.2X2S, T60.3X2A, T60.3X2D, T60.3X2S, T60.4X2A, T60.4X2D, T60.4X2S, T60.8X2A, T60.8X2D, T60.8X2S, T60.92XA, T60.92XD, T60.92XS, T61.02XA, T61.02XD, T61.02XS, T61.12XA, T61.12XD, T61.12XS, T61.772A, T61.772D, T61.772S, T61.782A, T61.782D, T61.782S, T61.8X2A, T61.8X2D, T61.8X2S, T61.92XA, T61.92XD, T61.92XS, T62.0X2A, T62.0X2D, T62.0X2S, T62.1X2A, T62.1X2D, T62.1X2S, T62.2X2A, T62.2X2D, T62.2X2S, T62.8X2A, T62.8X2D, T62.8X2S, T62.92XA, T62.92XD, T62.92XS, T63.002A, T63.002D, T63.002S T63.012A, T63.012D, T63.012S, T63.022A, T63.022D, T63.022S, T63.032A, T63.032D, T63.032S, T63.042A, T63.042D, T63.042S, T63.062A, T63.062D, T63.062S, T63.072A, T63.072D, T63.072S, T63.082A, T63.082D, T63.082S, T63.092A, T63.092D, T63.092S, T63.112A, T63.112D, T63.112S, T63.122A, T63.122D, T63.122S, T63.192A, T63.192D, T63.192S, T63.2X2A, T63.2X2D, T63.2X2S, T63.302A, T63.302D, T63.302S, T63.312A, T63.312D, T63.312S, T63.322A, T63.322D, T63.322S, T63.332A, T63.332D, T63.332S, T63.392A, T63.392D, T63.392S, T63.412A, T63.412D, T63.412S, T63.422A, T63.422D, T63.422S, T63.432A, T63.432D, T63.432S, T63.442A, T63.442D, T63.442S, T63.452A, T63.452D, T63.452S, T63.462A, T63.462D, T63.462S, T63.482A, T63.482D, T63.482S, T63.512A, T63.512D, T63.512S, T63.592A, T63.592D, T63.592S, T63.612A, T63.612D, T63.612S, T63.622A, T63.622D, T63.622S, T63.632A, T63.632D, T63.632S, T63.692A, T63.692D, T63.692S, T63.712A, T63.712D, T63.712S, T63.792A, T63.792D, T63.792S, T63.812A, T63.812D, T63.812S, T63.822A, T63.822D, T63.822S, T63.832A, T63.832D, T63.832S, T63.892A, T63.892D, T63.892S, T63.92XA, T63.92XD, T63.92XS, T64.02XA, T64.02XD, T64.02XS, T64.82XA, T64.82XD, T64.82XS, T65.0X2A, T65.0X2D, T65.0X2S, T65.1X2A, T65.1X2D, T65.1X2S, T65.212A, T65.212D, T65.212S, T65.222A, T65.222D, T65.222S, T65.292A, T65.292D, T65.292S, T65.3X2A, T65.3X2D, T65.3X2S, T65.4X2A, T65.4X2D, T65.4X2S, T65.5X2A, T65.5X2D, T65.5X2S, T65.6X2A, T65.6X2D, T65.6X2S, T65.812A, T65.812D, T65.812S, T65.822A, T65.822D, T65.822S, T65.832A, T65.832D, T65.832S, T65.892A, T65.892D, T65.892S, T65.92XA, T65.92XD, T65.92XS, T71.112A, T71.112D, T71.112S, T71.122A, T71.122D, T71.122S, T71.132A, T71.132D, T71.132S, T71.152A, T71.152D, T71.152S, T71.162A, T71.162D, T71.162S, T71.192A, T71.192D, T71.192S, T71.222A, T71.222D, T71.222S, T71.232A, T71.232D, T71.232S, T50.911, T50.912, T50.913, T50.914, T50.915, T50.916 \nAND\nPatient encounter during the performance period (CPT): 99221, 99222, 99223, 99231, 99232, 99233, 99238, 99239, 99291\nAND\nPatient alive at time of acute inpatient setting discharge\nAND\nPatient is discharged from an acute inpatient setting on or between January 1 and December 1 of the measurement period","Exclude discharges followed by readmission or direct transfer to a non-acute facility within the 30- day follow-up period, regardless of principal diagnosis for the readmission.\nExclude discharges followed by readmission or direct transfer to an acute facility within the 30-day follow-up period if the principal diagnosis was for non-mental health.\nClinician documented reason patient was not able to complete 7 day follow-up from acute inpatient setting discharge (i.e., patient death prior to follow-up visit, patient non-compliance for visit follow-up) (G9406)\nPatients who use hospice services any time during the measurement period (G9760)","A follow-up visit with a mental health provider within 7 days after acute inpatient discharge. Do not include visits that occur on the date of discharge (G9405)","Patient received follow-up within 7 days after discharge (G9405)","Patient did not receive follow-up within 7 days after discharge (G9407)","Providers are only reporting rate 2 of the MIPS measure for follow-up within 7 days after discharge.","An eligible provider is one who delivers mental health services and meets any of the following criteria:\n• An MD or doctor of osteopathy (DO) who is certified as a psychiatrist or child psychiatrist by the American Medical Specialties Board of Psychiatry and Neurology or by the American Osteopathic Board of Neurology and Psychiatry; or, if not certified, who successfully completed an accredited program of graduate medical or osteopathic education in psychiatry or child psychiatry and is licensed to practice patient care psychiatry or child psychiatry, if required by the state of practice.\n• An individual who is licensed as a psychologist in his/her state of practice, if required by the state of practice.\n• An individual who is certified in clinical social work by the American Board of Examiners; who is listed on the National Association of Social Worker’s Clinical Register; or who has a master’s degree in social work and is licensed or certified to practice as a social worker, if required by the state of practice.\n• A registered nurse (RN) who is certified by the American Nurses Credentialing Center (a subsidiary of the American Nurses Association) as a psychiatric nurse or mental health clinical nurse specialist, or who has a master’s degree in nursing with a specialization in\npsychiatric/mental health and two years of supervised clinical experience and is licensed to practice as a psychiatric or mental health nurse, if required by the state of practice.\n• An individual (normally with a master’s or a doctoral degree in marital and family therapy and at least two years of supervised clinical experience) who is practicing as a marital and family therapist and is licensed or a certified counselor by the state of practice, or if licensure or certification is not required by the state of practice, who is eligible for clinical membership in the American Association for Marriage and Family Therapy.\n• An individual (normally with a master’s or doctoral degree in counseling and at least two years of supervised clinical experience) who is practicing as a professional counselor and who is licensed or certified to do so by the state of practice, or if licensure or certification is not required by the state of practice, is a National Certified Counselor with a Specialty Certification in Clinical Mental Health Counseling from the National Board for Certified Counselors (NBCC).\n• A certified Community Mental Health Center (CMHC), or the comparable term (e.g. behavioral health organization, mental health agency, behavioral health agency) used within the state in which it is located, or a Certified Community Behavioral Health Clinic (CCBHC).\nOnly authorized CMHCs are considered mental health providers. To be authorized as a CMHC, an entity must meet one of the following criteria:\n- The entity has been certified by CMS to meet the conditions of participation (CoPs) that community mental health centers (CMHCs) must meet in order to participate in the Medicare program, as defined in the Code of Federal Regulations Title 42. CMS defines a\nCMHC as an entity that meets applicable licensing or certification requirements for CMHCs in the State in which it is located and provides the set of services specified in section 1913(c)(1) of the Public Health Service Act (PHS Act).\n- The entity has been licensed, operated, authorized, or otherwise recognized by a state or county in which it is located.\nOnly authorized CCBHCs are considered mental health providers. To be authorized as a CCBHC, an entity must meet one of the following criteria:\n- Has been certified by a State Medicaid agency as meeting criteria established by the Secretary for participation in the Medicaid CCBHC demonstration program pursuant to Protecting Access to Medicare Act § 223(a) (42 U.S.C. § 1396a note); or as meeting\ncriteria within the State’s Medicaid Plan to be considered a CCBHC.\n- Has been recognized by the Substance Abuse and Mental Health Services Administration, through the award of grant funds or otherwise, as a CCBHC that meets the certification criteria of a Certified Community Behavioral Health Clinic","M1-160","Yes","Inpatient Psychiatric Facility Quality Reporting\nMerit-Based Incentive Payment System (MIPS) Program\nCMS Medicaid Adult and Child Core Set\nMarketplace Quality Rating System (QRS)\nNQF CQMC Consensus Core Set: Behavioral Health\n"]
["B2-109","B2-109",null,"DPP for BHS","B2 - Percent Increase","Follow-Up after Hospitalization for Mental Illness 30-Day (discharges from state hospital)","Outcome","Y","01/01/21 - 06/30/21","Data Reporting & Status Update","Precentage increase Nov 21 - April 22","N",null,null,null,"Y","01/01/21 - 12/31/21","Data Reporting & Status Update",null,"N",null,null,null,"Medicaid","Medicaid, Uninsured, Other","Benchmark","NCQA Quality Compass HEDIS 2020 (2019)","NA",36.78,"CMHC","0576","NCQA","CMS MIPS #391 2020","https://qpp-cm-prod-content.s3.amazonaws.com/uploads/786/2020+CQM+Specifications+and+Supporting+Docs.zip","The percentage of discharges for patients 6 years of age and older who were hospitalized for treatment of selected mental illness or intentional self-harm diagnoses and who had a follow-up visit. The percentage of discharges for which the patient received follow-up within 30 days after discharge","Discharges from state hospitals","Discharges from state hospitals",null,"Encounters","Patients 6 years of age and older who were discharged from an acute inpatient setting (including acute care psychiatric facilities) with a principal diagnosis of mental illness or intentional self-harm on or between January 1 and December 1 of the measurement period","Patients aged 6 years and older as of the date of discharge\nAND\nDiagnosis for mental illness (ICD-10-CM): F20.0, F20.1, F20.2, F20.3, F20.5, F20.81, F20.89, F20.9, F21,\nF22, F23, F24, F25.0, F25.1, F25.8, F25.9, F28, F29, F30.10, F30.11, F30.12, F30.13, F30.2, F30.3, F30.4,\nF30.8, F30.9, F31.0, F31.10, F31.11, F31.12, F31.13, F31.2, F31.30, F31.31, F31.32, F31.4, F31.5, F31.60,\nF31.61, F31.62, F31.63, F31.64, F31.70, F31.71, F31.72, F31.73, F31.74, F31.75, F31.76, F31.77, F31.78,\nF31.81, F31.89, F31.9, F32.0, F32.1, F32.2, F32.3, F32.4, F32.5, F32.8, F32.81, F32.89, F32.9, F33.0, F33.1,\nF33.2,F33.3, F33.40, F33.41, F33.42, F33.8, F33.9, F34.0, F34.1, F34.8, F34.81, F34.89, F34.9, F39, F42,\nF42.2, F42.3, F42.4, F42.8, F42.9, F43.0, F43.10, F43.11, F43.12, F43.20, F43.21, F43.22, F43.23, F43.24,\nF43.25, F43.29, F43.8, F43.9, F44.89, F53, F53.0, F53.1, F60.0, F60.1, F60.2, F60.3, F60.4, F60.5, F60.6,\nF60.7, F60.81, F60.89, F60.9, F63.0, F63.1, F63.2, F63.3, F63.81, F63.89, F63.9, F68.10, F68.11, F68.12,\nF68.13, F68.8, F68.A, F84.0, F84.2, F84.3, F84.5, F84.8, F84.9, F90.0, F90.1, F90.2, F90.8, F90.9, F91.0,\nF91.1, F91.2, F91.3, F91.8, F91.9, F93.0, F93.8, F93.9, F94.0, F94.1, F94.2, F94.8, F94.9\nOR\nDiagnosis of intentional self-harm (ICD-10-CM): T14.91XA, T14.91XD, T14.91XS, T36.0X2A, T36.0X2D,\nT36.0X2S, T36.1X2A, T36.1X2D, T36.1X2S, T36.2X2A, T36.2X2D, T36.2X2S, T36.3X2A, T36.3X2D,\nT36.3X2S, T36.4X2A, T36.4X2D, T36.4X2S, T36.5X2A, T36.5X2D, T36.5X2S, T36.6X2A, T36.6X2D, T36.6X2S,\nT36.7X2A, T36.7X2D, T36.7X2S, T36.8X2A, T36.8X2D, T36.8X2S, T36.92XA, T36.92XD, T36.92XS, T37.0X2A,\nT37.0X2D, T37.0X2S, T37.1X2A, T37.1X2D, T37.1X2S, T37.2X2A, T37.2X2D, T37.2X2S, T37.3X2A, T37.3X2D,\nT37.3X2S, T37.4X2A, T37.4X2D, T37.4X2S, T37.5X2A, T37.5X2D, T37.5X2S, T37.8X2A, T37.8X2D, T37.8X2S,\nT37.92XA, T37.92XD, T37.92XS, T38.0X2A, T38.0X2D, T38.0X2S, T38.1X2A, T38.1X2D, T38.1X2S, T38.2X2A,\nT38.2X2D, T38.2X2S, T38.3X2A, T38.3X2D, T38.3X2S, T38.4X2A, T38.4X2D, T38.4X2S, T38.5X2A, T38.5X2D,\nT38.5X2S, T38.6X2A, T38.6X2D, T38.6X2S, T38.7X2A, T38.7X2D, T38.7X2S, T38.802A, T38.802D, T38.802S,\nT38.812A, T38.812D, T38.812S, T38.892A, T38.892D, T38.892S, T38.902A, T38.902D, T38.902S, T38.992A,\nT38.992D, T38.992S, T39.012A, T39.012D, T39.012S, T39.092A, T39.092D, T39.092S, T39.1X2A, T39.1X2D,\nT39.1X2S, T39.2X2A, T39.2X2D, T39.2X2S, T39.312A, T39.312D, T39.312S, T39.392A, T39.392D, T39.392S,\nT39.4X2A, T39.4X2D, T39.4X2S, T39.8X2A, T39.8X2D, T39.8X2S, T39.92XA, T39.92XD, T39.92XS, T40.0X2A,\nT40.0X2D, T40.0X2S, T40.1X2A, T40.1X2D, T40.1X2S, T40.2X2A, T40.2X2D, T40.2X2S, T40.3X2A, T40.3X2D,\nT40.3X2S, T40.4X2A, T40.4X2D, T40.4X2S, T40.5X2A, T40.5X2D, T40.5X2S, T40.602A, T40.602D, T40.602S,\nT40.692A, T40.692D, T40.692S, T40.7X2A, T40.7X2D, T40.7X2S, T40.8X2A, T40.8X2D, T40.8X2S, T40.902A,\nT40.902D, T40.902S, T40.992A, T40.992D, T40.992S, T41.0X2A, T41.0X2D, T41.0X2S, T41.1X2A, T41.1X2D,\nT41.1X2S, T41.202A, T41.202D, T41.202S, T41.292A, T41.292D, T41.292S, T41.3X2A, T41.3X2D, T41.3X2S,\nT41.42XA, T41.42XD, T41.42XS, T41.5X2A, T41.5X2D, T41.5X2S, T42.0X2A, T42.0X2D, T42.0X2S, T42.1X2A,\nT42.1X2D, T42.1X2S, T42.2X2A, T42.2X2D, T42.2X2S, T42.3X2A, T42.3X2D, T42.3X2S, T42.4X2A, T42.4X2D,\nT42.4X2S, T42.5X2A, T42.5X2D, T42.5X2S, T42.6X2A, T42.6X2D, T42.6X2S, T42.72XA, T42.72XD, T42.72XS,\nT42.8X2A, T42.8X2D, T42.8X2S, T43.012A, T43.012D, T43.012S, T43.022A, T43.022D, T43.022S, T43.1X2A,\nT43.1X2D, T43.1X2S, T43.202A, T43.202D, T43.202S, T43.212A, T43.212D, T43.212S, T43.222A, T43.222D,\nT43.222S, T43.292A, T43.292D, T43.292S, T43.3X2A, T43.3X2D, T43.3X2S, T43.4X2A, T43.4X2D, T43.4X2S,\nT43.502A, T43.502D, T43.502S, T43.592A, T43.592D, T43.592S, T43.602A, T43.602D, T43.602S, T43.612A,\nT43.612D, T43.612S, T43.622A, T43.622D, T43.622S, T43.632A, T43.632D, T43.632S, T43.642A, T43.642D,\nT43.642S, T43.692A, T43.692D, T43.692S, T43.8X2A, T43.8X2D, T43.8X2S, T43.92XA, T43.92XD, T43.92XS,\nT44.0X2A, T44.0X2D, T44.0X2S, T44.1X2A, T44.1X2D, T44.1X2S, T44.2X2A, T44.2X2D, T44.2X2S, T44.3X2A,\nT44.3X2D, T44.3X2S, T44.4X2A, T44.4X2D, T44.4X2S, T44.5X2A, T44.5X2D, T44.5X2S, T44.6X2A, T44.6X2D,\nT44.6X2S, T44.7X2A, T44.7X2D, T44.7X2S, T44.8X2A, T44.8X2D, T44.8X2S, T44.902A, T44.902D, T44.902S, \nT44.992A, T44.992D, T44.992S, T45.0X2A, T45.0X2D, T45.0X2S, T45.1X2A, T45.1X2D, T45.1X2S, T45.2X2A,\nT45.2X2D, T45.2X2S, T45.3X2A, T45.3X2D, T45.3X2S, T45.4X2A, T45.4X2D, T45.4X2S, T45.512A, T45.512D,\nT45.512S, T45.522A, T45.522D, T45.522S, T45.602A, T45.602D, T45.602S, T45.612A, T45.612D, T45.612S,\nT45.622A, T45.622D, T45.622S, T45.692A, T45.692D, T45.692S, T45.7X2A, T45.7X2D, T45.7X2S, T45.8X2A,\nT45.8X2D, T45.8X2S, T45.92XA, T45.92XD, T45.92XS, T46.0X2A, T46.0X2D, T46.0X2S, T46.1X2A, T46.1X2D,\nT46.1X2S, T46.2X2A, T46.2X2D, T46.2X2S, T46.3X2A, T46.3X2D, T46.3X2S, T46.4X2A, T46.4X2D, T46.4X2S,\nT46.5X2A, T46.5X2D, T46.5X2S, T46.6X2A, T46.6X2D, T46.6X2S, T46.7X2A, T46.7X2D, T46.7X2S, T46.8X2A,\nT46.8X2D, T46.8X2S, T46.902A, T46.902D, T46.902S, T46.992A, T46.992D, T46.992S, T47.0X2A, T47.0X2D,\nT47.0X2S, T47.1X2A, T47.1X2D, T47.1X2S, T47.2X2A, T47.2X2D, T47.2X2S, T47.3X2A, T47.3X2D, T47.3X2S,\nT47.4X2A, T47.4X2D, T47.4X2S, T47.5X2A, T47.5X2D, T47.5X2S, T47.6X2A, T47.6X2D, T47.6X2S, T47.7X2A,\nT47.7X2D, T47.7X2S, T47.8X2A, T47.8X2D, T47.8X2S, T47.92XA, T47.92XD, T47.92XS, T48.0X2A, T48.0X2D,\nT48.0X2S, T48.1X2A, T48.1X2D, T48.1X2S, T48.202A, T48.202D, T48.202S, T48.292A, T48.292D, T48.292S,\nT48.3X2A, T48.3X2D, T48.3X2S, T48.4X2A, T48.4X2D, T48.4X2S, T48.5X2A, T48.5X2D, T48.5X2S, T48.6X2A,\nT48.6X2D, T48.6X2S, T48.902A, T48.902D, T48.902S, T48.992A, T48.992D, T48.992S, T49.0X2A, T49.0X2D,\nT49.0X2S, T49.1X2A, T49.1X2D, T49.1X2S, T49.2X2A, T49.2X2D, T49.2X2S, T49.3X2A, T49.3X2D, T49.3X2S,\nT49.4X2A, T49.4X2D, T49.4X2S, T49.5X2A, T49.5X2D, T49.5X2S, T49.6X2A, T49.6X2D, T49.6X2S, T49.7X2A,\nT49.7X2D, T49.7X2S, T49.8X2A, T49.8X2D, T49.8X2S, T49.92XA, T49.92XD, T49.92XS, T50.0X2A, T50.0X2D,\nT50.0X2S, T50.1X2A, T50.1X2D, T50.1X2S, T50.2X2A, T50.2X2D, T50.2X2S, T50.3X2A, T50.3X2D, T50.3X2S,\nT50.4X2A, T50.4X2D, T50.4X2S, T50.5X2A, T50.5X2D, T50.5X2S, T50.6X2A, T50.6X2D, T50.6X2S, T50.7X2A,\nT50.7X2D, T50.7X2S, T50.8X2A, T50.8X2D, T50.8X2S, T50.902A, T50.902D, T50.902S, T50.992A, T50.992D,\nT50.992S, T50.A12A, T50.A12D, T50.A12S, T50.A22A, T50.A22D, T50.A22S, T50.A92A, T50.A92D, T50.A92S,\nT50.B12A, T50.B12D, T50.B12S, T50.B92A, T50.B92D, T50.B92S, T50.Z12A, T50.Z12D, T50.Z12S, T50.Z92A,\nT50.Z92D, T50.Z92S, T51.0X2A, T51.0X2D, T51.0X2S, T51.1X2A, T51.1X2D, T51.1X2S, T51.2X2A, T51.2X2D,\nT51.2X2S, T51.3X2A, T51.3X2D, T51.3X2S, T51.8X2A, T51.8X2D, T51.8X2S, T51.92XA, T51.92XD, T51.92XS,\nT52.0X2A, T52.0X2D, T52.0X2S, T52.1X2A, T52.1X2D, T52.1X2S, T52.2X2A, T52.2X2D, T52.2X2S, T52.3X2A,\nT52.3X2D, T52.3X2S, T52.4X2A, T52.4X2D, T52.4X2S, T52.8X2A, T52.8X2D, T52.8X2S, T52.92XA, T52.92XD,\nT52.92XS, T53.0X2A, T53.0X2D, T53.0X2S, T53.1X2A, T53.1X2D, T53.1X2S, T53.2X2A, T53.2X2D, T53.2X2S,\nT53.3X2A, T53.3X2D, T53.3X2S, T53.4X2A, T53.4X2D, T53.4X2S, T53.5X2A, T53.5X2D, T53.5X2S, T53.6X2A,\nT53.6X2D, T53.6X2S, T53.7X2A, T53.7X2D, T53.7X2S, T53.92XA, T53.92XD, T53.92XS, T54.0X2A, T54.0X2D,\nT54.0X2S, T54.1X2A, T54.1X2D, T54.1X2S, T54.2X2A, T54.2X2D, T54.2X2S, T54.3X2A, T54.3X2D, T54.3X2S,\nT54.92XA, T54.92XD, T54.92XS, T55.0X2A, T55.0X2D, T55.0X2S, T55.1X2A, T55.1X2D, T55.1X2S, T56.0X2A,\nT56.0X2D, T56.0X2S, T56.1X2A, T56.1X2D, T56.1X2S, T56.2X2A, T56.2X2D, T56.2X2S, T56.3X2A, T56.3X2D,\nT56.3X2S, T56.4X2A, T56.4X2D, T56.4X2S, T56.5X2A, T56.5X2D, T56.5X2S, T56.6X2A, T56.6X2D, T56.6X2S,\nT56.7X2A, T56.7X2D, T56.7X2S, T56.812A, T56.812D, T56.812S, T56.892A, T56.892D, T56.892S, T56.92XA,\nT56.92XD, T56.92XS, T57.0X2A, T57.0X2D, T57.0X2S, T57.1X2A, T57.1X2D, T57.1X2S, T57.2X2A, T57.2X2D,\nT57.2X2S, T57.3X2A, T57.3X2D, T57.3X2S, T57.8X2A, T57.8X2D, T57.8X2S, T57.92XA, T57.92XD, T57.92XS,\nT58.02XA, T58.02XD, T58.02XS, T58.12XA, T58.12XD, T58.12XS, T58.2X2A, T58.2X2D, T58.2X2S, T58.8X2A,\nT58.8X2D, T58.8X2S, T58.92XA, T58.92XD, T58.92XS, T59.0X2A, T59.0X2D, T59.0X2S, T59.1X2A, T59.1X2D,\nT59.1X2S, T59.2X2A, T59.2X2D, T59.2X2S, T59.3X2A, T59.3X2D, T59.3X2S, T59.4X2A, T59.4X2D, T59.4X2S,\nT59.5X2A, T59.5X2D, T59.5X2S, T59.6X2A, T59.6X2D, T59.6X2S, T59.7X2A, T59.7X2D, T59.7X2S, T59.812A,\nT59.812D, T59.812S, T59.892A, T59.892D, T59.892S, T59.92XA, T59.92XD, T59.92XS, T60.0X2A, T60.0X2D,\nT60.0X2S, T60.1X2A, T60.1X2D, T60.1X2S, T60.2X2A, T60.2X2D, T60.2X2S, T60.3X2A, T60.3X2D, T60.3X2S,\nT60.4X2A, T60.4X2D, T60.4X2S, T60.8X2A, T60.8X2D, T60.8X2S, T60.92XA, T60.92XD, T60.92XS, T61.02XA,\nT61.02XD, T61.02XS, T61.12XA, T61.12XD, T61.12XS, T61.772A, T61.772D, T61.772S, T61.782A, T61.782D,\nT61.782S, T61.8X2A, T61.8X2D, T61.8X2S, T61.92XA, T61.92XD, T61.92XS, T62.0X2A, T62.0X2D, T62.0X2S,\nT62.1X2A, T62.1X2D, T62.1X2S, T62.2X2A, T62.2X2D, T62.2X2S, T62.8X2A, T62.8X2D, T62.8X2S, T62.92XA,\nT62.92XD, T62.92XS, T63.002A, T63.002D, T63.002S T63.012A, T63.012D, T63.012S, T63.022A, T63.022D,\nT63.022S, T63.032A, T63.032D, T63.032S, T63.042A, T63.042D, T63.042S, T63.062A, T63.062D, T63.062S,\nT63.072A, T63.072D, T63.072S, T63.082A, T63.082D, T63.082S, T63.092A, T63.092D, T63.092S, T63.112A,\nT63.112D, T63.112S, T63.122A, T63.122D, T63.122S, T63.192A, T63.192D, T63.192S, T63.2X2A, T63.2X2D,\nT63.2X2S, T63.302A, T63.302D, T63.302S, T63.312A, T63.312D, T63.312S, T63.322A, T63.322D, T63.322S,\nT63.332A, T63.332D, T63.332S, T63.392A, T63.392D, T63.392S, T63.412A, T63.412D, T63.412S, T63.422A, \nT63.422D, T63.422S, T63.432A, T63.432D, T63.432S, T63.442A, T63.442D, T63.442S, T63.452A, T63.452D,\nT63.452S, T63.462A, T63.462D, T63.462S, T63.482A, T63.482D, T63.482S, T63.512A, T63.512D, T63.512S,\nT63.592A, T63.592D, T63.592S, T63.612A, T63.612D, T63.612S, T63.622A, T63.622D, T63.622S, T63.632A,\nT63.632D, T63.632S, T63.692A, T63.692D, T63.692S, T63.712A, T63.712D, T63.712S, T63.792A, T63.792D,\nT63.792S, T63.812A, T63.812D, T63.812S, T63.822A, T63.822D, T63.822S, T63.832A, T63.832D, T63.832S,\nT63.892A, T63.892D, T63.892S, T63.92XA, T63.92XD, T63.92XS, T64.02XA, T64.02XD, T64.02XS, T64.82XA,\nT64.82XD, T64.82XS, T65.0X2A, T65.0X2D, T65.0X2S, T65.1X2A, T65.1X2D, T65.1X2S, T65.212A, T65.212D,\nT65.212S, T65.222A, T65.222D, T65.222S, T65.292A, T65.292D, T65.292S, T65.3X2A, T65.3X2D, T65.3X2S,\nT65.4X2A, T65.4X2D, T65.4X2S, T65.5X2A, T65.5X2D, T65.5X2S, T65.6X2A, T65.6X2D, T65.6X2S, T65.812A,\nT65.812D, T65.812S, T65.822A, T65.822D, T65.822S, T65.832A, T65.832D, T65.832S, T65.892A, T65.892D,\nT65.892S, T65.92XA, T65.92XD, T65.92XS, T71.112A, T71.112D, T71.112S, T71.122A, T71.122D, T71.122S,\nT71.132A, T71.132D, T71.132S, T71.152A, T71.152D, T71.152S, T71.162A, T71.162D, T71.162S, T71.192A,\nT71.192D, T71.192S, T71.222A, T71.222D, T71.222S, T71.232A, T71.232D, T71.232S, T50.911, T50.912,\nT50.913, T50.914, T50.915, T50.916\nAND\nPatient encounter during the performance period (CPT): 99221, 99222, 99223, 99231, 99232, 99233,\n99238, 99239, 99291\nAND\nPatient alive at time of acute inpatient setting discharge\nAND\nPatient is discharged from an acute inpatient setting on or between January 1 and December 1 of the measurement period\n","Exclude discharges followed by readmission or direct transfer to a non-acute facility within the 30- day follow-up period, regardless of principal diagnosis for the readmission.\nExclude discharges followed by readmission or direct transfer to an acute facility within the 30-day follow-up period if the principal diagnosis was for non-mental health.\nClinician documented reason patient was not able to complete 30 day follow-up from acute inpatient setting discharge (e.g., patient death prior to follow-up visit, patient non-compliant for visit follow-up) (G9403)\nPatients who use hospice services any time during the measurement period (G9760)","A follow-up visit with a mental health provider within 30 days after acute inpatient discharge. Do not include visits that occur on the date of discharge (G9402)","Patient received follow-up on the date of discharge or within 30 days after discharge (G9402)","Patient did not receive follow-up within 30 days after discharge (G9404)","Providers are only reporting rate 1 of the MIPS measure for follow-up within 30 days after discharge.","An eligible provider is one who delivers mental health services and meets any of the following criteria:\n• An MD or doctor of osteopathy (DO) who is certified as a psychiatrist or child psychiatrist by the American Medical Specialties Board of Psychiatry and Neurology or by the American Osteopathic Board of Neurology and Psychiatry; or, if not certified, who successfully completed an accredited program of graduate medical or osteopathic education in psychiatry or child psychiatry and is licensed to practice patient care psychiatry or child psychiatry, if required by the state of practice.\n• An individual who is licensed as a psychologist in his/her state of practice, if required by the state of practice.\n• An individual who is certified in clinical social work by the American Board of Examiners; who is listed on the National Association of Social Worker’s Clinical Register; or who has a master’s degree in social work and is licensed or certified to practice as a social worker, if required by the state of practice.\n• A registered nurse (RN) who is certified by the American Nurses Credentialing Center (a subsidiary of the American Nurses Association) as a psychiatric nurse or mental health clinical nurse specialist, or who has a master’s degree in nursing with a specialization in\npsychiatric/mental health and two years of supervised clinical experience and is licensed to practice as a psychiatric or mental health nurse, if required by the state of practice.\n• An individual (normally with a master’s or a doctoral degree in marital and family therapy and at least two years of supervised clinical experience) who is practicing as a marital and family therapist and is licensed or a certified counselor by the state of practice, or if licensure or certification is not required by the state of practice, who is eligible for clinical membership in the American Association for Marriage and Family Therapy.\n• An individual (normally with a master’s or doctoral degree in counseling and at least two years of supervised clinical experience) who is practicing as a professional counselor and who is licensed or certified to do so by the state of practice, or if licensure or certification is not required by the state of practice, is a National Certified Counselor with a Specialty Certification in Clinical Mental Health Counseling from the National Board for Certified Counselors (NBCC).\n• A certified Community Mental Health Center (CMHC), or the comparable term (e.g. behavioral health organization, mental health agency, behavioral health agency) used within the state in which it is located, or a Certified Community Behavioral Health Clinic (CCBHC).\nOnly authorized CMHCs are considered mental health providers. To be authorized as a CMHC, an entity must meet one of the following criteria:\n- The entity has been certified by CMS to meet the conditions of participation (CoPs) that community mental health centers (CMHCs) must meet in order to participate in the Medicare program, as defined in the Code of Federal Regulations Title 42. CMS defines a\nCMHC as an entity that meets applicable licensing or certification requirements for CMHCs in the State in which it is located and provides the set of services specified in section 1913(c)(1) of the Public Health Service Act (PHS Act).\n- The entity has been licensed, operated, authorized, or otherwise recognized by a state or county in which it is located.\nOnly authorized CCBHCs are considered mental health providers. To be authorized as a CCBHC, an entity must meet one of the following criteria:\n- Has been certified by a State Medicaid agency as meeting criteria established by the Secretary for participation in the Medicaid CCBHC demonstration program pursuant to Protecting Access to Medicare Act § 223(a) (42 U.S.C. § 1396a note); or as meeting\ncriteria within the State’s Medicaid Plan to be considered a CCBHC.\n- Has been recognized by the Substance Abuse and Mental Health Services Administration, through the award of grant funds or otherwise, as a CCBHC that meets the certification criteria of a Certified Community Behavioral Health Clinic","M1-160","Yes","Inpatient Psychiatric Facility Quality Reporting\nMerit-Based Incentive Payment System (MIPS) Program\nCMS Medicaid Adult and Child Core Set\nMarketplace Quality Rating System (QRS)\nNQF CQMC Consensus Core Set: Behavioral Health"]
["B2-110","B2-110","Added","DPP for BHS","B2 - Percent Increase","Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up","Process","Y","01/01/21 - 06/30/21","Data Reporting & Status Update","Precentage increase Nov 21 - April 22","N",null,null,null,"Y","01/01/21 - 12/31/21","Data Reporting & Status Update",null,"N",null,null,null,"Medicaid","Medicaid, Uninsured, Other","Benchmark","NCQA Quality Compass HEDIS 2020 (2019)",86.13,"NA","CMHC","0421","CMS","CMS MIPS #128 2020","https://qpp.cms.gov/docs/QPP_quality_measure_specifications/CQM-Measures/2019_Measure_128_MIPSCQM.pdf","Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous twelve months of the current encounter. Normal parameters: Age 18 years and older BMI ≥ 18.5 and < 25 kg/m2.","Pyschiatry, Mental/Behavioral Health","Pyschiatry, Mental/Behavioral Health",null,"Individuals","All patients aged 18 and older on the date of the encounter with at least one eligible encounter during the measurement period","Patients aged ≥18 years on date of encounter\nAND\nPatient encounter during the performance period (CPT or HCPCS): 90791, 90792, 90832, 90834, 90837, 96156, 96158, 97161, 97162, 97163, 97165, 97166, 97167, 97802, 97803, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99236, 99304, 99305, 99306, 99307, 99308, 99309,99310, 99315, 99316, 99318, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99339, 99340, 99385*, 99386*, 99387*, 99395*, 99396*, 99397*, 99401*, 99402*, D7111, D7140, D7210, D7220, D7230, D7240, D7241, D7250, D7251, G0101, G0108, G0270, G0271, G0402, G0438, G0439, G0447, G0473\nWITHOUT\nTelehealth Modifier: GQ, GT, 95, POS 02","BMI not documented, documentation the patient is not eligible for BMI calculation: G8422\nOR\nBMI is documented as being outside of normal limits, follow-up plan is not documented, documentation the patient is not eligible: G8938\n\nNot Eligible for BMI Calculation or Follow-Up Plan (Denominator Exclusion) – A patient is not eligible if one or more of the following reasons are documented:\n•Patients receiving palliative or hospice care on the date of the current encounter or any time prior to the current encounter\n•Patients who are pregnant on the date of the current encounter or any time during the measurement period prior to the current encounter\n•Patients who refuse measurement of height and/or weight on the date of the current encounter or any time during the measurement period prior to the current encounter\n\nPatients with a documented BMI outside normal limits and a documented reason for not completing BMI follow-up plan during the current encounter or within the previous 12 months of the current encounter (Denominator Exception) –\n•Patients with a documented Medical Reason. The Medical Reason exception could include, but is not limited to, the following patients as deemed appropriate by the health care provider\n•Elderly patients (65 or older) for whom weight reduction/weight gain would complicate other underlying health conditions such as the following examples:\noIllness or physical disability\noMental illness, dementia, confusion\noNutritional deficiency, such as vitamin/mineral deficiency\n•Patient is in an urgent or emergent medical situation where time","Patients with a documented BMI during the encounter or during the previous twelve months, AND when the BMI is outside of normal parameters, a follow-up plan is documented during the encounter or during the previous twelve months of the current encounter","Performance Met: BMI is documented within normal parameters and no follow-up plan is required (G8420)\nOR\nPerformance Met: BMI is documented as above normal parameters and a follow-up plan is documented (G8417)\nOR\nPerformance Met: BMI is documented as below normal parameters and a follow-up plan is documented (G8418)\n\nPerformance Met for G8417 & G8418\n•If the provider documents a BMI and a follow-up plan at the current visit OR\n•If the patient has a documented BMI within the previous twelve months of the current encounter, the provider documents a follow-up plan at the current visit OR\n•If the patient has a documented BMI within the previous twelve months of the current encounter AND the patient has a documented follow-up plan for a BMI outside normal parameters within the previous twelve months of the current visit","Performance Not Met: BMI not documented and no reason is given (G8421)\nOR\nPerformance Not Met: BMI documented outside of normal parameters, no follow-up plan documented, no reason given (G8419)",null,"Definitions:\n\nBMI – Body mass index (BMI), is a number calculated using the Quetelet index: weight divided by height squared (W/H2) and is commonly used to classify weight categories. BMI can be calculated using:\nMetric Units: BMI = Weight (kg) / (Height (m) x Height (m))\nOR\nEnglish Units: BMI = Weight (lbs) / (Height (in) x Height (in)) x 703\n\nFollow-Up Plan – Proposed outline of treatment to be conducted as a result of a BMI outside of normal parameters. A follow-up plan may include, but is not limited to:\n•Documentation of education\n•Referral (for example a Registered Dietitian Nutritionist (RDN), occupational therapist, physical therapist, primary care provider, exercise physiologist, mental health professional, or surgeon), for lifestyle/behavioral therapy\n•Pharmacological interventions\n•Dietary supplements\n•Exercise counseling\n•Nutrition counseling","M1-147",null,"Medicare and Medicaid Electronic Health Record Incentive Program for Eligible Professionals (Unknown)\nMedicare Shared Savings Program (Unknown)\nMerit-Based Incentive Payment System (MIPS) Program (Active)"]
["R1-101",null,null,"RAPPS","R1 - Dollar Increase","Telehealth to provide virtual medical appointments with a primary care or specialty care provider ","Structure","Y","NA","Status Update","PMPM Nov 21 - April 22","N",null,null,null,"Y","NA","Status Update",null,"N",null,null,null,"NA","NA","NA","NA","NA","NA","RHC Attestation","NA","NA","NA",null,"Reporting on usage of telehealth to provide virtual medical appointments with a primary care or specialty care provider ","NA","NA",null,"NA",null,null,null,null,null,null,null,null,"NA",null,"Medicare Shared Savings Program (Unknown)"]
["R1-102",null,"Modified","RAPPS","R1 - Dollar Increase","Use of electronic health record (EHR)","Structure","Y","NA","Status Update","PMPM Nov 21 - April 22","N",null,null,null,"Y","NA","Status Update",null,"N",null,null,null,"NA","NA","NA","NA","NA","NA","RHC Attestation","NA","NA","NA",null,"Reporting on advanced use of electronic health record (EHR)","NA","NA",null,"NA",null,null,null,null,null,null,null,null,"NA",null,"Merit-Based Incentive Payment System (MIPS) Program (Active)"]
["R1-103",null,null,"RAPPS","R1 - Dollar Increase","Care team includes personnel in a care coordination role not requiring clinical licensure","Structure","Y","NA","Status Update","PMPM Nov 21 - April 22","N",null,null,null,"Y","NA","Status Update",null,"N",null,null,null,"NA","NA","NA","NA","NA","NA","RHC Attestation","NA","NA","NA",null,"Reporting on care team inclusion of personnel in a care coordination role not requiring clinical licensure","NA","NA",null,"NA",null,null,null,null,null,null,null,null,"NA",null,"NA"]
["R2-104",null,null,"RAPPS","R2 - Percent Rate Increase","Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) testing ","Process","Y","01/01/21 - 06/30/21","Data Reporting & Status Update","Precentage increase Nov 21 - April 22","N",null,null,null,"Y","01/01/21 - 12/31/21","Data Reporting & Status Update",null,"N",null,null,null,"Medicaid","Medicaid, Uninsured, Other","Benchmark","NCQA Quality Compas HEDIS 2020 (2019)","NA",88.77,"RHC","0057","NCQA","CMS Adult Core Set 2019","https://www.medicaid.gov/medicaid/quality-of-care/performance-measurement/adult-and-child-health-care-quality-measures/adult-core-set-reporting-resources/index.html","Percentage of patients ages 18 to 75 with diabetes (type 1 and type 2) who had a hemoglobin A1c (HbA1c) test.","General Practice, Family Practice, Internal Medicine, Geriatric Medicine, Preventive Medicine, Nephrology, Endocrinology, Nutrition/Dietician","Family Medicine; Internal Medicine; Preventive Medicine; Dietician, Registered","Endocrinology; Nephrology ","Individuals","Ages 18 to 75 as of December 31 of the measurement year.",{"$cut":{"chars":31097,"head":"Diabetes Value Set: \n[E10.10] Type 1 diabetes mellitus with ketoacidosis without coma\n[E10.11] Type 1 diabetes mellitus with ketoacidosis with coma\n[E10.21] Type 1 diabetes mellitus with diabetic nephropathy\n[E10.22] Type 1 diabetes mellitus with diabetic chronic kidney disease\n[E10.29] Type 1 diabetes mellitus with other diabetic kidney complication\n[E10.311] Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edema\n[E10.319] Type 1 diabetes mellitus with unspecified diabetic retinopathy without macular edema\n[E10.321] Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema\n[E10.3211] Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye\n[E10.3212] Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye\n[E10.3213] Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral\n[E10.3219] Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye\n[E10.329] Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema\n[E10.3291] Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye\n[E10.3292] Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye\n[E10.3293] Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral\n[E10.3299] Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye\n[E10.331] Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema\n[E10.3311] Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye\n[E10.3312] Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye\n[E10.3313] Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral\n[E10.3319] Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye\n[E10.339] Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema\n[E10.3391] Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye\n[E10.3392] Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye\n[E10.3393] Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral\n[E10.3399] Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye\n[E10.341] Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema\n[E10.3411] Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye\n[E10.3412] Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye\n[E10.3413] Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral\n[E10.3419] Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye\n[E10.349] Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema\n[E10.3491] Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye\n[E10.3492] Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye\n[E10.3493] Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral\n[E10.3499] Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye\n[E10.351] Type 1 diabetes mellitus with proliferative diabetic retinopath"}},{"$cut":{"chars":24871,"head":"Exclusions: Patients who do not have a diagnosis of diabetes (Diabetes Value Set), in any setting, during the measurement year or year prior to the measurement year and who had a diagnosis of gestational diabetes or steroid-induced diabetes (Diabetes Exclusions Value Set), in any setting, during the measurement year or the year prior to the measurement year. If the patient was included in this measure based on claim or encounter data, as described in the event/diagnosis criteria, the optional exclusions do not apply because the beneficiary had a diagnosis of diabetes\n\nDiabetes Exclusions Value Set:\n[E08.00] Diabetes mellitus due to underlying condition with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC)\n[E08.01] Diabetes mellitus due to underlying condition with hyperosmolarity with coma\n[E08.10] Diabetes mellitus due to underlying condition with ketoacidosis without coma\n[E08.11] Diabetes mellitus due to underlying condition with ketoacidosis with coma\n[E08.21] Diabetes mellitus due to underlying condition with diabetic nephropathy\n[E08.22] Diabetes mellitus due to underlying condition with diabetic chronic kidney disease\n[E08.29] Diabetes mellitus due to underlying condition with other diabetic kidney complication\n[E08.311] Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema\n[E08.319] Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy without macular edema\n[E08.321] Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema\n[E08.3211] Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, right eye\n[E08.3212] Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, left eye\n[E08.3213] Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, bilateral\n[E08.3219] Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye\n[E08.329] Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema\n[E08.3291] Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, right eye\n[E08.3292] Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, left eye\n[E08.3293] Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, bilateral\n[E08.3299] Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye\n[E08.331] Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema\n[E08.3311] Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, right eye\n[E08.3312] Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, left eye\n[E08.3313] Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, bilateral\n[E08.3319] Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye\n[E08.339] Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema\n[E08.3391] Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, right eye\n[E08.3392] Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, left eye\n[E08.3393] Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, bilateral\n[E08.3399"}},"An HbA1c test (HbA1c Tests Value Set) performed during the measurement year, as identified by claim/encounter or automated laboratory data. ","HbA1c Test Value Set: \n\nCPT: \n83036\n83037 \n\nLOINC: \n17856-6 Hemoglobin A1c/Hemoglobin.total in Blood by HPLC\n4548-4 Hemoglobin A1c/Hemoglobin.total in Blood\n4549-2 Hemoglobin A1c/Hemoglobin.total in Blood by Electrophoresis \n\nSNOMED CT US Edition:\n43396009 Hemoglobin A1c measurement (procedure) \n313835008 Hemoglobin A1c measurement aligned to the Diabetes Control and Complications Trial (procedure) \n",null,null,"Value sets adapted from Medicaid Adult Core Set 2020 Adult HEDIS codes ","C1-113",null,"CMS Medicaid Adult Core Set; NQF CQMC Consensus Core Set: ACO/PCMH/Primary Care"]
["R2-105",null,null,"RAPPS","R2 - Percent Rate Increase","Preventive Care and Screening: Influenza Immunization ","Process","Y","01/01/21 - 06/30/21","Data Reporting & Status Update","Precentage increase Nov 21 - April 22","N",null,null,null,"Y","01/01/21 - 12/31/21","Data Reporting & Status Update",null,"N",null,null,null,"Medicaid","Medicaid, Uninsured, Other","IOS","NA","NA","NA","RHC","0041","AMA-PCPI","eCQM - CMS147v10","https://ecqi.healthit.gov/ecqm/ep/2021/cms147v10","Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization","General Practice, Family Practice, Internal Medicine, Obstetrics/Gynecology, Pediatric Medicine, Preventive Medicine, Geriatric Medicine, Otolaryngology, Allergy/Immunology, Oncology, Rheumatology, Nephrology, Infectious Disease","Allergy & Immunology; Family Medicine; Internal Medicine; Obstetrics & Gynecology; Otolaryngology; Pediatrics; Preventive Medicine","Geriatrics; Infectious Disease; Nephrology; Oncology; Rheumatology","Individuals","All patients aged 6 months and older seen for a visit during the measurement period, and seen for a visit between October 1 and March 31\n","\"Initial Population\"\n  and ( exists \"Encounter During Influenza Season\"\n      or exists \"Hemodialysis During Influenza Season\"\n      or exists \"Peritoneal Dialysis During Influenza Season\")\n\n[\"Encounter, Performed\": \"Encounter-Influenza\"] FluEncounter\n  where FluEncounter.relevantPeriod starts during \"Influenza Season\"\n\n[\"Procedure, Performed\": \"Hemodialysis\"] FluSeasonHemodialysis\n  where FluSeasonHemodialysis.relevantPeriod overlaps \"Influenza Season\"\n\n[\"Procedure, Performed\": \"Peritoneal Dialysis\"] PeritonealDialysis\n  where PeritonealDialysis.relevantPeriod overlaps \"Measurement Period\"","Documentation of medical reason(s) for not receiving influenza immunization (e.g., patient allergy, other medical reasons).\nDocumentation of patient reason(s) for not receiving influenza immunization (e.g., patient declined, other patient reasons).\nDocumentation of system reason(s) for not receiving influenza immunization (e.g., vaccine not available, other system reasons).\n\nDenominator Exceptions\nexists \"Medical Patient or System Reason for Not Performing Influenza Vaccination\"\n  or exists \"Medical Patient or System Reason for Not Administering Influenza Vaccine\"\n  or exists \"Diagnosis of Allergy to Egg\"\n  or exists \"Egg Substance Allergy\"\n  or exists \"Diagnosis of Allergy to Influenza Vaccine\"\n  or exists \"Diagnosis of Intolerance to Influenza Vaccine\"\n  or exists \"Intolerance of Influenza Vaccination Procedure\"\n  or exists \"Allergy or Intolerance to Influenza Vaccine\n\n[\"Procedure, Not Performed\": \"Influenza Vaccination\"] NoFluVaccination\n  where NoFluVaccination.authorDatetime during \"Influenza Season Including August and September of the Prior Year\"\n    and ( NoFluVaccination.negationRationale in \"Medical Reason\"\n        or NoFluVaccination.negationRationale in \"Patient Reason\"\n        or NoFluVaccination.negationRationale in \"System Reason\"\n        or NoFluVaccination.negationRationale in \"Influenza Vaccination Declined\")\n\nor [\"Immunization, Not Administered\": \"Influenza Vaccine\"] NoFluVaccine\n  where NoFluVaccine.authorDatetime during \"Influenza Season Including August and September of the Prior Year\"\n    and ( NoFluVaccine.negationRationale in \"Medical Reason\"\n        or NoFluVaccine.negationRationale in \"Patient Reason\"\n        or NoFluVaccine.negationRationale in \"System Reason\"\n        or NoFluVaccine.negationRationale in \"Influenza Vaccination Declined\") \n\nor [\"Diagnosis\": \"Allergy to Eggs\"] EggAllergy\n  where EggAllergy.prevalencePeriod overlaps after \"Influenza Season\"\n\nor [\"Allergy/Intolerance\": \"Egg Substance\"] AllergyEggSubstance\n  where AllergyEggSubstance.prevalencePeriod overlaps after \"Influenza Season\"\n\nor [\"Diagnosis\": \"Allergy to Influenza Vaccine\"] FluVaccineAllergyDiagnosis\n  where FluVaccineAllergyDiagnosis.prevalencePeriod overlaps after \"Influenza Season\"\n\nor [\"Diagnosis\": \"Intolerance to Influenza Vaccine\"] FluVaccineIntoleranceDiagnosis\n  where FluVaccineIntoleranceDiagnosis.prevalencePeriod overlaps after \"Influenza Season\"\n\nor [\"Allergy/Intolerance\": \"Influenza Vaccination\"] FluVaccinationIntolerance\n  where FluVaccinationIntolerance.prevalencePeriod overlaps after \"Influenza Season\"\n\nor [\"Allergy/Intolerance\": \"Influenza Vaccine\"] FluVaccineAllergyIntolerance\n  where FluVaccineAllergyIntolerance.prevalencePeriod overlaps after \"Influenza Season\"","Patients who received an influenza immunization OR who reported previous receipt of an influenza immunization","exists \"Influenza Vaccination Procedure\"\n  or exists \"Influenza Immunization Administered\"\n  or exists \"Influenza Vaccine Previously Received\"\n\n[\"Procedure, Performed\": \"Influenza Vaccination\"] FluVaccination\n  where FluVaccination.relevantDatetime during \"Influenza Season Including August and September of the Prior Year\"\n\nor [\"Immunization, Administered\": \"Influenza Vaccine\"] AdministeredFluVaccine\n  where AdministeredFluVaccine.relevantDatetime during \"Influenza Season Including August and September of the Prior Year\"\n\nor [\"Assessment, Performed\": \"Previous Receipt of Influenza Vaccine\"] PreviousReceiptFluVaccine\n  where PreviousReceiptFluVaccine.relevantDatetime during \"Influenza Season Including August and September of the Prior Year\"",null,"For RAPPS reporting purposes, report denominator encounters that fall within the measurement period. For example, for CY2021, the denominator would include encounters from January - March 2021 and October - December 2021.","Definitions: \nPrevious Receipt - receipt of the current season's influenza immunization from another provider OR from same provider prior to the visit to which the measure is applied (typically, prior vaccination would include influenza vaccine given since August 1st)\n\n\nGuidance:\n\t\nThe timeframe for the visit during the \"Encounter, Performed\": \"Encounter-Influenza\" or \"Procedure, Performed\": \"Peritoneal Dialysis\" or \"Procedure, Performed\": \"Hemodialysis\" in the Population Criteria-Denominator, refers to the influenza season defined by the measure: October through March (October 1 for the year prior to the start of the reporting period through March 31 during the reporting period). The \"Encounter-Influenza\" Grouping OID detailed in the data criteria section below is comprised of several individual OIDs of different encounter types. The individual OIDs are included in the value set and should be reviewed to determine that an applicable visit occurred during the timeframe for \"Encounter, Performed\": \"Encounter-Influenza\" as specified in the denominator.\n\nTo enable reporting of this measure at the close of the reporting period, this measure will only assess the influenza season that ends in March of the reporting period. The subsequent influenza season (ending March of the following year) will be measured and reported in the following year.\n\nDue to the changing stance of the CDC/ACIP recommendations regarding the live attenuated influenza vaccine (LAIV) for a particular flu season, this measure will not include the administration of this specific formulation of the flu vaccination. Given the variance of the timeframes for the annual update cycles, program implementation, and publication of revised recommendations from the CDC/ACIP, it has been determined that the coding for this measure will specifically exclude this formulation, so as not to inappropriately include this form of the vaccine for flu seasons when CDC/ACIP explicitly advise against it. However, it is recommended that all eligible professionals or eligible clinicians to review the guidelines for each flu season to determine appropriateness of the LAIV and other formulations of the flu vaccine. Should the LAIV be recommended for administration for a particular flu season, eligible professional or clinician may consider one of the following options: 1) satisfy the numerator by reporting either previous receipt or using the CVX 88 for unspecified formulation, 2) report a denominator exception, either as a patient reason (e.g., for patient preference) or a system reason (e.g., the institution only carries LAIV).\n\nThis eCQM is a patient-based measure.\n\nThis version of the eCQM uses QDM version 5.5.  Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.","C1-269","Yes","Merit-Based Incentive Payment System (MIPS) Program, Medicaid Promoting Interoperability Program for Eligible Professionals"]

{"sheet":"NUCC Provider Taxonomy","index":13,"n_rows":811,"n_cols":12,"rows_kept":811,"cut":false,"hidden":true,"merged":[[0,0,0,6],[1,0,1,6]]}
["National Uniform Claim Committee (NUCC) Health Care Provider Taxonomy Code Set Version 21.0 - January 2021 (https://taxonomy.nucc.org)"]
["Please refer to the \"Introduction Tab\" for descriptions regarding the NUCC taxonomy structure of three distinct levels: \"Grouping\", \"Classification\", and \"Area of Specializiation\". Wherever a NUCC \"Definition\" is described as \"Definition to come\", then an available \"Definition\" or \"Code\" at the \"Classification\" level should be used as possible until NUCC updates the taxonomy code set version."]
["Grouping","Classification","Area of Specialization","Display Name","Definition","Code","NUCC Notes","Effective Date","Deactivation Date","Last Modified Date","Internal Notes - 20210302","DPP Measure? 20210302"]
["Other Service Providers","Acupuncturist",null,"Acupuncturist","An acupuncturist is a person who performs ancient therapy for alleviation of pain, anesthesia and treatment of some diseases. Acupuncturists use long, fine needles inserted into specific points in order to treat painful conditions or produce anesthesia.","171100000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Related Providers","Adult Companion",null,"Adult Companion","An individual who provides supervision, socialization, and non-medical care to a functionally impaired adult.  Companions may assist or supervise the individual with such tasks as meal preparation, laundry and shopping, but do not perform these activities as discrete services.  These services are provided in accordance with a therapeutic goal in the plan of care.","372600000X","[7/1/2003: new]","2003-10-01",null,null,"Delete - not a DPP measure","No"]
["Dental Providers","Advanced Practice Dental Therapist",null,"Advanced Practice Dental Therapist","An Advanced Practice Dental Therapist is:<br><br>(1) A dental therapist who has completed additional training beyond basic dental therapy education and provides dental services in accordance with state advanced practice dental therapist laws or statutes; or<br><br>(2) A dental hygienist with a graduate degree in advanced dental therapy prepared for independent and interdependent decision making and direct accountability for clinical judgment across the dental health care continuum.<br><br>The individual has been authorized by the relevant state board or a tribal entity to provide services under the remote supervision of a dentist. The functions of the advanced practice dental therapist vary based on the needs of the dentist, the educational preparation of the advanced practice dental therapist and state dental practice acts and regulations.","125K00000X","Source: Summarized from Minnesota Statute 150A.106. [7/1/2012: new]","2012-10-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Advanced Practice Midwife",null,"Advanced Practice Midwife","Midwifery practice as conducted by certified nurse-midwives (CNMs) and certified midwives (CMs) is the independent management of women's health care, focusing particularly on pregnancy, childbirth, the post partum period, care of the newborn, and the family planning and gynecologic needs of women. The CNM and CM practice within a health care system that provides for consultation, collaborative management, or referral, as indicated by the health status of the client. CNMs and CMs practice in accord with the Standards for the Practice of Midwifery, as defined by the American College of Nurse-Midwives (ACNM).","367A00000X","Source: American College of Nurse-Midwives, 2008  [7/1/2008: title changed, definition changed, source changed]  Additional Resources: American College of Nurse-Midwives www.acnm.org. The American Midwifery Certification Board, Inc. [AMCB, formerly the ACNM Certification Council, Inc. (ACC)] opened its national certification exam to non-nurse graduates of midwifery education programs and issued the first certified midwife (CM) credential in 1997. Certified midwives are educated to meet the same high standards that certified nurse-midwives must meet. These are the standards that every state in the U.S. has recognized as the legal basis for nurse-midwifery practice. All education programs for CMs, like CNMs, award a post-baccalaureate certificate or higher degree. CMs take the same AMCB certification exam as CNMs and study side by side with nurse-midwifery students in some education programs. As an organization, ACNM supports efforts to legally recognize CMs as qualified midwifery practitioners granted the same rights and responsibilities as CNMs.","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Transportation Services","Air Carrier",null,"Air Carrier","An air company that the Federal Aviation Administration, the certificate-holding district office (CHDO), regional Flight Standards Division (RFSD) offices, and AFS-900 has verified that the company is capable of operating safely and that it complies with the regulations and standards prescribed by the Administrator.","344800000X","Source: Federal Aviation Administration [1/1/2010: new]    Additional Resources: www.faa.gov/about/initiatives/atos/air_carrier/intro_to_part121_cert/","2010-04-01",null,null,"Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Allergy & Immunology","Intentionally left blank","Allergy & Immunology Physician","An allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Selected examples of such conditions include asthma, anaphylaxis, rhinitis, eczema, and adverse reactions to drugs, foods, and insect stings as well as immune deficiency diseases (both acquired and congenital), defects in host defense, and problems related to autoimmune disease, organ transplantation, or malignancies of the immune system.","207K00000X","Source: American Board of Medical Specialties, 2007, www.abms.org  [7/1/2007: added definition, added source]  Additional Resources: American Board of Allergy and Immunology, 2007.  http://www.abai.org/   No subspecialty certificates in allergy and immunology are offered by the American Board of Allergy and Immunology (ABAI). The ABAI, however, does offer formal special pathways for physicians seeking dual certification in allergy/immunology and pediatric pulmonology; allergy/immunology and pediatric rheumatology; and allergy/immunology and adult rheumatology.","2003-04-01",null,"2007-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Allergy & Immunology","Allergy","Allergy Physician","Definition to come.","207KA0200X",null,"2003-04-01",null,null,"Keep - Add somewhere that for TIPPS program, whenever a Definition is listed as \"Definition to come.\" by NUCC, then the Definition at the Classification level should be used as possible.","Yes"]
["Allopathic & Osteopathic Physicians","Allergy & Immunology","Clinical & Laboratory Immunology","Clinical & Laboratory Immunology (Allergy & Immunology) Physician","Definition to come.","207KI0005X",null,"2003-04-01",null,null,"Keep - Add somewhere that for TIPPS program, whenever a Definition is listed as \"Definition to come.\" by NUCC, then the Definition at the Classification level should be used as possible.","Yes"]
["Nursing & Custodial Care Facilities","Alzheimer Center (Dementia Center)",null,"Alzheimer Center (Dementia Center)","A freestanding facility or special care unit of a long term care facility focusing on patient care of individuals diagnosed with dementia or Alzheimer's Disease or their related diseases. Six elements of the facility/unit set it apart from other (the rest of the) facilities(y):  Admission of residents with dementia (including those with Alzheimer's disease);  Staff who are specially selected, trained, and supervised;  Activities that are specifically designed for the cognitively impaired;  A marketing of a special care unit in brochures;  A high level of family involvement; and  A physical environment designed to keep residents safe and segregated from other populations.",null,null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Transportation Services","Ambulance",null,"Ambulance","An emergency vehicle used for transporting patients to a health care facility after injury or illness. Types of ambulances used in the United States include ground (surface) ambulance, rotor-wing (helicopter), and fixed-wing aircraft (airplane).","311500000X","Source: Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 37.","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Transportation Services","Ambulance","Air Transport","Air Ambulance","Definition to come...","341600000X","[1/1/2005: title modified]","2002-04-01",null,"2005-01-01","Delete - not a DPP measure","No"]
["Transportation Services","Ambulance","Land Transport","Land Ambulance","Definition to come...","3416A0800X","[1/1/2005: title modified]","2002-04-01",null,"2005-01-01","Delete - not a DPP measure","No"]
["Transportation Services","Ambulance","Water Transport","Water Ambulance","Definition to come...","3416L0300X","[1/1/2005: title modified]","2002-04-01",null,"2005-01-01","Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Anaplastologist",null,"Anaplastologist","An anaplastologist is a professional who creates prostheses for the face and body.  Patients treated include those missing anatomy due to cancer, traumatic injury, or birth differences.  Generally, there are no state licensing requirements for anaplastologists.  Certification specific to anaplastology is provided through the Board for Certified Clinical Anaplastology (BCCA) with a credential title of Certified Clinical Anaplastologist (CCA).","3416S0300X","Source:  American Anaplastology Association,  www.anaplastology.org. [7/1/2006: new]","2006-10-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Anesthesiologist Assistant",null,"Anesthesiologist Assistant","An individual certified by the state to perform anesthesia services under the direct supervision of an anesthesiologist.  Anesthesiologist Assistants are required to have a bachelor's degree with a premed curriculum prior to entering a two-year anesthesiology assistant program, which is focused upon the delivery and maintenance of anesthesia care as well as advanced patient monitoring techniques.  An Anesthesiologist Assistant must work as a member of the anesthesia care team under the direction of a qualified Anesthesiologist.","229N00000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Anesthesiology",null,"Anesthesiology Physician","An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an operation or an obstetric or diagnostic procedure. The anesthesiologist assesses the risk of the patient undergoing surgery and optimizes the patient's condition prior to, during and after surgery. In addition to these management responsibilities, the anesthesiologist provides medical management and consultation in pain management and critical care medicine. Anesthesiologists diagnose and treat acute, long-standing and cancer pain problems; diagnose and treat patients with critical illnesses or severe injuries; direct resuscitation in the care of patients with cardiac or respiratory emergencies, including the need for artificial ventilation; and supervise post-anesthesia recovery.","367H00000X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007:  added definition, added source; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Anesthesiology, 2007.  http://www.theaba.org/; American Osteopathic Board of Anesthesiology, 2007, http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Anesthesiology.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Anesthesiology.","2003-04-01",null,"2011-07-01","Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Anesthesiology","Addiction Medicine","Addiction Medicine (Anesthesiology) Physician","An anesthesiologist who specializes in the diagnosis and treatment of addictions.","207L00000X","Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added]    Additional Resources: A Certification of Added Qualifications (CAQ) was, but is no longer issued by the American Osteopathic Board of Anesthesiology. ","2003-04-01",null,"2010-01-01","Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Anesthesiology","Critical Care Medicine","Critical Care Medicine (Anesthesiology) Physician","An anesthesiologist, who specializes in critical care medicine diagnoses, treats and supports patients with multiple organ dysfunction. This specialist may have administrative responsibilities for intensive care units and may also facilitate and coordinate patient care among the primary physician, the critical care staff and other specialists.","207LA0401X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007:  added definition, added source; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Anesthesiology, 2007.  http://www.theaba.org/; American Osteopathic Board of Anesthesiology, 2007, http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Anesthesiology.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Anesthesiology.","2003-04-01",null,"2011-07-01","Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Anesthesiology","Hospice and Palliative Medicine","Hospice and Palliative Medicine (Anesthesiology) Physician","An anesthesiologist with special knowledge and skills to prevent and relieve the suffering experienced by patients with life-limiting illnesses. This specialist works with an interdisciplinary hospice or palliative care team to maximize quality of life while addressing physical, psychological, social and spiritual needs of both patient and family throughout the course of the disease, through the dying process, and beyond for the family.  This specialist has expertise in the assessment of patients with advanced disease; the relief of distressing symptoms; the coordination of interdisciplinary patient and family-centered care in diverse venues; the use of specialized care systems including hospice; the management of the imminently dying patient; and legal and ethical decision making in end-of-life care.","207LC0200X","Source: American Academy of Hospice and Palliative Medicine, www.aahpm.org [1/1/2007: new]","2007-04-01",null,null,"Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Anesthesiology","Pain Medicine","Pain Medicine (Anesthesiology) Physician","An anesthesiologist who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic and/or cancer pain in both hospital and ambulatory settings. Patient care needs are also coordinated with other specialists.","207LH0002X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007:  added definition, added source; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Anesthesiology, 2007.  http://www.theaba.org/; American Osteopathic Board of Anesthesiology, 2007, http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Anesthesiology.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Anesthesiology.","2003-04-01",null,"2011-07-01","Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Anesthesiology","Pediatric Anesthesiology","Pediatric Anesthesiology Physician","An anesthesiologist who has had additional skill and experience in and is primarily concerned with the anesthesia, sedation, and pain management needs of infants and children.  A pediatric anesthesiologist generally provides services including the evaluation of complex medical problems in infants and children when surgery is necessary,  planning and care for children before and after surgery, pain control, anesthesia and sedation for any procedures out of the operating room such as MRI, CT scan, and radiation therapy.","207LP2900X","Source: American Academy of Pediatrics, www.aap.org [7/1/2006: new]","2006-10-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Art Therapist",null,"Art Therapist","(1) An individual who uses art to achieve the therapeutic goals of symptom relief, emotional integration, and recovery from or adjustment to illness or disability. (2) An art therapist uses a form of treatment that enables patients with mental or physical disabilities to use art as a way of expressing and dealing with feelings and inner conflicts. (3) An individual who uses arts modalities and creative processes during intentional intervention in therapeutic, rehabilitative, community, or educational settings to foster health, communication, and expression; promote the integration of physical, emotional, cognitive, and social functioning; enhance self-awareness; and facilitate change.","207LP3000X","Source: (1) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 107. (2) Art Therapy Program, Marymount College, Tarrytown, NY (3) National Coalition of Arts","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Behavioral Health & Social Service Providers","Assistant Behavior Analyst",null,"Assistant Behavior Analyst","An assistant behavior analyst is qualified by Behavior Analyst Certification Board certification and/or a state-issued license or credential in behavior analysis to practice under the supervision of an appropriately credentialed professional behavior analyst. An assistant behavior analyst delivers services consistent with the dimensions of applied behavior analysis and supervision requirements defined in state laws or regulations and/or national certification standards. Common services may include, but are not limited to, conducting behavioral assessments, analyzing data, writing behavior-analytic treatment plans, training and supervising others in implementation of components of treatment plans, and direct implementation of treatment plans.","221700000X","Association of Professional Behavior Analysts, www.apbahome.net and Behavior Analyst Certification Board (http://www.bacb.com) [7/1/2016: new]","2016-10-01",null,null,"Delete - not a DPP measure","No"]
["Podiatric Medicine & Surgery Service Providers","Assistant, Podiatric",null,"Podiatric Assistant","An individual who assists a podiatrist in tasks, such as exposing and developing x-rays; taking and recording patient histories; assisting in biomechanical evaluations and negative castings; preparing and sterilizing instruments and equipment; providing the patient with postoperative instructions; applying surgical dressings; preparing the patient for treatment, padding, and strapping; and performing routine office procedures.","211D00000X","Source: (1) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 622.","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing & Custodial Care Facilities","Assisted Living Facility",null,"Assisted Living Facility","A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.","310400000X","[7/1/2003: new]","2003-10-01",null,null,"Delete - not a DPP measure","No"]
["Nursing & Custodial Care Facilities","Assisted Living Facility","Assisted Living, Behavioral Disturbances","Assisted Living Facility (Behavioral Disturbances)","A facility providing supportive services to individuals who can function independently in most areas of activity, but exhibit abnormal behavioral responses and habits and therefore need special guidance, assistance and/or monitoring to assure safety and well being.  This type of facility requires a staff with special training in dealing with and redirecting negative, violent or destructive behaviors.","3104A0630X","[7/1/2003: new]","2003-10-01",null,null,"Delete - not a DPP measure","No"]
["Nursing & Custodial Care Facilities","Assisted Living Facility","Assisted Living, Mental Illness","Assisted Living Facility (Mental Illness)","A facility providing supportive services to individuals who can function independently in most areas of activity, but need special guidance, assistance and/or monitoring as the result of a psychiatric problem.  This type of facility requires a staff with special training in mental health training and dealing with psychiatric emergencies.","3104A0625X","[7/1/2003: new]","2003-10-01",null,null,"Delete - not a DPP measure","No"]
["Speech, Language and Hearing Service Providers","Audiologist","Intentionally left blank","Audiologist","(1) A specialist in evaluation, habilitation and rehabilitation of those whose communication disorders center in whole or in part in hearing function. Audiologists are autonomous professionals who identify, assess, and manage disorders of the auditory, balance and other neural systems. Audiologists provide audiological (aural) rehabilitation to children and adults across the entire age span. Audiologists select, fit and dispense amplification systems such as hearing aids and related devices. (2) An audiologist is a person qualified by a master's degree in audiology, licensed by the state, where applicable, and practicing within the scope of that license. Audiologists evaluate and treat patients with impaired hearing. They plan, direct and conduct rehabilitative programs with audiotry substitutional devises (hearing aids) and other therapy.","231H00000X","Source: (1) American Speech-Language-Hearing Association, (1996, Spring) Scope of practice in Audiology, p. 2","2002-04-01",null,null,"Keep - No Change","Yes"]
["Speech, Language and Hearing Service Providers","Audiologist","Assistive Technology Practitioner","Assistive Technology Practitioner Audiologist","Definition to come.","231HA2400X",null,"2002-04-01",null,null,"Keep - Add somewhere that for TIPPS program, whenever a Definition is listed as \"Definition to come.\" by NUCC, then the Definition at the Classification level should be used as possible.","Yes"]
["Speech, Language and Hearing Service Providers","Audiologist","Assistive Technology Supplier","Assistive Technology Supplier Audiologist","Definition to come.","231HA2500X",null,"2002-04-01",null,null,"Keep - Add somewhere that for TIPPS program, whenever a Definition is listed as \"Definition to come.\" by NUCC, then the Definition at the Classification level should be used as possible.","Yes"]
["Speech, Language and Hearing Service Providers","Audiologist-Hearing Aid Fitter","Intentionally left blank","Audiologist-Hearing Aid Fitter","An audiologist/hearing aid fitter is the professional who specializes in evaluating and treating people with hearing loss, conducts a wide variety of tests to determine the exact nature of an individual's hearing problem, presents a variety of treatment options to patients, dispenses and fits hearing aids, administers tests of balance to evaluate dizziness and provides hearing rehabilitation training. This classification should be used where individuals are licensed as \"audiologist-hearing aid fitters\" as opposed to states that license individuals as \"audiologists\".","237600000X","Source: American Academy of Audiology, 1735 N. Lynn St, Suite 950, Arlington VA 22209, (800)AAA-2336)","2002-04-01",null,null,"Keep - Even though there is already Classification for \"Audiologist\"","Yes"]
["Behavioral Health & Social Service Providers","Behavior Analyst",null,"Behavioral Analyst","A behavior analyst is qualified by at least a master's degree and Behavior Analyst Certification Board certification and/or a state-issued credential (such as a license) to practice behavior analysis independently. Behavior analysts provide the required supervision to assistant behavior analysts and behavior technicians. A behavior analyst delivers services consistent with the dimensions of applied behavior analysis. Common services may include, but are not limited to, conducting behavioral assessments, analyzing data, writing and revising behavior-analytic treatment plans, training others to implement components of treatment plans, and overseeing implementation of treatment plans.","103K00000X","Source: Association of Professional Behavior Analysts, www.apbahome.net and Behavior Analyst Certification Board (http://www.bacb.com) [7/1/2008: new, 1/1/2016: modified definition]","2008-10-01",null,"2016-01-01","Delete - not a DPP measure","No"]
["Behavioral Health & Social Service Providers","Behavior Technician",null,"Behavior Technician","The behavior technician is a paraprofessional who practices under the close, ongoing supervision of a behavior analyst or assistant behavior analyst certified by the Behavior Analyst Certification Board and/or credentialed by a state (such as through licensure). The behavior technician is primarily responsible for the implementation of components of behavior-analytic treatment plans developed by the supervisor. That may include collecting data on treatment targets and conducting certain types of behavioral assessments (e.g., stimulus preference assessments). The behavior technician does not design treatment or assessment plans or procedures but provides services as assigned by the supervisor responsible for his or her work.","106S00000X","Association of Professional Behavior Analysts, www.apbahome.net and Behavior Analyst Certification Board (http://www.bacb.com) [7/1/2016: new]","2016-10-01",null,null,"Delete - not a DPP measure","No"]
["Suppliers","Blood Bank",null,"Blood Bank","An institution (organization or distinct part thereof) that performs, or is responsible for the performance of, the collection, processing, storage and/or issuance of human blood and blood components, intended for transfusion. The institution may also collect, process, and/or distribute human tissue, including bone marrow and peripheral blood progenitor cells, intended for transplantation.","331L00000X","Source: American Association of Blood Banks, Standards for Blood Banks and Tranfusion, 17th ed.","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Transportation Services","Bus",null,"Bus","A public or private organization or business licensed to provide bus services.","347B00000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Agencies","Case Management",null,"Case Management Agency","An organization that is responsible for providing case management services.  The agency provides services which assist an individual in gaining access to needed medical, social, educational, and/or other services.  Case management services may be used to locate, coordinate, and monitor necessary appropriate services.  It may be used to encourage the use of cost-effective medical care by referrals to appropriate providers and to discourage over utilization of costly services.  Case management may also serve to provide necessary coordination of non-medical services such as vocational rehabilitation, education, employment, when the services provided enable the individual to function at the highest level.","251B00000X","Source:  CMS State Medicaid Manual Section 4442.3 [7/1/2006: definition modified]","2002-04-01",null,38899,"Delete - not a DPP measure","No"]
["Other Service Providers","Case Manager/Care Coordinator",null,"Case Manager/Care Coordinator","A person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other services.  The person has the ability to provide an assessment and review of completed plan of care on a periodic basis.  This person is also able to take collaborative action to coordinate the services with other providers and monitor the enrollee's progress toward the cost-effective achievement of objectives specified in the plan of care.  Credentials may vary from an experience in the fields of psychology, social work, rehabilitation, nursing or a closely related human service field, to a related Assoc of Arts Degree or to nursing credentials.  Some states may require certification in case management.","171M00000X","Source: CMS State Medicaid Manual Section 4442.3  [7/1/2006: new]","2006-10-01",null,null,"Delete - not a DPP measure","No"]
["Chiropractic Providers","Chiropractor",null,"Chiropractor","A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.","111N00000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Chiropractic Providers","Chiropractor","Independent Medical Examiner","Independent Medical Examiner Chiropractor","A special evaluator not involved with the medical care of the individual examinee that impartially evaluates the care being provided by other practitioners to clarify clinical, disability, liability or other case issues.","111NI0013X","Source: American Board of Independent Medical Examiners [1/1/2007: new]","2007-04-01",null,null,"Delete - not a DPP measure","No"]
["Chiropractic Providers","Chiropractor","Internist","Internist Chiropractor","The chiropractic internist may serve as a primary care physician or may see patients referred from other providers for evaluation and co-management. Evaluation is focused on the early detection of functional, nutritional, and pathological disorders. A chiropractic internist utilizes the diagnostic instruments necessary for proper examination. In cases where laboratory examination is necessary, a chiropractic internist utilizes a recognized reference laboratory facility. A chiropractic internist may manage his or her own cases or may refer to another specialist when prudent to do so. The chiropractic internist utilizes documented natural therapies, therapeutic lifestyle changes, patient education and other resources to promote patient health and avoidance of disease.","111NI0900X","Source: American Chiropractic Association, 2008 [7/1/2009: definition added]","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Chiropractic Providers","Chiropractor","Neurology","Neurology Chiropractor","Chiropractic Neurology is defined as the field of functional neurology that engages the internal - and external environment of the individual in a structured and targeted approach to affect positive changes in the nervous system and consequently the physiology and behavior of an individual. Chiropractic Neurologists are board-certified specialists in non-drug, non-surgical care for those with neurologically based health problems. There are many conditions people suffer from that are in this broad category: learning and attention disorders, headaches, vertigo, pain syndromes, developmental disorders, nerve injury, spinal cord injury, head injury or stroke, movement disorders, and many other conditions.","111NN0400X","Source: American Chiropractic Neurology Board, 2008 & American Chiropractic Association, 2008 [7/1/2009: definition added]","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Chiropractic Providers","Chiropractor","Nutrition","Nutrition Chiropractor","Chiropractic Nutrition is that specialty within the chiropractic profession that deals with the overall factors that affect the patient's ability to maintain the manipulative correction and thus sustain better neurological integrity. The Chiropractic Nutrition Specialist will perform extensive research on the patient's previous health history, ethnicity, and any family history related to what the patient is being treated for. Patients fill out questionnaires concerning dietary and sleep patterns and previous or present symptomology. A nutrition examination would be performed to assess areas such as absorption rates, adrenal function, kidney health, lung health etc. The patient is often instructed on how to check the pH of their saliva and urine, test for the presence of Candida Albicans, etc., at home. Outside laboratory testing includes blood, urine, hair analysis, food allergy testing etc. The patient's prescription and over the counter medications are recorded and analyzed.","111NN1001X","Source: American Chiropractic Association, 2008 [7/1/2009: definition added]","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Chiropractic Providers","Chiropractor","Occupational Health","Occupational Health Chiropractor","Occupational Health is that specialty within the chiropractic profession that deals with the prevention and management of work related injuries. It also considers and assists clients with State and Federal Compliance assistance. Occupational Health goes much farther than simply treating injured workers however. This may mean working with clients to promote optimum safety and ergonomic principles, interacting with the injured worker to promote safety and prevent future injuries, assisting a company with accident investigation to identify root cause, redesigning a workstation to eliminate hazards, working with safety teams, providing training programs etc. The list of potential services that the specialist can interact with a client company or patient is lengthy and varied involving both in office services as well as on site services.","111NX0100X","Source: American Chiropractic Association, 2008 [7/1/2009: title modified, definition added]","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Chiropractic Providers","Chiropractor","Orthopedic","Orthopedic Chiropractor","Chiropractic Orthopedics is defined as that branch of chiropractic medicine that includes the continued acquisition of knowledge relative to both normal functions and diseases of the human body as they relate to the bones, joints, capsules, discs, muscles, ligaments, tendons, their complete neurological and vascular components, referred organ systems and contiguous tissues. This also includes the development and perfection of skills relative to health maintenance when such exists and when not, the investigations, historical review, physical detection, correlative diagnosis development and complete management of any disorder within the bounds defined herein. Also necessary is the delivery of the combined knowledge and skill on a primary basis to patients who both need and desire this service to the eventual outcome of remissions, whenever resolution is not readily achievable. In addition the certified chiropractic orthopedist provides consultation services at the request of other qualified doctors seeking assistance in the care of their patients. The chiropractic orthopedist may also engage in the teaching and or research of subjects and materials relevant to pursuing the quest for knowledge in the ever changing field of the orthopedic specialty.","111NX0800X","Source: American Chiropractic Association, 2008 [7/1/2009: definition added]","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Chiropractic Providers","Chiropractor","Pediatric Chiropractor","Pediatric Chiropractor","The Pediatric Chiropractor is a chiropractor with specialized, advanced training and certification in the evaluation, care and management of health and wellness conditions of infancy, childhood and adolescence.  This specialist provides primary, comprehensive, therapeutic and preventative chiropractic health care for newborns through adolescents.","111NP0017X","Source: Council on Chiropractic Pediatrics, American Chiropractic Association, 2007  [1/1/2008: new]","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Chiropractic Providers","Chiropractor","Radiology","Radiology Chiropractor","Chiropractic radiology is a referral specialty that provides consultation services at the request of other qualified doctors. Chiropractic radiologists provide consultation in health care facilities (private offices, hospitals and teaching institutions) to meet the needs of referring doctors and their patients. The quality of the consultative services by the chiropractic radiologist in independent practice is reflected by the quality of their professional credentials. Chiropractic radiologists recommend, supervise, and interpret radiologic studies as well as advanced imaging procedures. They advise referring physicians on the necessity and appropriateness of radiologic services and whether to select or to avoid certain diagnostic or clinical procedures. In some instances the radiologist may act as a private practitioner. They may conduct research and apply diagnostic radiologic procedures and may be called upon to act as expert witnesses in matters of litigation.<br><br>Chiropractic radiologists are also concerned with imaging technology including image production, demonstration of normal and abnormal anatomy, and the interaction of energy and matter. The advances in the technological facets of radiology are so rapid that only qualified radiologists can reasonably be expected to maintain the high level of proficiency required to supervise and interpret these procedures. The practice of radiology continuously involves the application of this technology to patient imaging and treatment. It is now well recognized that chiropractic radiology includes, but is not limited to, plain film radiography, fluoroscopy, tomography, ultrasonography, radioisotope imaging, computed tomography, digital radiography, and magnetic resonance imaging. Individual practices may vary by intent, licensure, and scope of practice laws.","111NR0200X","Source: American Chiropractic Board of Radiology, 2009 [7/1/2009: definition added]","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Chiropractic Providers","Chiropractor","Rehabilitation","Rehabilitation Chiropractor","Rehabilitation is the discipline focused on restoring a patient's functional abilities to pre-injury or pre-disease status. Functional abilities are defined as those activities in one's daily life, work, or sports and recreational activities that an individual participates in. Relevant impairments (e.g. strength, endurance, flexibility, motor control, etc.) are often intermediate goals of rehabilitation, but the final goal of successful care is return to participation in activities in which the patient was successful before the onset of the injury or disease. Essential to a rehabilitation approach is a focus on patient-centered outcomes such as independence and self-management or self-care skills.","111NR0400X","Source:  The American Chiropractic Association (ACA) and the ACA Council on Physiological Therapeutics [7/1/2006: new]","2006-10-01",null,null,"Delete - not a DPP measure","No"]
["Chiropractic Providers","Chiropractor","Sports Physician","Sports Physician Chiropractor","A sports chiropractor is uniquely trained to provide care and treatment of injuries or illness resulting from sports and physical fitness activities.  Doctors of Chiropractic with the Diplomate American Chiropractic Board of Sports Physicians (DACBSP) or the Certified Chiropractic Sports Physician (CCSP), sport specialty certifications from the American Chiropractic Board of Sports Physicians, have advanced training in the assessment, management and rehabilitation of sports related injuries. Extremity care, rehabilitation and soft tissue procedures are common skills utilized by these doctors. The specialty training covers a broad spectrum from the pediatric athlete to professional and Olympic athletes, and everything in between, using a variety of techniques and modalities.","111NS0005X","Source: American Chiropractic Board of Sports Physicians, 2009 [7/1/2009: definition added]","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Chiropractic Providers","Chiropractor","Thermography","Thermography Chiropractor","Definition to come...","111NT0100X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Related Providers","Chore Provider",null,"Chore Provider","An individual who provides home maintenance services required to sustain a safe, sanitary living environment for individuals who because of age or disabilities is unable to perform the activities.  These services include heavy household chores such as washing floors, windows, and walls; tacking down loose rugs and tiles; and moving heavy items of furniture in order to provide safe access and egress.","372500000X","[7/1/2003: new]","2003-10-01",null,null,"Delete - not a DPP measure","No"]
["Nursing & Custodial Care Facilities","Christian Science Facility",null,"Deactivated - Christian Science Facility","Inactive, use 282J00000X","317400000X"," [7/1/2009: marked inactive]","2002-04-01",40086,null,"Delete - deactivated","No"]
["Hospitals","Christian Science Sanitorium",null,"Deactivated - Christian Science Sanitorium","Inactive, use 282J00000X","287300000X"," [7/1/2009: marked inactive]","2002-04-01",40086,null,"Delete - deactivated","No"]
["Hospitals","Chronic Disease Hospital",null,"Chronic Disease Hospital","(1) A hospital including a physical plant and personnel that provides multidisciplinary diagnosis and treatment for diseases that have one or more of the following characteristics: is permanent; leaves residual disability; is caused by nonreversible pathological alteration; requires special training of the patient for rehabilitation; and/or may be expected to require a long period of supervision or care. In addition, patients require the safety, security, and shelter of these specialized inpatient or partial hospitalization settings. (2) A hospital that provides medical and skilled nursing services to patients with long-term illnesses who are not in an acute phase but who require an intensity of services not available in nursing homes.","281P00000X","Source: (1) Expanded from Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988.","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Hospitals","Chronic Disease Hospital","Children","Children' s Chronic Disease Hospital","Definition to come...","281PC2000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center",null,"Clinic/Center","A facility or distinct part of one used for the diagnosis and treatment of outpatients. \"Clinic/Center\" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).","261Q00000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Adolescent and Children Mental Health","Adolescent and Children Mental Health Clinic/Center","An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents.  Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training.","261QM0855X","[7/1/2003: new]","2003-10-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Adult Day Care","Adult Day Care Clinic/Center","Definition to come...","261QA0600X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Adult Mental Health","Adult Mental Health Clinic/Center","An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults.","261QM0850X","[7/1/2003: new]","2003-10-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Ambulatory Family Planning Facility","Ambulatory Family Planning Facility","An abortion/family planning facility where services are provided at a fixed specific location.  An Ambulatory Family Planning Facility does not provide overnight accommodations. The following procedures may be performed at an Ambulatory Family Planning Facility: abortions, laproscopy, hysterectomies, tubule ligation and other related procedures. Abortion is considered voluntary termination of pregnancy.","261QA0005X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Ambulatory Fertility Facility","Ambulatory Fertility Facility","A fertility facility, which may be licensed, registered, or certified in some states,  that is not hospital-based, where services are provided at a fixed specific location. An Ambulatory Fertility Facility does not provide overnight accommodations. The following fertility procedures may be performed at an Ambulatory Fertility Facility: In Vitro Fertilization (IVF), Gamete Intrafallopian Transfer (GIFT), Embryo Transfer-Thaw (ET-T), Zygote Intrafallopian Transfer (ZIFT), Donor OOCYTE (DO) ","261QA0006X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Ambulatory Surgical","Ambulatory Surgical Clinic/Center","Definition to come...","261QA1903X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Amputee","Amputee Clinic/Center","An entity, facility, or distinct part of a facility providing counseling, fitting, custom design, prescriptive, and training services related to congenital or postoperative absence of all or part of a limb or limbs.","261QA0900X","[7/1/2003: new]","2003-10-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Augmentative Communication","Augmentative Communication Clinic/Center","An entity, facility, or distinct part of a facility staffed by audiology and/or speech professionals with special training in the evaluation of a patient's potential for use of an augmentative communication device, determination of the most appropriate device, adjustment and maintenance of the device, and training the patient to use the device.","261QA3000X","[7/1/2003: new]","2003-10-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Birthing","Birthing Clinic/Center","A freestanding birth center is a health facility other than a hospital where childbirth is planned to occur away from the pregnant woman's residence, and that provides prenatal, labor and delivery, and postpartum care, as well as other ambulatory services for women and newborns.","261QB0400X","Source: Summarized from Social Security Act [42 U.S.C. 1396d(1)(3)(B)] [1/1/2013: added definition]","2002-04-01",null,"2013-01-01","Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Community Health","Community Health Clinic/Center","Definition to come...","261QC1500X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Corporate Health","Corporate Health Clinic/Center","Definition to come...","261QC1800X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Critical Access Hospital","Critical Access Hospital Clinic/Center","An outpatient entity, facility, or distinct part of a facility within or affiliated with a Critical Access Hospital that provides access to primary care services for individuals in a small rural community and is Medicare certified.","261QC0050X","[7/1/2003: new]","2003-10-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Dental","Dental Clinic/Center","Definition to come...","261QD0000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Developmental Disabilities","Developmental Disabilities Clinic/Center","An entity, facility, or distinct part of a facility providing comprehensive, multidiscipline diagnostic, treatment, therapy, training, and counseling services to children with congenital disorders that precipitate developmental delays and in many instances mental deficiencies (e.g., Cerebral Palsy, metabolic disorders, Sturge-Weber Syndrome, etc.).","261QD1600X","[7/1/2003: new]","2003-10-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Emergency Care","Emergency Care Clinic/Center","Definition to come...","261QE0002X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","End-Stage Renal Disease (ESRD) Treatment","End-Stage Renal Disease (ESRD) Treatment Clinic/Center","Definition to come...","261QE0700X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Endoscopy","Endoscopy Clinic/Center","Definition to come...","261QE0800X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Family Planning, Non-Surgical","Non-Surgical Family Planning Clinic/Center","An entity, facility, or distinct part of a facility, or mobile unit providing non-surgical, family planning/reproductive services including physical examination, laboratory services such as PAP or pregnancy tests; pregnancy, pregnancy prevention/contraceptive, and nutritional counseling, and contraceptives or prescriptions for contraceptives.","261QF0050X","[7/1/2003: new]","2003-10-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Federally Qualified Health Center (FQHC)","Federally Qualified Health Center (FQHC)","Definition to come...","261QF0400X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Genetics","Genetics Clinic/Center","An entity, facility, or distinct part of a facility providing analysis of family history, genetic laboratory testing and analysis, diagnosis of genetic trait, prognosis and options.  Laboratory studies may be outsourced.","261QG0250X","[7/1/2003: new]","2003-10-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Health Service","Health Service Clinic/Center","Definition to come...","261QH0100X","[7/1/2006: modified title]","2002-04-01",null,"2006-07-01","Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Hearing and Speech","Hearing and Speech Clinic/Center","An entity, facility, or distinct part of a facility providing diagnostic, treatment, prescriptive, and therapy services related to congenital and acquired conditions and diseases that affect hearing capacity and speech ability.","261QH0700X","[7/1/2003: new]","2003-10-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Infusion Therapy","Infusion Therapy Clinic/Center","Definition to come...","261QI0500X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Lithotripsy","Lithotripsy Clinic/Center","Definition to come...","261QL0400X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Magnetic Resonance Imaging (MRI)","Magnetic Resonance Imaging (MRI) Clinic/Center","Definition to come...","261QM1200X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Medical Specialty","Medical Specialty Clinic/Center","An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization.  Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).","261QM2500X","[7/1/2003: new]","2003-10-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Medically Fragile Infants and Children Day Care","Medically Fragile Infants and Children Day Care","An entity, facility, or distinct part of a facility specially equipped and staffed to provide care for medically fragile children with varied and complex care needs (e.g., enteral or parental feeding, ostomy care, respiratory/ventilator care, medications and therapies, etc.).","261QM3000X","[7/1/2003: new]","2003-10-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Mental Health (Including Community Mental Health Center)","Mental Health Clinic/Center (Including Community Mental Health Center)","Definition to come...","261QM0801X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Methadone","Methadone Clinic","An entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction.","261QM2800X","[7/1/2003: new]","2003-10-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Migrant Health","Migrant Health Clinic/Center","Definition to come...","261QM1000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Military Ambulatory Procedure Visits Operational (Transportable)","Military Ambulatory Procedure Visits Operational (Transportable) Clinic/Center","\"Non-fixed\" facilities or distinct parts of a \"non-fixed\" facility, providing outpatient surgical procedures requiring medically supervised recovery. Does not include items issued directly to a patient from an outpatient pharmacy or patient transport. Includes initial \"take home\" pharmaceuticals.","261QM1103X","[1/1/2005: new]","2005-04-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Military and U.S. Coast Guard Ambulatory Procedure","Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center","That part of a \"fixed\" (non-temporary, non-deployed) DoD or Coast Guard entity furnishing surgical procedures requiring medically supervised recovery.  Similar to a civilian ambulatory surgical center.  May be in shared resources with a DoD or Coast Guard Clinic or a DoD Hospital.  Does not include items issued directly to a patient from an outpatient pharmacy or patient transport.  Includes initial \"take home\" pharmaceuticals.","261QM1101X","Source:  TRICARE Management Activity Uniform Business Office User's Guide [1/1/2005: title modified,  definition added; 7/1/2006 title modified, definition modified]","2002-04-01",null,"2006-07-01","Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Military Outpatient Operational (Transportable) Component","Military Outpatient Operational (Transportable) Component Clinic/Center","\"Non-fixed\" facilities or distinct parts of a \"non-fixed\" facility, providing outpatient medical and dental services, primarily intended for DoD active duty. The entity is funded with other than Defense Health Program funding. Non-DoD active duty may receive services from this entity. \"Non-fixed\" facilities are generally deployed DoD health care activities, not providing services on or in association with a DoD fort or base. \"Non-fixed\" facilities include outpatient services furnished onboard ships. \"Non-fixed\" facilities also include deployed clinics. Does not include items issued directly to a patient from an outpatient pharmacy or patient transport.","261QM1102X","[1/1/2005: title modified,  definition added]","2002-04-01",null,"2005-01-01","Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Military/U.S. Coast Guard Outpatient","Military/U.S. Coast Guard Outpatient Clinic/Center","The Defense Health Program or U.S. Coast Guard funded \"fixed\" facilities or distinct parts of a facility, providing outpatient medical and dental services, primarily for Uniformed Services beneficiaries.  A \"fixed\" facility is a non-temporary, non-deployed facility.  It includes mobile specialty units such as Magnetic Resonance Imaging (MRI) units that may furnish services at the \"fixed\" facility.  It includes, as examples, the institutional portion of outpatient encounters (except Ambulatory Procedure Visits), supplies issued (e.g., glasses, ostomy supplies, crutches), and radiology and laboratory studies.  Does not include items issued directly to a patient from an outpatient pharmacy or patient transport.","261QM1100X","Source:  TRICARE Management Activity Uniform Business Office User's Guide [1/1/2005: title modified,  definition added; 7/1/2006 title modified, definition modified]","2002-04-01",null,"2006-07-01","Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Multi-Specialty","Multi-Specialty Clinic/Center","Definition to come...","261QM1300X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Occupational Medicine","Occupational Medicine Clinic/Center","Definition to come...","261QX0100X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Oncology","Oncology Clinic/Center","An entity, facility, or distinct part of a facility providing diagnostic, treatment and prescriptive services related to cancerous conditions.  Services include chemotherapy infusions and monitoring of implanted chemotherapeutic agents.","261QX0200X","[7/1/2003: new]","2003-10-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Oncology, Radiation","Radiation Oncology Clinic/Center","Definition to come...","261QX0203X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Ophthalmologic Surgery","Ophthalmologic Surgery Clinic/Center","Definition to come...","261QS0132X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Oral and Maxillofacial Surgery","Oral and Maxillofacial Surgery Clinic/Center","The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.","261QS0112X","Source: Council on Dental Education and Licensure, American Dental Association","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Pain","Pain Clinic/Center","Definition to come...","261QP3300X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Physical Therapy","Physical Therapy Clinic/Center","An entity, facility, or distinct part of a facility providing diagnostic and treatment services related to physical rehabilitation. Physical therapy is a dynamic profession with an established theoretical and scientific base and widespread clinical applications in the restoration, maintenance, and promotion of optimal physical function. Physical therapists and physical therapist assistants are licensed health care professionals who are experts in the movement system and help individuals maintain, restore, and improve movement, activity, and functioning, thereby enabling optimal performance and enhancing health, well-being, and quality of life. Their services prevent, minimize, or eliminate impairments of body functions and structures, activity limitations, and participation restrictions. Physical therapy is provided for individuals of all ages who have or may develop impairments, activity limitations, and participation restrictions related to (1) conditions of the musculoskeletal, neuromuscular, cardiovascular, pulmonary, and/or integumentary systems or (2) the negative effects attributable to unique personal and environmental factors as they relate to human performance.","261QP2000X","Source: Guide to PT Practice 3.0 [1/1/2020: definition added]  Additional resources: http://guidetoptpractice.apta.org/ ; American Physical Therapy Association, www.apta.org.","2002-04-01",null,"2020-01-01","Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Podiatric","Podiatric Clinic/Center","Definition to come...","261QP1100X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Primary Care","Primary Care Clinic/Center","Definition to come...","261QP2300X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Prison Health","Prison Health Clinic/Center","Definition to come...","261QP2400X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Public Health, Federal","Federal Public Health Clinic/Center","Definition to come...","261QP0904X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Public Health, State or Local","State or Local Public Health Clinic/Center","Definition to come...","261QP0905X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Radiology","Radiology Clinic/Center","Definition to come...","261QR0200X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Radiology, Mammography","Mammography Clinic/Center","Definition to come...","261QR0206X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Radiology, Mobile","Mobile Radiology Clinic/Center","Definition to come...","261QR0208X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Radiology, Mobile Mammography","Mobile Mammography Clinic/Center","Definition to come...","261QR0207X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Recovery Care","Recovery Care Clinic/Center","Definition to come...","261QR0800X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Rehabilitation","Rehabilitation Clinic/Center","Definition to come...","261QR0400X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Rehabilitation, Cardiac Facilities","Cardiac Rehabilitation Clinic/Center","Definition to come...","261QR0404X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)","Comprehensive Outpatient Rehabilitation Facility (CORF)","Definition to come...","261QR0401X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Rehabilitation, Substance Use Disorder","Substance Use Disorder Rehabilitation Clinic/Center","Definition to come...","261QR0405X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Research","Research Clinic/Center","Definition to come...","261QR1100X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Rural Health","Rural Health Clinic/Center","Definition to come...","261QR1300X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Sleep Disorder Diagnostic","Sleep Disorder Diagnostic Clinic/Center","Definition to come...","261QS1200X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Student Health","Student Health Clinic/Center","Definition to come...","261QS1000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Ambulatory Health Care Facilities","Clinic/Center","Urgent Care","Urgent Care Clinic/Center","Definition to come.","261QU0200X",null,"2002-04-01",null,null,"Review - Keep or remove? \"Urgent Care\" is not a Physician or Clinician Type but a Classification \"Clinic/Center\"","Yes"]
["Ambulatory Health Care Facilities","Clinic/Center","VA","VA Clinic/Center","Definition to come...","261QV0200X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Other Service Providers","Clinical Ethicist",null,"Clinical Ethicist","A clinical ethicist has been trained in bioethics and ethics case consultation.  The clinical ethicist addresses medical-ethical dilemmas arising in clinical practice, such as end-of-life care, refusal of treatment, and futility of care; assists patients and health care providers with medical decision-making; and provides ethics education for patients and families.","174V00000X","Source: National Uniform Claim Committee [1/1/2011: new]","2011-04-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Clinical Exercise Physiologist",null,"Clinical Exercise Physiologist","A Clinical Exercise Physiologist is a health care professional who is trained to work with patients with chronic disease where exercise training has been shown to be of therapeutic benefit, including but not limited to cardiovascular and pulmonary disease, and metabolic disorders.","224Y00000X","Source:  What is a Clinical Exercise Physiologist? Clinical Exercise Physiology Association (CEPA), CEPA Executive Board, 2008  [10/1/2011: new]","2011-10-01",null,null,"Delete - not a DPP measure","No"]
["Laboratories","Clinical Medical Laboratory",null,"Clinical Medical Laboratory","(1) A clinical laboratory is a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, human beings. These examinations also include procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body. Facilities only collecting or preparing specimens (or both) or only serving as a mailing service and not performing testing are not considered clinical laboratories. (2) Any facility that examines materials from the human body for purposes of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of, the health of human beings. Typical divisions of a clinical laboratory include hematology, cytology, bacteriology, histology, biochemistry, medical toxicology, and serology.","291U00000X","Source: (1) Code of Federal Regulations #42, Public Health, Section 493.2. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 186.","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Behavioral Health & Social Service Providers","Clinical Neuropsychologist",null,"Clinical Neuropsychologist","A clinical psychologist who applies principles of assessment and intervention based upon the scientific study of human behavior as it relates to normal and abnormal functioning of the central nervous system. The specialty is dedicated to enhancing the understanding of brain-behavior relationships and the application of such knowledge to human problems.","103G00000X","Source:  American Psychological Association, www.apa.org  [1/1/2007: title modified, 1/1/2019: definition modified]","2002-04-01",null,"2007-01-01","Delete - not a DPP measure","No"]
["Behavioral Health & Social Service Providers","Clinical Neuropsychologist","Clinical","Deactivated - Clinical Neuropsychologist",null,"103GC0700X",null,"2002-04-01",39172,39083,"Delete - deactivated","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Clinical Nurse Specialist",null,"Clinical Nurse Specialist","A registered nurse who, through a graduate degree program in nursing, or through a formal post-basic education program or continuing education courses and clinical experience, is expert in a specialty area of nursing practice within one or more of the components of direct patient/client care, consultation, education, research and administration.","364S00000X","Sources: American Nurses Association, American Nurses Credentialing Center, 1996 Certification Catalogue and The Interagency Conference on Nursing Statistics.","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Clinical Nurse Specialist","Acute Care","Acute Care Clinical Nurse Specialist","Definition to come...","364SA2100X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Clinical Nurse Specialist","Adult Health","Adult Health Clinical Nurse Specialist","Definition to come...","364SA2200X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Clinical Nurse Specialist","Chronic Care","Chronic Care Clinical Nurse Specialist","Definition to come...","364SC2300X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Clinical Nurse Specialist","Community Health/Public Health","Community Health/Public Health Clinical Nurse Specialist","Definition to come...","364SC1501X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Clinical Nurse Specialist","Critical Care Medicine","Critical Care Medicine Clinical Nurse Specialist","Definition to come...","364SC0200X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Clinical Nurse Specialist","Emergency","Emergency Clinical Nurse Specialist","Definition to come...","364SE0003X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Clinical Nurse Specialist","Ethics","Ethics Clinical Nurse Specialist","Definition to come...","364SE1400X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Clinical Nurse Specialist","Family Health","Family Health Clinical Nurse Specialist","Definition to come...","364SF0001X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Clinical Nurse Specialist","Gerontology","Gerontology Clinical Nurse Specialist","Definition to come...","364SG0600X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Clinical Nurse Specialist","Holistic","Holistic Clinical Nurse Specialist","Definition to come...","364SH1100X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Clinical Nurse Specialist","Home Health","Home Health Clinical Nurse Specialist","Definition to come...","364SH0200X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Clinical Nurse Specialist","Informatics","Informatics Clinical Nurse Specialist","Definition to come...","364SI0800X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Clinical Nurse Specialist","Long-Term Care","Long-Term Care Clinical Nurse Specialist","Definition to come...","364SL0600X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Clinical Nurse Specialist","Medical-Surgical","Medical-Surgical Clinical Nurse Specialist","Definition to come...","364SM0705X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Clinical Nurse Specialist","Neonatal","Neonatal Clinical Nurse Specialist","Definition to come...","364SN0000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Clinical Nurse Specialist","Neuroscience","Neuroscience Clinical Nurse Specialist","Definition to come...","364SN0800X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Clinical Nurse Specialist","Occupational Health","Occupational Health Clinical Nurse Specialist","Definition to come...","364SX0106X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Clinical Nurse Specialist","Oncology","Oncology Clinical Nurse Specialist","Definition to come...","364SX0200X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Clinical Nurse Specialist","Oncology, Pediatrics","Pediatric Oncology Clinical Nurse Specialist","Definition to come...","364SX0204X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Clinical Nurse Specialist","Pediatrics","Pediatric Clinical Nurse Specialist","Definition to come...","364SP0200X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Clinical Nurse Specialist","Perinatal","Perinatal Clinical Nurse Specialist","Definition to come...","364SP1700X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Clinical Nurse Specialist","Perioperative","Perioperative Clinical Nurse Specialist","Definition to come...","364SP2800X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Clinical Nurse Specialist","Psychiatric/Mental Health","Psychiatric/Mental Health Clinical Nurse Specialist","Definition to come...","364SP0808X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Clinical Nurse Specialist","Psychiatric/Mental Health, Adult","Adult Psychiatric/Mental Health Clinical Nurse Specialist","Definition to come...","364SP0809X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Clinical Nurse Specialist","Psychiatric/Mental Health, Child & Adolescent","Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist","Definition to come...","364SP0807X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Clinical Nurse Specialist","Psychiatric/Mental Health, Child & Family","Child & Family Psychiatric/Mental Health Clinical Nurse Specialist","Definition to come...","364SP0810X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Clinical Nurse Specialist","Psychiatric/Mental Health, Chronically Ill","Chronically Ill Psychiatric/Mental Health Clinical Nurse Specialist","Definition to come...","364SP0811X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Clinical Nurse Specialist","Psychiatric/Mental Health, Community","Community Psychiatric/Mental Health Clinical Nurse Specialist","Definition to come...","364SP0812X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Clinical Nurse Specialist","Psychiatric/Mental Health, Geropsychiatric","Geropsychiatric Psychiatric/Mental Health Clinical Nurse Specialist","Definition to come...","364SP0813X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Clinical Nurse Specialist","Rehabilitation","Rehabilitation Clinical Nurse Specialist","Definition to come...","364SR0400X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Clinical Nurse Specialist","School","School Clinical Nurse Specialist","Definition to come...","364SS0200X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Clinical Nurse Specialist","Transplantation","Transplantation Clinical Nurse Specialist","Definition to come...","364ST0500X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Clinical Nurse Specialist","Women's Health","Women's Health Clinical Nurse Specialist","Definition to come...","364SW0102X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Clinical Pharmacology",null,"Clinical Pharmacology Physician","Clinical pharmacology encompasses the spectrum of activities related to the discovery, development, regulation, and utilization of safe and effective drugs.","208U00000X","Source: American Society for Clinical Pharmacology and Therapeutics, 2008  [7/1/2008: modified definition]    Additional Resources: Clinical pharmacology is a recognized fellowship program for physicians, pharmacists, and post-doctoral researchers delivered through medical education institutions accredited by the American Board of Clinical Pharmacology. http://www.ascpt.org/; American Board of Clinical Pharmacology http://www.abcp.net/","2003-04-01",null,null,"Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Colon & Rectal Surgery",null,"Colon & Rectal Surgery Physician","A colon and rectal surgeon is trained to diagnose and treat various diseases of the intestinal tract, colon, rectum, anal canal and perianal area by medical and surgical means. This specialist also deals with other organs and tissues (such as the liver, urinary and female reproductive system) involved with primary intestinal disease.","208C00000X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007:  added definition, added source]    Additional Resources: American Board of Colon and Rectal Surgery, 2007.  http://www.abcrs.org/.    Board certification for Medical Doctors (MDs) is provided by the American Board of Colon and Rectal Surgery.    Colon and rectal surgeons have the expertise to diagnose and often manage anorectal conditions such as hemorrhoids, fissures (painful tears in the anal lining), abscesses and fistulae (infections located around the anus and rectum) in the office setting. They also treat problems of the intestine and colon, and perform endoscopic procedures to evaluate and treat problems such as cancer, polyps (precancerous growths) and inflammatory conditions. ","2003-04-01",null,39264,"Delete - not a DPP measure","No"]
["Residential Treatment Facilities","Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",null,"Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility","A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.","320900000X","[7/1/2003: new, 1/1/2021: modified title, modified definition]","2003-10-01",null,44197,"Delete - not a DPP measure","No"]
["Residential Treatment Facilities","Community Based Residential Treatment Facility, Mental Illness",null,"Mental Illness Community Based Residential Treatment Facility","A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness.","320800000X","[7/1/2003: new]","2003-10-01",null,null,"Delete - not a DPP measure","No"]
["Other Service Providers","Community Health Worker",null,"Community Health Worker","Community health workers (CHW) are lay members of communities who work either for pay or as volunteers in association with the local health care system in both urban and rural environments and usually share ethnicity, language, socioeconomic status and life experiences with the community members they serve. They have been identified by many titles such as community health advisors, lay health advocates, \"promotores(as), outreach educators, community health representatives, peer health promoters, and peer health educators. CHWs offer interpretation and translation services, provide culturally appropriate health education and information, assist people in receiving the care they need, give informal counseling and guidance on health behaviors, advocate for individual and community health needs, and provide some direct services such as first aid and blood pressure screening.  Some examples of these practitioners are Community Health Aides or Practitioners established under 25 USC 1616 (l) under HHS, Indian Health Service, Public Health Service.","172V00000X","Source: Health Resources and Services Administration, US Department of Health and Human Services - National Workforce Study on Community Health Workers, March, 2007. [7/1/2007: new]    http://bhpr.hrsa.gov/healthworkforce/chw/","2007-10-01",null,null,"Delete - not a DPP measure","No"]
["Agencies","Community/Behavioral Health",null,"Community/Behavioral Health Agency","A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment.","251S00000X","Source:  National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition, 1/1/2021: modified definition]","2002-04-01",null,44197,"Delete - not a DPP measure","No"]
["Other Service Providers","Contractor",null,"Contractor","A person who contracts to supply certain materials or do certain work for a stipulated sum; esp., one whose business is contracting work in any of the building trades. For purposes of the taxonomy, a person who contracts to complete home repairs or modifications to accommodate a health condition (e.g. wheelchair ramp, kitchen counter lowering).","171W00000X","Source: Websters New World Dictionary of the American Language, Second College Edition, William Collins + World Publishing Co., Inc., New York: 1974, p. 308","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Other Service Providers","Contractor","Home Modifications","Home Modifications Contractor","Definition to come...","171WH0202X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Other Service Providers","Contractor","Vehicle Modifications","Vehicle Modifications Contractor","A contractor who makes modifications to private vehicles to accommodate a health condition.","171WV0202X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Behavioral Health & Social Service Providers","Counselor",null,"Counselor","A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification.","101Y00000X","Sources: Abridged from definitions provided by the National Board of Certified Counselors and the American Association of Pastoral Counselors.","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Behavioral Health & Social Service Providers","Counselor","Addiction (Substance Use Disorder)","Addiction (Substance Use Disorder) Counselor","Definition to come...","101YA0400X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Behavioral Health & Social Service Providers","Counselor","Mental Health","Mental Health Counselor","Definition to come...","101YM0800X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Behavioral Health & Social Service Providers","Counselor","Pastoral","Pastoral Counselor","Definition to come...","101YP1600X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Behavioral Health & Social Service Providers","Counselor","Professional","Professional Counselor","Definition to come...","101YP2500X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Behavioral Health & Social Service Providers","Counselor","School","School Counselor","Definition to come...","101YS0200X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing & Custodial Care Facilities","Custodial Care Facility",null,"Custodial Care Facility","A facility providing care that serves to assist an individual in the activities of daily living, such as assistance in walking, getting in and out of bed, bathing, dressing, feeding, and using the toilet, preparation of special diets, and supervision of medication that usually can be self-administered. Custodial care essentially is personal care that does not require the continuing attention of trained medical or paramedical personnel.","311Z00000X","Source: Paraphrased from Section 3159 A3 of the Medicare Intermediary Manual.","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing & Custodial Care Facilities","Custodial Care Facility","Adult Care Home","Adult Care Home Facility","A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment.","311ZA0620X","[7/1/2003: new]","2003-10-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Dance Therapist",null,"Dance Therapist","The dance therapist, sometimes called a movement therapist, focuses on rhythmic body movements as a medium of physical and psychological change. Dance therapy is practiced more often with mental health patients than with physically disabled patients. A master's degree is required by the American Dance Therapy Association to award the credentials Dance Therapist Registered (DTR).","225600000X","Source: Joel A. DeLisa and Bruce M. Gans, Rehabilitation Medicine: Principles and Practice Second Edition, J.B. Lippincott Company, Philadelphia: 1993, p. 11","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Agencies","Day Training, Developmentally Disabled Services",null,"Developmentally Disabled Services Day Training Agency","These agencies are authorized to provide day habilitation services to developmentally disabled individuals who live in their homes.  The function of day habilitation is to assist an individual to acquire and maintain those life skills that enable the individual to cope more effectively with the demands of independent living.  Also to raise the level of the individual's physical, mental, social, and vocational functioning.","251C00000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Related Providers","Day Training/Habilitation Specialist",null,"Day Training/Habilitation Specialist","Individuals experienced or trained in working with developmentally disabled individuals who need assistance in acquiring and maintaining life skills that enable them to cope more effectively with the demands of independent living.","373H00000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Dental Providers","Dental Assistant",null,"Dental Assistant","An individual who may or may not have completed an accredited dental assisting education program and who aids the dentist in providing patient care services and performs other nonclinical duties in the dental office or other patient care facility.  The scope of the patient care functions that may be legally delegated to the dental assistant varies based on the needs of the dentist the educational preparation of the dental assistant and state dental practice acts and regulations.  Patient care services are provided under the supervision of a dentist.  To avoid misleading the public, no occupational title other than dental assistant should be used to describe this dental auxiliary.","126800000X","Source: Comprehensive Policy Statement on Dental Auxiliaries, American Dental Association","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Dental Providers","Dental Hygienist",null,"Dental Hygienist","An individual who has completed an accredited dental hygiene education program, and an individual who has been licensed by a state board of dental examiners to provide preventive care services under the supervision of a dentist.  Functions that may be legally delegated to the dental hygienist vary based on the needs of the dentist, the educational preparation of the dental hygienist and state dental practice acts and regulations, but always include, at a minimum, scaling and polishing the teeth.  To avoid misleading the public, no occupational title other than dental hygienist should be used to describe this dental auxiliary.","124Q00000X","Source: Comprehensive Policy Statement on Dental Auxiliaries, American Dental Association.","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Laboratories","Dental Laboratory",null,"Dental Laboratory","A commercial laboratory specializing in the construction of dental appliances that conform to a dentist's specifications including the construction of dentures (complete or partial), orthodontic appliances, bridgework, crowns, and inlays.","292200000X","Source: Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 1245.","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Dental Providers","Dental Laboratory Technician",null,"Dental Laboratory Technician","An individual who has the skill and knowledge in the fabrication of dental appliances, prostheses and devices in accordance with a dentist's laboratory work authorization.  To avoid misleading the public, no occupational title other than dental laboratory technician or certified dental technician (when appropriate) should be used to describe this auxiliary.","126900000X","Source: Comprehensive Policy Statement on Dental Auxiliaries, American Dental Association.","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Dental Providers","Dental Therapist",null,"Dental Therapist","A Dental Therapist is an individual who has completed an accredited or non-accredited dental therapy program and who has been authorized by the relevant state board or a tribal entity to provide services within the scope of their practice under the supervision of a dentist. Functions that may be delegated to the dental therapist vary based on the needs of the dentist, the educational preparation of the dental therapist and state dental practice acts and regulations.","125J00000X","Source: Summarized from Minnesota Statute 150A.105. [7/1/2012: new]","2012-10-01",null,null,"Delete - not a DPP measure","No"]
["Dental Providers","Dentist",null,"Dentist","A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license.  There is no difference between the two degrees: dentists who have a DMD or DDS have the same education.  Universities have the prerogative to determine what degree is awarded.  Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation.  Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist.  State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry.  Additional post-graduate training is required to become a dental specialist.","122300000X","Source: Council on Dental Education and Licensure, American Dental Association","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Dental Providers","Dentist","Dental Public Health","Public Health Dentist","The science and art of preventing and controlling dental diseases and promoting dental health through organized community efforts.  It is that form of dental practice that serves the community as a patient rather than the individual.  It is concerned with the dental health education of the public, with applied dental research, and with the administration of group dental care programs as well as the prevention and control of dental diseases on a community basis.","1223D0001X","Source: Council on Dental Education and Licensure, American Dental Association","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Dental Providers","Dentist","Dentist Anesthesiologist","Dentist Anesthesiologist","A dentist who has successfully completed an accredited postdoctoral anesthesiology residency training program for dentists of two or more years duration, in accord with Commission on Dental Accreditation's Standards for Dental Anesthesiology Residency Programs, and/or meets the eligibility requirements for examination by the American Dental Board of Anesthesiology.","1223D0004X","Source: The American Society of Dentist Anesthesiologists  [1/1/2013: new]","2013-04-01",null,null,"Delete - not a DPP measure","No"]
["Dental Providers","Dentist","Endodontics","Endodontist","The branch of dentistry that is concerned with the morphology, physiology and pathology of the human dental pulp and periradicular tissues.  Its study and practice encompass the basic and clinical sciences including biology of the normal pulp, the etiology, diagnosis, prevention and treatment of diseases and injuries of the pulp and associated periradicular conditions.","1223E0200X","Source: Council on Dental Education and Licensure, American Dental Association","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Dental Providers","Dentist","General Practice","General Practice Dentistry","A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. ","1223G0001X","Source: Academy of General Dentistry","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Dental Providers","Dentist","Oral and Maxillofacial Pathology","Oral and Maxillofacial Pathology Dentist","The specialty of dentistry and discipline of pathology that deals with the nature, identification, and management of diseases affecting the oral and maxillofacial regions.  It is a science that investigates the causes, processes, and effects of these diseases.  The practice of oral and maxillofacial pathology includes research and diagnosis of diseases using clinical, radiographic, microscopic, biochemical, or other examinations.","1223P0106X","Source: Council on Dental Education and Licensure, American Dental Association","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Dental Providers","Dentist","Oral and Maxillofacial Radiology","Oral and Maxillofacial Radiology Dentist","The specialty of dentistry and discipline of radiology concerned with the production and interpretation of images and data produced by all modalities of radiant energy that are used for the diagnosis and management of diseases, disorders and conditions of the oral and maxillofacial region.","1223X0008X","Source: Council on Dental Education and Licensure, American Dental Association","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Dental Providers","Dentist","Oral and Maxillofacial Surgery","Oral and Maxillofacial Surgery (Dentist)","The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.","1223S0112X","Source: Council on Dental Education and Licensure, American Dental Association","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Dental Providers","Dentist","Orofacial Pain","Orofacial Pain Dentist","A dentist who assesses, diagnoses, and treats patients with complex chronic orofacial pain and dysfunction disorders, oromotor and jaw behavior disorders, and chronic head/neck pain.  The dentist has successfully completed an accredited postdoctoral orofacial pain residency training program for dentists of two or more years duration, in accord with the Commission on Dental Accreditation's Standards for Orofacial Pain Residency Programs, and/or meets the requirements for examination and board certification by the American Board of Orofacial Pain.","1223X2210X","Source:  American Academy of Orofacial Pain, http://www.aaop.org [7/1/2019: new]<br/><br/>Additional Resources: American Board of Orofacial Pain, http://www.abop.net","2019-10-01",null,null,"Delete - not a DPP measure","No"]
["Dental Providers","Dentist","Orthodontics and Dentofacial Orthopedics","Orthodontics and Dentofacial Orthopedic Dentist","That area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of their related structures and the adjustment of relationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of functional forces within the craniofacial complex.  Major responsibilities of orthodontic practice include the diagnosis, prevention, interception and treatment of all forms of malocclusion of the teeth and associated alterations in their surrounding structures; the design, application and control of functional and corrective appliances; and the guidance of the dentition and its supporting structures to attain and maintain optimum occlusal relations in physiologic and esthetic harmony among facial and cranial structures.","1223X0400X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Dental Providers","Dentist","Pediatric Dentistry","Pediatric Dentist","An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.","1223P0221X","Source: Council on Dental Education and Licensure, American Dental Association","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Dental Providers","Dentist","Periodontics","Periodontist","That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues.","1223P0300X","Source: Council on Dental Education and Licensure, American Dental Association","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Dental Providers","Dentist","Prosthodontics","Prosthodontist","That branch of dentistry pertaining to the restoration and maintenance of oral functions, comfort, appearance and health of the patient by the restoration of natural teeth and/or the replacement of missing teeth and contiguous oral and maxillofacial tissues with artificial substitutes.","1223P0700X","Source: Council on Dental Education and Licensure, American Dental Association","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Dental Providers","Denturist",null,"Denturist","Definition to come.","122400000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Suppliers","Department of Veterans Affairs (VA) Pharmacy",null,"Department of Veterans Affairs (VA) Pharmacy","Department of Veterans Affairs (VA) Pharmacy means any place under VA jurisdiction where drugs are dispensed and Pharmaceutical Care is provided to enrolled Veterans, by licensed pharmacists. The Pharmacy is reviewed by JCAHO, utilizes the VA hospital's DEA number, and has a designated NCPDP number. VA facility pharmacies include Inpatient (Institutional), Outpatient, Consolidated Mail Outpatient Pharmacies (CMOPs), Research, Addiction Treatment Centers, Long Term Care and Community Based Outpatient Clinics Pharmacies. The VHA Pharmacy Benefits Management - Strategic Healthcare Group has oversight for professional and practice activities of VA Pharmacies. Each pharmacy is under the direct supervision of a U.S. or U.S. territory licensed pharmacist, and has staffing to meet its designated scope of service.","332100000X","Source: Pharmacy Benefits Management - Strategic Healthcare Group, Veterans Health Administration, Department of Veterans Affairs  [1/1/2006: new]","2006-04-01",null,null,"Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Dermatology","Intentionally left blank","Dermatology Physician","A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.","207N00000X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: added definition, added source]    Additional Resources: American Board of Dermatology, 2007.  http://www.abderm.org/    Board certification is provided by the American Board of Dermatology.   ","2003-04-01",null,"2007-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Dermatology","Clinical & Laboratory Dermatological Immunology","Clinical & Laboratory Dermatological Immunology Physician","A dermatologist who utilizes various specialized laboratory procedures to diagnose disorders characterized by defective responses of the body's immune system. Immunodermatologists also may provide consultation in the management of these disorders and administer specialized forms of therapy for these diseases.","207NI0002X","Source: American Board of Medical Specialties, 2007.  www.abms.org  [7/1/2007: added definition, added source]    Additional Resources: American Board of Dermatology, 2007.  http://www.abderm.org/    Board certification is provided by the American Board of Dermatology.  ","2003-04-01",null,"2007-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Dermatology","Dermatopathology","Dermatopathology Physician","A dermatopathologist has the expertise to diagnose and monitor diseases of the skin including infectious, immunologic, degenerative and neoplastic diseases. This entails the examination and interpretation of specially prepared tissue sections, cellular scrapings and smears of skin lesions by means of routine and special (electron and fluorescent) microscopes.","207ND0900X","Source: American Board of Medical Specialties, 2007.  www.abms.org  [7/1/2007: added definition, added source; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Dermatology, 2007.  http://www.abderm.org/; American Osteopathic Board of Dermatology, 2007. http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Dermatology.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Dermatology.","2003-04-01",null,"2011-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Dermatology","MOHS-Micrographic Surgery","MOHS-Micrographic Surgery Physician","The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery.  Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S.","207ND0101X","Source: American College of Mohs Surgery, 2007 [1/1/2008: added definition, added source]  Additional Resources: Additional Resources: http://www.mohscollege.org/; American Board of Dermatology, 2007.  http://www.abderm.org/","2003-04-01",null,"2008-01-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Dermatology","Pediatric Dermatology","Pediatric Dermatology Physician","A pediatric dermatologist has, through additional special training, developed expertise in the treatment of specific skin disease categories with emphasis on those diseases which predominate in infants, children and adolescents.","207NP0225X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: changed definition, added source]    Additional Resources: American Board of Dermatology, 2007, http://www.abderm.org/  A subspecialty certificate was approved by ABMS in 2000.    ACGME Accredited Residency Program Requirements:  None.","2003-04-01",null,"2007-07-01","Keep - Clarify in Specs FAQ or Stakeholder Feedback, etc. that the eligible physician or clinician is at the Classification level, and any subspecialization can be found under the Area of Specialization level. For example, a physician may have a pediatric subspecialty (Area of Specialization) but not necessarily be a pediatrics physician (Classification).","Yes"]
["Allopathic & Osteopathic Physicians","Dermatology","Procedural Dermatology","Procedural Dermatology Physician","Procedural Dermatology, a subspecialty of Dermatology, encompassing a wide variety of surgical procedures and methods to remove or modify skin tissue for health or cosmetic benefit. These methods include scalpel surgery, laser surgery, chemical surgery, cryosurgery (liquid nitrogen), electrosurgery, aspiration surgery, liposuction, injection of filler substances, and Mohs micrographic controlled surgery (a special technique for the removal of growths, especially skin cancers).","207NS0135X","Source: American Board of Dermatology, 2007, www.abderm.org [1/1/2008: definition added, source added, title changed]    Additional Resources:  Some ABMS board certified dermatologists have completed a one-year ACGME approved fellowship in Procedural Dermatology, which has been offered since 2003. At this time the ABD does not offer subspecialty certification in Procedural Dermatology.","2003-04-01",null,"2008-01-01","Keep - No Change","Yes"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Developmental Therapist",null,"Developmental Therapist","A Developmental Therapist is a person qualified by completion of an approved program in Developmental Therapy and where applicable credentialed by the state and practicing within the scope of the credential, or credentialed by completion of education experiences as approved by the state and practicing within the scope of that credential or, where state credentialing does not exist, certified by the Board of the Developmental Therapy Association. A developmental therapist evaluates children's global development in order to identify areas of developmental delay whether arising from physiological, neurological, or environmental factors, or a combination of factors; and designs, implements, and modifies therapeutic interventions for the child and the family to promote the child's acquisition of skills in a variety of developmental areas, including cognitive processes and social interaction in order to maximize functional independence and developmental homeostasis, and improve the quality of life at home and in the community; and provides consultation for the parents and other professionals working with the family on global development.","222Q00000X","Source: The Illinois Developmental Therapists Association [1/1/2007: new]","2007-04-01",null,null,"Delete - not a DPP measure","No"]
["Dietary & Nutritional Service Providers","Dietary Manager",null,"Dietary Manager","A dietary manager is a trained food services professional who is charged with maintaining cost/profit objectives, purchasing foods and services for the department and supervising staff.. Dietary managers are trained to understand the basic nutritional needs of clients and work in partnership with dietitians, who offer specialized nutritional expertise. The CDM certified dietary manager designation is an advanced professional credential awarded to dietary managers who have completed specific course work, have passed the national credentialing exams (including a sanitation and safety exam) and have applied for certification.","132700000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Dietary & Nutritional Service Providers","Dietetic Technician, Registered",null,"Registered Dietetic Technician","A Dietetic Technician, Registered (DTR)/Nutrition and Dietetics Technician, Registered (NDTR) is an individual holding a nationally protected title issued by the Commission on Dietetic Registration (CDR) to qualified individuals who obtain an associate's degree or higher and successfully complete a sliding set of academic, examination, and practice requirements accredited by the Accreditation Council for Education in Nutrition and Dietetics (ACEND) or established by CDR, the nature of which are dependent upon the level of academic degree obtained. The scope of practice of the NDTR focuses on food, nutrition, and dietetics practice, as well as related services. NDTRs work under the supervision of a Registered Dietitian Nutritionist (RDN) when in direct patient/client nutrition care, and may work independently in providing general nutrition education to healthy populations. Patient/client populations include individuals receiving individualized care who have medical conditions or diseases, as well as at-risk individuals receiving personalized nutrition guidance as part of preventive health care.","136A00000X","Source:  Academy of Nutrition and Dietetics Definition of Terms List, Current Version, https://www.eatrightpro.org/practice/quality-management/scope-of-practice [7/1/2019:modified definition]","2002-04-01",null,"2019-07-01","Delete - not a DPP measure","No"]
["Dietary & Nutritional Service Providers","Dietitian, Registered","Intentionally left blank","Registered Dietitian","A Registered Dietitian (RD)/Registered Dietitian Nutritionist (RDN) is an individual uniquely trained in the science of nutrition and practice of dietetics to design and provide medical nutrition therapy (MNT) and other evidence-based applications of the Nutrition Care Process (NCP) that exemplify the profession's systematic approach to providing high quality nutrition care. Registered dietitians provide MNT for the purpose of disease prevention or management, or to treat or rehabilitate an illness, injury, or condition, with the use of specific, indicated physical and cognitive nutrition care services comprised of one or more of the following aspects of the NCP: nutrition assessment/reassessment, nutrition diagnosis, nutrition intervention (e.g., nutrition counseling, therapeutic diet ordering, and nutrition education) and nutrition monitoring and evaluation.","133V00000X","Source:  Academy of Nutrition and Dietetics Definition of Terms List , Current Version, https://www.eatrightpro.org/practice/quality-management/scope-of-practice [7/1/2019:modified definition]","2002-04-01",null,"2019-07-01","Keep - No Change","Yes"]
["Dietary & Nutritional Service Providers","Dietitian, Registered","Nutrition, Gerontological","Gerontological Nutrition Registered Dietitian","An individual who is a Specialist in Gerontological Nutrition and provides nutrition care to promote quality of life and optimal health for older adults across the continuum of care, including: acute care, post-acute care, primary care, long-term care, assisted living, home care, palliative care, community-based nutrition, food service, correctional facilities, and government programs. RDN who works indirectly with gerontological nutrition through roles in management, industry, education, and research.","133VN1101X","Source:  The Commission on Dietetic Registration, https://www.cdrnet.org/certifications/specialty-practice-experience [7/1/2019: new]","2019-10-01",null,null,"Keep - No Change","Yes"]
["Dietary & Nutritional Service Providers","Dietitian, Registered","Nutrition, Metabolic","Metabolic Nutrition Registered Dietitian","Definition to come.","133VN1006X",null,"2002-04-01",null,null,"Keep - Add somewhere that for TIPPS program, whenever a Definition is listed as \"Definition to come.\" by NUCC, then the Definition at the Classification level should be used as possible.","Yes"]
["Dietary & Nutritional Service Providers","Dietitian, Registered","Nutrition, Obesity and Weight Management","Obesity and Weight Management Nutrition Registered Dietitian","An individual who is a Board Certified Specialist for Obesity and Weight Management and educates, supports, and advocates for patients and clients to understand and manage their weight and associated risks through the use of nutritional, behavioral health, medical, surgical, pharmacotherapeutic, and exercise and physical activity interventions.","133VN1201X","Source:  The Commission on Dietetic Registration, https://www.cdrnet.org/certifications/specialty-practice-experience [7/1/2019: new]","2019-10-01",null,null,"Keep - No Change","Yes"]
["Dietary & Nutritional Service Providers","Dietitian, Registered","Nutrition, Oncology","Oncology Nutrition Registered Dietitian","An individual who is a Board Certified Specialist in Oncology Nutrition and provides direct nutrition care for individuals at risk for or diagnosed with cancer. RDNs working directly with individuals at risk for, or diagnosed with, any type of malignancy or pre-malignant condition, in a variety of settings (e.g. hospitals, clinics, cancer centers, hospices, public health), OR indirectly through roles in management, education, industry, and research practice linked specifically to oncology nutrition. RDN who works indirectly with oncology nutrition through roles in management, education, industry, and research.","133VN1301X","Source:  The Commission on Dietetic Registration, https://www.cdrnet.org/certifications/specialty-practice-experience [7/1/2019: new]","2019-10-01",null,null,"Keep - No Change","Yes"]
["Dietary & Nutritional Service Providers","Dietitian, Registered","Nutrition, Pediatric","Pediatric Nutrition Registered Dietitian","An individual who is a Board Certified Specialist in Pediatric Nutrition and applies evidence-based nutrition knowledge in providing medical nutrition therapy for pediatric patients. Specialists work directly with healthy and/or ill children (newborn up to 21 years of age) as well as children with special health care needs in a variety of settings (hospitals, community-based and/or family-centered programs, education programs, home, etc.), OR indirectly through management, care coordination, education, quality improvement, or research practice linked specifically to pediatric nutrition.","133VN1004X","Source:  The Commission on Dietetic Registration, https://www.cdrnet.org/certifications/specialty-practice-experience [7/1/2019: definition added, source added]","2002-04-01",null,"2019-07-01","Keep - Clarify in Specs FAQ or Stakeholder Feedback, etc. that the eligible physician or clinician is at the Classification level, and any subspecialization can be found under the Area of Specialization level. For example, a physician may have a pediatric subspecialty (Area of Specialization) but not necessarily be a pediatrics physician (Classification).","Yes"]
["Dietary & Nutritional Service Providers","Dietitian, Registered","Nutrition, Pediatric Critical Care","Pediatric Critical Care Nutrition Registered Dietitian","An individual who is a Board Certified Specialist in Pediatric Critical Care Nutrition and applies evidence-based nutrition knowledge in providing medical nutrition therapy for critically ill infants, children and adolescents. Additional roles could include coordination, education, quality improvement, or research linked specifically to pediatric critical care nutrition.","133VN1401X","Source:  The Commission on Dietetic Registration, https://www.cdrnet.org/certifications/specialty-practice-experience [7/1/2019: new]","2019-10-01",null,null,"Keep - Clarify in Specs FAQ or Stakeholder Feedback, etc. that the eligible physician or clinician is at the Classification level, and any subspecialization can be found under the Area of Specialization level. For example, a physician may have a pediatric subspecialty (Area of Specialization) but not necessarily be a pediatrics physician (Classification).","Yes"]
["Dietary & Nutritional Service Providers","Dietitian, Registered","Nutrition, Renal","Renal Nutrition Registered Dietitian","An individual who is a Board Certified Specialist in Renal Nutrition and works directly with adult and/or pediatric patients with acute kidney injury, chronic kidney disease (CKD) stages 1-5, or receiving renal replacement therapies (dialysis/transplant) in a variety of settings, OR works indirectly in management, education, or research practice linked specifically to renal nutrition. The specialist in renal/nephrology nutrition is responsible for nutrition assessment, diagnosis, intervention, monitoring, and evaluation.","133VN1005X","Source:  The Commission on Dietetic Registration, https://www.cdrnet.org/certifications/specialty-practice-experience [7/1/2019: definition added, source added]","2002-04-01",null,"2019-07-01","Keep - No Change","Yes"]
["Dietary & Nutritional Service Providers","Dietitian, Registered","Nutrition, Sports Dietetics","Sports Dietetics Nutrition Registered Dietitian","An individual who is a Board Certified Specialist in Sports Dietetics and applies evidence-based nutrition knowledge in exercise and sports. RDNs specializing in sports dietetics assess, educate, and counsel athletes and active individuals. They design, implement, and manage safe and effective nutrition strategies that enhance lifelong health, fitness, and optimal performance.","133VN1501X","Source:  The Commission on Dietetic Registration, https://www.cdrnet.org/certifications/specialty-practice-experience [7/1/2019: new]","2019-10-01",null,null,"Keep - No Change","Yes"]
["Behavioral Health & Social Service Providers","Drama Therapist",null,"Drama Therapist","Drama therapists are trained in the intentional use of drama and theatre processes to achieve therapeutic goals. Drama therapists provide psychotherapy for individuals living with mental health and behavioral concerns that may result in psychological suffering, impaired relationships, or distress in daily activities. Drama therapy promotes wellness and healing within the context of a therapeutic relationship for individuals of varying ability levels across the lifespan. Drama therapy can take many forms depending on individual and group needs, skill and ability levels, interests, and therapeutic goals. Processes and techniques may include improvisation, theater games, storytelling, and enactment.","101200000X","Source:  North American Drama Therapy Association, www.nadta.org [1/1/2021: new]","2021-04-01",null,null,"Delete - not a DPP measure","No"]
["Other Service Providers","Driver",null,"Driver","A person employed to operate a motor vehicle as a carrier of persons or property.","172A00000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Suppliers","Durable Medical Equipment & Medical Supplies",null,"Durable Medical Equipment & Medical Supplies","A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.","332B00000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Suppliers","Durable Medical Equipment & Medical Supplies","Customized Equipment","Customized Equipment (DME)","Definition to come...","332BC3200X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Suppliers","Durable Medical Equipment & Medical Supplies","Dialysis Equipment & Supplies","Dialysis Equipment & Supplies (DME)","Definition to come...","332BD1200X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Suppliers","Durable Medical Equipment & Medical Supplies","Nursing Facility Supplies","Nursing Facility Supplies (DME)","Definition to come...","332BN1400X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Suppliers","Durable Medical Equipment & Medical Supplies","Oxygen Equipment & Supplies","Oxygen Equipment & Supplies (DME)","Definition to come...","332BX2000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Suppliers","Durable Medical Equipment & Medical Supplies","Parenteral & Enteral Nutrition","Parenteral & Enteral Nutrition Supplies (DME)","Definition to come...","332BP3500X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Related Providers","Doula",null,"Doula","Doulas work in a variety of settings and have been trained to provide physical, emotional, and informational support to a mother before, during, and just after birth and/or provide emotional and practical support to a mother during the postpartum period.","374J00000X","Source:  National Uniform Claim Committee, 2009 [7/1/2009: new]","2009-10-01",null,null,"Delete - not a DPP measure","No"]
["Agencies","Early Intervention Provider Agency",null,"Early Intervention Provider Agency","Early intervention services are an effective way to address the needs of infants and toddlers who have developmental delays or disabilities. The services are made available through a federal law known as the Individuals with Disabilities Education Act (IDEA). IDEA provides states and territories with specific requirements for providing early intervention services to infants and toddlers with special needs. In turn, each state and territory develops its own policies for carrying out IDEA and its requirements. Broadly speaking, early intervention services are special services for eligible infants and toddlers and their families. These services are designed to identify and meet children's needs in five developmental areas. These areas are: physical development, cognitive development, communication, social or emotional development, and adaptive development.","252Y00000X","Source: National Dissemination Center for Children with Disabilities [7/1/2007: new]    http://www.nichcy.org/pubs/parent/pa2txt.htm","2007-10-01",null,null,"Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Electrodiagnostic Medicine",null,"Electrodiagnostic Medicine Physician","Electrodiagnostic medicine is the medical subspecialty that applies neurophysiologic techniques to diagnose, evaluate, and treat patients with impairments of the neurologic, neuromuscular, and/or muscular systems.  Qualified physicians are trained in performing electrophysiological testing and interpretation of the test data.  They require knowledge in anatomy, physiology, kinesiology, histology, and pathology of the brain, spinal cord, autonomic nerves, cranial nerves, peripheral nerves, neuromuscular junction, and muscles. They must know clinical features and treatment of diseases of the central, peripheral, and autonomic nervous systems, as well as those of neuromuscular junction and muscle. Physicians also require special knowledge about electric signal processing, including waveform analysis, electronics and instrumentation, stimulation and recording equipment, and statistics.","204R00000X","Source: American Association of Neuromuscular & Electrodiagnostic Medicine, 2011. www.aanem.org [1/1/2011: new]  Additional Resources:  American Board of Electrodiagnostic Medicine, 2011.  www.abemexam.org","2011-04-01",null,null,"Delete - not a DPP measure","No"]
["Emergency Medical Service Providers","Emergency Medical Technician, Basic",null,"Basic Emergency Medical Technician","A Basic EMT is an individual trained and certified to perform basic life support treatment in medical emergencies based on individual state boards.","146N00000X","Sources: Tabers Medical Dictionary and Florida EMS Clearing House.","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Emergency Medical Service Providers","Emergency Medical Technician, Intermediate",null,"Intermediate Emergency Medical Technician","An Intermediate EMT is an individual trained and certified to perform intermediate life support treatment in medical emergencies based on individual state boards.","146M00000X","Sources: Tabers Medical Dictionary and Florida EMS Clearing House.","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Emergency Medical Service Providers","Emergency Medical Technician, Paramedic",null,"Paramedic","An EMT, Paramedic is an individual trained and certified to perform advanced life support (ALS) in medical emergencies based on individual state boards.","146L00000X","Sources: Tabers Medical Dictionary and Florida EMS Clearing House.","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Emergency Medicine","Intentionally left blank","Emergency Medicine Physician","An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury.","207P00000X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Emergency Medicine, 2007.  http://www.abem.org/public/; American Osteopathic Board of Emergency Medicine, 2007. http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Emergency Medicine.","2003-04-01",null,"2011-07-01","Delete - Will be removed in CHIRP","Yes"]
["Allopathic & Osteopathic Physicians","Emergency Medicine","Emergency Medical Services","Emergency Medical Services (Emergency Medicine) Physician","An emergency medicine physician who specializes in non-hospital based emergency medical services (e.g., disaster site, accident scene, transport vehicle, etc.) to provide pre-hospital assessment, treatment, and transport patients.","207PE0004X","Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added]    Additional Resources: A Certification of Added Qualifications (CAQ) is issued by the American Osteopathic Board of Emergency Medicine.","2003-04-01",null,"2010-01-01","Delete - Will be removed in CHIRP","Yes"]
["Allopathic & Osteopathic Physicians","Emergency Medicine","Hospice and Palliative Medicine","Hospice and Palliative Medicine (Emergency Medicine) Physician","An emergency medicine physician with special knowledge and skills to prevent and relieve the suffering experienced by patients with life-limiting illnesses. This specialist works with an interdisciplinary hospice or palliative care team to maximize quality of life while addressing physical, psychological, social and spiritual needs of both patient and family throughout the course of the disease, through the dying process, and beyond for the family.  This specialist has expertise in the assessment of patients with advanced disease; the relief of distressing symptoms; the coordination of interdisciplinary patient and family-centered care in diverse venues; the use of specialized care systems including hospice; the management of the imminently dying patient; and legal and ethical decision making in end-of-life care.","207PH0002X","Source: American Academy of Hospice and Palliative Medicine, www.aahpm.org [1/1/2007: new]","2007-04-01",null,null,"Delete - Will be removed in CHIRP","Yes"]
["Allopathic & Osteopathic Physicians","Emergency Medicine","Medical Toxicology","Medical Toxicology (Emergency Medicine) Physician","Medical toxicologists are physicians who specialize in the prevention, evaluation, treatment and monitoring of injury and illness from exposures to drugs and chemicals, as well as biological and radiological agents. Medical toxicologists care for people in clinical, academic, governmental and public health settings, and provide poison control center leadership. Important areas of medical toxicology include acute drug poisoning, adverse drug events, drug abuse, addiction and withdrawal, chemicals and hazardous materials, terrorism preparedness, venomous bites and stings and environmental and workplace exposures.","207PT0002X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Emergency Medicine, 2007.  http://www.abem.org/public/.   American Osteopathic Board of Emergency Medicine, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Emergency Medicine.","2003-04-01",null,"2011-07-01","Delete - Will be removed in CHIRP","Yes"]
["Allopathic & Osteopathic Physicians","Emergency Medicine","Pediatric Emergency Medicine","Pediatric Emergency Medicine (Emergency Medicine) Physician","Pediatric Emergency Medicine is a clinical subspecialty that focuses on the care of the acutely ill or injured child in the setting of an emergency department.","207PP0204X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: added definition, added source]  Additional Resources: American Board of Emergency Medicine, 2007.  http://www.abem.org/public/    Board certification is provided by the American Board of Emergency Medicine.  Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine.  ","2003-04-01",null,"2007-07-01","Delete - Will be removed in CHIRP","Yes"]
["Allopathic & Osteopathic Physicians","Emergency Medicine","Sports Medicine","Sports Medicine (Emergency Medicine) Physician","An emergency physician with special knowledge in sports medicine is responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention and management of injury and illness. A sports medicine physician has knowledge and experience in the promotion of wellness and the role of exercise in promoting a healthy lifestyle. Knowledge of exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation and epidemiology is essential to the practice of sports medicine.","207PS0010X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Emergency Medicine, 2007.  http://www.abem.org/public/.   American Osteopathic Board of Emergency Medicine, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Emergency Medicine.","2003-04-01",null,"2011-07-01","Delete - Will be removed in CHIRP","Yes"]
["Allopathic & Osteopathic Physicians","Emergency Medicine","Undersea and Hyperbaric Medicine","Undersea and Hyperbaric Medicine (Emergency Medicine) Physician","A specialist who treats decompression illness and diving accident cases and uses hyperbaric oxygen therapy to treat such conditions as carbon monoxide poisoning, gas gangrene, non-healing wounds, tissue damage from radiation and burns, and bone infections.  This specialist also serves as a consultant to other physicians in all aspects of hyperbaric chamber operations, and assesses risks and applies appropriate standards to prevent disease and disability in divers and other persons working in altered atmospheric conditions.","207PE0005X","Source: American Board of Emergency Medicine [7/1/2008: source added, additional resources added]    Additional Resources: Additional Resources: www.abem.org & American Board of Preventive Medicine www.abprevmed.org","2003-04-01",null,null,"Delete - Will be removed in CHIRP","Yes"]
["Suppliers","Emergency Response System Companies",null,"Emergency Response System Companies","A supplier of a personal emergency response system (PERS), which is an electronic device that enables a patient to receive emergency assistance when needed. The PERS is one of two different methodologies of notification: (1) where the patient summons emergency assistance themselves directly through the device or (2) emergency assistance is summoned through secure activation by the caretaker/guardian, which sends the device location to emergency responders.","333300000X","Source: National Uniform Claim Committee, 2010  [7/1/2007: new, 7/1/2010: modified]","2007-10-01",null,null,"Delete - not a DPP measure","No"]
["Hospital Units","Epilepsy Unit",null,"Epilepsy Hospital Unit","An Epilepsy Unit is a distinct unit of a hospital that provides services that may include observation, urgent care, diagnostic testing, treatment, and medication management for patients with seizure disorders.","273100000X","Source:  National Uniform Claim Committee [7/1/2007: new]","2007-10-01",null,null,"Delete - not a DPP measure","No"]
["Managed Care Organizations","Exclusive Provider Organization",null,"Exclusive Provider Organization","(1) An EPO is a form of PPO, in which patients must visit a caregiver that is specified on its panel of providers (is a participating provider). If a visit to an outside(not participating) provider is made the EPO offers very limited or no coverage for the medical service; (2) While similar to a PPO in that an EPO allows patients to go outside the network for care, if they do so in an EPO, they are required to pay the entire cost of care. An EPO differs from an HMO in that EPO physicians do not receive capitation but instead are reimbursed only for actual services provided; (3) An organization identical to a preferred provider organization except that persons enrolled in the plan are eligible to receive benefits only when they use the services of the contracting providers. No benefits are available when non-contracting providers are used, except in certain emergency situations.","302F00000X","Source: (1) Medical Interface: Managed Care A thru Z- Managed Care Terms published by Medicom International, Bronxville, New York Telephone (914) 337-5023, p. 15; (2) \"Glossary of terms used in managed care\" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 58; (3) Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988.","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Suppliers","Eye Bank",null,"Eye Bank","An eye bank procures and distributes eyes for transplant, education and research. To promote patient safety, donated eyes and donor medial histories are evaluated based on strict Eye Bank Association of America Medical Standards","332G00000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Suppliers","Eyewear Supplier",null,"Eyewear Supplier","An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist.","332H00000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Family Medicine","Intentionally left blank","Family Medicine Physician","Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.","207Q00000X","Source:  American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition]<br><br>Note:  The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences.<br><br>Additional Resources:  American Board of Family Medicine, www.theabfm.org.  American Osteopathic Board of Family Physicians, www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine.","2003-04-01",null,"2007-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Family Medicine","Addiction Medicine","Addiction Medicine (Family Medicine) Physician","A family medicine physician who specializes in the diagnosis and treatment of addictions.","207QA0401X","Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added]    Additional Resources: A Certification of Added Qualifications (CAQ) was, but is no longer issued by the American Osteopathic Board of Family Physicians.","2003-04-01",null,"2010-01-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Family Medicine","Adolescent Medicine","Adolescent Medicine (Family Medicine) Physician","A family medicine physician with multidisciplinary training in the unique physical, psychological and social characteristics of adolescents and their health care problems and needs.","207QA0000X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Family Medicine, 2007.  http://www.theabfm.org/.  American Osteopathic Board of Family Medicine, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Medicine.","2003-04-01",null,"2011-07-01","Keep - Clarify in Specs FAQ or Stakeholder Feedback, etc. that the eligible physician or clinician is at the Classification level, and any subspecialization can be found under the Area of Specialization level. For example, a physician may have a pediatric subspecialty (Area of Specialization) but not necessarily be a pediatrics physician (Classification).","Yes"]
["Allopathic & Osteopathic Physicians","Family Medicine","Adult Medicine","Adult Medicine Physician","Definition to come.","207QA0505X",null,"2003-04-01",null,null,"Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Family Medicine","Geriatric Medicine","Geriatric Medicine (Family Medicine) Physician","A family medicine physician with special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes, and the hospital.","207QG0300X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Family Medicine, 2007.  http://wwwtheabfm.org/.  American Osteopathic Board of Family Medicine, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Medicine.","2003-04-01",null,"2011-07-01","Keep - Clarify in Specs FAQ or Stakeholder Feedback, etc. that the eligible physician or clinician is at the Classification level, and any subspecialization can be found under the Area of Specialization level. For example, a physician may have a pediatric subspecialty (Area of Specialization) but not necessarily be a pediatrics physician (Classification).","Yes"]
["Allopathic & Osteopathic Physicians","Family Medicine","Hospice and Palliative Medicine","Hospice and Palliative Medicine (Family Medicine) Physician","A family medicine physician with special knowledge and skills to prevent and relieve the suffering experienced by patients with life-limiting illnesses. This specialist works with an interdisciplinary hospice or palliative care team to maximize quality of life while addressing physical, psychological, social and spiritual needs of both patient and family throughout the course of the disease, through the dying process, and beyond for the family.  This specialist has expertise in the assessment of patients with advanced disease; the relief of distressing symptoms; the coordination of interdisciplinary patient and family-centered care in diverse venues; the use of specialized care systems including hospice; the management of the imminently dying patient; and legal and ethical decision making in end-of-life care.","207QH0002X","Source: American Academy of Hospice and Palliative Medicine, www.aahpm.org [1/1/2007: new]","2007-04-01",null,null,"Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Family Medicine","Obesity Medicine","Obesity Medicine (Family Medicine) Physician","A physician who specializes in the treatment of obesity demonstrates competency in and a thorough understanding of the treatment of obesity and the genetic, biologic, environmental, social, and behavioral factors that contribute to obesity. The obesity medicine physician employs therapeutic interventions including diet, physical activity, behavioral change, and pharmacotherapy. The obesity medicine physician utilizes a comprehensive approach, and may include additional resources such as dietitians, exercise physiologists, mental health professionals and bariatric surgeons as indicated to achieve optimal results. Additionally, the obesity medicine physician maintains competency in providing pre- peri- and post-surgical care of bariatric surgery patients, promotes the prevention of obesity, and advocates for those who suffer from obesity.","207QB0002X","Source:  American Board of Obesity Medicine, www.abom.org [10/1/2007: new, 7/1/2015: title and definition modified]  Additional Resource: American Society of Bariatric Physicians, www.asbp.org.","2007-10-01",null,null,"Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Family Medicine","Sleep Medicine","Sleep Medicine (Family Medicine) Physician","A Family Medicine Physician who practices Sleep Medicine is certified in the subspecialty of sleep medicine and specializes in the clinical assessment, physiologic testing, diagnosis, management and prevention of sleep and circadian rhythm disorders. Sleep specialists treat patients of any age and use multidisciplinary approaches. Disorders managed by sleep specialists include, but are not limited to, sleep related breathing disorders, insomnia, hypersomnias, circadian rhythm sleep disorders, parasomnias and sleep related movement disorders.","207QS1201X","Source: American Academy of Sleep Medicine, 2008, www.aasm.org  [7/1/2008: new]","2008-10-01",null,null,"Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Family Medicine","Sports Medicine","Sports Medicine (Family Medicine) Physician","A family medicine physician that is trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the health care of the individual engaged in physical exercise (sports) whether as an individual or in team participation.","207QS0010X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Family Medicine, 2007.  http://www.theabfm.org/.  American Osteopathic Board of Family Medicine, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Medicine.","2003-04-01",null,"2011-07-01","Keep - No Change","Yes"]
["Agencies","Foster Care Agency",null,"Foster Care Agency","A Foster Care Agency is an agency that provides foster care as defined in the Code of Federal Regulations (CFR) as \"24-hour substitute care for children outside their own homes.\" Foster care settings include, but are not limited to, nonrelative foster family homes, relative foster homes (whether payments are being made or not), group homes, emergency shelters, residential facilities, and pre-adoptive homes.","253J00000X","Source: Code Of Federal Regulations, Title 45, Volume 4, Part 1355, Section 57 [1/1/2008: new]","2008-04-01",null,null,"Delete - not a DPP measure","No"]
["Other Service Providers","Funeral Director",null,"Funeral Director","A person, usually an embalmer, whose business is to arrange for the burial or cremation of the dead and to assist at the funeral rites.","176P00000X","Source: Joint Commission on Accreditation of Healthcare Organizations, Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Oakbrook Terrace, IL: 1994, p. 323","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Hospitals","General Acute Care Hospital",null,"General Acute Care Hospital","An acute general hospital is an institution whose primary function is to provide inpatient diagnostic and therapeutic services for a variety of medical conditions, both surgical and non-surgical, to a wide population group. The hospital treats patients in an acute phase of illness or injury, characterized by a single episode or a fairly short duration, from which the patient returns to his or her normal or previous level of activity.","282N00000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Hospitals","General Acute Care Hospital","Children","Children's Hospital","Definition to come...","282NC2000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Hospitals","General Acute Care Hospital","Critical Access","Critical Access Hospital","Definition to come.","282NC0060X","[7/1/2003: new]","2003-10-01",null,null,"Delete - not a DPP measure","No"]
["Hospitals","General Acute Care Hospital","Rural","Rural Acute Care Hospital","Definition to come...","282NR1301X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Hospitals","General Acute Care Hospital","Women","Women's Hospital","Definition to come...","282NW0100X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","General Practice","Intentionally left blank","General Practice Physician","Definition to come...","208D00000X",null,"2003-04-01",null,null,"Keep - There is no Definition for this one at the Classification or Area of Specialization level… so just provide guidance to use the Code as applicable until NUCC defines this Classification.","Yes"]
["Other Service Providers","Genetic Counselor, MS",null,"Genetic Counselor (M.S.)","A masters trained health care provider who collects and interprets genetic family histories; assesses the risk of disease occurrence or recurrence; identifies interventions to manage or ameliorate disease risk; educates about inheritance, testing, management, prevention, ethical issues, resources, and research; and counsels to promote informed choices and adaptation. Certification was established in 1993 by the American Board of Genetic Counseling and prior to that by the American Board of Medical Genetics. Requirements for experience, licensure, and job responsibilities vary among the states.","170300000X","Source: National Society of Genetic Counselors [7/1/2005: new]","2005-10-01",null,null,"Delete - not a DPP measure","No"]
["Other Service Providers","Health & Wellness Coach",null,"Health & Wellness Coach","The Health & Wellness Coach is trained in motivational theories, strategies, and communication techniques, which are used to assist patients to develop intrinsic motivation and obtain skills to create sustainable change for improved health and well-being. Health and wellness coaching is a patient-centered approach wherein patients at least partially determine their goals, use self-discovery or active learning processes together with content education to work toward their goals, and self-monitor behaviors to increase accountability, all within the context of an interpersonal relationship with a coach.","171400000X","Source:  National Board for Health & Wellness Coaching, www.nbhwc.org [1/1/2021: new]","2021-04-01",null,null,"Delete - not a DPP measure","No"]
["Other Service Providers","Health Educator",null,"Health Educator","Health educators work in a variety of settings providing education to individuals or groups of individuals on healthy behaviors, wellness, and health-related topics with the goal of preventing diseases and health problems.  Health educators generally require a bachelor's degree and may receive additional training, such as through mentoring, internships, or volunteer work.","174H00000X","Source:  National Uniform Claim Committee, 2009 [7/1/2009: new]","2009-10-01",null,null,"Delete - not a DPP measure","No"]
["Managed Care Organizations","Health Maintenance Organization",null,"Health Maintenance Organization","(1) A form of health insurance in which its members prepay a premium for the HMO's health services which generally include inpatient and ambulatory care. For the patient, an HMO means reduced out-of-pocket costs (i.e. no deductible), no paperwork (i.e. insurance forms), and only a small copayment for each office visit to cover the paperwork handled by the HMO; (2) A organization of health care personnel and facilities that provides a comprehensive range of health services to an enrolled population for a fixed sum of money paid in advance for a specified period of time. These health services include a wide variety of medical treatments and consults, inpatient and outpatient hospitalization, home health service, ambulance service, and sometimes dental and pharmacy services. The HMO may be organized as a group model, an individual practice association (IPA), a network model or a staff model.","302R00000X","Source: (1) Medical Interface: Managed Care A thru Z- Managed Care Terms published by Medicom International, Bronxville, New York Telephone (914) 337-5023, p. 20; (2) \"Glossary of terms used in managed care\" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 58","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Suppliers","Hearing Aid Equipment",null,"Hearing  Aid Equipment","The manufacture and/or sale of electronic hearing aids, their component parts, and related products and services on a national basis.","332S00000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Speech, Language and Hearing Service Providers","Hearing Instrument Specialist",null,"Hearing Instrument Specialist","Individuals who test hearing for the selection, adaptation, fitting, adjusting, servicing, and sale of hearing aids. Hearing Instrument Specialist is a designation provided individuals who qualify by the National Hearing Aid Society","237700000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Suppliers","Home Delivered Meals",null,"Home Delivered Meals","Home-delivered meals are those services or activities designed to prepare and deliver one or more meals a day to an individual's residence in order to prevent institutionalization, malnutrition, and feelings of isolation. Component services or activities may include the cost of personnel, equipment, and food; assessment of nutritional and dietary needs; nutritional education and counseling; socialization services; and information and referral.","332U00000X","Source: Code of Federal Regulations #45, Part 96, Appendix A, Uniform Definition of Services.","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Agencies","Home Health",null,"Home Health Agency","A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety.","251E00000X","Source:  CFR42 Chapter IV Part 484,  http://www.access.gpo.gov/nara/cfr/waisidx_99/42cfr484_99.html [7/1/2007: definition added, source added]","2002-04-01",null,"2007-07-01","Delete - not a DPP measure","No"]
["Nursing Service Related Providers","Home Health Aide",null,"Home Health Aide","A person trained to assist public health nurses, home health nurses, and other health professionals in the bedside care of patients in their homes.","374U00000X","Source: Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988.","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Agencies","Home Infusion",null,"Home Infusion Agency","Definition to come...","251F00000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Related Providers","Homemaker",null,"Homemaker","An individual who provides general household activities such as meal preparation, laundry, and light housekeeping, when the individual regularly responsible for these activities is temporarily absent or unable to provide for himself.  Homemakers must meet the state defined training standards.","376J00000X","[7/1/2003: definition added]","2002-04-01",null,"2003-07-01","Delete - not a DPP measure","No"]
["Other Service Providers","Homeopath",null,"Homeopath","A provider who is educated and trained in a system of therapeutics in which diseases are treated by drugs which are capable of producing in healthy persons symptoms like those of the disease to be treated. Treatment requires administering a drug in minute doses.","175L00000X","Source: Dorland's Illustrated Medical Dictionary. 26th edition. Philadelphia: W.B. Saunders Company, 1981.","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Agencies","Hospice Care, Community Based",null,"Community Based Hospice Care Agency","Definition to come...","251G00000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing & Custodial Care Facilities","Hospice, Inpatient",null,"Inpatient Hospice","A provider organization, or distinct part of the organization, which renders an interdisciplinary program providing palliative care, chiefly medical relief of pain and supporting services, which addresses the emotional, social, financial, and legal needs of terminally ill patients and their families where an institutional care environment is required for the patient.","315D00000X","Source: AHA Guide, American Hospital Association.","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Hospitalist",null,"Hospitalist Physician","Hospitalists are physicians whose primary professional focus is the general medical care of hospitalized patients. Their activities include patient care, teaching, research, and leadership related to Hospital Medicine. The term 'hospitalist' refers to physicians whose practice emphasizes providing care for hospitalized patients.","208M00000X","Source: American Society of Hospital Medicine, 2007.  http://www.hospitalmedicine.org/ [7/1/2009: definition added]  Additional Resources: Hospitalist is a recognized fellowship specialty program offered by many medical institutions.  There is no board certification for the specialty at this point.","2003-04-01",null,null,"Delete - not a DPP measure","No"]
["Agencies","In Home Supportive Care",null,"In Home Supportive Care Agency","An In Home Supportive Care Agency provides services in the patient's home with the goal of enabling the patient to remain at home.  The services provided may include personal care services such as hands-on assistance with activities of daily living (ADLs), e.g., eating, bathing, dressing, and bladder and bowel requirements; homemaker services and instrumental activities of daily living (IADLs), e.g., taking medications, shopping for groceries, laundry, housekeeping, and companionship; and/or supervision or cuing so that a person can perform tasks themselves.","253Z00000X","Source: National Uniform Claim Committee, 2008 [7/1/2008: new]","2008-10-01",null,null,"Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Independent Medical Examiner",null,"Independent Medical Examiner Physician","A special evaluator not involved with the medical care of the individual examinee that impartially evaluates the care being provided by other practitioners to clarify clinical, disability, liability or other case issues.","202C00000X","Source: American Board of Independent Medical Examiners, www.abime.org [1/1/2007: new]","2007-04-01",null,null,"Delete - not a DPP measure","No"]
["Suppliers","Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",null,"Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy","An Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy means a pharmacy operated by the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization, all of which are defined in Section 4 of the Indian Health Care Improvement Act, 25 U.S.C. 1603.","332800000X","Source: The Medicare Prescription Drug, Improvement and Modernization Act of 2003  [1/1/2006: new]","2006-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing & Custodial Care Facilities","Intermediate Care Facility, Mental Illness",null,"Mental Illness Intermediate Care Facility","A nursing facility that provides an intermediate level of nursing care to individuals whose functional abilities are significantly compromise by mental illness.","310500000X","[7/1/2003: new]","2003-10-01",null,null,"Delete - not a DPP measure","No"]
["Nursing & Custodial Care Facilities","Intermediate Care Facility, Mentally Retarded",null,"Intellectual Disabilities Intermediate Care Facility","(1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals.","315P00000X","Sources: (1) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 403 (2) Paraphrased from Code of Federal Regulations #42, Public Health, Section 440.150(c).","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Internal Medicine","Intentionally left blank","Internal Medicine Physician","A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.","207R00000X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Internal Medicine, 2007.  http://www.abim.org/.  American Osteopathic Board of Internal Medicine, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Internal  Medicine.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal  Medicine.","2003-04-01",null,"2011-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Internal Medicine","Addiction Medicine","Addiction Medicine (Internal Medicine) Physician","An internist doctor of osteopathy that specializes in the treatment of addiction disorders.  A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Added Qualifications in the field of Addiction Medicine.","207RA0401X","Source: American Osteopathic Board of Internal Medicine, 2007.  [7/1/2008: added definition, added source; 7/1/2011: modified source]<br><br>Additional Resources: http://www.osteopathic.org/certification","2003-04-01",null,"2011-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Internal Medicine","Adolescent Medicine","Adolescent Medicine (Internal Medicine) Physician","An internist who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs.","207RA0000X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Internal Medicine, 2007.  http://www.abim.org/.  American Osteopathic Board of Internal Medicine, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Internal  Medicine.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal  Medicine.","2003-04-01",null,"2011-07-01","Keep - Clarify in Specs FAQ or Stakeholder Feedback, etc. that the eligible physician or clinician is at the Classification level, and any subspecialization can be found under the Area of Specialization level. For example, a physician may have a pediatric subspecialty (Area of Specialization) but not necessarily be a pediatrics physician (Classification).","Yes"]
["Allopathic & Osteopathic Physicians","Internal Medicine","Adult Congenital Heart Disease","Adult Congenital Heart Disease Physician","A physician who specializes in the care and treatment of adults with congenital heart disease. Adult congenital heart disease (ACHD) physicians are trained to understand the complexities of congenital heart disease, anatomy, physiology, surgical repairs, and long-term complications and use that to manage ACHD with acquired heart disease, including heart failure, arrhythmias, and pulmonary hypertension.","207RA0002X","Source: American College of Cardiology, www.acc.org [7/1/2018: new]","2018-10-01",null,null,"Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Internal Medicine","Advanced Heart Failure and Transplant Cardiology","Advanced Heart Failure and Transplant Cardiology Physician","Specialists in Advanced Heart Failure and Transplant Cardiology would participate in the inpatient and outpatient management of patients with advanced heart failure across the spectrum from consideration for high-risk cardiac surgery, cardiac transplantation, or mechanical circulatory support, to pre-and post-operative evaluation and management of patients with cardiac transplants and mechanical support devices, and end-of-life care for patients with end-stage heart failure.","207RA0001X","Source:  American Board of Internal Medicine, www.abim.org  [7/1/2015: new]","2015-10-01",null,null,"Keep - Clarify in Specs FAQ or Stakeholder Feedback, etc. that the eligible physician or clinician is at the Classification level, and any subspecialization can be found under the Area of Specialization level. For example, a physician may have a pediatric subspecialty (Area of Specialization) but not necessarily be a pediatrics physician (Classification).","Yes"]
["Allopathic & Osteopathic Physicians","Internal Medicine","Allergy & Immunology","Allergy & Immunology (Internal Medicine) Physician","An internist doctor of osteopathy that specializes in the treatment of allergy and immunologic disorders.  A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Special Qualifications in the field of Allergy & Immunology.","207RA0201X","Source: American Osteopathic Board of Internal Medicine, 2007.  [7/1/2008: added definition, added source; 7/1/2011: modified source]<br><br>Additional Resources: http://www.osteopathic.org/certification","2003-04-01",null,"2011-07-01","Keep - Clarify in Specs FAQ or Stakeholder Feedback, etc. that the eligible physician or clinician is at the Classification level, and any subspecialization can be found under the Area of Specialization level. For example, a physician may have a pediatric subspecialty (Area of Specialization) but not necessarily be a pediatrics physician (Classification).","Yes"]
["Allopathic & Osteopathic Physicians","Internal Medicine","Cardiovascular Disease","Cardiovascular Disease Physician","An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.","207RC0000X","Source: American Osteopathic Board of Internal Medicine, 2008  [7/1/2008: added definition, added source; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Internal Medicine,  http://www.abim.org/.  American Osteopathic Board of Internal Medicine,  https://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine.","2003-04-01",null,"2011-07-01","Keep - Clarify in Specs FAQ or Stakeholder Feedback, etc. that the eligible physician or clinician is at the Classification level, and any subspecialization can be found under the Area of Specialization level. For example, a physician may have a pediatric subspecialty (Area of Specialization) but not necessarily be a pediatrics physician (Classification).","Yes"]
["Allopathic & Osteopathic Physicians","Internal Medicine","Clinical & Laboratory Immunology","Clinical & Laboratory Immunology (Internal Medicine) Physician","An internal medicine physician who specializes in clinical and laboratory immunology disease management.","207RI0001X","Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added]    Additional Resources: A certification was, but is no longer issued by the American Board of Internal Medicine.  ","2003-04-01",null,"2010-01-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Internal Medicine","Clinical Cardiac Electrophysiology","Clinical Cardiac Electrophysiology Physician","A field of special interest within the subspecialty of cardiovascular disease, specialty of Internal Medicine, which involves intricate technical procedures to evaluate heart rhythms and determine appropriate treatment for them.","207RC0001X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Internal Medicine, 2007.  http://www.abim.org/.  American Osteopathic Board of Internal Medicine, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Internal  Medicine.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal  Medicine.","2003-04-01",null,"2011-07-01","Keep - Clarify in Specs FAQ or Stakeholder Feedback, etc. that the eligible physician or clinician is at the Classification level, and any subspecialization can be found under the Area of Specialization level. For example, a physician may have a pediatric subspecialty (Area of Specialization) but not necessarily be a pediatrics physician (Classification).","Yes"]
["Allopathic & Osteopathic Physicians","Internal Medicine","Critical Care Medicine","Critical Care Medicine (Internal Medicine) Physician","An internist who diagnoses, treats and supports patients with multiple organ dysfunction. This specialist may have administrative responsibilities for intensive care units and may also facilitate and coordinate patient care among the primary physician, the critical care staff and other specialists.","207RC0200X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Internal Medicine, 2007.  http://www.abim.org/.  American Osteopathic Board of Internal Medicine, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Internal  Medicine.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal  Medicine.","2003-04-01",null,"2011-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Internal Medicine","Endocrinology, Diabetes & Metabolism","Endocrinology, Diabetes & Metabolism Physician","An internist who concentrates on disorders of the internal (endocrine) glands such as the thyroid and adrenal glands. This specialist also deals with disorders such as diabetes, metabolic and nutritional disorders, obesity, pituitary diseases and menstrual and sexual problems.","207RE0101X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Internal Medicine, 2007.  http://www.abim.org/.  American Osteopathic Board of Internal Medicine, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Internal  Medicine.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal  Medicine.","2003-04-01",null,"2011-07-01","Keep - Clarify in Specs FAQ or Stakeholder Feedback, etc. that the eligible physician or clinician is at the Classification level, and any subspecialization can be found under the Area of Specialization level. For example, a physician may have a pediatric subspecialty (Area of Specialization) but not necessarily be a pediatrics physician (Classification).","Yes"]
["Allopathic & Osteopathic Physicians","Internal Medicine","Gastroenterology","Gastroenterology Physician","An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs.","207RG0100X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Internal Medicine, 2007.  http://www.abim.org/.  American Osteopathic Board of Internal Medicine, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Internal  Medicine.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal  Medicine.","2003-04-01",null,"2011-07-01","Keep - Clarify in Specs FAQ or Stakeholder Feedback, etc. that the eligible physician or clinician is at the Classification level, and any subspecialization can be found under the Area of Specialization level. For example, a physician may have a pediatric subspecialty (Area of Specialization) but not necessarily be a pediatrics physician (Classification).","Yes"]
["Allopathic & Osteopathic Physicians","Internal Medicine","Geriatric Medicine","Geriatric Medicine (Internal Medicine) Physician","An internist who has special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes and the hospital.","207RG0300X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Internal Medicine, 2007.  http://www.abim.org/.  American Osteopathic Board of Internal Medicine, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Internal  Medicine.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal  Medicine.","2003-04-01",null,"2011-07-01","Keep - Clarify in Specs FAQ or Stakeholder Feedback, etc. that the eligible physician or clinician is at the Classification level, and any subspecialization can be found under the Area of Specialization level. For example, a physician may have a pediatric subspecialty (Area of Specialization) but not necessarily be a pediatrics physician (Classification).","Yes"]
["Allopathic & Osteopathic Physicians","Internal Medicine","Hematology","Hematology (Internal Medicine) Physician","An internist with additional training who specializes in diseases of the blood, spleen and lymph. This specialist treats conditions such as anemia, clotting disorders, sickle cell disease, hemophilia, leukemia and lymphoma.","207RH0000X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Internal Medicine, 2007.  http://www.abim.org/.  American Osteopathic Board of Internal Medicine, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Internal  Medicine.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal  Medicine.","2003-04-01",null,"2011-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Internal Medicine","Hematology & Oncology","Hematology & Oncology Physician","An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders.  A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology.  The Certificate is NO longer offered.","207RH0003X","Source: American Osteopathic Board of Internal Medicine, 2007.  [7/1/2008: definition added, source added; 7/1/2011: modified source]<br><br>Additional Resources: http://www.osteopathic.org/certification","2003-04-01",null,"2011-07-01","Keep - Clarify in Specs FAQ or Stakeholder Feedback, etc. that the eligible physician or clinician is at the Classification level, and any subspecialization can be found under the Area of Specialization level. For example, a physician may have a pediatric subspecialty (Area of Specialization) but not necessarily be a pediatrics physician (Classification).","Yes"]
["Allopathic & Osteopathic Physicians","Internal Medicine","Hepatology","Hepatology Physician","The discipline of Hepatology encompasses the structure, function, and diseases of the liver and biliary tract. The American Board of Internal Medicine considers Hepatology part of the subspecialty of gastroenterology. Physicians who identify themselves as Hepatologists usually, but not always, have been trained in gastrointestinal programs.","207RI0008X","Training Programs, and/or Fellowships, Preceptorships: The American Association for the Study of Liver Diseases (AASLD) is the major professional society organized for physicians with an interest in Hepatology. A subcommittee of that organization has published guidelines for training programs in the 1992 November issue of Hepatology. Source: The American Board of Internal Medicine 9/1993    ACGME Accredited Residency Program Requirements:  None ","2003-04-01",null,null,"Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Internal Medicine","Hospice and Palliative Medicine","Hospice and Palliative Medicine (Internal Medicine) Physician","An internal medicine physician with special knowledge and skills to prevent and relieve the suffering experienced by patients with life-limiting illnesses. This specialist works with an interdisciplinary hospice or palliative care team to maximize quality of life while addressing physical, psychological, social and spiritual needs of both patient and family throughout the course of the disease, through the dying process, and beyond for the family.  This specialist has expertise in the assessment of patients with advanced disease; the relief of distressing symptoms; the coordination of interdisciplinary patient and family-centered care in diverse venues; the use of specialized care systems including hospice; the management of the imminently dying patient; and legal and ethical decision making in end-of-life care.","207RH0002X","Source: American Academy of Hospice and Palliative Medicine, www.aahpm.org [1/1/2007: new]","2007-04-01",null,null,"Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Internal Medicine","Hypertension Specialist","Hypertension Specialist Physician","A Hypertension Specialist is a physician who concentrates on all aspects of the diagnosis and treatment of hypertension.","207RH0005X","Source:  American Society of Hypertension, www.ash-us.org [7/1/2011: new]  Additional Resources:  The American Society of Hypertension Specialists Program offers an examination and designation for Hypertension Specialists.  This subspecialty is not a Board certificate issued by either the American Board of Internal Medicine or the American Osteopathic Board of Internal Medicine.","2011-10-01",null,null,"Keep - Clarify in Specs FAQ or Stakeholder Feedback, etc. that the eligible physician or clinician is at the Classification level, and any subspecialization can be found under the Area of Specialization level. For example, a physician may have a pediatric subspecialty (Area of Specialization) but not necessarily be a pediatrics physician (Classification).","Yes"]
["Allopathic & Osteopathic Physicians","Internal Medicine","Infectious Disease","Infectious Disease Physician","An internist who deals with infectious diseases of all types and in all organ systems. Conditions requiring selective use of antibiotics call for this special skill. This physician often diagnoses and treats AIDS patients and patients with fevers which have not been explained. Infectious disease specialists may also have expertise in preventive medicine and travel medicine.","207RI0200X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Internal Medicine, 2007.  http://www.abim.org/.  American Osteopathic Board of Internal Medicine, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Internal  Medicine.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal  Medicine.","2003-04-01",null,"2011-07-01","Keep - Clarify in Specs FAQ or Stakeholder Feedback, etc. that the eligible physician or clinician is at the Classification level, and any subspecialization can be found under the Area of Specialization level. For example, a physician may have a pediatric subspecialty (Area of Specialization) but not necessarily be a pediatrics physician (Classification).","Yes"]
["Allopathic & Osteopathic Physicians","Internal Medicine","Interventional Cardiology","Interventional Cardiology Physician","An area of medicine within the subspecialty of cardiology, which uses specialized imaging and other diagnostic techniques to evaluate blood flow and pressure in the coronary arteries and chambers of the heart and uses technical procedures and medications to treat abnormalities that impair the function of the cardiovascular system.","207RI0011X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: added definition, added source]   Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/    Board Certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine.  ACGME Accredited Residency Program Requirements:  1 year of training plus a prerequisite of 3 years Internal Medicine, 3 years Cardiovascular Disease for a total of 7 years.  ABMS Approved Subspecialty Certificate  (Internal Medicine)","2003-04-01",null,"2007-07-01","Keep - Clarify in Specs FAQ or Stakeholder Feedback, etc. that the eligible physician or clinician is at the Classification level, and any subspecialization can be found under the Area of Specialization level. For example, a physician may have a pediatric subspecialty (Area of Specialization) but not necessarily be a pediatrics physician (Classification).","Yes"]
["Allopathic & Osteopathic Physicians","Internal Medicine","Magnetic Resonance Imaging (MRI)","Magnetic Resonance Imaging (MRI) Internal Medicine Physician","Definition to come.","207RM1200X",null,"2003-04-01",null,null,"Keep - Add somewhere that for TIPPS program, whenever a Definition is listed as \"Definition to come.\" by NUCC, then the Definition at the Classification level should be used as possible.","Yes"]
["Allopathic & Osteopathic Physicians","Internal Medicine","Medical Oncology","Medical Oncology Physician","An internist who specializes in the diagnosis and treatment of all types of cancer and other benign and malignant tumors. This specialist decides on and administers therapy for these malignancies as well as consults with surgeons and radiotherapists on other treatments for cancer.","207RX0202X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: added definition, added source. 11/5/2007: corrected definition]  ","2003-04-01",null,"2007-11-05","Keep - Clarify in Specs FAQ or Stakeholder Feedback, etc. that the eligible physician or clinician is at the Classification level, and any subspecialization can be found under the Area of Specialization level. For example, a physician may have a pediatric subspecialty (Area of Specialization) but not necessarily be a pediatrics physician (Classification).","Yes"]
["Allopathic & Osteopathic Physicians","Internal Medicine","Nephrology","Nephrology Physician","An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation.","207RN0300X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Internal Medicine, 2007.  http://www.abim.org/.  American Osteopathic Board of Internal Medicine, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Internal  Medicine.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal  Medicine.","2003-04-01",null,"2011-07-01","Keep - Clarify in Specs FAQ or Stakeholder Feedback, etc. that the eligible physician or clinician is at the Classification level, and any subspecialization can be found under the Area of Specialization level. For example, a physician may have a pediatric subspecialty (Area of Specialization) but not necessarily be a pediatrics physician (Classification).","Yes"]
["Allopathic & Osteopathic Physicians","Internal Medicine","Obesity Medicine","Obesity Medicine (Internal Medicine) Physician","A physician who specializes in the treatment of obesity demonstrates competency in and a thorough understanding of the treatment of obesity and the genetic, biologic, environmental, social, and behavioral factors that contribute to obesity. The obesity medicine physician employs therapeutic interventions including diet, physical activity, behavioral change, and pharmacotherapy. The obesity medicine physician utilizes a comprehensive approach, and may include additional resources such as dietitians, exercise physiologists, mental health professionals and bariatric surgeons as indicated to achieve optimal results. Additionally, the obesity medicine physician maintains competency in providing pre- peri- and post-surgical care of bariatric surgery patients, promotes the prevention of obesity, and advocates for those who suffer from obesity.","207RB0002X","Source:  American Board of Obesity Medicine, www.abom.org [10/1/2007: new, 7/1/2015: title and definition modified]  Additional Resource: American Society of Bariatric Physicians, www.asbp.org.","2007-10-01",null,null,"Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Internal Medicine","Pulmonary Disease","Pulmonary Disease Physician","An internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational and environmental diseases, bronchitis, sleep disorders, emphysema and other complex disorders of the lungs.","207RP1001X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Internal Medicine, 2007.  http://www.abim.org/.  American Osteopathic Board of Internal Medicine, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Internal  Medicine.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal  Medicine.","2003-04-01",null,"2011-07-01","Keep - Clarify in Specs FAQ or Stakeholder Feedback, etc. that the eligible physician or clinician is at the Classification level, and any subspecialization can be found under the Area of Specialization level. For example, a physician may have a pediatric subspecialty (Area of Specialization) but not necessarily be a pediatrics physician (Classification).","Yes"]
["Allopathic & Osteopathic Physicians","Internal Medicine","Rheumatology","Rheumatology Physician","An internist who treats diseases of joints, muscle, bones and tendons. This specialist diagnoses and treats arthritis, back pain, muscle strains, common athletic injuries and \"collagen\" diseases.","207RR0500X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Internal Medicine, 2007.  http://www.abim.org/.  American Osteopathic Board of Internal Medicine, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Internal  Medicine.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal  Medicine.","2003-04-01",null,"2011-07-01","Keep - Clarify in Specs FAQ or Stakeholder Feedback, etc. that the eligible physician or clinician is at the Classification level, and any subspecialization can be found under the Area of Specialization level. For example, a physician may have a pediatric subspecialty (Area of Specialization) but not necessarily be a pediatrics physician (Classification).","Yes"]
["Allopathic & Osteopathic Physicians","Internal Medicine","Sleep Medicine","Sleep Medicine (Internal Medicine) Physician","An Internist who practices Sleep Medicine is certified in the subspecialty of sleep medicine and specializes in the clinical assessment, physiologic testing, diagnosis, management and prevention of sleep and circadian rhythm disorders. Sleep specialists treat patients of any age and use multidisciplinary approaches. Disorders managed by sleep specialists include, but are not limited to, sleep related breathing disorders, insomnia, hypersomnias, circadian rhythm sleep disorders, parasomnias and sleep related movement disorders.","207RS0012X","Source: American Academy of Sleep Medicine, www.aasm.org [7/1/2006: new]","2006-10-01",null,null,"Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Internal Medicine","Sports Medicine","Sports Medicine (Internal Medicine) Physician","An internist trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the healthcare of the individual.","207RS0010X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Internal Medicine, 2007.  http://www.abim.org/.  American Osteopathic Board of Internal Medicine, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Internal  Medicine.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal  Medicine.","2003-04-01",null,"2011-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Internal Medicine","Transplant Hepatology","Transplant Hepatology Physician","An internist with special knowledge and the skill required of a gastroenterologist to care for patients prior to and following hepatic transplantation that spans all phases of liver transplantation. Selection of appropriate recipients requires assessment by a team having experience in evaluating the severity and prognosis of patients with liver disease.","207RT0003X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: new]    Additional Resources: American Board of Internal Medicine, 2007.  http://www.abim.org/.    Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine.","2007-10-01",null,null,"Keep - No Change","Yes"]
["Other Service Providers","Interpreter",null,"Interpreter","An Interpreter is a person who translates oral communication between two or more people.  This includes translating from one language to another or interpreting sign language.  An interpreter is necessary for medical care when the patient does not speak the language of the health care provider or when the patient has a disability involving spoken language.","171R00000X","Source:  National Medicaid EDI HIPAA NPI Sub Work Group [7/1/2006: new]","2006-10-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Kinesiotherapist",null,"Kinesiotherapist","A provider trained and educated in the applied science of medically prescribed therapeutic exercise, education and adapted physical activities designed to improve the quality of line and health of adults and children by developing physical fitness, increasing mobility and independence, and improving psychosocial behavior. The kinesiotherapist seeks a coach-player relationship in which he/she helps the patient/client reach the goal of becoming an independent, self-sustaining person. Kinesiotherapists, as compared with physical therapists, put more emphasis on geriatric care, reconditioning and fitness, and psychiatric care. A large percentage of kinesiotherapists practice in Veterans Administration hospitals.","226300000X","Source: The Kinesiotherapy Association.","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Other Service Providers","Lactation Consultant, Non-RN",null,"Lactation Consultant (Non-RN)","An individual trained to provide breastfeeding assistance services to both mothers and infants. Lactation Consultants are not required to be nurses and are trained through specific courses of education. The Lactation Consultant may have additional certification through a national or international organization.","174N00000X","Source: National Uniform Claim Committee [1/1/2011: new]","2011-04-01",null,null,"Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Legal Medicine",null,"Legal Medicine (M.D./D.O.) Physician","Legal Medicine is a special field of medicine that focuses on various aspects of medicine and law. Historically, the practice of legal medicine made contributions to medicine as a scientific instrument to solve criminal perplexities. Since World War II, the domain of legal medicine has broadened to include not only aspects of medical science to solve legal and criminal problems but aspects of law as it applies to medicine. Legal Medicine continues to grow as medicolegal issues like medical malpractice and liability, government regulation of health care, issues of tort reform, and moral and ethical complexities presented by technological advances become increasingly prominent. Many medical schools have implemented courses which supply medicolegal instruction for medical students, and many law schools now offer medicolegal courses. Also, dual degree programs in law and medicine have been created to assist physicians to bridge the gap between medicine and the law.","209800000X","Source: American Board of Legal Medicine 08/1992. www.ablminc.org [7/1/2009: definition reformatted]    Additional Resources: Training Programs, and/or Fellowships, Preceptorships: Certification available through the American Board of Legal Medicine. ACGME Accredited Residency Program Requirements: None.","2003-04-01",null,null,"Delete - not a DPP measure","No"]
["Other Service Providers","Legal Medicine",null,"Legal Medicine","The specialty areas of medicine concerned with matters of, and relations with, substantive law and legal institutions; such as the conduct of medical examinations at crime scenes, performance of autopsies, giving of expert medical testimony in judicial proceedings, medical treatment of inmates of penal institutions, the practice of trauma medicine in law enforcement settings, and other clinical practice and medical science applications in the fields of law, law enforcement, and corrections.","173000000X","Source: Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988.","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Licensed Practical Nurse",null,"Licensed Practical Nurse","An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.","164W00000X","Source: Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988.","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Licensed Psychiatric Technician",null,"Licensed Psychiatric Technician","An individual licensed by the state board as a Psychiatric Technician based upon completion of a prescribed course of theory and clinical practice, with two thirds of the clinical practice time focused on mental and developmental disorders.  The psychiatric technician practices under the direct supervision of a physician, psychologist, registered nurse or other professional to provide care to patients with mental disorders and developmental disabilities.","167G00000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Licensed Vocational Nurse",null,"Licensed Vocational Nurse","An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. [An alternate term for licensed practical nurse arising from difference in occupational titles between states and post-high school training programs and institutions.] Requirements for education, experience, licensure, and job responsibilities vary among the states.","164X00000X","Source: Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988.","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Agencies","Local Education Agency (LEA)",null,"Local Education Agency (LEA)","The term local education agency means a public board of education or other public authority legally constituted within a State to either provide administrative control or direction of, or perform a service function for public schools serving individuals ages 0 - 21 in a state, city, county, township, school district, or other political subdivision including a combination of school districts or counties recognized in a State as an administrative agency for its public schools.  An LEA may provide, or employ professional who provide, services to children included in the Individuals with Disabilities Education Act (IDEA), such services may include, but are not limited to, such medical services as physical, occupational, and speech therapy.","251300000X","Source: Portions of IDEA Regulations Part B (34 CFR Part 300.18, Assistance to States for the Education of Children with Disabilities)  [1/1/2006: new]","2006-04-01",null,null,"Delete - not a DPP measure","No"]
["Other Service Providers","Lodging",null,"Lodging Provider","A public or privately owned facility providing overnight lodging to individuals traveling long distances or receiving prolonged outpatient medical services away from home.","177F00000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Hospitals","Long Term Care Hospital",null,"Long Term Care Hospital","Long-term care hospitals (LTCHs) furnish extended medical and rehabilitative care to individuals who are clinically complex and have multiple acute or chronic conditions.","282E00000X","Source:  American Hospital Association [7/1/2006: new]","2006-10-01",null,null,"Delete - not a DPP measure","No"]
["Behavioral Health & Social Service Providers","Marriage & Family Therapist",null,"Marriage & Family Therapist","A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist.  A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems.   A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups.","106H00000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Massage Therapist",null,"Massage Therapist","An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes.","225700000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Mastectomy Fitter",null,"Mastectomy Fitter","An individual trained in the fitting and adjusting of breast prostheses and management of post-mastectomy prostheses services.","224900000X","Source: National Uniform Claim Committee [7/1/2010: new]  Additional Resources:  American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org.","2010-10-01",null,null,"Delete - not a DPP measure","No"]
["Other Service Providers","Meals",null,"Meals Provider","A public or privately owned facility providing meals to individuals traveling long distances or receiving prolonged outpatient medical services away from home.","174200000X","Source:  SD DSS Non-Emergency Medical Transportation program Transportation Services [7/1/2010: new]","2010-10-01",null,null,"Delete - not a DPP measure","No"]
["Other Service Providers","Mechanotherapist",null,"Mechanotherapist","A practitioner of mechanotherapy examines patients by verbal inquiry, examination of the musculoskeletal system by hand, and visual inspection and observation.  In the treatment of patients, mechanotherapists employ the techniques of advised or supervised exercise; electrical neuromuscular stimulation; massage or manipulation; or air, water, heat, cold, sound, or infrared ray therapy.","172M00000X","Source:  Summarized from Ohio Revised Code 4731.15 [1/1/2007: new]","2007-04-01",null,null,"Delete - not a DPP measure","No"]
["Suppliers","Medical Foods Supplier",null,"Medical Foods Supplier","A supplier of special replacement foods for clients with errors of metabolism that prohibit them from eating a regular diet.   Medical foods are lacking in the compounds which cause complications of the metabolic disorder, and are not generally available in grocery stores, health food stores, or pharmacies.","335G00000X","Source:  The Children with Special Healthcare Needs (CSHCN) Services Program, a program of the Texas Department of State Health Services  [10/1/2011: new]","2011-10-01",null,null,"Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Medical Genetics","Clinical Biochemical Genetics","Clinical Biochemical Genetics Physician","A clinical biochemical geneticist demonstrates competence in performing and interpreting biochemical analyses relevant to the diagnosis and management of human genetic diseases and is a consultant regarding laboratory diagnosis of a broad range of inherited disorders.","207SG0202X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added]    Additional Resources: American Board of Medical Genetics, 2007.  http://www.abmg.org/.    Board certification for Medical Doctors (MDs) is provided by the American Board of Medical Genetics. ","2003-04-01",null,"2007-07-01","Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Medical Genetics","Clinical Cytogenetics","Clinical Cytogenetics Physician","A clinical cytogeneticist demonstrates competence in providing laboratory diagnostic and clinical interpretive services dealing with cellular components, particularly chromosomes, associated with heredity.","207SC0300X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added]    Additional Resources: American Board of Medical Genetics, 2007.  http://www.abmg.org/.    Board certification for Medical Doctors (MDs) is provided by the American Board of Medical Genetics.   A general certificate was first issued by the ABMS in 1982.  ACGME Accredited Residency Program Requirements:  None.","2003-04-01",null,"2007-07-01","Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Medical Genetics","Clinical Genetics (M.D.)","Clinical Genetics (M.D.) Physician","A clinical geneticist demonstrates competence in providing comprehensive diagnostic, management and counseling services for genetic disorders.","207SG0201X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added]    Additional Resources: American Board of Medical Genetics, 2007.  http://www.abmg.org/.    Board certification for Medical Doctors (MDs) is provided by the American Board of Medical Genetics. ","2003-04-01",null,"2007-07-01","Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Medical Genetics","Clinical Molecular Genetics","Clinical Molecular Genetics Physician","A clinical molecular geneticist demonstrates competence in performing and interpreting molecular analyses relevant to the diagnosis and management of human genetic diseases and is a consultant regarding laboratory diagnosis of a broad range of inherited disorders.","207SG0203X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added]    Additional Resources: American Board of Medical Genetics, 2007.  http://www.abmg.org/.    Board certification for Medical Doctors (MDs) is provided by the American Board of Medical Genetics.","2003-04-01",null,"2007-07-01","Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Medical Genetics","Molecular Genetic Pathology","Molecular Genetic Pathology (Medical Genetics) Physician","A board certified subspecialty, the molecular genetic pathologist is expert in the principles, theory and technologies of molecular biology and molecular genetics. This expertise is used to make or confirm diagnoses of Mendelian genetic disorders, of human development, infectious diseases and malignancies and to assess the natural history of those disorders. A molecular genetic pathologist provides information about gene structure, function and alteration, and applies laboratory techniques for diagnosis, treatment and prognosis for individuals with related disorders.","207SM0001X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added]    Additional Resources: American Board of Medical Genetics, 2007.  http://www.abmg.org/.    Board certification for Medical Doctors (MDs) is provided by the American Board of Medical Genetics.    A subspecialty certificate for MGG was approved by the ABMS in 1999.    ACGME Accredited Residency Program Requirements:  Proposal under development.","2003-04-01",null,"2007-07-01","Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Medical Genetics","Ph.D. Medical Genetics","Ph.D. Medical Genetics Physician","A medical geneticist works in association with a medical specialist, is affiliated with a clinical genetics program and serves as a consultant to medical and dental specialists.","207SG0205X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added]    Additional Resources: American Board of Medical Genetics, 2007.  http://www.abmg.org/.    Board certification for Medical Doctors (MDs) is provided by the American Board of Medical Genetics.","2003-04-01",null,"2007-07-01","Delete - not a DPP measure","No"]
["Other Service Providers","Medical Genetics, Ph.D. Medical Genetics",null,"Ph.D. Medical Genetics","A medical geneticist works in association with a medical specialist, is affiliated with a clinical genetics program, and serves as a consultant to medical and dental specialists. ","170100000X"," A general certificate was first issued by ABMS in 1982.  ACGME Accredited Residency Program Requirements:  None.","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Hospital Units","Medicare Defined Swing Bed Unit",null,"Medicare Defined Swing Bed Hospital Unit","A unit of a hospital that has a Medicare provider agreement and has been granted approval from HCFA to provide post-hospital extended care services and be reimbursed as a swing-bed unit.","275N00000X","Source: Code of Federal Regulations #42, Section 482.66.","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Other Service Providers","Midwife",null,"Midwife","A Midwife is a trained professional with special expertise in supporting women to maintain a healthy pregnancy birth, offering expert individualized care, education, counseling, and support to a woman and her newborn throughout the childbearing cycle. A Midwife is a skilled and independent practitioner who has undergone formalized training. Midwives are not required to be nurses and may be trained via multiple routes of education (apprenticeship, workshop, formal classes, or programs, etc., usually a combination). The educational background requirements and licensing requirements vary by state. The Midwife may or may not be certified by a state or national organization.","176B00000X","Source:  The National Uniform Claim Committee [7/1/2007: title changed, definition changed, source changed]","2002-04-01",null,"2007-07-01","Delete - not a DPP measure","No"]
["Other Service Providers","Midwife, Lay",null,"Lay Midwife","A person qualified by experience and limited specialized training to provide obstetric and neo-natal care in the management of women having normal pregnancy, labor and childbirth. The lay midwife is licensed in some states.","175M00000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Laboratories","Military Clinical Medical Laboratory",null,"Military Clinical Medical Laboratory","A Department of Defense (DoD) medical clinical reference laboratory not associated with a DoD Hospital or DoD Clinic. An example is the Armed Forces Institute of Pathology.","291900000X","[1/1/2005: new]","2005-04-01",null,null,"Delete - not a DPP measure","No"]
["Other Service Providers","Military Health Care Provider",null,"Military Health Care Provider","Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes.","171000000X","[7/1/2005: new]","2005-10-01",null,null,"Delete - not a DPP measure","No"]
["Other Service Providers","Military Health Care Provider","Independent Duty Corpsman","Independent Duty Corpsman","A Navy Independent Duty Corpsman (IDC) is an active duty Sailor who has successfully completed one of the Navy's specific IDC training programs.  IDCs are formally trained and educated to perform primary medical care and minor surgical services in a variety of health care and non-health care settings worldwide under indirect physician supervision.  IDCs provide care to Department of Defense operational forces and other supporting forces such as contractors and foreign nationals.","1710I1002X","Source:  Bureau of Medicine and Surgery, Department of the Navy  [7/1/2005: new]","2005-10-01",null,null,"Delete - not a DPP measure","No"]
["Other Service Providers","Military Health Care Provider","Independent Duty Medical Technicians","Independent Duty Medical Technicians","An Independent Duty Medical Technician (IDMT) is specially trained and educated to perform primary medical care, minor surgical services, and treatment of dental disorders for active duty military members in a variety of health care and non-health care settings worldwide under direct and indirect physician supervision.  An IDMT may take medical histories, perform physical exams, order lab tests and x-rays, prescribe medications, and give immunizations. IDMTs work under the direct supervision of a physician preceptor when at home station and indirectly when assigned to a Mobile Aid Station, Mobile Medical Unit, remote site, or otherwise deployed specifically as an IDMT.  An IDMT may be an experienced Aerospace Medical Service Technician who meets special task qualifications and is recommended for training by the Aerospace Medical Service Functional Manager at their Medical Treatment Facility.  IDMTs maintain certification as Nationally Registered Emergency Medical Technicians and as Immunization Back-up Technicians.","1710I1003X","Source:  Air Force Surgeon General Office  [7/1/2005: new]","2005-10-01",null,null,"Delete - not a DPP measure","No"]
["Hospitals","Military Hospital",null,"Military Hospital","A health care facility operated by the Department of Defense.","286500000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Hospitals","Military Hospital","Community Health","Deactivated - Military Hospital",null,"2865C1500X","[1/1/2005: marked inactive]","2002-04-01","2005-03-31",null,"Delete - deactivated","No"]
["Hospitals","Military Hospital","Military General Acute Care Hospital","Military General Acute Care Hospital","A Department of Defense (DoD) health care organization furnishing inpatient care 24 hours per day in \"fixed\" facilities, primarily for DoD beneficiaries. Entity is Defense Health Program (DHP) funded. A \"fixed\" facility is a non-temporary, non-deployed facility usually used for health care services. It includes mobile specialty units such as Magnetic Resonance Imaging (MRI) units that may furnish services at the \"fixed\" facility. It includes those services and institutional costs usually included in a Diagnosis Related Group as well as \"pass-through\" items.","2865M2000X","[1/1/2005: title modified,  definition added]","2002-04-01",null,"2005-01-01","Delete - not a DPP measure","No"]
["Hospitals","Military Hospital","Military General Acute Care Hospital. Operational (Transportable)","Operational (Transportable) Military General Acute Care Hospital","A Department of Defense (DoD) health care organization furnishing inpatient care 24 hours per day in \"non-fixed\" or deployed facilities. Entity is not Defense Health Program funded. Services are primarily intended for DoD active duty though some services may be furnished for non-DoD active duty. \"Non-fixed\" facilities are generally deployed DoD health care activities, not providing services on or in association with a DoD fort or base. \"Non-fixed\" facilities include hospital ships.","2865X1600X","[1/1/2005: title modified,  definition added]","2002-04-01",null,"2005-01-01","Delete - not a DPP measure","No"]
["Suppliers","Military/U.S. Coast Guard Pharmacy",null,"Military/U.S. Coast Guard Pharmacy","A Department of Defense (DoD) or U.S. Coast Guard entity whose primary function is to store, prepare and dispense pharmaceuticals and other associated items to Uniformed Services beneficiaries.  These pharmacies may be associated with a DoD or U.S. Coast Guard clinic, DoD Hospital or freestanding.  Usually associated with outpatient services.","332000000X","Source:  TRICARE Management Activity Uniform Business Office User's Guide [1/1/2005: new; 7/1/2006: modified title, modified definition]","2005-04-01",null,"2006-07-01","Delete - not a DPP measure","No"]
["Transportation Services","Military/U.S. Coast Guard Transport",null,"Military/U.S. Coast Guard Transport, ","Definition to come...","341800000X","[1/1/2005: new; 7/1/2006 title modified]","2005-04-01",null,"2006-07-01","Delete - not a DPP measure","No"]
["Transportation Services","Military/U.S. Coast Guard Transport","Military or U.S. Coast Guard Ambulance, Air Transport","Military or U.S. Coast Guard Air Transport Ambulance","Vehicle and staff for patient emergency or non-emergency air transport.","3418M1120X","Source:  TRICARE Management Activity Uniform Business Office User's Guide [1/1/2005: new; 7/1/2006 modified title, added source]","2005-04-01",null,"2006-07-01","Delete - not a DPP measure","No"]
["Transportation Services","Military/U.S. Coast Guard Transport","Military or U.S. Coast Guard Ambulance, Ground Transport","Military or U.S. Coast Guard Ground Transport Ambulance","Vehicle and staff for patient emergency or non-emergency ground transport. Includes traditional ambulances as well as ambulance buses.","3418M1110X","Source:  TRICARE Management Activity Uniform Business Office User's Guide [1/1/2005: new; 7/1/2006 modified title, added source]","2005-04-01",null,"2006-07-01","Delete - not a DPP measure","No"]
["Transportation Services","Military/U.S. Coast Guard Transport","Military or U.S. Coast Guard Ambulance, Water Transport","Military or U.S. Coast Guard Water Transport Ambulance","Vehicle and staff for patient emergency or non-emergency sea/water transport","3418M1130X","Source:  TRICARE Management Activity Uniform Business Office User's Guide [1/1/2005: new; 7/1/2006 modified title, added source]","2005-04-01",null,"2006-07-01","Delete - not a DPP measure","No"]
["Group","Multi-Specialty",null,"Multi-Specialty Group","A business group of one or more individual practitioners, who practice with different areas of specialization.","193200000X","[7/1/2003: new]","2003-10-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Music Therapist",null,"Music Therapist","Music therapists use music interventions to assess clients' strengths and needs, develop goals, implement services, and evaluate and document progress for individuals of all ages.  Music therapists facilitate changes in physical, cognitive, emotional, and/or psychosocial health.","225A00000X","Source:  American Music Therapy Association","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Other Service Providers","Naprapath",null,"Naprapath","Naprapathy means a branch of medicine that focuses on the evaluation and treatment of neuron-muscular conditions.  Doctors of naprapathy are connective tissue specialists.  Education and training are defined through individual states' licensing/certification requirements.","172P00000X","Source:  National Uniform Claim Committee [1/1/2007: new]","2007-04-01",null,null,"Delete - not a DPP measure","No"]
["Other Service Providers","Naturopath",null,"Naturopath","Diagnoses, treats, and cares for patients, using system of practice that bases treatment of physiological functions and abnormal conditions on natural laws governing human body: Utilizes physiological, psychological, and mechanical methods, such as air, water, light, heat, earth, phototherapy, food and herb therapy, psychotherapy, electrotherapy, physiotherapy, minor and orificial surgery, mechanotherapy, naturopathic corrections and manipulation, and natural methods or modalities, together with natural medicines, natural processed foods, and herbs and nature's remedies. Excludes major surgery, therapeutic use of x ray and radium, and use of drugs, except those assimilable substances containing elements or compounds which are components of body tissues and are physiologically compatible to body processes for maintenance of life.","175F00000X","Source: The Federal Dictionary of Occupational Titles, U.S. Department of Labor, Washington, D.C., section #079, 101-014 [7/1/2007: definition changed, source added]","2002-04-01",null,"2007-07-01","Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Neurological Surgery","Intentionally left blank","Neurological Surgery Physician","A neurological surgeon provides the operative and non-operative management (i.e., prevention, diagnosis, evaluation, treatment, critical care, and rehabilitation) of disorders of the central, peripheral, and autonomic nervous systems, including their supporting structures and vascular supply; the evaluation and treatment of pathological processes which modify function or activity of the nervous system; and the operative and non-operative management of pain. A neurological surgeon treats patients with disorders of the nervous system; disorders of the brain, meninges, skull, and their blood supply, including the extracranial carotid and vertebral arteries; disorders of the pituitary gland; disorders of the spinal cord, meninges, and vertebral column, including those which may require treatment by spinal fusion or instrumentation; and disorders of the cranial and spinal nerves throughout their distribution.","207T00000X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added]    Additional Resources: American Board of Neurological Surgery, 2007.  http://www.abns.org/.    Board certification for Medical Doctors (MDs) is provided by the American Board of Neurological Surgery.","2003-04-01",null,"2007-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Neuromusculoskeletal Medicine & OMM",null,"Neuromusculoskeletal Medicine & OMM Physician","The Neuromusculoskeletal Medicine and Osteopathic Manipulative Medicine physician directs special attention to the neuromusculoskeletal system and its interaction with other body systems. Neuromusculoskeletal Medicine and Osteopathic Manipulative Medicine encompasses increased knowledge and understanding of osteopathic principles and practice and heightened technical skills of osteopathic manipulative medicine, and integrates each of these into the management of pediatric, adolescent, adult, and geriatric patients.","204D00000X","Source: American Osteopathic Association, 2017 [7/1/2017: added definition]<br><br>Additional Resources: American Osteopathic Board of Neuromusculoskeletal Medicine, 2017, http://www.osteopathic.org/certification","2003-04-01",null,null,"Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Neuromusculoskeletal Medicine, Sports Medicine",null,"Sports Medicine (Neuromusculoskeletal Medicine) Physician","Definition to come.","204C00000X",null,"2003-04-01",null,null,"Delete - not a DPP measure","No"]
["Transportation Services","Non-emergency Medical Transport (VAN)",null,"Non-emergency Medical Transport (VAN)","A land vehicle with a capacity to meet special height, clearance, access, and seating, for the conveyance of persons in non-emergency situations. The vehicle may or may not be required to meet local county or state regulations.","343900000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Suppliers","Non-Pharmacy Dispensing Site",null,"Non-Pharmacy Dispensing Site","A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.)","332900000X","Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC)  [1/1/2006: new]","2006-04-01",null,null,"Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Nuclear Medicine",null,"Nuclear Medicine Physician","A nuclear medicine specialist employs the properties of radioactive atoms and molecules in the diagnosis and treatment of disease and in research. Radiation detection and imaging instrument systems are used to detect disease as it changes the function and metabolism of normal cells, tissues and organs. A wide variety of diseases can be found in this way, usually before the structure of the organ involved by the disease can be seen to be abnormal by any other techniques. Early detection of coronary artery disease (including acute heart attack), early cancer detection and evaluation of the effect of tumor treatment, diagnosis of infection and inflammation anywhere in the body and early detection of blood clot in the lungs are all possible with these techniques. Unique forms of radioactive molecules can attack and kill cancer cells (e.g., lymphoma, thyroid cancer) or can relieve the severe pain of cancer that has spread to bone","207U00000X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Nuclear Medicine, 2007.  http://www.abnm.org/.    A doctor of osteopathy was able to obtain a Certificate of Added Qualifications in the field of Nuclear Medicine.  The Certificate is NO longer offered.<br><br>American Osteopathic Board of Nuclear Medicine, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Nuclear Medicine.","2003-04-01",null,"2011-07-01","Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Nuclear Medicine","In Vivo & In Vitro Nuclear Medicine","In Vivo & In Vitro Nuclear Medicine Physician","A nuclear medicine physician who specializes in in vivo and in vitro nuclear medicine.","207UN0903X","Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added]    Additional Resources: A Certification of Added Qualifications (CAQ) was, but is no longer issued by the American Osteopathic Board of Nuclear Medicine.","2003-04-01",null,"2010-01-01","Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Nuclear Medicine","Nuclear Cardiology","Nuclear Cardiology Physician","A nuclear medicine physician who specializes in nuclear cardiology.","207UN0901X","Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added]    Additional Resources: A Certification of Added Qualifications (CAQ) was, but is no longer issued by the American Osteopathic Board of Nuclear Medicine.","2003-04-01",null,"2010-01-01","Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Nuclear Medicine","Nuclear Imaging & Therapy","Nuclear Imaging & Therapy Physician","A nuclear medicine physician who specializes in nuclear imaging and therapy.","207UN0902X","Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added]    Additional Resources: A Certification of Added Qualifications (CAQ) was, but is no longer issued by the American Osteopathic Board of Nuclear Medicine.","2003-04-01",null,"2010-01-01","Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Nurse Anesthetist, Certified Registered",null,"Certified Registered Nurse Anesthetist","(1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition.","367500000X","Sources: (1) Council on Certification of Nurse Anesthetists, Park Ridge, IL, and Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. (2) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 548.","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Nurse Practitioner","Intentionally left blank","Nurse Practitioner","(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.","363L00000X","Source: (1) American Nurses' Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549.","2002-04-01",null,null,"New - Add as Grouping/Classification eligible with eligible Physician","Yes"]
["Physician Assistants & Advanced Practice Nursing Providers","Nurse Practitioner","Acute Care","Acute Care Nurse Practitioner","Definition to come...","363LA2100X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Nurse Practitioner","Adult Health","Adult Health Nurse Practitioner","Definition to come...","363LA2200X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Nurse Practitioner","Community Health","Community Health Nurse Practitioner","Definition to come...","363LC1500X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Nurse Practitioner","Critical Care Medicine","Critical Care Medicine Nurse Practitioner","Definition to come...","363LC0200X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Nurse Practitioner","Family","Family Nurse Practitioner","Definition to come...","363LF0000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Nurse Practitioner","Gerontology","Gerontology Nurse Practitioner","Definition to come...","363LG0600X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Nurse Practitioner","Neonatal","Neonatal Nurse Practitioner","Definition to come...","363LN0000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Nurse Practitioner","Neonatal, Critical Care","Critical Care Neonatal Nurse Practitioner","Definition to come...","363LN0005X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Nurse Practitioner","Obstetrics & Gynecology","Obstetrics & Gynecology Nurse Practitioner","Definition to come...","363LX0001X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Nurse Practitioner","Occupational Health","Occupational Health Nurse Practitioner","Definition to come...","363LX0106X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Nurse Practitioner","Pediatrics","Pediatric Nurse Practitioner","Definition to come...","363LP0200X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Nurse Practitioner","Pediatrics, Critical Care","Critical Care Pediatric Nurse Practitioner","Definition to come...","363LP0222X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Nurse Practitioner","Perinatal","Perinatal Nurse Practitioner","Definition to come...","363LP1700X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Nurse Practitioner","Primary Care","Primary Care Nurse Practitioner","Definition to come...","363LP2300X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Nurse Practitioner","Psychiatric/Mental Health","Psychiatric/Mental Health Nurse Practitioner","Definition to come...","363LP0808X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Nurse Practitioner","School","School Nurse Practitioner","Definition to come...","363LS0200X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Nurse Practitioner","Women's Health","Women's Health Nurse Practitioner","Definition to come...","363LW0102X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Related Providers","Nurse's Aide",null,"Nurse's Aide","(1) An unlicensed individual who is trained to function in an assistive role to the licensed nurse in the provision of patient/client activities as delegated by the nurse; (2) An individual trained (either on-the-job or through a formal course generally of less than one year) and experienced in performing patient or client-care nursing tasks that do not require the skills of a specialist, technician, or professional. Examples of tasks performed by nurses aides include changing clothes, diapers, and beds; assisting patients to perform exercises or personal hygiene tasks, and supporting communication or social interaction. Specific education and credentials are not required for this work.","376K00000X","Source: (1) American Nurses Association, Registered Professional Nurses and Unlicensed Personnel, 2nd ed., 1996; (2) Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988.","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Agencies","Nursing Care",null,"Nursing Care Agency","A Nursing Care Agency is an entity that provides skilled nursing care through the services of a Registered Nurse (RN) or a Licensed Practical Nurse (LPN), by employees, contracted individuals, or via a registry, in a variety of settings. The agency may engage in providing private duty nursing and/or staffing services.","251J00000X","Source: National Uniform Claim Committee, 2008 [7/1/2008: modified definition]","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing & Custodial Care Facilities","Nursing Facility/Intermediate Care Facility",null,"Nursing Facility/Intermediate Care Facility","An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals.","313M00000X","Source: Paraphrased from Section 1919 (a) of the Social Security Act.","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Related Providers","Nursing Home Administrator",null,"Nursing Home Administrator","An individual, often licensed by the state, who is responsible for the management of a nursing home.","376G00000X","Source: Lexikon: Dictionary of Health Care Terms, Organizations, and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL, 1994, p. 552.","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Dietary & Nutritional Service Providers","Nutritionist",null,"Nutritionist","A specialist in adapting and applying food and nutrient knowledge to the solution of food and nutritional problems, the control of disease, and the promotion of health. Nutritionists perform research, instruct groups and individuals about nutritional requirements, and assist people in developing meal patterns that meet their nutritional needs; (2) A nutritionist is someone who has completed undergraduate and/or graduate training in the discipline of nutrition without necessarily meeting the academic and experience requirements to qualify for the Registered Dietitian designation.","133N00000X","Source: (1) Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988.","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Dietary & Nutritional Service Providers","Nutritionist","Nutrition, Education","Nutrition Education Nutritionist","Definition to come...","133NN1002X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Obstetrics & Gynecology","Intentionally left blank","Obstetrics & Gynecology Physician","An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.","207V00000X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Obstetrics and Gynecology, 2007.  http://www.abog.org/.  American Osteopathic Board of Obstetrics and Gynecology, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology.","2003-04-01",null,"2011-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Obstetrics & Gynecology","Critical Care Medicine","Critical Care Medicine (Obstetrics & Gynecology) Physician","An obstetrician/gynecologist, who specializes in critical care medicine diagnoses, treats and supports female patients with multiple organ dysfunction. This specialist may have administrative responsibilities for intensive care units and may also facilitate and coordinate patient care among the primary physician, the critical care staff and other specialists.","207VC0200X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Obstetrics and Gynecology, 2007.  http://www.abog.org/.  American Osteopathic Board of Obstetrics and Gynecology, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology.","2003-04-01",null,"2011-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Obstetrics & Gynecology","Female Pelvic Medicine and Reconstructive Surgery","Female Pelvic Medicine and Reconstructive Surgery (Obstetrics & Gynecology) Physician","A subspecialist in Female Pelvic Medicine and Reconstructive Surgery is a physician in Urology or Obstetrics and Gynecology who, by virtue of education and training, is prepared to provide consultation and comprehensive management of women with complex benign pelvic conditions, lower urinary tract disorders, and pelvic floor dysfunction. Comprehensive management includes those diagnostic and therapeutic procedures necessary for the total care of the patient with these conditions and complications resulting from them.","207VF0040X","Source: American Board of Medical Specialties, 2011. [1/1/2012: new]  Resources:  www.abms.org","2012-04-01",null,null,"Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Obstetrics & Gynecology","Gynecologic Oncology","Gynecologic Oncology Physician","An obstetrician/gynecologist who provides consultation and comprehensive management of patients with gynecologic cancer, including those diagnostic and therapeutic procedures necessary for the total care of the patient with gynecologic cancer and resulting complications.","207VX0201X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Obstetrics and Gynecology, 2007.  http://www.abog.org/.  American Osteopathic Board of Obstetrics and Gynecology, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology.","2003-04-01",null,"2011-07-01","Keep - Clarify in Specs FAQ or Stakeholder Feedback, etc. that the eligible physician or clinician is at the Classification level, and any subspecialization can be found under the Area of Specialization level. For example, a physician may have a pediatric subspecialty (Area of Specialization) but not necessarily be a pediatrics physician (Classification).","Yes"]
["Allopathic & Osteopathic Physicians","Obstetrics & Gynecology","Gynecology","Gynecology Physician","Definition to come.","207VG0400X",null,"2003-04-01",null,null,"Keep - Add somewhere that for TIPPS program, whenever a Definition is listed as \"Definition to come.\" by NUCC, then the Definition at the Classification level should be used as possible.","Yes"]
["Allopathic & Osteopathic Physicians","Obstetrics & Gynecology","Hospice and Palliative Medicine","Hospice and Palliative Medicine (Obstetrics & Gynecology) Physician","An obstetrician/gynecologist with special knowledge and skills to prevent and relieve the suffering experienced by patients with life-limiting illnesses. This specialist works with an interdisciplinary hospice or palliative care team to maximize quality of life while addressing physical, psychological, social and spiritual needs of both patient and family throughout the course of the disease, through the dying process, and beyond for the family.  This specialist has expertise in the assessment of patients with advanced disease; the relief of distressing symptoms; the coordination of interdisciplinary patient and family-centered care in diverse venues; the use of specialized care systems including hospice; the management of the imminently dying patient; and legal and ethical decision making in end-of-life care.","207VH0002X","Source: American Academy of Hospice and Palliative Medicine, www.aahpm.org [1/1/2007: new]","2007-04-01",null,null,"Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Obstetrics & Gynecology","Maternal & Fetal Medicine","Maternal & Fetal Medicine Physician","An obstetrician/gynecologist who cares for, or provides consultation on, patients with complications of pregnancy. This specialist has advanced knowledge of the obstetrical, medical and surgical complications of pregnancy and their effect on both the mother and the fetus. The specialist also possesses expertise in the most current diagnostic and treatment modalities used in the care of patients with complicated pregnancies.","207VM0101X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Obstetrics and Gynecology, 2007.  http://www.abog.org/.  American Osteopathic Board of Obstetrics and Gynecology, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology.","2003-04-01",null,"2011-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Obstetrics & Gynecology","Obesity Medicine","Obesity Medicine (Obstetrics & Gynecology) Physician","A physician who specializes in the treatment of obesity demonstrates competency in and a thorough understanding of the treatment of obesity and the genetic, biologic, environmental, social, and behavioral factors that contribute to obesity. The obesity medicine physician employs therapeutic interventions including diet, physical activity, behavioral change, and pharmacotherapy. The obesity medicine physician utilizes a comprehensive approach, and may include additional resources such as dietitians, exercise physiologists, mental health professionals and bariatric surgeons as indicated to achieve optimal results. Additionally, the obesity medicine physician maintains competency in providing pre- peri- and post-surgical care of bariatric surgery patients, promotes the prevention of obesity, and advocates for those who suffer from obesity.","207VB0002X","Source:  American Board of Obesity Medicine, www.abom.org [10/1/2007: new, 7/1/2015: title and definition modified]  Additional Resource: American Society of Bariatric Physicians, www.asbp.org.","2007-10-01",null,null,"Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Obstetrics & Gynecology","Obstetrics","Obstetrics Physician","Definition to come.","207VX0000X",null,"2003-04-01",null,null,"Keep - Add somewhere that for TIPPS program, whenever a Definition is listed as \"Definition to come.\" by NUCC, then the Definition at the Classification level should be used as possible.","Yes"]
["Allopathic & Osteopathic Physicians","Obstetrics & Gynecology","Reproductive Endocrinology","Reproductive Endocrinology Physician","An obstetrician/gynecologist who is capable of managing complex problems relating to reproductive endocrinology and infertility.","207VE0102X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Obstetrics and Gynecology, 2007.  http://www.abog.org/.  American Osteopathic Board of Obstetrics and Gynecology, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology.","2003-04-01",null,"2011-07-01","Keep - Clarify in Specs FAQ or Stakeholder Feedback, etc. that the eligible physician or clinician is at the Classification level, and any subspecialization can be found under the Area of Specialization level. For example, a physician may have a pediatric subspecialty (Area of Specialization) but not necessarily be a pediatrics physician (Classification).","Yes"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Occupational Therapist","Intentionally left blank","Occupational Therapist","An occupational therapist is a person who has graduated from an entry-level occupational therapy program accredited by the Accreditation Council for Occupational Therapy Education (ACOTE) or predecessor organizations, or approved by the World Federation of Occupational Therapists (WFOT), or an equivalent international occupational therapy education program; has successfully completed a period of supervised fieldwork experience required by the occupational therapy program; has passed a nationally recognized entry-level examination for occupational therapists, and fulfills state requirements for licensure, certification, or registration. An occupational therapist provides interventions based on evaluation and which emphasize the therapeutic use of everyday life activities (i.e., occupations) with individuals or groups for the purpose of facilitating participation in roles and situations and in home, school, workplace, community and other settings. Occupational therapy services are provided for the purpose of promoting health and wellness and are provided to those who have or are at risk for developing an illness, injury, disease, disorder, condition, impairment, disability, activity limitation, or participation restriction. Occupational therapists address the physical, cognitive, psychosocial, sensory, and other aspects of occupational performance in a variety of contexts to support engagement in everyday life activities that affect health, well-being, and quality of life.","225X00000X","Source: The Guide to Occupational Therapy Practice, 2nd edition. Bethesda: American Occupational Therapy Association, 2007. [7/1/2008: definition changed, added source]","2002-04-01",null,null,"Keep - No Change","Yes"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Occupational Therapist","Driving and Community Mobility","Driving and Community Mobility Occupational Therapist","Occupational therapists can optimize and prolong an older driver's ability to drive safely and ease the transition to other forms of transportation if driving cessation becomes necessary.  By identifying strengths as well as physical or cognitive challenges, occupational therapists can evaluate an individual's overall ability to operate a vehicle safely and recommend assistive devices or behavioral changes to limit risks.  Occupational therapy practitioners offer a continuum of services related to community mobility, from evaluation of driving performance, through counseling and support for lifestyle changes, to maintaining independence and quality of life.","225XR0403X","Source: The Guide to Occupational Therapy Practice, 2nd edition. Bethesda: American Occupational Therapy Association, 2007. [7/1/2008: title changed, definition added, source added]  Additional Resources: The American Occupational Therapy Association (AOTA) does offer voluntary specialty certification for a Driving & Community Mobility Occupational Therapist if the applicant meets the following requirements: <ul> <li>Professional or technical degree or equivalent in occupational therapy.  <li>Certified or licensed by and in good standing with an AOTA recognized credentialing or regulatory body.  <li>Minimum of 2,000 hours of experience as an occupational therapist or occupational therapy assistant.  <li>600 hours of experience delivering occupational therapy services in the certification area to clients (individuals, groups, or populations) in the last 3 calendar years. Service delivery may be paid or voluntary.  <li>Verification of employment. </ul> AOTA Fact Sheets: Older Driver","2002-04-01",null,null,"Keep - No Change","Yes"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Occupational Therapist","Environmental Modification","Environmental Modification Occupational Therapist","Occupational therapy practitioners are experts at identifying the cause of difficulties in performance of activities of daily living and instrumental activities of daily living.  Occupational therapy practitioners evaluate the client, their environment, and their occupational performance in that environment, as well as make recommendations for products to improve the fit between the client, place, and activity.  Occupational therapists can evaluate both the skills of the client and the environmental features that support or limit the performance of meaningful or necessary activities, thereby enhancing health, safety and well-being.  Based on this assessment, they recommend modification and intervention strategies that improve the fit between the person and his or her environment.","225XE0001X","Source: The Guide to Occupational Therapy Practice, 2nd edition. Bethesda: American Occupational Therapy Association, 2007. [7/1/2008: new]  Additional Resources: The American Occupational Therapy Association (AOTA) does offer voluntary specialty certification for an Environmental Modification Occupational Therapist if the applicant meets the following requirements: <ul> <li>Professional or technical degree or equivalent in occupational therapy.  <li>Certified or licensed by and in good standing with an AOTA recognized credentialing or regulatory body.  <li>Minimum of 2,000 hours of experience as an occupational therapist or occupational therapy assistant.  <li>600 hours of experience delivering occupational therapy services in the certification area to clients (individuals, groups, or populations) in the last 3 calendar years. Service delivery may be paid or voluntary.  <li>Verification of employment. </ul>AOTA Fact Sheets: Home Modifications","2008-10-01",null,null,"Keep - No Change","Yes"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Occupational Therapist","Ergonomics","Ergonomics Occupational Therapist","Definition to come.","225XE1200X",null,"2002-04-01",null,null,"Keep - Add somewhere that for TIPPS program, whenever a Definition is listed as \"Definition to come.\" by NUCC, then the Definition at the Classification level should be used as possible.","Yes"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Occupational Therapist","Feeding, Eating & Swallowing","Feeding, Eating & Swallowing Occupational Therapist","Occupational therapists provide interventions to clients of all ages with feeding, eating and swallowing difficulties.  Occupational therapists provide comprehensive rehabilitative, habilitative, and palliative dysphagia care, which includes collaborating with clients to provide individualized compensatory swallowing strategies, modified diet textures, adapted mealtime environments, enhanced feeding skills, preparatory exercises and positioning to clients, reinforcement of mealtime strategies to enhance and improve swallowing skills, and training to caregivers to enhance eating and feeding performance.  Occupational therapists provide screening and in-depth clinical assessment which may include instrumental dysphagia assessments including videofluroscopy.","225XF0002X","Source: The Guide to Occupational Therapy Practice, 2nd edition. Bethesda: American Occupational Therapy Association, 2007. [7/1/2008: new]  Additional Resources: The American Occupational Therapy Association (AOTA) does offer voluntary specialty certification for a Feeding, Eating & Swallowing Occupational Therapist if the applicant meets the following requirements: <ul> <li>Professional or technical degree or equivalent in occupational therapy.  <li>Certified or licensed by and in good standing with an AOTA recognized credentialing or regulatory body.  <li>Minimum of 2,000 hours of experience as an occupational therapist or occupational therapy assistant.  <li>600 hours of experience delivering occupational therapy services in the certification area to clients (individuals, groups, or populations) in the last 3 calendar years. Service delivery may be paid or voluntary.  <li>Verification of employment. </ul>AOTA Specialized Knowledge and Skills Paper: Feeding, Eating and Swallowing in Occupational Therapy Practice, 2007; AOTA Fact Sheets: OT: A Vital Role in Dysphagia Care","2008-10-01",null,null,"Keep - No Change","Yes"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Occupational Therapist","Gerontology","Gerontology Occupational Therapist","Occupational therapists work with older adults in virtually every setting: assisted living, wellness programs, hospitals, nursing homes, senior centers, clinics and in the home. Occupational therapists bring an understanding of the importance of participation and occupation for overall well-being to those who are experiencing disabling conditions related to aging. The primary overarching goal of occupational therapy services with this population is to maximize independence and participation, thereby enabling an older person to continue to live successfully in his or her chosen environment. Occupational therapists can help older adults by developing strategies to help or maintain safety and well-being, to assist with life transitions, and to compensate for challenges they experience in activities of daily living, instrumental activities of daily living, leisure participation, social participation, and productive activities.","225XG0600X","Source: The Guide to Occupational Therapy Practice, 2nd edition. Bethesda: American Occupational Therapy Association, 2007. [7/1/2008: new]  Additional Resources: The American Occupational Therapy Association (AOTA) does offer voluntary board certification for a Gerontology Occupational Therapist if the applicant meets the following requirements: <ul> <li>Professional degree or equivalent in occupational therapy.  <li>Certified or licensed by and in good standing with an AOTA recognized credentialing or regulatory body.  <li>Minimum of 5 years of practice as an occupational therapist.  <li>Minimum of 5,000 hours of experience as an occupational therapist in the certification area in the last 7 calendar years.  <li>Minimum of 500 hours of experience delivering occupational therapy services in the certification area to clients (individuals, groups, or populations) in the last 5 calendar years. Service delivery may be paid or voluntary.  <li>Verification of employment. </ul>AOTA Fact Sheets: Senior Center and Assisted Living Facilities","2008-10-01",null,null,"Keep - No Change","Yes"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Occupational Therapist","Hand","Hand Occupational Therapist","Definition to come.","225XH1200X",null,"2002-04-01",null,null,"Keep - Add somewhere that for TIPPS program, whenever a Definition is listed as \"Definition to come.\" by NUCC, then the Definition at the Classification level should be used as possible.","Yes"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Occupational Therapist","Human Factors","Human Factors Occupational Therapist","Definition to come.","225XH1300X",null,"2002-04-01",null,null,"Keep - Add somewhere that for TIPPS program, whenever a Definition is listed as \"Definition to come.\" by NUCC, then the Definition at the Classification level should be used as possible.","Yes"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Occupational Therapist","Low Vision","Low Vision Occupational Therapist","Occupational therapists enable children and adults with visual impairment to engage in their chosen daily living activities safely and as independently as possible.  This is accomplished by 1) teaching the person to use their remaining vision as efficiently as possible to complete activities; (2) modifying activities so that they can be completed with less vision; (3) training the person in use of adaptive equipment to compensate for vision loss, including high and low technology assistive devices; and (4) modifying the person's environment.","225XL0004X","Source: The Guide to Occupational Therapy Practice, 2nd edition. Bethesda: American Occupational Therapy Association, 2007. [7/1/2008: new]  Additional Resources: The American Occupational Therapy Association (AOTA) does offer voluntary specialty certification for a Low Vision Occupational Therapist if the applicant meets the following requirements: <ul> <li>Professional or technical degree or equivalent in occupational therapy.  <li>Certified or licensed by and in good standing with an AOTA recognized credentialing or regulatory body.  <li>Minimum of 2,000 hours of experience as an occupational therapist or occupational therapy assistant.  <li>600 hours of experience delivering occupational therapy services in the certification area to clients (individuals, groups, or populations) in the last 3 calendar years. Service delivery may be paid or voluntary.  <li>Verification of employment. </ul>AOTA Fact Sheets: Low Vision; OT Services for Individuals with Visual Impairments","2008-10-01",null,null,"Keep - No Change","Yes"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Occupational Therapist","Mental Health","Mental Health Occupational Therapist","Occupational therapists provide treatment for people recovering from a mental or physical illness to regain their independence and stability and to engage in normal daily occupations (work, home, family life, school, leisure).  Occupational therapists provide particular emphasis on interventions that result in improved quality of life and decrease hospitalization.","225XM0800X","Source: The Guide to Occupational Therapy Practice, 2nd edition. Bethesda: American Occupational Therapy Association, 2007. [7/1/2008: new]  Additional Resources: The American Occupational Therapy Association (AOTA) does offer voluntary board certification for a Mental Health Occupational Therapist if the applicant meets the following requirements: <ul> <li>Professional degree or equivalent in occupational therapy.  <li>Certified or licensed by and in good standing with an AOTA recognized credentialing or regulatory body.  <li>Minimum of 5 years of practice as an occupational therapist.  <li>Minimum of 5,000 hours of experience as an occupational therapist in the certification area in the last 7 calendar years.  <li>Minimum of 500 hours of experience delivering occupational therapy services in the certification area to clients (individuals, groups, or populations) in the last 5 calendar years. Service delivery may be paid or voluntary.  <li>Verification of employment. </ul>AOTA Fact Sheets: Partial Hospitalization Programs and Consumer","2008-10-01",null,null,"Keep - No Change","Yes"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Occupational Therapist","Neurorehabilitation","Neurorehabilitation Occupational Therapist","Definition to come.","225XN1300X",null,"2002-04-01",null,null,"Keep - Add somewhere that for TIPPS program, whenever a Definition is listed as \"Definition to come.\" by NUCC, then the Definition at the Classification level should be used as possible.","Yes"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Occupational Therapist","Pediatrics","Pediatric Occupational Therapist","Occupational therapists provide services to infants, toddlers and children who have or who are at risk for developmental delays or disabilities. Occupational therapy is concerned with a child's ability to participate in daily life activities or \"occupations.\"  Occupational therapists use their unique expertise to help children with social-emotional, physical, cognitive, communication, and adaptive behavioral challenges and to help children to be prepared for and perform important learning and school-related activities and to fulfill their rule as students.  Through an understanding of the impact of disability, illness, and impairment on a child's development, plan, ability to learn new skills, and overall occupational performance, occupational therapists design interventions that promote healthy development, establish needed skills, and/or modify environments, all in support of participation in daily activities.","225XP0200X","Source: The Guide to Occupational Therapy Practice, 2nd edition. Bethesda: American Occupational Therapy Association, 2007. [7/1/2008: new]   Additional Resources: The American Occupational Therapy Association (AOTA) does offer voluntary board certification for a Pediatric Occupational Therapist if the applicant meets the following requirements: <ul> <li>Professional degree or equivalent in occupational therapy.  <li>Certified or licensed by and in good standing with an AOTA recognized credentialing or regulatory body.  <li>Minimum of 5 years of practice as an occupational therapist.  <li>Minimum of 5,000 hours of experience as an occupational therapist in the certification area in the last 7 calendar years.  <li>Minimum of 500 hours of experience delivering occupational therapy services in the certification area to clients (individuals, groups, or populations) in the last 5 calendar years. Service delivery may be paid or voluntary.  <li>Verification of employment. </ul> AOTA Specialized Knowledge and Skills Paper: Occupational Therapy Practice in the Neonatal Intensive Care Unity (2006); AOTA Fact Sheets: Children and the Tsunami, OT for Children Birth to 3 Years of Age, OT's Role with Autism, OT in Educational Settings Under the Individuals with Disabilities Education Act, Transforming Caseload to Workload in School Based and Early Intervention OT Services, OT in Preschool Settings.","2002-04-01",null,null,"Keep - Clarify in Specs FAQ or Stakeholder Feedback, etc. that the eligible physician or clinician is at the Classification level, and any subspecialization can be found under the Area of Specialization level. For example, a physician may have a pediatric subspecialty (Area of Specialization) but not necessarily be a pediatrics physician (Classification).","Yes"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Occupational Therapist","Physical Rehabilitation","Physical Rehabilitation Occupational Therapist","Occupational therapists are experts at helping people lead as independent a life as possible.  Occupational therapists bring an understanding of the physical and psychological implications of illness and injury and their effects on peoples' ability to perform the tasks of daily living.  Occupational therapists provide interventions that can aide a person in completing ADL and IADL tasks, such as dressing, bathing, preparing meals, and driving.  They also may fabricate custom orthotics to improve function, evaluate the environment for safety hazards and recommend adaptations to remove those hazards, help a person compensate for cognitive changes, and build a persons' physical endurance and strength. Occupational therapists' knowledge of adapting tasks and modifying the environment to compensate for functional limitations is used to increase the involvement of clients and to promote safety and success.","225XP0019X","Source: The Guide to Occupational Therapy Practice, 2nd edition. Bethesda: American Occupational Therapy Association, 2007. [7/1/2008: new]  Additional Resources: The American Occupational Therapy Association (AOTA) does offer voluntary board certification for a Physical Rehabilitation Occupational Therapist if the applicant meets the following requirements: <ul> <li>Professional degree or equivalent in occupational therapy.  <li>Certified or licensed by and in good standing with an AOTA recognized credentialing or regulatory body.  <li>Minimum of 5 years of practice as an occupational therapist.  <li>Minimum of 5,000 hours of experience as an occupational therapist in the certification area in the last 7 calendar years.  <li>Minimum of 500 hours of experience delivering occupational therapy services in the certification area to clients (individuals, groups, or populations) in the last 5 calendar years. Service delivery may be paid or voluntary.  <li>Verification of employment. </ul>AOTA Consumer Tip Sheets: Stroke, Hip","2008-10-01",null,null,"Keep - No Change","Yes"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Occupational Therapy Assistant",null,"Occupational Therapy Assistant","An occupational therapy assistant is a person who has graduated from an occupational therapy assistant program accredited by the Accreditation Council for Occupational Therapy Education (ACOTE) or predecessor organizations, has successfully completed a period of supervised fieldwork experience required by the accredited occupational therapy assistant program, has passed a nationally recognized entry-level examination for occupational therapy assistants, and fulfills state requirements for licensure, certification, or registration. An occupational therapy assistant provides interventions under the supervision of an occupational therapist which emphasize the therapeutic use of everyday life activities (i.e., occupations) with individuals or groups for the purpose of facilitating participation in roles and situations and in home, school, workplace, community and other settings. Occupational therapy services are provided for the purpose of promoting health and wellness and are provided to those who have or are at risk for developing an illness, injury, disease, disorder, condition, impairment, disability, activity limitation, or participation restriction. Occupational therapy assistants address the physical, cognitive, psychosocial, sensory, and other aspects of occupational performance in a variety of contexts to support engagement in everyday life activities that affect health, well-being, and quality of life.","224Z00000X","Source: The Guide to Occupational Therapy Practice, 2nd edition. Bethesda: American Occupational Therapy Association, 2007. [7/1/2008: definition changed, source changed]","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Occupational Therapy Assistant","Driving and Community Mobility","Driving and Community Mobility Occupational Therapy Assistant","Occupational therapy assistants contribute to the completion of an individualized occupational therapy driving and community mobility evaluation by administering delegated assessments and identifying findings that impact the client's occupational performance. Clients engage in the assessment and occupational profile process to customize the evaluation to their individual driving and community mobility needs.  Occupational therapy assistants administer and continuously modify individualized in-vehicle and community mobility assessments within the naturalistic context of the community in response to the occupational performance and safety behaviors of the client.  They also implement an individualized intervention plan, within the parameters established in collaboration with the occupational therapist that reflects the contexts of the client and meets his or her occupational performance and safety needs.  Occupational therapy assistants address immediate and long-term implications of psychosocial issues related to compromised driving and community mobility throughout the occupational therapy process and makes recommendations to the occupational therapist for modification to service delivery.","224ZR0403X","Source: The Guide to Occupational Therapy Practice, 2nd edition. Bethesda: American Occupational Therapy Association, 2007. [7/1/2008: new]  Additional Resources: The American Occupational Therapy Association (AOTA) does offer voluntary specialty certification for a Driving & Community Mobility Occupational Therapy Assistant if the applicant meets the following requirements: <ul> <li>Professional or technical degree or equivalent in occupational therapy.  <li>Certified or licensed by and in good standing with an AOTA recognized credentialing or regulatory body.  <li>Minimum of 2,000 hours of experience as an occupational therapist or occupational therapy assistant.  <li>600 hours of experience delivering occupational therapy services in the certification area to clients (individuals, groups, or populations) in the last 3 calendar years. Service delivery may be paid or voluntary.  <li>Verification of employment. </ul>AOTA Fact Sheets: Older Driver; AOTA Website: Specialty Certification","2008-10-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Occupational Therapy Assistant","Environmental Modification","Environmental Modification Occupational Therapy Assistant","Occupational therapy assistants provide environmental modifications under the supervision of an occupational therapist.  OTAs develop and implement an individualized occupational therapy environmental modification plan that reflects the relevant contexts of the client and relevant others and maximizes current and future occupational performance, safety, and participation of the client. Clients receive environmental modification recommendations and interventions that enable them to meet occupational performance and participation goals and that have adequate flexibility to accommodate for their future needs.","224ZE0001X","Source: The Guide to Occupational Therapy Practice, 2nd edition. Bethesda: American Occupational Therapy Association, 2007. [7/1/2008: new]  Additional Resources: The American Occupational Therapy Association (AOTA) does offer voluntary specialty certification for an Environmental Modification Occupational Therapy Assistant if the applicant meets the following requirements: <ul> <li>Professional or technical degree or equivalent in occupational therapy.  <li>Certified or licensed by and in good standing with an AOTA recognized credentialing or regulatory body.  <li>Minimum of 2,000 hours of experience as an occupational therapist or occupational therapy assistant.  <li>600 hours of experience delivering occupational therapy services in the certification area to clients (individuals, groups, or populations) in the last 3 calendar years. Service delivery may be paid or voluntary.  <li>Verification of employment. </ul>Fact Sheet: Home Modifications and OT,  AOTA Website: Specialty Certifications","2008-10-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Occupational Therapy Assistant","Feeding, Eating & Swallowing","Feeding, Eating & Swallowing Occupational Therapy Assistant","Occupational therapy assistants provide environmental modifications under the supervision of an occupational therapist.  OTAs develop and implement an individualized occupational therapy environmental modification plan that reflects the relevant contexts of the client and relevant others and maximizes current and future occupational performance, safety, and participation of the client. Clients receive environmental modification recommendations and interventions that enable them to meet occupational performance and participation goals and that have adequate flexibility to accommodate for their future needs.","224ZF0002X","Source: The Guide to Occupational Therapy Practice, 2nd edition. Bethesda: American Occupational Therapy Association, 2007. [7/1/2008: new]  Additional Resources: The American Occupational Therapy Association (AOTA) does offer voluntary specialty certification for a Feeding, Eating & Swallowing Occupational Therapy Assistant if the applicant meets the following requirements: <ul> <li>Professional or technical degree or equivalent in occupational therapy.  <li>Certified or licensed by and in good standing with an AOTA recognized credentialing or regulatory body.  <li>Minimum of 2,000 hours of experience as an occupational therapist or occupational therapy assistant.  <li>600 hours of experience delivering occupational therapy services in the certification area to clients (individuals, groups, or populations) in the last 3 calendar years. Service delivery may be paid or voluntary.  <li>Verification of employment. </ul>AOTA Website: Specialty Certifications; AOTA Specialized Knowledge and Skills Paper: Feeding, Eating and Swallowing in Occupational Therapy Practice, 2007; AOTA Fact Sheets: OT: A Vital Role in Dysphagia Care","2008-10-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Occupational Therapy Assistant","Low Vision","Low Vision Occupational Therapy Assistant","Occupational therapy assistants contribute to the completion of an individualized occupational therapy low-vision evaluation under the direction and supervision of the occupational therapist to identify factors that may facilitate, compensate for, or inhibit use of vision in occupational performance.  Clients are engaged in the identification of strengths, limitations, and goals as they relate to low vision to optimize independence and participation in desired occupations.  Occupational therapy assistants also contribute to the development and implementation of an individualized occupational therapy low-vision intervention plan in collaboration with the occupational therapist, client, and relevant others that reflects the client's priorities for occupational performance.","224ZL0004X","Source: The Guide to Occupational Therapy Practice, 2nd edition. Bethesda: American Occupational Therapy Association, 2007. [7/1/2008: new]  Additional Resources: The American Occupational Therapy Association (AOTA) does offer voluntary specialty certification for a Low Vision Occupational Therapy Assistant if the applicant meets the following requirements: <ul> <li>Professional or technical degree or equivalent in occupational therapy.  <li>Certified or licensed by and in good standing with an AOTA recognized credentialing or regulatory body.  <li>Minimum of 2,000 hours of experience as an occupational therapist or occupational therapy assistant.  <li>600 hours of experience delivering occupational therapy services in the certification area to clients (individuals, groups, or populations) in the last 3 calendar years. Service delivery may be paid or voluntary.  <li>Verification of employment. </ul>AOTA Fact Sheets: Low Vision; OT Services for Individuals with Visual Impairments","2008-10-01",null,null,"Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Ophthalmology","Intentionally left blank","Ophthalmology Physician","An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses.","207W00000X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Ophthalmology, 2007.  http://www.abop.org/.  American Osteopathic Board of Ophthalmology and Otolaryngology, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Ophthalmology.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology.","2003-04-01",null,"2011-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Ophthalmology","Cornea and External Diseases Specialist","Cornea and External Diseases Specialist Physician","An ophthalmologist who specializes in diseases of the cornea, sclera, eyelids, conjunctiva, and anterior segment of the eye.","207WX0120X","Source: American Academy of Ophthalmology, www.aao.org [1/1/2018: new]","2018-04-01",null,null,"Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Ophthalmology","Glaucoma Specialist","Glaucoma Specialist (Ophthalmology) Physician","An ophthalmologist who specializes in the treatment of glaucoma and other disorders related to increased intraocular pressure and optic nerve damage.  This specialty involves the medical and surgical treatment of these conditions.","207WX0009X","Source: American Academy of Ophthalmology, www.aao.org [1/1/2017: new]  Additional Resources: Association of University Professors of Ophthalmology, www.aupo.org","2017-04-01",null,null,"Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Ophthalmology","Neuro-ophthalmology","Neuro-ophthalmology Physician","A neuro-ophthalmologist is a subspecialist of ophthalmology.  This physician evaluates, treats, and studies disorders of the eye, orbit and nervous system having to do with interactions of the visual motor and visual sensory systems with the central nervous system. Neuro-ophthalmologists manage patients with complex and severe neuro-ophthalmological disorders.","207WX0109X","Source: American Academy of Ophthalmology, www.aao.org [7/1/2017: new]<br><br>Additional Resources: Association of University Professors of Ophthalmology, www.aupo.org.","2017-10-01",null,null,"Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Ophthalmology","Ophthalmic Plastic and Reconstructive Surgery","Ophthalmic Plastic and Reconstructive Surgery Physician","A physician who specializes in oculofacial plastic and reconstructive surgery. This subspecialty combines orbital and periocular surgery with facial plastic surgery, and includes aesthetic and reconstructive surgery of the face, orbit, eyelid, and lacrimal system. Practitioners evaluate, diagnose and treat conditions involving the eyelids, brows, midface, orbits, lacrimal systems and surrounding and supporting structures of the face and neck.","207WX0200X","Source:  American Academy of Ophthalmology, 2015. www.aao.org [1/1/2016: new]","2016-04-01",null,null,"Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Ophthalmology","Pediatric Ophthalmology and Strabismus Specialist","Pediatric Ophthalmology and Strabismus Specialist Physician Physician","An ophthalmologist who specializes in pediatric ophthalmology and strabismus management. The subspecialty includes the medical and surgical management of eye disorders found in children. Some of the more common disorders include amblyopia, strabismus, refractive error, cataract and glaucoma. These disorders may be related to neurological and endocrinological diseases, trauma, or aging changes in the extraocular muscles requiring medical, optical and surgical management.","207WX0110X","Source: American Academy of Ophthalmology, www.aao.org [7/1/2017: new]<br><br>Additional Resources: Association of University Professors of Ophthalmology, www.aupo.org.","2017-10-01",null,null,"Keep - Clarify in Specs FAQ or Stakeholder Feedback, etc. that the eligible physician or clinician is at the Classification level, and any subspecialization can be found under the Area of Specialization level. For example, a physician may have a pediatric subspecialty (Area of Specialization) but not necessarily be a pediatrics physician (Classification).","Yes"]
["Allopathic & Osteopathic Physicians","Ophthalmology","Retina Specialist","Retina Specialist (Ophthalmology) Physician","An ophthalmologist who specializes in the diagnosis and treatment of vitreoretinal diseases.","207WX0107X","Source: American Society of Retina Specialists, www.asrs.org [1/1/2017: new]<br><br>Additional Resources: American Academy of Ophthalmology, www.aao.org.  Macula Society, www.maculasociety.org.  Retina Society, www.retinasociety.org.  Association of University Professors of Ophthalmology, www.aupo.org.","2017-04-01",null,null,"Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Ophthalmology","Uveitis and Ocular Inflammatory Disease","Uveitis and Ocular Inflammatory Disease (Ophthalmology) Physician","An ophthalmologist who specializes in the treatment of intraocular inflammation, scleritis, keratitis and infectious disorders affecting the eye and inflammatory disorders of the adnexa and/or orbit.","207WX0108X","Source: American Academy of Ophthalmology, www.aao.org [1/1/2017: new]<br><br>Additional Resources: Association of University Professors of Ophthalmology, www.aupo.org","2017-04-01",null,null,"Keep - No Change","Yes"]
["Eye and Vision Services Providers","Optometrist",null,"Optometrist","Doctors of optometry (ODs) are the primary health care professionals for the eye.  Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye.  An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree.  Some optometrists complete an optional residency in a specific area of practice.  Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. ","152W00000X","Source:  American Optometric Association (AOA), approved by the AOA's Board of Trustees, June 21, 2005. [7/1/2006: definition modified]","2002-04-01",null,"2006-07-01","Delete - not a DPP measure","No"]
["Eye and Vision Services Providers","Optometrist","Corneal and Contact Management","Corneal and Contact Management Optometrist","The professional activities performed by an Optometrist related to the fitting of contact lenses to an eye, ongoing evaluation of the cornea's ability to sustain successful contact lens wear, and treatment of any external eye or corneal condition which can affect contact lens wear.","152WC0802X","Source: American Optometric Association [1/1/2009: added definition, added source]","2002-04-01",null,"2009-01-01","Delete - not a DPP measure","No"]
["Eye and Vision Services Providers","Optometrist","Low Vision Rehabilitation","Low Vision Rehabilitation Optometrist","Optometrists who specialize in low-vision care having training to assess visual function, prescribe low-vision devices, develop treatment plans, and recommend other vision rehabilitation services.","152WL0500X","Source: American Optometric Association [1/1/2009: added definition, added source]","2002-04-01",null,"2009-01-01","Delete - not a DPP measure","No"]
["Eye and Vision Services Providers","Optometrist","Occupational Vision","Occupational Vision Optometrist","Optometrists who work in Occupational Vision, the branch of environmental optometry, consider all aspects of the relationship between work and vision, visual performances, eye safety, and health.","152WX0102X","Source: American Optometric Association [1/1/2009: added definition, added source]","2002-04-01",null,"2009-01-01","Delete - not a DPP measure","No"]
["Eye and Vision Services Providers","Optometrist","Pediatrics","Pediatric Optometrist","Optometrists who work in Pediatrics are concerned with the prevention, development, diagnosis, and treatment of visual problems in children.","152WP0200X","Source: American Optometric Association [1/1/2009: added definition, added source]","2002-04-01",null,"2009-01-01","Delete - not a DPP measure","No"]
["Eye and Vision Services Providers","Optometrist","Sports Vision","Sports Vision Optometrist","An optometrist who offers services designed to care for unique vision care needs of athletes, which may include one of more of the following services:  corrective vision care unique to a specific sporting environment; protective eyewear for the prevention of sports-related injuries; vision enhancement - which may include vision therapy and techniques to improve visual skills specific to the athlete's sport.","152WS0006X","Source: American Optometric Association [1/1/2009: added definition, added source]","2002-04-01",null,"2009-01-01","Delete - not a DPP measure","No"]
["Eye and Vision Services Providers","Optometrist","Vision Therapy","Vision Therapy Optometrist","Optometrists who specialize in vision therapy as a treatment process used to improve vision function. It includes a broad range of developmental and rehabilitative treatment programs individually prescribed to remediate specific sensory, motor and/or visual perceptual dysfunctions.","152WV0400X","Source: American Optometric Association [1/1/2009: added definition, added source]","2002-04-01",null,"2009-01-01","Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Oral & Maxillofacial Surgery",null,"Oral & Maxillofacial Surgery (D.M.D.)","Oral and maxillofacial surgeons are trained to recognize and treat a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. They are also trained to administer anesthesia, and provide care in an office setting. They are trained to treat problems such as the extraction of wisdom teeth, misaligned jaws, tumors and cysts of the jaw and mouth, and to perform dental implant surgery.","204E00000X"," Source: American College of Surgeons, 2013. www.facs.org [7/1/2013: definition added, source added, additional resources added]    Additional Resources: American Board of Oral and Maxillofacial Surgery and American Association of Oral and Maxillofacial Surgeons    While this is generally considered a specialty of dentistry, physicians can also be board certified as oral and maxillofacial surgeons through the American Board of Oral and Maxillofacial Surgery.","2003-04-01",null,"2013-07-01","Delete - not a DPP measure","No"]
["Dental Providers","Oral Medicinist",null,"Oral Medicinist","A dentist with advanced training specializing in the recognition and treatment of oral conditions resulting from the interrelationship between oral disease and systemic health. The Oral Medicinist manages clinical and non-surgical treatment of non-dental pathologies affecting the oral and maxillofacial region, such as cancer, organ transplants, and acute and chronic pain. Activities include provision of interdisciplinary patient care in collaboration with medical specialists and other dentists in hospitals and outpatient medical clinics in the management of patients with complex medical conditions requiring multidisciplinary healthcare intervention.","125Q00000X","Source: National Uniform Claim Committee [1/1/2015: new]  Additional Resources: American Academy of Oral Medicine","2015-04-01",null,null,"Delete - not a DPP measure","No"]
["Suppliers","Organ Procurement Organization",null,"Organ Procurement Organization","A federally designated organization that works with hospital personnel in retrieval of organs for transplantation. The federal government designates an OPO's service area and the hospitals with which an OPO is to establish working relationships.","335U00000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Orthopaedic Surgery","Intentionally left blank","Orthopaedic Surgery Physician","An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means.  An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system.","207X00000X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Orthopaedic Surgery, 2007.  http://www.abos.org/.  American Osteopathic Board of Orthopaedic Surgery, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Orthopaedic Surgery.","2003-04-01",null,"2011-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Orthopaedic Surgery","Adult Reconstructive Orthopaedic Surgery","Adult Reconstructive Orthopaedic Surgery Physician","Recognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, adult reconstructive orthopaedic surgeons deal with reconstructive procedures such as joint arthroplasty (i.e., hip and knee), osteotomy, arthroscopy, soft-tissue reconstruction, and a variety of other adult reconstructive surgical procedures. ","207XS0114X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added]    Additional Resources: American Board of Orthopaedic Surgery, 2007.  http://www.abos.org/.      Separate board certification is not currently offered.","2003-04-01",null,"2007-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Orthopaedic Surgery","Foot and Ankle Surgery","Orthopaedic Foot and Ankle Surgery Physician","Recognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, foot and ankle surgeons deal with adult reconstructive foot and ankle surgery, adult foot and ankle trauma, sports medicine foot and ankle, and children's foot and ankle reconstructive surgery.","207XX0004X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: title modified, definition added, source added]    Additional Resources: American Board of Orthopaedic Surgery, 2007.  http://www.abos.org/.    Separate board certification is not currently offered.    ACGME Accredited Residency Program Requirements:  1 year of training with 5 years Orthopedic Surgery for a total of 6 years.","2003-04-01",null,"2007-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Orthopaedic Surgery","Hand Surgery","Orthopaedic Hand Surgery Physician","An orthopaedic surgeon trained in the investigation, preservation and restoration by medical, surgical and rehabilitative means of all structures of the upper extremity directly affecting the form and function of the hand and wrist.","207XS0106X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Orthopaedic Surgery, 2007.  http://www.abos.org/.  American Osteopathic Board of Orthopaedic Surgery, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Orthopaedic Surgery.","2003-04-01",null,"2011-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Orthopaedic Surgery","Orthopaedic Surgery of the Spine","Orthopaedic Surgery of the Spine Physician","Recognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, orthopaedic surgeons of the spine deal with the evaluation and nonoperative and operative treatment of the full spectrum of primary spinal disorders including trauma, degenerative, deformity, tumor, and reconstructive.","207XS0117X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added]    Additional Resources: American Board of Orthopaedic Surgery, 2007.  http://www.abos.org/.     Separate board certification is not currently offered.","2003-04-01",null,"2007-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Orthopaedic Surgery","Orthopaedic Trauma","Orthopaedic Trauma Physician","Recognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, orthopaedic trauma surgeons deal with the evaluation and management of acute orthopaedic injuries, evaluation and treatment of post-traumatic deformities and nonunions, acute and delayed reconstruction of pelvic and acetabular fractures, as well as osteotomy in the adult hip for treatment of hip arthritis.","207XX0801X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added]    Additional Resources: American Board of Orthopaedic Surgery, 2007.  http://www.abos.org/.     Separate board certification is not currently offered.","2003-04-01",null,"2007-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Orthopaedic Surgery","Pediatric Orthopaedic Surgery","Pediatric Orthopaedic Surgery Physician","An orthopedic surgeon who has additional training and experience in diagnosing, treating and managing musculoskeletal problems in infants, children and adolescents.  These may include limb and spine deformities (such as club foot, scoliosis); gait abnormalities (limping); bone and joint infections; broken bones.","207XP3100X","Source: American Academy of Pediatrics, www.aap.org [7/1/2006: new]","2006-10-01",null,null,"Keep - Clarify in Specs FAQ or Stakeholder Feedback, etc. that the eligible physician or clinician is at the Classification level, and any subspecialization can be found under the Area of Specialization level. For example, a physician may have a pediatric subspecialty (Area of Specialization) but not necessarily be a pediatrics physician (Classification).","Yes"]
["Allopathic & Osteopathic Physicians","Orthopaedic Surgery","Sports Medicine","Sports Medicine (Orthopaedic Surgery) Physician","An orthopaedic surgeon trained in sports medicine provides appropriate care for all structures of the musculoskeletal system directly affected by participation in sporting activity. This specialist is proficient in areas including conditioning, training and fitness, athletic performance and the impact of dietary supplements, pharmaceuticals, and nutrition on performance and health, coordination of care within the team setting utilizing other health care professionals, field evaluation and management, soft tissue biomechanics and injury healing and repair. Knowledge and understanding of the principles and techniques of rehabilitation, athletic equipment and orthotic devices enables the specialist to prevent and manage athletic injuries.","207XX0005X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition changed, source changed]    Additional Resources: American Board of Orthopaedic Surgery, 2007.  http://www.abos.org/.     Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery.    ACGME Accredited Program Requirements: 1 year GME in the specialty + 5 years of Orthopaedic Surgery for a total of 6 years","2003-04-01",null,"2007-07-01","Keep - No Change","Yes"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Orthotic Fitter",null,"Orthotic Fitter","An individual trained in the management of fitting prefabricated orthoses.","225000000X","Source:  National Uniform Claim Committee [1/1/2011: title modified, definition modfied]  Additional Resources:  American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org.","2002-04-01",null,"2011-01-01","Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Orthotist",null,"Orthotist","A health care professional who is specifically educated and trained to manage comprehensive orthotic patient care, including musculoskeletal and neuromuscular anomalies resulting from injuries or disease processes involving the lower extremity, upper extremity or spinal segment/s and positional deformation of the cranium. Orthotists assess specific patient needs, formulate an appropriate treatment plan, implement the treatment plan and provide follow-up care.","222Z00000X","Source:  American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified]  Additional Resources:  American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org.","2002-04-01",null,"2013-07-01","Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Otolaryngology","Intentionally left blank","Otolaryngology Physician","An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise.","207Y00000X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Otolaryngology, 2007.  http://www.aboto.org/.  American Osteopathic Board of Ophthalmology and Otolaryngology, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology.   Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology.","2003-04-01",null,"2011-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Otolaryngology","Facial Plastic Surgery","Facial Plastic Surgery Physician","An otolaryngologist who specializes in facial plastic surgery.","207YS0123X","Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added]    Additional Resources: A General Certificate was, but is no longer issued by the American Osteopathic Board of Ophthalmology and Otolaryngology.","2003-04-01",null,"2010-01-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Otolaryngology","Otolaryngic Allergy","Otolaryngic Allergy Physician","An otolaryngologist who specializes in the diagnosis and treatment of otolaryngic allergies and other allergic diseases.","207YX0602X","Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added]    Additional Resources: A Certification of Added Qualifications (CAQ) is issued by the American Osteopathic Board of Ophthalmology and Otolaryngology.","2003-04-01",null,"2010-01-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Otolaryngology","Otolaryngology/Facial Plastic Surgery","Otolaryngology/Facial Plastic Surgery Physician","An otolaryngologist who specializes in the diagnosis and surgical treatment of head and neck conditions.","207YX0905X","Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added]    Additional Resources: A General Certificate is issued by the American Osteopathic Board of Ophthalmology and Otolaryngology.","2003-04-01",null,"2010-01-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Otolaryngology","Otology & Neurotology","Otology & Neurotology Physician","An otolaryngologist who treats diseases of the ear and temporal bone, including disorders of hearing and balance. The additional training in otology and neurotology emphasizes the study of embryology, anatomy, physiology, epidemiology, pathophysiology, pathology, genetics, immunology, microbiology and the etiology of diseases of the ear and temporal bone.","207YX0901X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added]    Additional Resources: American Board of Otolaryngology, 2007.  http://www.aboto.org/.    Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology.","2003-04-01",null,"2007-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Otolaryngology","Pediatric Otolaryngology","Pediatric Otolaryngology Physician","A pediatric otolaryngologist has special expertise in the management of infants and children with disorders that include congenital and acquired conditions involving the aerodigestive tract, nose and paranasal sinuses, the ear and other areas of the head and neck. The pediatric otolaryngologist has special skills in the diagnosis, treatment, and management of childhood disorders of voice, speech, language and hearing.","207YP0228X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added]    Additional Resources: American Board of Otolaryngology, 2007.  http://www.aboto.org/.    Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology.","2003-04-01",null,"2007-07-01","Keep - Clarify in Specs FAQ or Stakeholder Feedback, etc. that the eligible physician or clinician is at the Classification level, and any subspecialization can be found under the Area of Specialization level. For example, a physician may have a pediatric subspecialty (Area of Specialization) but not necessarily be a pediatrics physician (Classification).","Yes"]
["Allopathic & Osteopathic Physicians","Otolaryngology","Plastic Surgery within the Head & Neck","Plastic Surgery within the Head & Neck (Otolaryngology) Physician","An otolaryngologist with additional training in plastic and reconstructive procedures within the head, face, neck and associated structures, including cutaneous head and neck oncology and reconstruction, management of maxillofacial trauma, soft tissue repair and neural surgery. The field is diverse and involves a wide age range of patients, from the newborn to the aged. While both cosmetic and reconstructive surgeries are practiced, there are many additional procedures which interface with them.","207YX0007X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added]    Additional Resources: American Board of Otolaryngology, 2007.  http://www.aboto.org/.    Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology.   Board certification for Doctors of Osteopathy is currently provided in the subspecialty of Otolaryngology/Facial Plastic Surgery (see Taxonomy Code 207YX0905X)","2003-04-01",null,"2007-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Otolaryngology","Sleep Medicine","Sleep Medicine (Otolaryngology) Physician","An Otolaryngologist who practices Sleep Medicine is certified in the subspecialty of sleep medicine and specializes in the clinical assessment, physiologic testing, diagnosis, management and prevention of sleep and circadian rhythm disorders. Sleep specialists treat patients of any age and use multidisciplinary approaches. Disorders managed by sleep specialists include, but are not limited to, sleep related breathing disorders, insomnia, hypersomnias, circadian rhythm sleep disorders, parasomnias and sleep related movement disorders.","207YS0012X","Source: American Academy of Sleep Medicine, www.aasm.org [7/1/2006: new]","2006-10-01",null,null,"Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Pain Medicine","Interventional Pain Medicine","Interventional Pain Medicine Physician","Interventional Pain Medicine is the discipline of medicine devoted to the diagnosis and treatment of pain and related disorders principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment.","208VP0014X",null,"2003-04-01",null,null,"Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Pain Medicine","Pain Medicine","Pain Medicine Physician","Pain Medicine is a primary medical specialty based on a distinct body of knowledge and a well-defined scope of clinical practice that is founded on science, research and education.  It is concerned with the study of pain, the prevention of pain, and the evaluation, treatment, and rehabilitation of persons in pain.  A comprehensive evaluation incorporates the physical, psychological, cognitive and socio-cultural contributions to pain.  The treatment protocol may include pharmacological, invasive, behavioral, cognitive, rehabilitative and complementary strategies provided in a concurrent focused and patient specific manner.  The pain medicine physician often serves the patient as a frontline physician regarding their pain, but also may serve as a consultant to other physicians, direct an interdisciplinary/multidisciplinary treatment team, conduct research, or advocate for the patient's pain care with public and private agencies.  The Pain Medicine physician may work in variety of settings including office, clinic, hospital, university, or governmental/public agencies.","208VP0000X","Source: American Academy of Pain Medicine, www.painmed.org<br><br>Additional Resources: The American Board of Pain Medicine provides Board Certification.","2003-04-01",null,null,"Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Pathology","Anatomic Pathology","Anatomic Pathology Physician","A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biologic, chemical and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion and monitoring of disease.","207ZP0101X","Source: American Board of Medical Specialties, 2007. [7/1/2007: definition added, source added, 7/1/2009: definition reformatted; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Pathology, 2007. http://www.abpath.org/. American Osteopathic Board of Pathology, 2007. http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Pathology (note: this taxonomy code identifies the \"anatomic pathology only\" route). To acknowledge the diverse activities in the practice of pathology and to accommodate the interests of individuals wanting to enter the field, the ABP offers primary certification through the following three routes: combined anatomic pathology and clinical pathology, anatomic pathology only and clinical pathology only. Primary certification in anatomic pathology or clinical pathology may be combined with some of the subspecialty certifications.","2003-04-01",null,"2011-07-01","Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Pathology","Anatomic Pathology & Clinical Pathology","Anatomic Pathology & Clinical Pathology Physician","A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biologic, chemical and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion and monitoring of disease.","207ZP0102X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added, 7/1/2009: definition reformatted]    Additional Resources: American Board of Pathology, 2007. http://www.abpath.org/    This taxonomy code identifies the combined anatomic pathology & clinical pathology route. Board certification for Medical Doctors (MDs) is provided by the American Board of Pathology. To acknowledge the diverse activities in the practice of pathology and to accommodate the interests of individuals wanting to enter the field, the ABP offers primary certification through the following three routes: combined anatomic pathology and clinical pathology, anatomic pathology only and clinical pathology only. Primary certification in anatomic pathology or clinical pathology may be combined with some of the subspecialty certifications.","2003-04-01",null,"2007-07-01","Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Pathology","Blood Banking & Transfusion Medicine","Blood Banking & Transfusion Medicine Physician","A physician who specializes in blood banking/transfusion medicine is responsible for the maintenance of an adequate blood supply, blood donor and patient-recipient safety and appropriate blood utilization. Pre-transfusion compatibility testing and antibody testing assure that blood transfusions, when indicated, are as safe as possible. This physician directs the preparation and safe use of specially prepared blood components, including red blood cells, white blood cells, platelets and plasma constituents, and marrow or stem cells for transplantation.","207ZB0001X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Pathology, 2007.  http://www.abpath.org/.  American Osteopathic Board of Pathology, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Pathology.  Board certification for Doctors of Osteopathy (DOs) was provided by the American Osteopathic Board of Pathology.  The Certification is NO longer provided.","2003-04-01",null,"2011-07-01","Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Pathology","Chemical Pathology","Chemical Pathology Physician","A chemical pathologist has expertise in the biochemistry of the human body as it applies to the understanding of the cause and progress of disease. This physician functions as a clinical consultant in the diagnosis and treatment of human disease. Chemical pathology entails the application of biochemical data to the detection, confirmation or monitoring of disease.","207ZP0104X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Pathology, 2007.  http://www.abpath.org/.  American Osteopathic Board of Pathology, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Pathology.  Board certification for Doctors of Osteopathy (DOs) was provided by the American Osteopathic Board of Pathology.  The Certification is NO longer provided.","2003-04-01",null,"2011-07-01","Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Pathology","Clinical Informatics","Clinical Informatics (Pathology) Physician","Physicians who practice Clinical Informatics collaborate with other health care and information technology professionals to analyze, design, implement and evaluate information and communication systems that enhance individual and population health outcomes, improve patient care, and strengthen the clinician-patient relationship. Clinical Informaticians use their knowledge of patient care combined with their understanding of informatics concepts, methods, and tools to: assess information and knowledge needs of health care professionals and patients; characterize, evaluate, and refine clinical processes; develop, implement, and refine clinical decision support systems; and lead or participate in the procurement, customization, development, implementation, management, evaluation, and continuous improvement of clinical information systems.","207ZC0008X","Source: The American Board of Preventive Medicine, 2013. www.theabpm.org [1/1/2014: new]  Additional Resources: The American Board of Pathology, www.abpath.org","2014-04-01",null,null,"Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Pathology","Clinical Pathology","Clinical Pathology Physician","A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biologic, chemical and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion and monitoring of disease.","207ZC0006X","Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: new, 7/1/2009: definition reformatted]   Additional Resources: American Board of Pathology, 2007. http://www.abpath.org/   This taxonomy code identifies the combined anatomic \"clinical pathology only\" route. Board Certification for Medical Doctors (MDs) is provided by the American Board of Pathology. To acknowledge the diverse activities in the practice of pathology and to accommodate the interests of individuals wanting to enter the field, the ABP offers primary certification through the following three routes: combined anatomic pathology and clinical pathology, anatomic pathology only and clinical pathology only. Primary certification in anatomic pathology or clinical pathology may be combined with some of the subspecialty certifications.","2007-10-01",null,null,"Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Pathology","Clinical Pathology/Laboratory Medicine","Clinical Pathology/Laboratory Medicine Physician","A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biologic, chemical and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion and monitoring of disease.","207ZP0105X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Pathology, 2007.  http://www.abpath.org/.  American Osteopathic Board of Pathology, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Pathology.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pathology.","2003-04-01",null,"2011-07-01","Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Pathology","Cytopathology","Cytopathology Physician","A cytopathologist is an anatomic pathologist trained in the diagnosis of human disease by means of the study of cells obtained from body secretions and fluids, by scraping, washing, or sponging the surface of a lesion, or by the aspiration of a tumor mass or body organ with a fine needle.  A major aspect of a cytopathologist's practice is the interpretation of Papanicolaou-stained smears of cells from the female reproductive systems, the \"Pap\" test.  However, the cytopathologist's expertise is applied to the diagnosis of cells from all systems and areas of the body.  He/she is a consultant to all medical specialists.","207ZC0500X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition changed, source added]    Additional Resources: American Board of Pathology, 2007.  http://www.abpath.org/.     Board certification for Medical Doctors (MDs) is provided by the American Board of Pathology.","2003-04-01",null,"2007-07-01","Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Pathology","Dermatopathology","Dermatopathology (Pathology) Physician","A dermatopathologist is an expert in diagnosing and monitoring diseases of the skin including infectious, immunologic, degenerative, and neoplastic diseases.  This entails the examination and interpretation of specially prepared tissue sections, cellular scrapings, and smears of skin lesions by means of light microscopy, electron microscopy, and fluorescence microscopy.","207ZD0900X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition changed, source added]    Additional Resources: American Board of Pathology, 2007.  http://www.abpath.org/.     Board certification for Medical Doctors (MDs) is provided by the American Board of Pathology.    A subspecialty certificate was first issued by the ABMS in 1974.    ACGME Accredited Residency Program Requirements:  None.","2003-04-01",null,"2007-07-01","Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Pathology","Forensic Pathology","Forensic Pathology Physician","A forensic pathologist is expert in investigating and evaluating cases of sudden, unexpected, suspicious and violent death as well as other specific classes of death defined by law. The forensic pathologist serves the public as coroner or medical examiner, or by performing medicolegal autopsies for such officials.","207ZF0201X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Pathology, 2007.  http://www.abpath.org/.  American Osteopathic Board of Pathology, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Pathology.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pathology.","2003-04-01",null,"2011-07-01","Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Pathology","Hematology","Hematology (Pathology) Physician","A hematopathologist is expert in diseases that affect blood cells, blood clotting mechanisms, bone marrow and lymph nodes. This physician has the knowledge and technical skills essential for the laboratory diagnosis of anemias, leukemias, lymphomas, bleeding disorders and blood clotting disorders.","207ZH0000X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Pathology, 2007.  http://www.abpath.org/.  American Osteopathic Board of Pathology, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Pathology.  Board certification for Doctors of Osteopathy (DOs) was provided by the American Osteopathic Board of Pathology.  The Certification is NO longer provided.","2003-04-01",null,"2011-07-01","Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Pathology","Immunopathology","Immunopathology Physician","A pathologist who specializes in the diagnosis of immunologic diseases.","207ZI0100X","Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added]    Additional Resources: A Certification of Added Qualifications (CAQ) was, but is no longer issued by the American Osteopathic Board of Pathology.","2003-04-01",null,"2010-01-01","Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Pathology","Medical Microbiology","Medical Microbiology Physician","A medical microbiologist is expert in the isolation and identification of microbial agents that cause infectious disease. Viruses, bacteria and fungi, as well as parasites, are identified and, where possible, tested for susceptibility to appropriate antimicrobial agents.","207ZM0300X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Pathology, 2007.  http://www.abpath.org/.  American Osteopathic Board of Pathology, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Pathology.  Board certification for Doctors of Osteopathy (DOs) was provided by the American Osteopathic Board of Pathology.  The Certification is NO longer provided.","2003-04-01",null,"2011-07-01","Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Pathology","Molecular Genetic Pathology","Molecular Genetic Pathology (Pathology) Physician","A molecular genetic pathologist is expert in the principles, theory and technologies of molecular biology and molecular genetics. This expertise is used to make or confirm diagnoses of Mendelian genetic disorders, disorders of human development, infectious diseases and malignancies, and to assess the natural history of those disorders. A molecular genetic pathologist provides information about gene structure, function and alteration and applies laboratory techniques for diagnosis, treatment and prognosis for individuals with related disorders.","207ZP0007X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition changed, source changed]    Additional Resources: American Board of Pathology, 2007.  http://www.abpath.org/.     Board certification for Medical Doctors (MDs) is provided by the American Board of Pathology.       A subspecialty certificate for MGG was approved by the ABMS in 1999.     ACGME Accredited Residency Program Requirements:  Proposal under development.","2003-04-01",null,"2007-07-01","Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Pathology","Neuropathology","Neuropathology Physician","A neuropathologist is expert in the diagnosis of diseases of the nervous system and skeletal muscles and functions as a consultant primarily to neurologists and neurosurgeons. The neuropathologist is knowledgeable in the infirmities of humans as they affect the nervous and neuromuscular systems, be they degenerative, infectious, metabolic, immunologic, neoplastic, vascular or physical in nature.","207ZN0500X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Pathology, 2007.  http://www.abpath.org/.  American Osteopathic Board of Pathology, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Pathology.  Board certification for Doctors of Osteopathy (DOs) was provided by the American Osteopathic Board of Pathology.  The Certification is NO longer provided.","2003-04-01",null,"2011-07-01","Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Pathology","Pediatric Pathology","Pediatric Pathology Physician","A pediatric pathologist is expert in the laboratory diagnosis of diseases that occur during fetal growth, infancy and child development. The practice requires a strong foundation in general pathology and substantial understanding of normal growth and development, along with extensive knowledge of pediatric medicine.","207ZP0213X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added]    Additional Resources: American Board of Pathology, 2007.  http://www.abpath.org/.     Board certification for Medical Doctors (MDs) is provided by the American Board of Pathology.","2003-04-01",null,"2007-07-01","Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Pediatrics","Intentionally left blank","Pediatrics Physician","A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.","208000000X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Pediatrics, 2007.  http://www.abp.org/.  American Osteopathic Board of Pediatrics, 2007.  http://www.osteopathic.org/certificatio<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics.","2003-04-01",null,"2011-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Pediatrics","Adolescent Medicine","Pediatric Adolescent Medicine Physician","A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs.","2080A0000X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Pediatrics, 2007.  http://www.abp.org/.  American Osteopathic Board of Pediatrics, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics.","2003-04-01",null,"2011-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Pediatrics","Child Abuse Pediatrics","Child Abuse Pediatrics Physician","A Child Abuse Pediatrician serves as a resource to children, families and communities by accurately diagnosing abuse; consulting with community agencies on child safety; providing expertise in courts of law; treating consequences of abuse and neglect; directing child abuse and neglect prevention programs and participating on multidisciplinary teams investigating; and managing child abuse cases. ","2080C0008X","Source: American Board of Medical Specialties, 2009 [7/1/2009: new]","2009-10-01",null,null,"Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Pediatrics","Clinical & Laboratory Immunology","Pediatric Clinical & Laboratory Immunology Physician","A pediatrician who specializes in clinical and laboratory immunology disease management.","2080I0007X","Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added]    Additional Resources: A certification was, but is no longer issued by the American Board of Pediatrics.","2003-04-01",null,"2010-01-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Pediatrics","Developmental - Behavioral Pediatrics","Developmental - Behavioral Pediatrics Physician","A developmental-behavioral specialist is a pediatrician with special training and experience who aims to foster understanding and promotion of optimal development of children and families through research, education, clinical care and advocacy efforts. This physician assists in the prevention, diagnosis, and management of developmental difficulties and problematic behaviors in children and in the family dysfunctions that compromise children's development.","2080P0006X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition changed, source changed, 3/26/2008: definition corrected]    Additional Resources: American Board of Pediatrics, 2007.  http://www.abp.org/.    Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics.","2003-04-01",null,"2007-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Pediatrics","Hospice and Palliative Medicine","Pediatric Hospice and Palliative Medicine Physician","A pediatrician with special knowledge and skills to prevent and relieve the suffering experienced by patients with life-limiting illnesses. This specialist works with an interdisciplinary hospice or palliative care team to maximize quality of life while addressing physical, psychological, social and spiritual needs of both patient and family throughout the course of the disease, through the dying process, and beyond for the family.  This specialist has expertise in the assessment of patients with advanced disease; the relief of distressing symptoms; the coordination of interdisciplinary patient and family-centered care in diverse venues; the use of specialized care systems including hospice; the management of the imminently dying patient; and legal and ethical decision making in end-of-life care.","2080H0002X","Source: American Academy of Hospice and Palliative Medicine, www.aahpm.org [1/1/2007: new]","2007-04-01",null,null,"Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Pediatrics","Medical Toxicology","Pediatric Medical Toxicology Physician","Medical toxicologists are physicians that specialize in the prevention, evaluation, treatment and monitoring of injury and illness from exposures to drugs and chemicals, as well as biological and radiological agents. Medical toxicologists care for people in clinical, academic, governmental and public health settings, and provide poison control center leadership. Important areas of medical toxicology include acute drug poisoning, adverse drug events, drug abuse, addiction and withdrawal, chemicals and hazardous materials, terrorism preparedness, venomous bites and stings, and environmental and workplace exposures.","2080T0002X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition changed, source added]    Additional Resources: American Board of Pediatrics, 2007.  http://www.abp.org/.    Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics.    ACGME Accredited Residency Program Requirements:  Medical Toxicology (EM) 2 years with 3-4 years Emergency Medicine for a total of 5-6 years; for Medical Toxicology (Preventive Medicine) 2 years with 3 years Preventive Medicine for a total of 5 years.  Medical Toxicology (Pediatrics):  None.    ABMS Approved Subspecialty Certificates (Emergency Medicine) (Pediatrics) (Preventive Medicine)","2003-04-01",null,"2007-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Pediatrics","Neonatal-Perinatal Medicine","Neonatal-Perinatal Medicine Physician","A pediatrician who is the principal care provider for sick newborn infants. Clinical expertise is used for direct patient care and for consulting with obstetrical colleagues to plan for the care of mothers who have high-risk pregnancies.","2080N0001X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Pediatrics, 2007.  http://www.abp.org/.  American Osteopathic Board of Pediatrics, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics.","2003-04-01",null,"2011-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Pediatrics","Neurodevelopmental Disabilities","Pediatric Neurodevelopmental Disabilities Physician","A pediatrician who treats children having developmental delays or learning disorders including those associated with visual and hearing impairment, mental retardation, cerebral palsy, spina bifida, autism and other chronic neurologic conditions. This specialist provides medical consultation and education and assumes leadership in the interdisciplinary management of children with neurodevelopmental disorders. They may also focus on the early identification and diagnosis of neurodevelopmental disabilities in infants and young children as well as on changes that occur as the child with developmental disabilities grows.","2080P0008X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition changed, source changed]    Additional Resources: American Board of Pediatrics, 2007.  http://www.abp.org/.     Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics.","2003-04-01",null,"2007-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Pediatrics","Obesity Medicine","Pediatric Obesity Medicine Physician","A physician who specializes in the treatment of obesity demonstrates competency in and a thorough understanding of the treatment of obesity and the genetic, biologic, environmental, social, and behavioral factors that contribute to obesity. The obesity medicine physician employs therapeutic interventions including diet, physical activity, behavioral change, and pharmacotherapy. The obesity medicine physician utilizes a comprehensive approach, and may include additional resources such as dietitians, exercise physiologists, mental health professionals and bariatric surgeons as indicated to achieve optimal results. Additionally, the obesity medicine physician maintains competency in providing pre- peri- and post-surgical care of bariatric surgery patients, promotes the prevention of obesity, and advocates for those who suffer from obesity.","2080B0002X","Source:  American Board of Obesity Medicine, www.abom.org [7/1/2015: new]  Additional Resource: American Society of Bariatric Physicians, www.asbp.org.","2015-10-01",null,null,"Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Pediatrics","Pediatric Allergy/Immunology","Pediatric Allergy/Immunology Physician","A pediatrician who specializes in the diagnosis and treatment of allergies, allergic reactions, and immunologic diseases in children.","2080P0201X","Source: National Uniform Claim Committee, 2009 [1/1/2010: title modified, definition added, source added]    Additional Resources: A Certification of Special Qualifications (CSQ) is issued by the American Osteopathic Board of Pediatrics.","2003-04-01",null,"2010-01-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Pediatrics","Pediatric Cardiology","Pediatric Cardiology Physician","A pediatric cardiologist provides comprehensive care to patients with cardiovascular problems. This specialist is skilled in selecting, performing and evaluating the structural and functional assessment of the heart and blood vessels, and the clinical evaluation of cardiovascular disease.","2080P0202X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Pediatrics, 2007.  http://www.abp.org/.  American Osteopathic Board of Pediatrics, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics.  Board certification for Doctors of Osteopathy (DOs) was provided by the American Osteopathic Board of Pediatrics.  The Certification is no longer offered.","2003-04-01",null,"2011-07-01","Keep - Clarify in Specs FAQ or Stakeholder Feedback, etc. that the eligible physician or clinician is at the Classification level, and any subspecialization can be found under the Area of Specialization level. For example, a physician may have a pediatric subspecialty (Area of Specialization) but not necessarily be a pediatrics physician (Classification).","Yes"]
["Allopathic & Osteopathic Physicians","Pediatrics","Pediatric Critical Care Medicine","Pediatric Critical Care Medicine Physician","A pediatrician expert in advanced life support for children from the term or near-term neonate to the adolescent. This competence extends to the critical care management of life-threatening organ system failure from any cause in both medical and surgical patients and to the support of vital physiological functions. This specialist may have administrative responsibilities for intensive care units and also facilitates patient care among other specialists.","2080P0203X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition changed, source added]    Additional Resources: American Board of Pediatrics, 2007.  http://www.abp.org/.    Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics.    ACGME Accredited Residency Program Requirements: 2 years of training with 3 years Pediatrics plus 1 year Pediatric Critical Care for certification for a total of 6 years.    ABMS Approved Subspecialty Certificate (Pediatrics)","2003-04-01",null,"2007-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Pediatrics","Pediatric Emergency Medicine","Pediatric Emergency Medicine (Pediatrics) Physician","A pediatrician who has special qualifications to manage emergencies in infants and children.","2080P0204X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added]    Additional Resources: American Board of Pediatrics, 2007.  http://www.abp.org/.    Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics.","2003-04-01",null,"2007-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Pediatrics","Pediatric Endocrinology","Pediatric Endocrinology Physician","A pediatrician who provides expert care to infants, children and adolescents who have diseases that result from an abnormality in the endocrine glands (glands which secrete hormones). These diseases include diabetes mellitus, growth failure, unusual size for age, early or late pubertal development, birth defects, the genital region and disorders of the thyroid, the adrenal and pituitary glands.","2080P0205X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Pediatrics, 2007.  http://www.abp.org/.  American Osteopathic Board of Pediatrics, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics.","2003-04-01",null,"2011-07-01","Keep - Clarify in Specs FAQ or Stakeholder Feedback, etc. that the eligible physician or clinician is at the Classification level, and any subspecialization can be found under the Area of Specialization level. For example, a physician may have a pediatric subspecialty (Area of Specialization) but not necessarily be a pediatrics physician (Classification).","Yes"]
["Allopathic & Osteopathic Physicians","Pediatrics","Pediatric Gastroenterology","Pediatric Gastroenterology Physician","A pediatrician who specializes in the diagnosis and treatment of diseases of the digestive systems of infants, children and adolescents. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using lighted scopes to see internal organs.","2080P0206X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added]    Additional Resources: American Board of Pediatrics, 2007.  http://www.abp.org/.    Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics.","2003-04-01",null,"2007-07-01","Keep - Clarify in Specs FAQ or Stakeholder Feedback, etc. that the eligible physician or clinician is at the Classification level, and any subspecialization can be found under the Area of Specialization level. For example, a physician may have a pediatric subspecialty (Area of Specialization) but not necessarily be a pediatrics physician (Classification).","Yes"]
["Allopathic & Osteopathic Physicians","Pediatrics","Pediatric Hematology-Oncology","Pediatric Hematology & Oncology Physician","A pediatrician trained in the combination of pediatrics, hematology and oncology to recognize and manage pediatric blood disorders and cancerous diseases.","2080P0207X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Pediatrics, 2007.  http://www.abp.org/.  American Osteopathic Board of Pediatrics, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics.  Board certification for Doctors of Osteopathy (DOs) was provided by the American Osteopathic Board of Pediatrics.  The Certification is no longer offered.","2003-04-01",null,"2011-07-01","Keep - Clarify in Specs FAQ or Stakeholder Feedback, etc. that the eligible physician or clinician is at the Classification level, and any subspecialization can be found under the Area of Specialization level. For example, a physician may have a pediatric subspecialty (Area of Specialization) but not necessarily be a pediatrics physician (Classification).","Yes"]
["Allopathic & Osteopathic Physicians","Pediatrics","Pediatric Infectious Diseases","Pediatric Infectious Diseases Physician","A pediatrician trained to care for children in the diagnosis, treatment and prevention of infectious diseases. This specialist can apply specific knowledge to affect a better outcome for pediatric infections with complicated courses, underlying diseases that predispose to unusual or severe infections, unclear diagnoses, uncommon diseases and complex or investigational treatments.","2080P0208X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Pediatrics, 2007.  http://www.abp.org/.  American Osteopathic Board of Pediatrics, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics.  Board certification for Doctors of Osteopathy (DOs) was provided by the American Osteopathic Board of Pediatrics.  The Certification is no longer offered.","2003-04-01",null,"2011-07-01","Keep - Clarify in Specs FAQ or Stakeholder Feedback, etc. that the eligible physician or clinician is at the Classification level, and any subspecialization can be found under the Area of Specialization level. For example, a physician may have a pediatric subspecialty (Area of Specialization) but not necessarily be a pediatrics physician (Classification).","Yes"]
["Allopathic & Osteopathic Physicians","Pediatrics","Pediatric Nephrology","Pediatric Nephrology Physician","A pediatrician who deals with the normal and abnormal development and maturation of the kidney and urinary tract, the mechanisms by which the kidney can be damaged, the evaluation and treatment of renal diseases, fluid and electrolyte abnormalities, hypertension and renal replacement therapy.","2080P0210X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Pediatrics, 2007.  http://www.abp.org/.  American Osteopathic Board of Pediatrics, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics.  Board certification for Doctors of Osteopathy (DOs) was provided by the American Osteopathic Board of Pediatrics.  The Certification is no longer offered.","2003-04-01",null,"2011-07-01","Keep - Clarify in Specs FAQ or Stakeholder Feedback, etc. that the eligible physician or clinician is at the Classification level, and any subspecialization can be found under the Area of Specialization level. For example, a physician may have a pediatric subspecialty (Area of Specialization) but not necessarily be a pediatrics physician (Classification).","Yes"]
["Allopathic & Osteopathic Physicians","Pediatrics","Pediatric Pulmonology","Pediatric Pulmonology Physician","A pediatrician dedicated to the prevention and treatment of all respiratory diseases affecting infants, children and young adults. This specialist is knowledgeable about the growth and development of the lung, assessment of respiratory function in infants and children, and experienced in a variety of invasive and noninvasive diagnostic techniques.","2080P0214X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Pediatrics, 2007.  http://www.abp.org/.  American Osteopathic Board of Pediatrics, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics.  Board certification for Doctors of Osteopathy (DOs) was provided by the American Osteopathic Board of Pediatrics.  The Certification is no longer offered.","2003-04-01",null,"2011-07-01","Keep - Clarify in Specs FAQ or Stakeholder Feedback, etc. that the eligible physician or clinician is at the Classification level, and any subspecialization can be found under the Area of Specialization level. For example, a physician may have a pediatric subspecialty (Area of Specialization) but not necessarily be a pediatrics physician (Classification).","Yes"]
["Allopathic & Osteopathic Physicians","Pediatrics","Pediatric Rheumatology","Pediatric Rheumatology Physician","A pediatrician who treats diseases of joints, muscle, bones and tendons. A pediatric rheumatologist diagnoses and treats arthritis, back pain, muscle strains, common athletic injuries and \"collagen\" diseases.","2080P0216X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added]    Additional Resources: American Board of Pediatrics, 2007.  http://www.abp.org/.    Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics.","2003-04-01",null,"2007-07-01","Keep - Clarify in Specs FAQ or Stakeholder Feedback, etc. that the eligible physician or clinician is at the Classification level, and any subspecialization can be found under the Area of Specialization level. For example, a physician may have a pediatric subspecialty (Area of Specialization) but not necessarily be a pediatrics physician (Classification).","Yes"]
["Allopathic & Osteopathic Physicians","Pediatrics","Pediatric Transplant Hepatology","Pediatric Transplant Hepatology Physician","A pediatrician with expertise in transplant hepatology encompasses the special knowledge and skill required of pediatric gastroenterologists to care for patients prior to and following hepatic transplantation; it spans all phases of liver transplantation.","2080T0004X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: new]    Additional Resources; American Board of Pediatrics, 2007.  http://www.abp.org/.    Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics.","2007-10-01",null,null,"Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Pediatrics","Sleep Medicine","Pediatric Sleep Medicine Physician","A Pediatrician who practices Sleep Medicine is certified in the subspecialty of sleep medicine and specializes in the clinical assessment, physiologic testing, diagnosis, management and prevention of sleep and circadian rhythm disorders. Sleep specialists treat patients of any age and use multidisciplinary approaches. Disorders managed by sleep specialists include, but are not limited to, sleep related breathing disorders, insomnia, hypersomnias, circadian rhythm sleep disorders, parasomnias and sleep related movement disorders.","2080S0012X","Source: American Academy of Sleep Medicine, www.aasm.org [7/1/2006: new]","2006-10-01",null,null,"Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Pediatrics","Sports Medicine","Pediatric Sports Medicine Physician","A pediatrician who is responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the healthcare of the individual engaged in physical exercise (sports) whether as an individual or in team participation.","2080S0010X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Pediatrics, 2007.  http://www.abp.org/.  American Osteopathic Board of Pediatrics, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics.","2003-04-01",null,"2011-07-01","Keep - No Change","Yes"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Pedorthist",null,"Pedorthist","An individual who is trained in the management and treatment of conditions of the foot, ankle, and lower extremities requiring fitting, fabricating, and adjusting of pedorthic devices.","224L00000X","Source: National Uniform Claim Committee [7/1/2010: new]  Additional Resources:  American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org.","2010-10-01",null,null,"Delete - not a DPP measure","No"]
["Other Service Providers","Peer Specialist",null,"Peer Specialist","Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.","175T00000X","Source: National Uniform Claim Committee [7/1/2014: new]","2014-10-01",null,null,"Delete - not a DPP measure","No"]
["Technologists, Technicians & Other Technical Service Providers","Perfusionist",null,"Perfusionist","A perfusionist operates extracorporeal circulation and autotransfusion equipment during any medical situation where it is necessary to support or temporarily replace the patient's circulatory or respiratory function. The perfusionist is knowledgeable concerning the variety of equipment available to perform extracorporeal circulation functions and is responsible, in consultation with the physician, for selecting the appropriate equipment and techniques to be used.","242T00000X","Source:  Health Professions Career and Education Directory, American Medical Association [1/1/2007: new]","2007-04-01",null,null,"Delete - not a DPP measure","No"]
["Emergency Medical Service Providers","Personal Emergency Response Attendant",null,"Personal Emergency Response Attendant","Individuals that are specially trained to assist patients living at home with urgent/emergent situations.  These individuals must be able to perform CPR and basic first aid and have sufficient counseling skills to allay fears and assist in working through processes necessary to resolve the crisis.  Functions may include transportation to various facilities and businesses, contacting agencies to initiate remediation service or providing reassurance.","146D00000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Pharmacy Service Providers","Pharmacist",null,"Pharmacist","An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy.  The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care.","183500000X","Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified]","2002-04-01",null,"2006-01-01","Delete - not a DPP measure","No"]
["Pharmacy Service Providers","Pharmacist","Ambulatory Care","Ambulatory Care Pharmacist","A licensed pharmacist who has demonstrated specialized knowledge and skill in the provision of integrated, accessible health care services by pharmacists and is accountable for addressing medication needs, developing sustained partnerships with patients, and practicing in the context of family and community.","1835P2201X","Source:  Board of Pharmacy Specialties, www.bpsweb.org   [7/1/2015: new]","2015-10-01",null,null,"Delete - not a DPP measure","No"]
["Pharmacy Service Providers","Pharmacist","Critical Care","Critical Care Pharmacist","A licensed pharmacist who has demonstrated specialized knowledge and skill in the delivery of patient care services by pharmacists, as integral members of interprofessional teams, working to ensure the safe and effective use of medications in critically ill patients.","1835C0205X","Source: Board of Pharmacy Specialties, www.bpsweb.org  [1/1/2016: new]","2016-04-01",null,null,"Delete - not a DPP measure","No"]
["Pharmacy Service Providers","Pharmacist","General Practice","Deactivated - Pharmacist",null,"1835G0000X","[1/1/2006: marked inactive, use value 183500000X]","2002-04-01","2006-03-31",null,"Delete - deactivated","No"]
["Pharmacy Service Providers","Pharmacist","Geriatric","Geriatric Pharmacist","A pharmacist who is certified in geriatric pharmacy practice is designated as a \"Certified Geriatric Pharmacist\" (CGP).  To become certified, candidates are expected to be knowledgeable about principles of geriatric pharmacotherapy and the provision of pharmaceutical care to the elderly.","1835G0303X","Source:  Commission for Certification in Geriatric Pharmacy (www.ccgp.org) [7/1/2006: new]","2006-10-01",null,null,"Delete - not a DPP measure","No"]
["Pharmacy Service Providers","Pharmacist","Nuclear","Nuclear Pharmacist","A licensed pharmacist who has demonstrated specialized knowledge and skill in procurement, compounding, quality control testing, dispensing, distribution, and monitoring of radiopharmaceuticals.","1835N0905X","Source:  Specialty certification and recertification program administered by Board of Pharmaceutical Specialties, www.bpsweb.org [7/1/2006: modified title, added definition]","2002-04-01",null,"2006-07-01","Delete - not a DPP measure","No"]
["Pharmacy Service Providers","Pharmacist","Nutrition Support","Nutrition Support Pharmacist","A licensed pharmacist who has demonstrated specialized knowledge and skill in maintenance and/or restoration of optimal nutritional status, designing and modifying treatment according to patient needs.","1835N1003X","Source:  Specialty certification and recertification program administered by Board of Pharmaceutical Specialties, www.bpsweb.org [7/1/2006: definition modified]","2002-04-01",null,"2006-07-01","Delete - not a DPP measure","No"]
["Pharmacy Service Providers","Pharmacist","Oncology","Oncology Pharmacist","A licensed pharmacist who has demonstrated specialized knowledge and skill in developing, recommending, implementing, monitoring, and modifying pharmacotherapeutic plans to optimize outcomes in patients with malignant diseases.","1835X0200X","Source:  Specialty certification and recertification program administered by Board of Pharmaceutical Specialties, www.bpsweb.org [7/1/2006: new]","2006-10-01",null,null,"Delete - not a DPP measure","No"]
["Pharmacy Service Providers","Pharmacist","Pediatrics","Pediatric Pharmacist","A licensed pharmacist who has demonstrated specialized knowledge and skill in the delivery of patient care services by pharmacists that ensures the safe and effective use of medications for all children from neonates through adolescents.","1835P0200X","Source: Board of Pharmacy Specialties, www.bpsweb.org   [1/1/2016: new]","2016-04-01",null,null,"Delete - not a DPP measure","No"]
["Pharmacy Service Providers","Pharmacist","Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist","Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist","Pharmacist Clinician/Clinical Pharmacy Specialist is a pharmacist with additional training and an expanded scope of practice that may include prescriptive authority, therapeutic management, and disease management.","1835P0018X","Source: National Uniform Claim Committee, 2007 [1/1/2008: new]","2008-04-01",null,null,"Delete - not a DPP measure","No"]
["Pharmacy Service Providers","Pharmacist","Pharmacotherapy","Pharmacotherapy Pharmacist","A licensed pharmacist who has demonstrated specialized knowledge and skill in optimizing pharmacotherapeutic care of patients, by developing, implementing, monitoring, and modifying complex treatment plans, providing advanced level education and consultation, and collaborating with other health professionals in the management of therapy.","1835P1200X","Source:  Specialty certification and recertification program administered by Board of Pharmaceutical Specialties, www.bpsweb.org [7/1/2006: modified definition]","2002-04-01",null,"2006-07-01","Delete - not a DPP measure","No"]
["Pharmacy Service Providers","Pharmacist","Psychiatric","Psychiatric Pharmacist","A licensed pharmacist who has demonstrated specialized knowledge and skill in optimizing care of patients with psychiatric illness by assessing and monitoring patients, recognizing drug-induced problems, and recommending appropriate treatment plans.","1835P1300X","Source:  Specialty certification and recertification program administered by Board of Pharmaceutical Specialties, www.bpsweb.org [7/1/2006: modified title, added definition]","2002-04-01",null,"2006-07-01","Delete - not a DPP measure","No"]
["Suppliers","Pharmacy",null,"Pharmacy","A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.","333600000X","Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: added definition]","2002-04-01",null,"2006-01-01","Delete - not a DPP measure","No"]
["Suppliers","Pharmacy","Clinic Pharmacy","Clinic Pharmacy","A pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision of a pharmacist.","3336C0002X","Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC)  [1/1/2006: new]","2006-04-01",null,null,"Delete - not a DPP measure","No"]
["Suppliers","Pharmacy","Community/Retail Pharmacy","Community/Retail Pharmacy","A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.","3336C0003X","Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC)  [1/1/2006: new]","2006-04-01",null,null,"Delete - not a DPP measure","No"]
["Suppliers","Pharmacy","Compounding Pharmacy","Compounding Pharmacy","A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner's Prescription Drug Order or initiative based on the Practitioner/Patient/Pharmacist relationship in the course of professional practice.  A compounding pharmacy utilizes specialized equipment and specially designed facilities necessary to meet the legal and quality requirements of its scope of compounding practice.","3336C0004X","Sources:  NABP Model Practice Act, Appendix C - Good Compounding Practice,  USP <795> and <797>, and Pharmacy Compounding Accreditation Board [7/1/2006: new]","2006-10-01",null,null,"Delete - not a DPP measure","No"]
["Suppliers","Pharmacy","Home Infusion Therapy Pharmacy","Home Infusion Therapy Pharmacy","Pharmacy-based, decentralized patient care organization with expertise in USP 797-compliant sterile drug compounding that provides care to patients with acute or chronic conditions generally pertaining to parenteral administration of drugs, biologics and nutritional formulae administered through catheters and/or needles in home and alternate sites. Extensive professional pharmacy services, care coordination, infusion nursing services, supplies and equipment are provided to optimize efficacy and compliance.","3336H0001X","Source: National Home Infusion Association  [1/1/2006: new]","2006-04-01",null,null,"Delete - not a DPP measure","No"]
["Suppliers","Pharmacy","Institutional Pharmacy","Institutional Pharmacy","A pharmacy in a hospital (inpatient) or institution used by pharmacists for the compounding and delivery of medicinal preparations to be administered to the patient by nursing or other authorized personnel. Institutional Pharmacies also counsel patients and caregivers; administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.","3336I0012X","Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC)  [1/1/2006: new]","2006-04-01",null,null,"Delete - not a DPP measure","No"]
["Suppliers","Pharmacy","Long Term Care Pharmacy","Long Term Care Pharmacy","A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities for mentally retarded, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements.","3336L0003X","Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC)  [1/1/2006: new]","2006-04-01",null,null,"Delete - not a DPP measure","No"]
["Suppliers","Pharmacy","Mail Order Pharmacy","Mail Order Pharmacy","A pharmacy where pharmacists compound or dispense prescriptions or other medications in accordance with federal and state law, using common carriers to deliver the medications to patient or their caregivers. Mail order pharmacies counsel patients and caregivers (sometimes independent of the dispensing process) through telephone or email contact and provide other professional services associated with pharmaceutical care appropriate to the setting. Mail order pharmacies are licensed as a Mail Order Pharmacy in the state where they are located and may also be licensed or registered as nonresident pharmacies in other states.","3336M0002X","Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC)  [1/1/2006: new]","2006-04-01",null,null,"Delete - not a DPP measure","No"]
["Suppliers","Pharmacy","Managed Care Organization Pharmacy","Managed Care Organization Pharmacy","A pharmacy owned by a managed care organization (MCO) used by pharmacists for the compounding and dispensing of medicinal preparations to that MCO's covered members only.","3336M0003X","Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC)  [1/1/2006: new]","2006-04-01",null,null,"Delete - not a DPP measure","No"]
["Suppliers","Pharmacy","Nuclear Pharmacy","Nuclear Pharmacy","A pharmacy dedicated to the compounding and dispensing of radioactive materials for use in nuclear imaging and nuclear medical procedures.","3336N0007X","Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC)  [1/1/2006: new]","2006-04-01",null,null,"Delete - not a DPP measure","No"]
["Suppliers","Pharmacy","Specialty Pharmacy","Specialty Pharmacy","A pharmacy that dispenses generally low volume and high cost medicinal preparations to patients who are undergoing intensive therapies for illnesses that are generally chronic, complex and potentially life threatening. Often these therapies require specialized delivery and administration.","3336S0011X","Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC)  [1/1/2006: new]","2006-04-01",null,null,"Delete - not a DPP measure","No"]
["Pharmacy Service Providers","Pharmacy Technician",null,"Pharmacy Technician","A person who works under the direct supervision of a licensed pharmacist and performs many pharmacy-related functions that do not require the professional judgment of a pharmacist.","183700000X","Source: Pharmacy Technician Certification Board, www.ptcb.org [1/1/2006: modified definition, modified source]","2002-04-01",null,"2006-01-01","Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Phlebology",null,"Phlebology Physician","Phlebology is the medical discipline that involves the diagnosis and treatment of venous disorders, including spider veins, varicose veins, chronic venous insufficiency, venous leg ulcers, congenital venous abnormalities, venous thromboembolism and other disorders of venous origin.   A phlebologist has attained a minimum of 50 hours of CME units in phlebology-related courses, and is knowledgeable of and trained in a variety of diagnostic techniques including physical examination, venous imaging techniques such as duplex ultrasound, CT and MR, plethysmographic techniques and laboratory evaluation related to venous thromboembolism.  The phlebologist is also trained in a variety of therapeutic interventions, which may include compression, sclerotherapy, cutaneous vascular laser, endovenous thermoablation procedures (laser and radiofrequency) endovenous chemical ablation, surgical procedures (e.g., ambulatory phlebectomy, venous ligation), vasoactive medications and the management of venous thromboembolism.","202K00000X","Source: American College of Phlebology 12/2006. www.phelbology.org [1/1/2007: new, 7/1/2009: definition reformatted]    Additional Resources: Training Programs, Fellowships, and/or Preceptorships: Certification exam is being established by the American Board of Phlebology. ACGME Accredited Residency Program Requirements: None","2007-04-01",null,null,"Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Physical Medicine & Rehabilitation","Intentionally left blank","Physical Medicine & Rehabilitation Physician","Physical medicine and rehabilitation, also referred to as rehabilitation medicine, is the medical specialty concerned with diagnosing, evaluating, and treating patients with physical disabilities. These disabilities may arise from conditions affecting the musculoskeletal system such as neck and back pain, sports injuries, or other painful conditions affecting the limbs, such as carpal tunnel syndrome. Alternatively, the disabilities may result from neurological trauma or disease such as spinal cord injury, head injury or stroke. A physician certified in physical medicine and rehabilitation is often called a physiatrist. The primary goal of the physiatrist is to achieve maximal restoration of physical, psychological, social and vocational function through comprehensive rehabilitation. Pain management is often an important part of the role of the physiatrist. For diagnosis and evaluation, a physiatrist may include the techniques of electromyography to supplement the standard history, physical, x-ray and laboratory examinations. The physiatrist has expertise in the appropriate use of therapeutic exercise, prosthetics (artificial limbs), orthotics and mechanical and electrical devices.","208100000X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Physical Medicine and Rehabilitation, 2007.  http://www.abpmr.org/.  American Osteopathic Board of Physical Medicine and Rehabilitation, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Physical Medicine and Rehabilitation.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Physical Medicine and Rehabilitation.","2003-04-01",null,"2011-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Physical Medicine & Rehabilitation","Brain Injury Medicine","Brain Injury Medicine (Physical Medicine & Rehabilitation) Physician","A Brain Injury Medicine physician specializes in disorders of brain function due to injury and disease.  These disorders encompass a range of medical, physical, neurologic, cognitive, sensory, and behavioral disorders that result in psychosocial, educational, and vocational consequences.","2081P0301X","Source: American Board of Physical Medicine and Rehabilitation, 2015. www.abpmr.org [1/1/2016: new]","2016-04-01",null,null,"Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Physical Medicine & Rehabilitation","Hospice and Palliative Medicine","Hospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician","A physical medicine and rehabilitation physician with special knowledge and skills to prevent and relieve the suffering experienced by patients with life-limiting illnesses. This specialist works with an interdisciplinary hospice or palliative care team to maximize quality of life while addressing physical, psychological, social and spiritual needs of both patient and family throughout the course of the disease, through the dying process, and beyond for the family.  This specialist has expertise in the assessment of patients with advanced disease; the relief of distressing symptoms; the coordination of interdisciplinary patient and family-centered care in diverse venues; the use of specialized care systems including hospice; the management of the imminently dying patient; and legal and ethical decision making in end-of-life care.","2081H0002X","Source: American Academy of Hospice and Palliative Medicine, www.aahpm.org [1/1/2007: new]","2007-04-01",null,null,"Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Physical Medicine & Rehabilitation","Neuromuscular Medicine","Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician","A physician who specializes in neuromuscular medicine possesses specialized knowledge in the science, clinical evaluation and management of these disorders. This encompasses the knowledge of the pathology, diagnosis and treatment of these disorders at a level that is significantly beyond the training and knowledge expected of a general neurologist, child neurologist or physiatrist.","2081N0008X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: new]    Additional Resources: American Board of Physical Medicine and Rehabilitation, 2007.  http://www.abpmr.org/.     Board certification for Medical Doctors (MDs) is provided by the American Board of Physical Medicine and Rehabilitation. ","2007-10-01",null,null,"Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Physical Medicine & Rehabilitation","Pain Medicine","Pain Medicine (Physical Medicine & Rehabilitation) Physician","A physician who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic or cancer pain in both hospital and ambulatory settings. Patient care needs may also be coordinated with other specialists. ","2081P2900X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition changed, source changed]    Additional Resources: American Board of Physical Medicine and Rehabilitation, 2007.  http://www.abpmr.org/.     Board certification for Medical Doctors (MDs) is provided by the American Board of Physical Medicine and Rehabilitation.    A subspecialty certificate  was approved by the ABMS in 1999.    ACGME Accredited Residency Program Requirements:  Proposal under development.","2003-04-01",null,"2007-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Physical Medicine & Rehabilitation","Pediatric Rehabilitation Medicine","Pediatric Rehabilitation Medicine Physician","A physiatrist who utilizes an interdisciplinary approach and addresses the prevention, diagnosis, treatment and management of congenital and childhood-onset physical impairments including related or secondary medical, physical, functional, psychosocial and vocational limitations or conditions, with an understanding of the life course of disability. This physician is trained in the identification of functional capabilities and selection of the best of rehabilitation intervention strategies, with an understanding of the continuum of care.","2081P0010X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition changed, source added]    Additional Resources: American Board of Physical Medicine and Rehabilitation, 2007.  http://www.abpmr.org/.     Board certification for Medical Doctors (MDs) is provided by the American Board of Physical Medicine and Rehabilitation.    A subspecialty certificate for PRM was approved by the ABMS in 1999.    ACGME Accredited Residency Program Requirements:  Early discussions underway","2003-04-01",null,"2007-07-01","Keep - Clarify in Specs FAQ or Stakeholder Feedback, etc. that the eligible physician or clinician is at the Classification level, and any subspecialization can be found under the Area of Specialization level. For example, a physician may have a pediatric subspecialty (Area of Specialization) but not necessarily be a pediatrics physician (Classification).","Yes"]
["Allopathic & Osteopathic Physicians","Physical Medicine & Rehabilitation","Spinal Cord Injury Medicine","Spinal Cord Injury Medicine Physician","A physician who addresses the prevention, diagnosis, treatment and management of traumatic spinal cord injury and non-traumatic etiologies of spinal cord dysfunction by working in an interdisciplinary manner. Care is provided to patients of all ages on a lifelong basis and covers related medical, physical, psychological and vocational disabilities and complications. ","2081P0004X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition changed, source added]    Additional Resources: American Board of Physical Medicine and Rehabilitation, 2007.  http://www.abpmr.org/.     Board certification for Medical Doctors (MDs) is provided by the American Board of Physical Medicine and Rehabilitation.    ACGME Accredited Residency Program Requirements:   1 year of training with 3-5 years in relevant specialty for a total of 4-6 years.    ABMS Approved Subspecialty Certificate:  (Physical Medicine and Rehabilitation)","2003-04-01",null,"2007-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Physical Medicine & Rehabilitation","Sports Medicine","Sports Medicine (Physical Medicine & Rehabilitation) Physician","A physician who specializes in Sports Medicine is responsible for continuous care related to the enhancement of health and fitness as well as the prevention of injury and illness. The specialist possesses knowledge and experience in the promotion of wellness and the prevention of injury from many areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation and injuries. It is the goal of a Sports Medicine specialist to improve the healthcare of the individual engaged in physical exercise.","2081S0010X","Source:  American Board of Medical Specialties, 2009.  www.abms.org [7/1/2009: definition added]","2003-04-01",null,null,"Keep - No Change","Yes"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Physical Therapist","Intentionally left blank","Physical Therapist","Physical therapists (PTs) are licensed health care professionals who diagnose and treat individuals of all ages, from newborns to the very oldest, who have medical problems or other health-related conditions that limit their abilities to move and perform functional activities in their daily lives. PTs examine each individual and develop a plan using treatment techniques to promote the ability to move, reduce pain, restore function, and prevent disability. In addition, PTs work with individuals to prevent the loss of mobility before it occurs by developing fitness- and wellness-oriented programs for healthier and more active lifestyles. PTs: 1.Diagnose and manage movement dysfunction and enhance physical and functional abilities. 2.Restore, maintain, and promote not only optimal physical function but optimal wellness and fitness and optimal quality of life as it relates to movement and health. 3.Prevent the onset, symptoms, and progression of impairments, functional limitations, and disabilities that may result from diseases, disorders, conditions, or injuries. 4.Treat conditions of the musculoskeletal, neuromuscular, cardiovascular, pulmonary, and/or integumentary systems. 5.Address the negative effects attributable to unique personal and environmental factors as they relate to human performance. 6.PTs provide care for people in a variety of settings, including hospitals, private practices, outpatient clinics, home health agencies, schools, sports and fitness facilities, work settings, and nursing homes. State licensure is required in each state in which a PT practices.","225100000X","Source: American Physical Therapy Association [1/1/2020: definition modified]  Additional resources: https://www.apta.org/PTCareers/RoleofaPT/","2002-04-01",null,"2020-01-01","Keep - No Change","Yes"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Physical Therapist","Cardiopulmonary","Cardiopulmonary Physical Therapist","A licensed physical therapist, including but not limited to an individual who is a Board Certified Specialist in Cardiovascular & Pulmonary Physical Therapy, who has demonstrated specialized knowledge and skill in cardiovascular and pulmonary anatomy and physiology medicine, rehabilitation, critical care, and emergency and trauma.","2251C2600X","Source: American Physical Therapy Association [1/1/2020: definition added]  Additional resources: http://www.abpts.org/uploadedFiles/ABPTSorg/Specialist_Certification/DSP/DSP-Cardio.pdf","2002-04-01",null,"2020-01-01","Keep - No Change","Yes"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Physical Therapist","Electrophysiology, Clinical","Clinical Electrophysiology Physical Therapist","A licensed physical therapist, including but not limited to an individual who is a Board Certified Specialist in Clinical Electrophysiologic Physical Therapy, who has demonstrated specialized knowledge and skill in electrophysiologic examinations and evaluations and encompasses both the professional and technical components of the observation, recording, analysis, and interpretation of bioelectric muscle and nerve potentials, detected by means of surface or needle electrodes, for the purpose of evaluating the integrity of the neuromuscular system. Electrophysiologic evaluations include, but are not limited to, electrodiagnostic testing, which includes clinical needle electromyography, motor and sensory nerve conduction studies, and other evoked potential procedures.","2251E1300X","Source: American Physical Therapy Association [1/1/2020: definition added]  Additional Resources: https://www.apta.org/apta-and-you/leadership-and-governance/policies/electrophysiologic-examination-evaluation ; http://www.abpts.org/Certification/ClinicalElectrophysiology/","2002-04-01",null,"2020-01-01","Keep - No Change","Yes"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Physical Therapist","Ergonomics","Ergonomics Physical Therapist","A licensed physical therapist who has demonstrated specialized knowledge and skills pertaining to the workplace, occupational demands, prevention of work-related injury, management of the worker with job-related symptoms or participation restrictions, and provides individual, group or population level evaluation, intervention and consulting to enhance worker performance.","2251E1200X","Source: American Physical Therapy Association [1/1/2020: definition added]  Additional Resources: www.apta.org","2002-04-01",null,"2020-01-01","Keep - No Change","Yes"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Physical Therapist","Geriatrics","Geriatric Physical Therapist","A licensed physical therapist, including but not limited to an individual who is a Board Certified Specialist in Geriatric Physical Therapy, who has demonstrated specialized knowledge and skill in the comprehensive biopsychosocial assessment and evidence-based management of movement in aging adults. This includes, but is not limited to, specialized knowledge in and consideration of normal age-related changes and pathological manifestations across all systems; cognition and mental health; polypharmacy; fall risk mitigation; bone health; healthy and active aging, and socioeconomic and health policy issues affecting aging adults. The geriatric physical therapist is an integral part of the interdisciplinary geriatric team and serves as an advocate for the highest level of well-being for the older adult.","2251G0304X","Source: American Physical Therapy Association [1/1/2020: definition added]  Additional resources: www.apta.org","2002-04-01",null,"2020-01-01","Keep - No Change","Yes"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Physical Therapist","Hand","Hand Physical Therapist","Definition to come.","2251H1200X",null,"2002-04-01",null,null,"Keep - Add somewhere that for TIPPS program, whenever a Definition is listed as \"Definition to come.\" by NUCC, then the Definition at the Classification level should be used as possible.","Yes"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Physical Therapist","Human Factors","Human Factors Physical Therapist","Definition to come.","2251H1300X",null,"2002-04-01",null,null,"Keep - Add somewhere that for TIPPS program, whenever a Definition is listed as \"Definition to come.\" by NUCC, then the Definition at the Classification level should be used as possible.","Yes"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Physical Therapist","Neurology","Neurology Physical Therapist","A licensed physical therapist, including but not limited to an individual who is a Board Certified Specialist in Neurologic Physical Therapy, who has demonstrated specialized knowledge and skill in neuroanatomy and neurophysiology, including knowledge of central, peripheral, and autonomic nervous systems in populations with and without neurologic conditions; motor control and movement sciences in populations with and without neurologic conditions; behavioral sciences, including psychology and neuropsychology, and psychiatry; and medical management and pharmacology.","2251N0400X","Source: American Physical Therapy Association [1/1/2020: definition added]  Additional resources: http://www.abpts.org/uploadedFiles/ABPTSorg/Specialist_Certification/DSP/DSP-Neurology.pdf","2002-04-01",null,"2020-01-01","Keep - No Change","Yes"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Physical Therapist","Orthopedic","Orthopedic Physical Therapist","A licensed physical therapist, including but not limited to an individual who is a Board Certified Specialist in Orthopaedic Physical Therapy, who has demonstrated specialized knowledge and skill in human anatomy and physiology, movement science; pathology/pathophysiology, pain science, medical and surgical considerations, orthopaedic physical therapy theory and practice, and critical inquiry for evidence-based practice.","2251X0800X","Source: American Physical Therapy Association [1/1/2020: definition added]  Additional resources: http://www.abpts.org/uploadedFiles/ABPTSorg/Specialist_Certification/DSP/DSP-Orthopaedics.pdf","2002-04-01",null,"2020-01-01","Keep - No Change","Yes"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Physical Therapist","Pediatrics","Pediatric Physical Therapist","A licensed physical therapist, including but not limited to an individual who is a Board Certified Specialist in Pediatric Physical Therapy, who has demonstrated specialized knowledge and skill in anatomy, histology, including embryonic development, genetics, biomechanics, neurological function, neuroscience, and pathology, behavioral sciences, and understanding of diseases or conditions that necessitate physical therapy care, that affect systems that in turn necessitate physical therapy care (comorbidities), and that influence the type of intervention that can be given.","2251P0200X","Source: American Physical Therapy Association [1/1/2020: definition added]  Additional resources: http://www.abpts.org/uploadedFiles/ABPTSorg/Specialist_Certification/DSP/DSP-Pediatrics.pdf","2002-04-01",null,"2020-01-01","Keep - Clarify in Specs FAQ or Stakeholder Feedback, etc. that the eligible physician or clinician is at the Classification level, and any subspecialization can be found under the Area of Specialization level. For example, a physician may have a pediatric subspecialty (Area of Specialization) but not necessarily be a pediatrics physician (Classification).","Yes"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Physical Therapist","Sports","Sports Physical Therapist","A licensed physical therapist, including but not limited to an individual who is a Board Certified Specialist in Sports Physical Therapy, who has demonstrated specialized knowledge and skill in human anatomy and physiology, movement science, pathology and pathophysiology, medical and surgical intervention, and health and wellness, as well as rehabilitation/return to sports, management of acute injury/illness, medical and surgical consideration, injury prevention, and sports performance enhancement.","2251S0007X","Source: American Physical Therapy Association [1/1/2020: definition added]  Additional resources: http://www.abpts.org/uploadedFiles/ABPTSorg/Specialist_Certification/DSP/DSP-Sports.pdf","2002-04-01",null,"2020-01-01","Keep - No Change","Yes"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Physical Therapy Assistant",null,"Physical Therapy Assistant","(1)Physical therapist assistants are skilled health care providers who are graduates of a physical therapist assistant associate degree program accredited by an agency recognized by the Secretary of the U.S. Department of Education or Council on Postsecondary Accreditation, who assists the physical therapist in providing physical therapy. The supervising physical therapist is directly responsible for the actions of the physical therapist assistant. The PTA performs physical therapy procedures and related tasks that have been selected and delegated by the supervising physical therapist. Duties of the PTA include assisting the physical therapist in implementing treatment programs, training patients in exercised and activities of daily living, conducting treatments, and reporting to the physical therapist on the patient's responses. In addition to direct patient care, the PTA may also perform such functions as patient transport, and clinic or equipment preparation and maintenance. Currently more than half of all states require PTAs to be licensed, registered or certified. (2) An individual who works under the supervision of a physical therapist to assist him or her in providing physical therapy services. A physical therapy assistant may, for instance, help patients follow an appropriate exercise program that will increase their strength, endurance, coordination, and range of motion and train patients to perform activities of daily life.","225200000X","Source: (1) American Physical Therapy Association, P.O. Box 37257, Washington, D.C. 20013. (2) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 612","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Physician Assistant","Intentionally left blank","Physician Assistant","A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.","363A00000X",null,"2002-04-01",null,null,"New - Add as Grouping/Classification eligible with eligible Physician","Yes"]
["Physician Assistants & Advanced Practice Nursing Providers","Physician Assistant","Medical","Medical Physician Assistant","Definition to come...","363AM0700X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Physician Assistants & Advanced Practice Nursing Providers","Physician Assistant","Surgical","Surgical Physician Assistant","Definition to come...","363AS0400X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Laboratories","Physiological Laboratory",null,"Physiological Laboratory","A laboratory that operates independently of a hospital and physician's office to furnish physiological diagnostic services (e.g. EEG's , EKG's, scans, etc.). Facilities offering ONLY physiological services are not certified as independent laboratories. If an independent laboratory offers physiological services IN ADDITION to clinical laboratory services, they are surveyed only for compliance with the clinical laboratory regulations because there are no health and safety regulations for physiological services.","293D00000X","Source: Paraphrased from the Medicare Carrier Manual, Section 2070.5.","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Plastic Surgery","Intentionally left blank","Plastic Surgery Physician","A plastic surgeon deals with the repair, reconstruction or replacement of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial structures, hand, extremities, breast and trunk and external genitalia or cosmetic enhancement of these areas of the body. Cosmetic surgery is an essential component of plastic surgery. The plastic surgeon uses cosmetic surgical principles to both improve overall appearance and to optimize the outcome of reconstructive procedures. The surgeon uses aesthetic surgical principles not only to improve undesirable qualities of normal structures but in all reconstructive procedures as well.","208200000X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added]    Additional Resources: American Board of Plastic Surgery, 2007.  http://www.abplsurg.org/.    Board certification for Medical Doctors (MDs) is provided by the American Board of Plastic Surgery.","2003-04-01",null,"2007-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Plastic Surgery","Plastic Surgery Within the Head and Neck","Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician","A plastic surgeon with additional training in plastic and reconstructive procedures within the head, face, neck and associated structures, including cutaneous head and neck oncology and reconstruction, management of maxillofacial trauma, soft tissue repair and neural surgery. The field is diverse and involves a wide age range of patients, from the newborn to the aged. While both cosmetic and reconstructive surgery is practiced, there are many additional procedures which interface with them.","2082S0099X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition changed, source added]    Additional Resources: American Board of Plastic Surgery, 2007.  http://www.abplsurg.org/.    Board certification for Medical Doctors (MDs) is provided by the American Board of Plastic Surgery.    A subspecialty certificate was approved by the ABMS in 2000.    ACGME Accredited Residency Program Requirements:  None.","2003-04-01",null,"2007-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Plastic Surgery","Surgery of the Hand","Surgery of the Hand (Plastic Surgery) Physician","A plastic surgeon with additional training in the investigation, preservation, and restoration by medical, surgical and rehabilitative means of all structures of the upper extremity directly affecting the form and function of the hand and wrist.","2082S0105X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added]    Additional Resources: American Board of Plastic Surgery, 2007.  http://www.abplsurg.org/.    Board certification for Medical Doctors (MDs) is provided by the American Board of Plastic Surgery.","2003-04-01",null,"2007-07-01","Keep - No Change","Yes"]
["Podiatric Medicine & Surgery Service Providers","Podiatrist","Intentionally left blank","Podiatrist","A podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy.","213E00000X",null,"2002-04-01",null,null,"Keep - No Change","Yes"]
["Podiatric Medicine & Surgery Service Providers","Podiatrist","Foot & Ankle Surgery","Foot & Ankle Surgery Podiatrist","Definition to come.","213ES0103X",null,"2002-04-01",null,null,"Keep - Add somewhere that for TIPPS program, whenever a Definition is listed as \"Definition to come.\" by NUCC, then the Definition at the Classification level should be used as possible.","Yes"]
["Podiatric Medicine & Surgery Service Providers","Podiatrist","Foot Surgery","Foot Surgery Podiatrist","Definition to come.","213ES0131X",null,"2002-04-01",null,null,"Keep - Add somewhere that for TIPPS program, whenever a Definition is listed as \"Definition to come.\" by NUCC, then the Definition at the Classification level should be used as possible.","Yes"]
["Podiatric Medicine & Surgery Service Providers","Podiatrist","General Practice","Deactivated - Podiatrist",null,"213EG0000X","[7/1/2006: marked inactive, use value 213E00000X]","2002-04-01","2006-09-30",null,"Delete - deactivated","No"]
["Podiatric Medicine & Surgery Service Providers","Podiatrist","Primary Podiatric Medicine","Primary Podiatric Medicine Podiatrist","Definition to come.","213EP1101X",null,"2002-04-01",null,null,"Keep - Add somewhere that for TIPPS program, whenever a Definition is listed as \"Definition to come.\" by NUCC, then the Definition at the Classification level should be used as possible.","Yes"]
["Podiatric Medicine & Surgery Service Providers","Podiatrist","Public Medicine","Public Medicine Podiatrist","Definition to come.","213EP0504X",null,"2002-04-01",null,null,"Keep - Add somewhere that for TIPPS program, whenever a Definition is listed as \"Definition to come.\" by NUCC, then the Definition at the Classification level should be used as possible.","Yes"]
["Podiatric Medicine & Surgery Service Providers","Podiatrist","Radiology","Radiology Podiatrist","Definition to come.","213ER0200X",null,"2002-04-01",null,null,"Keep - Add somewhere that for TIPPS program, whenever a Definition is listed as \"Definition to come.\" by NUCC, then the Definition at the Classification level should be used as possible.","Yes"]
["Podiatric Medicine & Surgery Service Providers","Podiatrist","Sports Medicine","Sports Medicine Podiatrist","Definition to come...","213ES0000X",null,"2002-04-01",null,null,"Keep - No Change","Yes"]
["Behavioral Health & Social Service Providers","Poetry Therapist",null,"Poetry Therapist","A medical or mental health professional who has attained credentials after satisfactorily completing a poetry therapy training program approved by the National Federation for Biblio/Poetry Therapy (NFBPT). Training includes didactic work, peer group experience, and supervised practicum.<br><br>An NFBPT credentialed certified poetry therapist (CPT) or registered poetry therapist (PTR) integrates discussion of published literature and reflective or creative writing into the psychotherapeutic process to achieve goals of emotional well-being, symptom reduction, and improved interpersonal communication.<br><br>Certified poetry therapists and registered poetry therapists are licensed mental health professionals with advanced training in the theory and practice of poetry therapy. CPTs and PTRs are qualified to work independently with emotionally troubled populations in clinical, rehabilitative, community and educational institutions. They also work with emotionally healthy individuals adjusting to developmental issues, life crises, or disabilities. The PTR completes an advanced level of training and fieldwork, commensurate with the highest levels of clinical practice. The terms poetry therapy, applied poetry facilitation, journal therapy, bibliotherapy, biblio/poetry therapy, and poetry/journal therapy reflect the interactive use of literature and/or writing to promote personal growth and emotional healing. In addition to poetry, poetry therapy applies all forms or written and spoken language including story, myth, folk and fairy tale and other genres of poetic expression as well as journal, memoir, and narrative. The poetry therapy process integrates discussion of published literature and reflective or creative writing for expression and communication of thoughts and feelings to facilitate participants' emotional well-being. The field of poetry therapy encompasses all of these modalities, though only a duly trained and licensed clinical practitioner can be credentialed as CPT or PTR.","102X00000X","Source: The National Federation for Biblio/Poetry Therapy [7/1/2007: new]","2007-10-01",null,null,"Delete - not a DPP measure","No"]
["Managed Care Organizations","Point of Service",null,"Point of Service","This product may also be called an open-ended HMO and offers a transition product incorporating features of both HMOs and PPOs. Beneficiaries are enrolled in an HMO but have the option to go outside the networks for an additional cost.","305S00000X","Source: \"Glossary of terms used in managed care\" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 62","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Suppliers","Portable X-ray and/or Other Portable Diagnostic Imaging Supplier",null,"Portable X-ray and/or Other Portable Diagnostic Imaging Supplier","A supplier that provides one or more of the following portable services, including but not limited to, x-ray, electrocardiogram (EKG), long-term EKG (Holter Monitor), bone densitometry, sonography, and other imaging services in accordance with all state and federal requirements, under the general supervision of a qualified physician.  All necessary resources are transported to the patient's location where the services are performed.","335V00000X","Source: National Uniform Claim Committee, 2015 [1/1/2016: title and definition modified]","2002-04-01",null,"2016-01-01","Delete - not a DPP measure","No"]
["Managed Care Organizations","Preferred Provider Organization",null,"Preferred Provider Organization","A group of physicians and/or hospitals who contract with an employer to provide services to their employees. In a PPO, the patient may got to the physician of his/her choice, even if that physician does not participate in the PPO, but the patient receives care at a lower benefit level.","305R00000X","Source: \"Glossary of terms used in managed care\" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/ October 1995, p. 62","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Other Service Providers","Prevention Professional",null,"Prevention Professional","Prevention Professionals work in programs aimed to address specific patient needs, such as suicide prevention, violence prevention, alcohol avoidance, drug avoidance, and tobacco prevention.   The goal of the program is to reduce the risk of relapse, injury, or re-injury of the patient.  Prevention Professionals work in a variety of settings and provide appropriate case management, mediation, referral, and mentorship services.  Individuals complete prevention professionals training for the population of patients with whom they work.","405300000X","Source: National Uniform Claim Committee, 2015 [1/1/2016: new]","2016-04-01",null,null,"Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Preventive Medicine","Addiction Medicine","Addiction Medicine (Preventive Medicine) Physician","A physician engaged in the subspecialty practice of Addiction Medicine who specializes in the prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction.","2083A0300X","Source: American Board of Preventive Medicine, www.theabpm.org [1/1/2019: new]","2019-04-01",null,null,"Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Preventive Medicine","Aerospace Medicine","Aerospace Medicine Physician","Aerospace medicine focuses on the clinical care, research, and operational support of the health, safety, and performance of crewmembers and passengers of air and space vehicles, together with the support personnel who assist operation of such vehicles. This population often works and lives in remote, isolated, extreme, or enclosed environments under conditions of physical and psychological stress. Practitioners strive for an optimal human-machine match in occupational settings rich with environmental hazards and engineering countermeasures.","2083A0100X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Preventive Medicine, 2007.  http://www.abprevmed.org/.  American Osteopathic Board of Preventive Medicine, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Preventive Medicine.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Preventive Medicine.","2003-04-01",null,"2011-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Preventive Medicine","Clinical Informatics","Clinical Informatics Physician","Physicians who practice Clinical Informatics collaborate with other health care and information technology professionals to analyze, design, implement and evaluate information and communication systems that enhance individual and population health outcomes, improve patient care, and strengthen the clinician-patient relationship. Clinical Informaticians use their knowledge of patient care combined with their understanding of informatics concepts, methods, and tools to: assess information and knowledge needs of health care professionals and patients; characterize, evaluate, and refine clinical processes; develop, implement, and refine clinical decision support systems; and lead or participate in the procurement, customization, development, implementation, management, evaluation, and continuous improvement of clinical information systems.","2083C0008X","Source: The American Board of Preventive Medicine, 2013 [1/1/2014: new]  Additional Resources: The American Board of Preventive Medicine, www.theabpm.org","2014-04-01",null,null,"Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Preventive Medicine","Medical Toxicology","Medical Toxicology (Preventive Medicine) Physician","Medical toxicologists are physicians who specialize in the prevention, evaluation, treatment and monitoring of injury and illness from exposures to drugs and chemicals, as well as biological and radiological agents. Medical toxicologists care for people in clinical, academic, governmental and public health settings, and provide poison control center leadership. Important areas of medical toxicology include acute drug poisoning, adverse drug events, drug abuse, addiction and withdrawal, chemicals and hazardous materials, terrorism preparedness, venomous bites and stings, and environmental and workplace exposures.","2083T0002X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added]    Additional Resources: American Board of Preventive Medicine, 2007.  http://www.abprevmed.org/.    Board certification for Medical Doctors (MDs) is provided by the American Board of Preventive Medicine.","2003-04-01",null,"2007-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Preventive Medicine","Obesity Medicine","Obesity Medicine (Preventive Medicine) Physician","A physician who specializes in the treatment of obesity demonstrates competency in and a thorough understanding of the treatment of obesity and the genetic, biologic, environmental, social, and behavioral factors that contribute to obesity. The obesity medicine physician employs therapeutic interventions including diet, physical activity, behavioral change, and pharmacotherapy. The obesity medicine physician utilizes a comprehensive approach, and may include additional resources such as dietitians, exercise physiologists, mental health professionals and bariatric surgeons as indicated to achieve optimal results. Additionally, the obesity medicine physician maintains competency in providing pre- peri- and post-surgical care of bariatric surgery patients, promotes the prevention of obesity, and advocates for those who suffer from obesity.","2083B0002X","Source:  American Board of Obesity Medicine, www.abom.org [7/1/2015: new]  Additional Resource: American Society of Bariatric Physicians, www.asbp.org.","2015-10-01",null,null,"Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Preventive Medicine","Occupational Medicine","Occupational Medicine Physician","Occupational medicine focuses on the health of workers, including the ability to perform work; the physical, chemical, biological, and social environments of the workplace; and the health outcomes of environmental exposures. Practitioners in this field address the promotion of health in the work place, and the prevention and management of occupational and environmental injury, illness, and disability.","2083X0100X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added]    Additional Resources: American Board of Preventive Medicine, 2007.  http://www.abprevmed.org/.    Board certification for Medical Doctors (MDs) is provided by the American Board of Preventive Medicine.","2003-04-01",null,"2007-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Preventive Medicine","Preventive Medicine/Occupational Environmental Medicine","Preventive Medicine/Occupational Environmental Medicine Physician","A preventive medicine physician who specializes in preventive medicine/occupational-environmental medicine, which is focused on protecting the population from occupational and environmental conditions.","2083P0500X","Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added]   Additional Resources: A General Certificate is issued by the American Osteopathic Board of Preventive Medicine.","2003-04-01",null,"2010-01-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Preventive Medicine","Public Health & General Preventive Medicine","Public Health & General Preventive Medicine Physician","Public health and general preventive medicine focuses on promoting health, preventing disease, and managing the health of communities and defined populations. These practitioners combine population-based public health skills with knowledge of primary, secondary, and tertiary prevention-oriented clinical practice in a wide variety of settings.","2083P0901X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Preventive Medicine, 2007.  http://www.abprevmed.org/.  American Osteopathic Board of Preventive Medicine, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Preventive Medicine.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Preventive Medicine.","2003-04-01",null,"2011-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Preventive Medicine","Sports Medicine","Sports Medicine (Preventive Medicine) Physician","A preventive medicine physician who specializes in the diagnosis and treatment of sports related conditions and injuries.","2083S0010X","Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added]   Additional Resources: A Certification of Added Qualifications (CAQ) is issued by the American Osteopathic Board of Preventive Medicine.","2003-04-01",null,"2010-01-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Preventive Medicine","Undersea and Hyperbaric Medicine","Undersea and Hyperbaric Medicine (Preventive Medicine) Physician","A specialist who treats decompression illness and diving accident cases and uses hyperbaric oxygen therapy to treat such conditions as carbon monoxide poisoning, gas gangrene, non-healing wounds, tissue damage from radiation and burns and bone infections. This specialist also serves as consultant to other physicians in all aspects of hyperbaric chamber operations and assesses risks and applies appropriate standards to prevent disease and disability in divers and other persons working in altered atmospheric conditions.","2083P0011X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added]    Additional Resources: American Board of Preventive Medicine, 2007.  http://www.abprevmed.org/.    Board certification for Medical Doctors (MDs) is provided by the American Board of Preventive Medicine.","2003-04-01",null,"2007-07-01","Keep - No Change","Yes"]
["Transportation Services","Private Vehicle",null,"Private Vehicle","An individual paid to provide non-emergency transportation using their privately owned/leased vehicle.","347C00000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Agencies","Program of All-Inclusive Care for the Elderly (PACE) Provider Organization",null,"PACE Provider Organization","A PACE provider organization is a not-for-profit private or public entity that is primarily engaged in providing PACE services(unique capitated managed care benefits for the frail elderly which include comprehensive medical and social services).  The following characteristics also apply to a PACE organization.  It must:  have a governing board that includes community representation; be able to provide complete PACE services regardless of frequency or duration of services; have a physical site to provide adult day services; have a defined service area; have safeguards against conflict of interest; have demonstrated fiscal soundness and have a formal Participant Bill of Rights.","251T00000X","Source:  Centers for Medicare and Medicaid, PACE Fact Sheet http://www.cms.hhs.gov/PACE/Downloads/PACEFactSheet.pdf [7/1/2006: new]","2006-10-01",null,null,"Delete - not a DPP measure","No"]
["Suppliers","Prosthetic/Orthotic Supplier",null,"Prosthetic/Orthotic Supplier","An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition.","335E00000X","Source:  American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified]  Additional Resources:  American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org.","2002-04-01",null,"2013-07-01","Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Prosthetist",null,"Prosthetist","A health care professional who is specifically educated and trained to manage comprehensive prosthetic patient care for individuals who have sustained complete or partial limb loss or absence. Prosthetists assess specific patient needs, formulate an appropriate treatment plan, implement the treatment plan and provide follow-up care.","224P00000X","Source:  American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified]  Additional Resources:  American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org.","2002-04-01",null,"2013-07-01","Delete - not a DPP measure","No"]
["Hospitals","Psychiatric Hospital",null,"Psychiatric Hospital","An organization including a physical plant and personnel that provides multidisciplinary diagnostic and treatment mental health services to patients requiring the safety, security, and shelter of the inpatient or partial hospitalization settings.","283Q00000X","Source: Expanded from Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988.","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Residential Treatment Facilities","Psychiatric Residential Treatment Facility",null,"Psychiatric Residential Treatment Facility","A residential treatment facility (RTF) is a facility or distinct part of a facility that provides to children and adolescents, a total, twenty-four hour, therapeutically planned group living and learning situation where distinct and individualized psychotherapeutic interventions can take place. Residential treatment is a specific level of care to be differentiated from acute, intermediate, and long-term hospital care, when the least restrictive environment is maintained to allow for normalization of the patient's surroundings. The RTF must be both physically and programmatically distinct if it is a part or subunit of a larger treatment program. An RTF is organized and professionally staffed to provide residential treatment of mental disorders to children and adolescents who have sufficient intellectual potential to respond to active treatment (that is, for whom it can reasonably be assumed that treatment of the mental disorder will result in an improved ability to function outside the RTF) for whom outpatient treatment, partial hospitalization or protected and structured environment is medically or psychologically necessary","323P00000X","Source: Champus Policy manual, Volume II, p. 6010.47M dated 9/12/94. Revision: Definition title revised 7/1/03","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Hospital Units","Psychiatric Unit",null,"Psychiatric Hospital Unit","In general, a distinct unit of a hospital that provides acute or long-term care to emotionally disturbed patients, including patients admitted for diagnosis and those admitted for treatment of psychiatric problems on the basis of physicians' orders and approved nursing care plans. Long-term care may include intensive supervision to the chronically mentally ill, mentally disordered or other mentally incompetent persons; (2) For Medicare, a distinct part of a general acute care hospital admitting only patients whose admission to the unit is required for active treatment, whose treatment is of an intensity that can be provided only in an inpatient hospital setting, and whose condition is described by a psychiatric principal diagnosis contained in the Third Edition of the American Psychiatric Association Diagnostic and Statistical Manual or in Chapter 5 (Mental Disorders) of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). The unit must furnish, through the use of qualified personnel, psychological services, social work services, psychiatric nursing, occupational therapy, and recreational therapy. The unit must maintain medical records that permit determination of the degree and intensity of treatment provided to individuals who are furnished services in the unit; the unit must meet special staff requirements in that the unit must have adequate numbers of qualified professional and supportive staff to evaluate inpatients, formulate written, individualized, comprehensive treatment plans, provide active treatment measures and engage in discharge planning.","273R00000X","Source: (1) AHA Annual Survey p. A10 1996 AHA Guide; (2) Code of Federal Regulations #42, Section 412.27.","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Psychiatry & Neurology","Addiction Medicine","Addiction Medicine (Psychiatry & Neurology) Physician","A doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to obtain a Certificate of Added Qualifications in the field of Addiction Medicine","2084A0401X","Source: American Osteopathic Board of Neurology and Psychiatry, 2007 [1/1/2008: definition added, source added; 7/1/2011: modified source]<br><br>Additional Resources: http://www.osteopathic.org/certification","2003-04-01",null,"2011-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Psychiatry & Neurology","Addiction Psychiatry","Addiction Psychiatry Physician","Addiction Psychiatry is a subspecialty of psychiatry that focuses on evaluation and treatment of individuals with alcohol, drug, or other substance-related disorders, and of individuals with dual diagnosis of substance-related and other psychiatric disorders.","2084P0802X","Source:  The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition]","2003-04-01",null,"2007-01-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Psychiatry & Neurology","Behavioral Neurology & Neuropsychiatry","Behavioral Neurology & Neuropsychiatry Physician","Behavioral Neurology & Neuropsychiatry is a medical subspecialty involving the diagnosis and treatment of neurologically based behavioral issues.","2084B0040X","Source: National Uniform Claim Committee. [1/1/2012: new]  Additional Resources:  American Academy of Neurology, www.aan.com.","2012-04-01",null,null,"Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Psychiatry & Neurology","Brain Injury Medicine","Brain Injury Medicine (Psychiatry & Neurology) Physician","A Brain Injury Medicine physician specializes in disorders of brain function due to injury and disease.  These disorders encompass a range of medical, physical, neurologic, cognitive, sensory, and behavioral disorders that result in psychosocial, educational, and vocational consequences.","2084P0301X","Source: American Board of Physical Medicine and Rehabilitation, 2015. www.abpmr.org [1/1/2016: new]","2016-04-01",null,null,"Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Psychiatry & Neurology","Child & Adolescent Psychiatry","Child & Adolescent Psychiatry Physician","Child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence.","2084P0804X","Source:  The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition]","2003-04-01",null,"2007-01-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Psychiatry & Neurology","Clinical Neurophysiology","Clinical Neurophysiology Physician","Clinical Neurophysiology is a subspecialty with psychiatric or neurologic expertise in the diagnosis and management of central, peripheral, and autonomic nervous system disorders using combined clinical evaluation and electrophysiologic testing such as electroencephalography (EEG), electromyography (EMG), and nerve conduction studies (NCS).","2084N0600X","Source:  The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition]","2003-04-01",null,"2007-01-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Psychiatry & Neurology","Diagnostic Neuroimaging","Diagnostic Neuroimaging (Psychiatry & Neurology) Physician","A licensed physician, who has completed a residency program in Neurology, and who has additional training, experience, and competence in the standards of performance and interpretation of Magnetic Resonance Imaging (MRI / MRA) of the head, spine, and peripheral nerves, and Computed Tomography (CT) of the head and spine. Physicians are trained in the administration of contrast media and the recognition and treatment of adverse reactions to contrast media. Neuroimaging training encompasses thorough knowledge of clinical neurology, neurophysiology, neuroanatomy, neurochemistry, neuropharmacology, and dynamics of cerebrospinal fluid circulation.  Physicians possess special expertise in the technical aspects and clinical applications of each of the modalities and techniques of neuroimaging.","2084D0003X","Source:  American Academy of Neurology, www.aan.com [1/1/2007: new]","2007-04-01",null,null,"Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Psychiatry & Neurology","Forensic Psychiatry","Forensic Psychiatry Physician","Forensic Psychiatry is a subspecialty with psychiatric focus on interrelationships with civil, criminal and administrative law, evaluation and specialized treatment of individuals involved with the legal system, incarcerated in jails, prisons, and forensic psychiatry hospitals.","2084F0202X","Source:  The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition]","2003-04-01",null,"2007-01-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Psychiatry & Neurology","Geriatric Psychiatry","Geriatric Psychiatry Physician","Geriatric Psychiatry is a subspecialty with psychiatric expertise in prevention, evaluation, diagnosis and treatment of mental and emotional disorders in the elderly, and improvement of psychiatric care for healthy and ill elderly patients.","2084P0805X","Source:  The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition]","2003-04-01",null,"2007-01-01","Keep - Clarify in Specs FAQ or Stakeholder Feedback, etc. that the eligible physician or clinician is at the Classification level, and any subspecialization can be found under the Area of Specialization level. For example, a physician may have a pediatric subspecialty (Area of Specialization) but not necessarily be a pediatrics physician (Classification).","Yes"]
["Allopathic & Osteopathic Physicians","Psychiatry & Neurology","Hospice and Palliative Medicine","Hospice and Palliative Medicine (Psychiatry & Neurology) Physician","A psychiatrist or neurologist with special knowledge and skills to prevent and relieve the suffering experienced by patients with life-limiting illnesses. This specialist works with an interdisciplinary hospice or palliative care team to maximize quality of life while addressing physical, psychological, social and spiritual needs of both patient and family throughout the course of the disease, through the dying process, and beyond for the family.  This specialist has expertise in the assessment of patients with advanced disease; the relief of distressing symptoms; the coordination of interdisciplinary patient and family-centered care in diverse venues; the use of specialized care systems including hospice; the management of the imminently dying patient; and legal and ethical decision making in end-of-life care.","2084H0002X","Source: American Academy of Hospice and Palliative Medicine, www.aahpm.org [1/1/2007: new]","2007-04-01",null,null,"Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Psychiatry & Neurology","Neurocritical Care","Neurocritical Care Physician","The medical subspecialty of Neurocritical Care is devoted to the comprehensive, multisystem care of the critically-ill neurological patient. Like other intensivists, the neurointensivist generally assumes the primary role for coordinating the care of his or her patients in the ICU, both the neurological and medical management of the patient.  They may also provide consultative services for these patients as requested within the health system.","2084A2900X","Source: Adapted from the United Council for Neurologic Subspecialties website definition at: http://www.ucns.org/go/subspecialty/neurocritical [7/1/2016: new]","2016-10-01",null,null,"Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Psychiatry & Neurology","Neurodevelopmental Disabilities","Neurodevelopmental Disabilities Physician Physician","A pediatrician or neurologist who specializes in the diagnosis and management of chronic conditions that affect the developing and mature nervous system such as cerebral palsy, mental retardation and chronic behavioral syndromes, or neurologic conditions. ","2084P0005X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition changed, source added]    Additional Resources: American Board of Psychiatry and Neurology, 2007.  http://www.abpn.org/.      Board certification for Medical Doctors (MDs) is provided by the American Board of Psychiatry and Neurology.    A subspecialty certificate for NDN was approved by the ABMS in 1999.    ACGME Accredited Residency Program Requirements:  Ongoing early discussions regarding proposal.","2003-04-01",null,"2007-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Psychiatry & Neurology","Neurology","Neurology Physician","A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures.","2084N0400X","Source:  The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition]","2003-04-01",null,"2007-01-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Psychiatry & Neurology","Neurology with Special Qualifications in Child Neurology","Neurology with Special Qualifications in Child Neurology Physician","A Child Neurologist specializes in neurology with special skills in diagnosis and treatment of neurologic disorders of the neonatal period, infancy, early childhood, and adolescence.","2084N0402X","Source:  The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition]","2003-04-01",null,"2007-01-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Psychiatry & Neurology","Neuromuscular Medicine","Neuromuscular Medicine (Psychiatry & Neurology) Physician","A neurologist or child neurologist who specializes in the diagnosis and management of disorders of nerve, muscle or neuromuscular junction, including amyotrophic lateral sclerosis, peripheral neuropathies (e.g., diabetic and immune mediated neuropathies), various muscular dystrophies, congenital and acquired myopathies, inflammatory myopathies (e.g., polymyositis, inclusion body myositis) and neuromuscular transmission disorders (e.g., myasthenia gravis, Lambert-Eaton myasthenic syndrome).","2084N0008X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: new]    Additional Resources: American Board of Psychiatry and Neurology, 2007.  http://www.abpn.org/.    Board certification for Medical Doctors (MDs) is provided by the American Board of Psychiatry and Neurology","2007-10-01",null,null,"Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Psychiatry & Neurology","Obesity Medicine","Obesity Medicine (Psychiatry & Neurology) Physician","A physician who specializes in the treatment of obesity demonstrates competency in and a thorough understanding of the treatment of obesity and the genetic, biologic, environmental, social, and behavioral factors that contribute to obesity. The obesity medicine physician employs therapeutic interventions including diet, physical activity, behavioral change, and pharmacotherapy. The obesity medicine physician utilizes a comprehensive approach, and may include additional resources such as dietitians, exercise physiologists, mental health professionals and bariatric surgeons as indicated to achieve optimal results. Additionally, the obesity medicine physician maintains competency in providing pre- peri- and post-surgical care of bariatric surgery patients, promotes the prevention of obesity, and advocates for those who suffer from obesity.","2084B0002X","Source:  American Board of Obesity Medicine, www.abom.org [10/1/2007: new, 7/1/2015: title and definition modified]  Additional Resource: American Society of Bariatric Physicians, www.asbp.org.","2007-10-01",null,null,"Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Psychiatry & Neurology","Pain Medicine","Pain Medicine (Psychiatry & Neurology) Physician","A neurologist, child neurologists or psychiatrist who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic or cancer pain in both hospital and ambulatory settings. Patient care needs may also be coordinated with other specialists.","2084P2900X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition changed, source added]    Additional Resources: American Board of Psychiatry and Neurology, 2007.  http://www.abpn.org/.      Board certification for Medical Doctors (MDs) is provided by the American Board of Psychiatry and Neurology.    A subspecialty certificate was approved by ABMS in 1998.    ACGME Accredited Residency Program Requirements:  None.","2003-04-01",null,"2007-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Psychiatry & Neurology","Psychiatry","Psychiatry Physician","A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems.","2084P0800X","Source:  The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition]","2003-04-01",null,"2007-01-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Psychiatry & Neurology","Psychosomatic Medicine","Psychosomatic Medicine Physician","Psychosomatic Medicine is subspecialty in the diagnosis and treatment of psychiatric disorders and symptoms in complex medically ill patients. This subspecialty includes treatment of patients with acute or chronic medical, neurological, obstetrical or surgical illness in which psychiatric illness is affecting their medical care and/or quality of life such as HIV infection, organ transplantation, heart disease, renal failure, cancer, stroke, traumatic brain injury, high-risk pregnancy and COPD, among others. Patients also may be those who have a psychiatric disorder that is the direct consequence of a primary medical condition, or a somatoform disorder or psychological factors affecting a general medical condition. Psychiatrists specializing in Psychosomatic Medicine provide consultation-liaison services in general medical hospitals, attend on medical psychiatry inpatient units, and provide collaborative care in primary care and other outpatient settings.","2084P0015X","Source:  The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new]","2007-04-01",null,null,"Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Psychiatry & Neurology","Sleep Medicine","Sleep Medicine (Psychiatry & Neurology) Physician","A Psychiatrist or Neurologist who practices Sleep Medicine is certified in the subspecialty of sleep medicine and specializes in the clinical assessment, physiologic testing, diagnosis, management and prevention of sleep and circadian rhythm disorders. Sleep specialists treat patients of any age and use multidisciplinary approaches. Disorders managed by sleep specialists include, but are not limited to, sleep related breathing disorders, insomnia, hypersomnias, circadian rhythm sleep disorders, parasomnias and sleep related movement disorders.","2084S0012X","Source: American Academy of Sleep Medicine, www.aasm.org [7/1/2006: new]","2006-10-01",null,null,"Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Psychiatry & Neurology","Sports Medicine","Sports Medicine (Psychiatry & Neurology) Physician","A psychiatrist or neurologist who specializes in the diagnosis and treatment of sports related conditions and injuries.","2084S0010X","Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added]   Additional Resources: A Certification of Added Qualifications (CAQ) was, but is no longer issued by the American Osteopathic Board of Neurology and Psychiatry.","2003-04-01",null,"2010-01-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Psychiatry & Neurology","Vascular Neurology","Vascular Neurology Physician","Vascular Neurology is a subspecialty in the evaluation, prevention, treatment and recovery from vascular diseases of the nervous system. This subspecialty includes the diagnosis and treatment of vascular events of arterial or venous origin from a large number of causes that affect the brain or spinal cord such as ischemic stroke, intracranial hemorrhage, spinal cord ischemia and spinal cord hemorrhage.","2084V0102X","Source:  The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition]","2003-04-01",null,"2007-01-01","Keep - No Change","Yes"]
["Behavioral Health & Social Service Providers","Psychoanalyst",null,"Psychoanalyst","Psychoanalysis is a comprehensive, theoretical framework which, when applied to a treatment process, consists of an intensive verbal, therapeutic relationship between an analyst and an analysand which aims for symptom relief, emotional growth, and personal integration. The psychoanalytic treatment process includes, but is not limited to, the recognition of unconscious processes and conflicts; the significance of developmental influences; and the impact of resistances, defenses, transference and countertransference phenomena. Treatment is enhanced by an understanding developed in the analyst's training and personal analysis of unconscious manifestations, such as dreams, slips of the tongue, fantasies and day dreams. Psychoanalytic technique varies in relation to theoretical orientation.","102L00000X","Source:  Registry of Psychoanalysts published by the National Association for the Advancement of Psychoanalysis [1/1/2007: new; 7/1/2007: definition changed, source changed]","2007-04-01",null,"2007-07-01","Delete - not a DPP measure","No"]
["Behavioral Health & Social Service Providers","Psychologist",null,"Psychologist","A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health.  The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation.  Psychological services may be rendered to individuals, families, groups and the public.","103T00000X","Source:  American Psychological Association [1/1/2007: modified definition]","2002-04-01",null,"2007-01-01","Delete - not a DPP measure","No"]
["Behavioral Health & Social Service Providers","Psychologist","Addiction (Substance Use Disorder)","Addiction (Substance Use Disorder) Psychologist ","A psychologist with a proficiency that involves the application of psychological treatment of addiction stemming from the use of alcohol and other psychoactive substances (e.g., nicotine, marijuana, cocaine, heroin) or behavioral addictions (e.g., gambling) with the aim of cessation or reduction of use and/or the amelioration of emotional, behavioral, interpersonal and other problems arising from the addictive behavior.","103TA0400X","Source: American Psychological Association, www.apa.org  [1/1/2019: new definition]<br/><br/>Additional Resources:  The APA proficiency is Addiction Psychology.","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Behavioral Health & Social Service Providers","Psychologist","Adult Development & Aging","Adult Development & Aging Psychologist","A psychologist who specializes in geropsychology, which applies the knowledge and methods of psychology to understanding and helping older persons and their families to maintain well-being, overcome problems and achieve maximum potential during later life. Professional geropsychology appreciates the wide diversity among older adults, the complex ethical issues that can arise in geriatric practice and the importance of interdisciplinary models of care.","103TA0700X","Source:  American Psychological Association, www.apa.org  [1/1/2019: new definition]<br/><br/>Additional Resources:  The APA specialty is \"Geropsychology.\"","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Behavioral Health & Social Service Providers","Psychologist","Clinical","Clinical Psychologist","A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.","103TC0700X","Source:  American Psychological Association, www.apa.org  [1/1/2019: new definition]","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Behavioral Health & Social Service Providers","Psychologist","Clinical Child & Adolescent","Clinical Child & Adolescent Psychologist","A psychologist who develops and applies scientific knowledge to the delivery of psychological services to infants, toddlers, children and adolescents within their social context.  Of particular importance to the specialty of clinical child psychology is an understanding of the basic psychological needs of children and adolescents, and how the family and other social contexts influence the socio-emotional adjustment, cognitive development, behavioral adaptation and health status of children and adolescents.","103TC2200X","Source:  American Psychological Association, www.apa.org  [1/1/2007: title modified, 1/1/2019: new definition]<br/><br/>Additional Resources:  The APA specialty is \"Clinical Child Psychology.\"","2002-04-01",null,"2007-01-01","Delete - not a DPP measure","No"]
["Behavioral Health & Social Service Providers","Psychologist","Cognitive & Behavioral","Cognitive & Behavioral Psychologist","A psychologist who reflects an experimental-clinical approach distinguished by use of principles of human learning and development and theories of cognitive processing to promote meaningful change in maladaptive human behavior and thinking.","103TB0200X","Source:  American Psychological Association, www.apa.org  [1/1/2007: title modified, 1/1/2019: new definition]<br/><br/>Additional Resources:  The APA specialty is \"Behavioral and Cognitive Psychology.\"","2002-04-01",null,"2007-01-01","Delete - not a DPP measure","No"]
["Behavioral Health & Social Service Providers","Psychologist","Counseling","Counseling Psychologist","A psychologist who specializes in general practice and health service. It focuses on how people function both personally and in their relationships at all ages. Counseling psychology addresses the emotional, social, work, school and physical health concerns people may have at different stages in their lives, focusing on typical life stresses and more severe issues with which people may struggle as individuals and as a part of families, groups and organizations. Counseling psychologists help people with physical, emotional and mental health issues improve their sense of well-being, alleviate feelings of distress and resolve crises. They also provide assessment, diagnosis, and treatment of more severe psychological symptoms.","103TC1900X","Source:  American Psychological Association, www.apa.org  [1/1/2019: new definition]","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Behavioral Health & Social Service Providers","Psychologist","Educational","Deactivated - Psychologist",null,"103TE1000X","[1/1/2007: marked inactive]","2002-04-01","2007-03-31",null,"Delete - deactivated","No"]
["Behavioral Health & Social Service Providers","Psychologist","Exercise & Sports","Exercise & Sports Psychologist","A psychologist with a proficiency in sports psychology that uses psychological knowledge and skills to address optimal performance and well-being of athletes, developmental and social aspects of sports participation, and systemic issues associated with sports settings and organizations. APA recognizes sport psychology as a proficiency acquired after a doctoral degree in one of the primary areas of psychology and licensure as a psychologist. This proficiency does not include those who have earned a doctoral degree in sport psychology but are not licensed psychologists. \t Sport Psychology interventions are designed to assist athletes and other sports participants (e.g., coaches, administrators, parents) from a wide array of settings, levels of competition, and ages, ranging from recreational youth participants to professional and Olympic athletes to master's level performers.","103TE1100X","Source:  American Psychological Association, www.apa.org  [1/1/2019: new definition]<br/><br/>Additional Resources:  The APA proficiency is \"Sport Psychology.\"","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Behavioral Health & Social Service Providers","Psychologist","Family","Family Psychologist","A psychologist whose specialty is founded on principles of systems theory with the interpersonal system of the family the focus of assessment, intervention and research.","103TF0000X","Source:  American Psychological Association, www.apa.org  [1/1/2019: new definition]<br/><br/>Additional Resources:  The APA specialty is \"Couple and Family Psychology.\"","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Behavioral Health & Social Service Providers","Psychologist","Forensic","Forensic Psychologist","A psychologist whose specialty is characterized by activities primarily intended to provide professional psychological expertise within the judicial and legal systems.","103TF0200X","Source:  American Psychological Association, www.apa.org  [1/1/2019: new definition]","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Behavioral Health & Social Service Providers","Psychologist","Group Psychotherapy","Group Psychotherapy Psychologist","A psychologist who specializes in group psychology and group psychotherapy that is an evidenced-based specialty that prepares group leaders to identify and capitalize on developmental and healing possibilities embedded in the interpersonal/intrapersonal functioning of individual group members as well as collectively for the group.  Emphasis is placed on the use of group dynamics to assist and treat individual group members.  The specialty is applicable to all age groups, children, adolescents, adults and older adults, for a wide variety of conditions and concerns, and in numerous and diverse settings.","103TP2701X","Source:  American Psychological Association, www.apa.org  [1/1/2007: modified title, 1/1/2019: new definition]<br/><br/>Additional Resources:  The APA specialty is \"Group Psychology and Group Psychotherapy.\"","2002-04-01",null,"2007-01-01","Delete - not a DPP measure","No"]
["Behavioral Health & Social Service Providers","Psychologist","Health","Health Psychologist","A psychologist who specializes in clinical health psychology that investigates and implements clinical services across diverse populations and settings to promote health and well-being and to prevent, treat, and manage illness and disability.  Clinical health psychology sees health as the confluence of psychological, social, cultural, and biological factors and applies this understanding to professional activities including:<br><br>* Research<br><br>* Clinical service<br><br>* Consulting with, educating, and supervising other health care providers and psychologists<br><br>* Advising organizations, institutions, the public, and policymakers","103TH0004X","Source:  American Psychological Association, www.apa.org    [1/1/2007: new, 7/1/2008: definition added, source added, 1/1/2019: definition modified, source modified]  Additional Resources:  The APA specialty is \"Clinical Health Psychology.\"","2007-04-01",null,null,"Delete - not a DPP measure","No"]
["Behavioral Health & Social Service Providers","Psychologist","Health Service","Health Service Psychologist","A psychologist, certified/licensed at the independent practice level in his/her state, who is duly trained and experienced in the delivery of direct, preventative, assessment, and therapeutic intervention services to individuals whose growth, adjustment, or functioning is actually impaired or is demonstrably at high risk of impairment (1974).","103TH0100X","Source:  National Register of Health Service Providers in Psychology website http://www.nationalregister.org/about_NR.html [7/1/2006: modified title, added definition]","2002-04-01",null,"2006-07-01","Delete - not a DPP measure","No"]
["Behavioral Health & Social Service Providers","Psychologist","Men & Masculinity","Deactivated - Psychologist Men & Masculinity",null,"103TM1700X","[1/1/2007: marked inactive]","2002-04-01","2007-03-31",null,"Delete - deactivated","No"]
["Behavioral Health & Social Service Providers","Psychologist","Intellectual & Developmental Disabilities","Intellectual & Developmental Disabilities Psychologist","Definition to come...","103TM1800X","[1/1/2021: modified title]","2002-04-01",null,"2021-01-01","Delete - not a DPP measure","No"]
["Behavioral Health & Social Service Providers","Psychologist","Prescribing (Medical)","Prescribing (Medical) Psychologist","A licensed, doctoral-level psychologist authorized to prescribe and has undergone specialized education and training in preparation for prescriptive practice and has passed an examination accepted by the state board of psychology relevant to establishing competence for prescribing, and has received from the state board of psychology a current certificate granting prescriptive authority, which has not been revoked or suspended.","103TP0016X","Source:  American Psychological Association, www.apa.org    [1/1/2007: new, 1/1/2019: definition modified, source modified]","2007-04-01",null,null,"Delete - not a DPP measure","No"]
["Behavioral Health & Social Service Providers","Psychologist","Psychoanalysis","Psychoanalysis Psychologist","A psychologist whose specialty is distinguished from other specialties by its body of knowledge and its intensive treatment approaches. It aims at structural changes and modifications of a person's personality. Psychoanalysis promotes awareness of unconscious, maladaptive and habitually recurrent patterns of emotion and behavior, allowing previously unconscious aspects of the self to become integrated and promoting optimal functioning, healing and creative expression.","103TP0814X","Source:  American Psychological Association, www.apa.org [1/1/2019, definition modified, source modified]","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Behavioral Health & Social Service Providers","Psychologist","Psychotherapy","Deactivated - Psychologist Psychotherapy",null,"103TP2700X","[1/1/2007: marked inactive]","2002-04-01","2007-03-31",null,"Delete - deactivated","No"]
["Behavioral Health & Social Service Providers","Psychologist","Rehabilitation","Rehabilitation Psychologist","A psychologist who specializes in the study and application of psychological principles on behalf of persons who have disability due to injury or illness. Rehabilitation psychologists, often within teams, assess and treat cognitive, emotional, and functional difficulties, and help people to overcome barriers to participation in life activities. Rehabilitation psychologists are involved in practice, research, and advocacy, with the broad goal of fostering independence and opportunity for people with disabilities.","103TR0400X","Source: American Psychological Association, www.apa.org [1/1/2019: definition added]","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Behavioral Health & Social Service Providers","Psychologist","School","School Psychologist","A psychologist whose specialty is concerned with the science and practice of psychology with children, youth, families; learners of all ages; and the schooling process. The basic education and training of school psychologists prepares them to provide a range of psychological diagnosis, assessment, intervention, prevention, health promotion, and program development and evaluation services with a special focus on the developmental processes of children and youth within the context of schools, families and other systems.  School psychologists are prepared to intervene at the individual and system level, and develop, implement, and evaluate preventive programs. In these efforts, they conduct ecologically valid assessments and intervene to promote positive learning environments within which children and youth from diverse backgrounds to ensure that all have equal access to effective educational and psychological services that promote healthy development","103TS0200X","Source:  American Psychological Association, www.apa.org [1/1/2019: definition added]","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Behavioral Health & Social Service Providers","Psychologist","Women","Deactivated - Psychotherapy Women",null,"103TW0100X","[1/1/2007: marked inactive]","2002-04-01","2007-03-31",null,"Delete - deactivated","No"]
["Agencies","Public Health or Welfare",null,"Public Health or Welfare Agency","Definition to come...","251K00000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Pulmonary Function Technologist",null,"Pulmonary Function Technologist","An individual who is trained and qualified to perform pulmonary diagnostic tests.  In the course of conducting these tests, the Pulmonary Function Technologist is able to setup, calibrate, maintain, and ensure the quality assurance of the pulmonary function testing equipment.  In the laboratory, clinical or patient care setting the technologist instructs patients, elicits cooperation, performs procedures, monitors patient response, and evaluates patient performance.  Tests results are calculated, compared with predicted normal ranges, and evaluated for reliability.  The technologist collects clinical history data and evaluates the clinical implications of the test results.","225B00000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Technologists, Technicians & Other Technical Service Providers","Radiologic Technologist",null,"Radiologic Technologist","An individual who is trained and qualified in the art and science of both ionizing and non-ionizing radiation for the purposes of diagnostic medical imaging, interventional procedures and therapeutic treatment.","247100000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Technologists, Technicians & Other Technical Service Providers","Radiologic Technologist","Bone Densitometry","Bone Densitometry Radiologic Technologist","Definition to come.","2471B0102X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Technologists, Technicians & Other Technical Service Providers","Radiologic Technologist","Cardiac-Interventional Technology","Cardiac-Interventional Technology Radiologic Technologist","Definition to come.","2471C1106X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Technologists, Technicians & Other Technical Service Providers","Radiologic Technologist","Cardiovascular-Interventional Technology","Cardiovascular-Interventional Technology Radiologic Technologist","Definition to come...","2471C1101X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Technologists, Technicians & Other Technical Service Providers","Radiologic Technologist","Computed Tomography","Computed Tomography Radiologic Technologist","Definition to come...","2471C3401X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Technologists, Technicians & Other Technical Service Providers","Radiologic Technologist","Magnetic Resonance Imaging","Magnetic Resonance Imaging Radiologic Technologist","Definition to come...","2471M1202X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Technologists, Technicians & Other Technical Service Providers","Radiologic Technologist","Mammography","Mammography Radiologic Technologist","Definition to come...","2471M2300X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Technologists, Technicians & Other Technical Service Providers","Radiologic Technologist","Nuclear Medicine Technology","Nuclear Medicine Technology Radiologic Technologist","Definition to come.","2471N0900X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Technologists, Technicians & Other Technical Service Providers","Radiologic Technologist","Quality Management","Quality Management Radiologic Technologist","Definition to come...","2471Q0001X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Technologists, Technicians & Other Technical Service Providers","Radiologic Technologist","Radiation Therapy","Radiation Therapy Radiologic Technologist","Definition to come...","2471R0002X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Technologists, Technicians & Other Technical Service Providers","Radiologic Technologist","Radiography","Radiography Radiologic Technologist","Definition to come...","2471C3402X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Technologists, Technicians & Other Technical Service Providers","Radiologic Technologist","Sonography","Sonography Radiologic Technologist","Definition to come...","2471S1302X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Technologists, Technicians & Other Technical Service Providers","Radiologic Technologist","Vascular Sonography","Vascular Sonography Radiologic Technologist","Definition to come.","2471V0105X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Technologists, Technicians & Other Technical Service Providers","Radiologic Technologist","Vascular-Interventional Technology","Vascular-Interventional Technology Radiologic Technologist","Definition to come.","2471V0106X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Radiology","Body Imaging","Body Imaging Physician","A Radiology doctor of Osteopathy that specializes in Body Imaging.","2085B0100X","Source: National Uniform Claim Committee, 2008   [7/1/2008: definition added, source added]    Additional Resources: The American Osteopathic Board of Radiology no longer offers a certificate in this specialty.","2003-04-01",null,null,"Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Radiology","Diagnostic Neuroimaging","Diagnostic Neuroimaging (Radiology) Physician","A licensed physician, who has completed a residency program in Neurology, and who has additional training, experience, and competence in the standards of performance and interpretation of Magnetic Resonance Imaging (MRI / MRA) of the head, spine, and peripheral nerves, and Computed Tomography (CT) of the head and spine. Physicians are trained in the administration of contrast media and the recognition and treatment of adverse reactions to contrast media. Neuroimaging training encompasses thorough knowledge of clinical neurology, neurophysiology, neuroanatomy, neurochemistry, neuropharmacology, and dynamics of cerebrospinal fluid circulation.  Physicians possess special expertise in the technical aspects and clinical applications of each of the modalities and techniques of neuroimaging.","2085D0003X","Source:  American Academy of Neurology, www.aan.com [1/1/2007: new]","2007-04-01",null,null,"Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Radiology","Diagnostic Radiology","Diagnostic Radiology Physician","A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.","2085R0202X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Radiology, 2007.  http://www.theabr.org/.   American Osteopathic Board of Radiology, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology.","2003-04-01",null,"2011-07-01","Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Radiology","Diagnostic Ultrasound","Diagnostic Ultrasound Physician","A Radiology doctor of Osteopathy that specializes in Diagnostic Ultrasound.","2085U0001X","Source: National Uniform Claim Committee, 2008   [7/1/2008: definition added, source added]    Additional Resources: The American Osteopathic Board of Radiology no longer offers a certificate in this specialty.  [Note: In medical practice, Diagnostic Ultrasound is part of the scope of training and practice of a Diagnostic Radiologists - see Taxonomy Code 2085R0202X.]","2003-04-01",null,null,"Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Radiology","Hospice and Palliative Medicine","Hospice and Palliative Medicine (Radiology) Physician","A radiologist with special knowledge and skills to prevent and relieve the suffering experienced by patients with life-limiting illnesses. This specialist works with an interdisciplinary hospice or palliative care team to maximize quality of life while addressing physical, psychological, social and spiritual needs of both patient and family throughout the course of the disease, through the dying process, and beyond for the family.  This specialist has expertise in the assessment of patients with advanced disease; the relief of distressing symptoms; the coordination of interdisciplinary patient and family-centered care in diverse venues; the use of specialized care systems including hospice; the management of the imminently dying patient; and legal and ethical decision making in end-of-life care.","2085H0002X","Source: American Academy of Hospice and Palliative Medicine, www.aahpm.org [1/1/2007: new]","2007-04-01",null,null,"Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Radiology","Neuroradiology","Neuroradiology Physician","A radiologist who diagnoses and treats diseases utilizing imaging procedures as they relate to the brain, spine and spinal cord, head, neck and organs of special sense in adults and children.","2085N0700X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Radiology, 2007.  http://www.theabr.org/.   American Osteopathic Board of Radiology, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology.","2003-04-01",null,"2011-07-01","Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Radiology","Nuclear Radiology","Nuclear Radiology Physician","A radiologist who is involved in the analysis and imaging of radionuclides and radiolabeled substances in vitro and in vivo for diagnosis and the administration of radionuclides and radiolabeled substances for the treatment of disease.","2085N0904X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Radiology, 2007.  http://www.theabr.org/.   American Osteopathic Board of Radiology, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology.","2003-04-01",null,"2011-07-01","Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Radiology","Pediatric Radiology","Pediatric Radiology Physician","A radiologist who is proficient in all forms of diagnostic imaging as it pertains to the treatment of diseases in the newborn, infant, child and adolescent. This specialist has knowledge of both imaging and interventional procedures related to the care and management of diseases of children. A pediatric radiologist must be highly knowledgeable of all organ systems as they relate to growth and development, congenital malformations, diseases peculiar to infants and children and diseases that begin in childhood but cause substantial residual impairment in adulthood.","2085P0229X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Radiology, 2007.  http://www.theabr.org/.   American Osteopathic Board of Radiology, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology.","2003-04-01",null,"2011-07-01","Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Radiology","Radiation Oncology","Radiation Oncology Physician","A radiologist who deals with the therapeutic applications of radiant energy and its modifiers and the study and management of disease, especially malignant tumors.","2085R0001X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]<br><br>Additional Resources: American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification","2003-04-01",null,"2011-07-01","Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Radiology","Radiological Physics","Radiological Physics Physician","A radiological physicist deals with the diagnostic and therapeutic applications of roentgen rays, gamma rays from sealed sources, ultrasonic radiation and radio-frequency radiation, as well as the equipment associated with their production and use, including radiation safety.","2085R0205X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added]    Additional Resources: American Board of Radiology, 2007.  http://www.theabr.org/.    Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology.","2003-04-01",null,"2007-07-01","Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Radiology","Therapeutic Radiology","Therapeutic Radiology Physician","Definition to come...","2085R0203X",null,"2003-04-01",null,null,"Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Radiology","Vascular & Interventional Radiology","Vascular & Interventional Radiology Physician","A radiologist who diagnoses and treats diseases by various radiologic imaging modalities. These include fluoroscopy, digital radiography, computed tomography, sonography and magnetic resonance imaging.","2085R0204X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added]    Additional Resources: American Board of Radiology, 2007.  http://www.theabr.org/.    Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology.","2003-04-01",null,"2007-07-01","Delete - not a DPP measure","No"]
["Technologists, Technicians & Other Technical Service Providers","Radiology Practitioner Assistant",null,"Radiology Practitioner Assistant","A Radiology Practitioner Assistant (RPA) is a health professional certified as a registered radiographer with the American Registry of Radiologic Technologists (ARRT) and, in addition, is credentialed to provide primary radiology health care with radiologist supervision. Radiology Practitioner Assistants are qualified by graduation from an educational program recognized by the Board of Directors of athe Certification Board for Radiology Practitioner Assistants (CBRPA) and certified by the CBRPA. Within the Radiologist/RPA relationship, Radiology Practitioner Assistants exercise autonomy in decision making in the role of a primary caregiver with regard to patient assessment, patient management and in providing a broad range of radiology diagnostic and interventional services. The clinical role of the Radiology Practitioner Assistant includes primary and specialty care in radiology practice settings in rural and urban areas.","243U00000X","Source: Certification Board of Radiology Practitioner Assistants [7/1/2008: new]  Additional Resources: www.cbrpa.org","2008-10-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Recreation Therapist",null,"Recreation Therapist","A recreation therapist uses recreational activities for intervention in some physical, social or emotional behavior to bring about a desired change in that behavior and promote the growth and development of the patient.","225800000X","Source: Joel A. DeLisa and Bruce M. Gans, Rehabilitation Medicine: Principles and Practice Second Edition, J.B. Lippincott Company, Philadelphia: 1993, p. 7","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Recreational Therapist Assistant",null,"Recreational Therapist Assistant","Recreational Therapist Assistants work in support of or assistant to Recreational Therapists treating patients with disabilities, injuries, and illnesses.  Recreational Therapist Assistants work in a variety of settings providing treatments using recreational activities, including games, sports, and crafts.","226000000X","Source:  National Uniform Claim Committee, 2015   [1/1/2016: new]","2016-04-01",null,null,"Delete - not a DPP measure","No"]
["Other Service Providers","Reflexologist",null,"Reflexologist","Reflexologists perform a non-invasive complementary modality involving thumb and finger techniques to apply alternating pressure to the reflexes within the reflex maps of the body located on the feet, hands, and outer ears. Reflexologists apply pressure to specific areas (feet, hands, and ears) to promote a response from an area far removed from the tissue stimulated via the nervous system and acupuncture meridians. Reflexologists are recommended to complete a minimum of 200 hours of education, typically including anatomy & physiology, Reflexology theory, body systems, zones, meridians & relaxation response, ethics, business standards, and supervised practicum.","173C00000X","Source: National Uniform Claim Committee (based on the American Reflexology Certification Board definition of Reflexology), 2007  [1/1/2008: new]    Additional Resources:  Foot and hand reflexology is a scientific art based on the premise that there are zones and reflex areas in the feet and hands which correspond to all body parts. The physical act of applying specific pressures using thumb, finger and hand techniques result in stress reduction which causes a physiological change in the body. Reflexology is a non-invasive, complementary modality involving thumb and finger techniques to apply alternating pressure to reflexes shown on reflex maps of the body located on the feet, hands, and outer ears.  American Reflexology Certification Board, www.arcb.net/definiti.htm; Reflexology Association of America, www.reflexology-usa.org/standards.html ","2008-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse",null,"Registered Nurse","(1) A registered nurse is a person qualified by graduation from an accredited nursing school (depending upon schooling, a registered nurse may receive either a diploma from a hospital program, an associate degree in nursing (A.D.N.) or a Bachelor of Science degree in nursing (B.S.N.), who is licensed or certified by the state, and is practicing within the scope of that license or certification. R.N.'s assist patient in recovering and maintaining their physical or mental health. They assist physicians during treatments and examinations and administer medications. (2) A provider who is trained and educated in a formal nursing education program at an accredited school of nursing, passes a national certification examination, and is licensed by the state to practice nursing. The individual provides nursing services to patients or clients in areas such as health promotion, disease prevention, acute and chronic care and restoration and maintenance of health across the life span.","163W00000X","Sources: (2) American Nurses Association, American Nurses Credentialing Center, 1996 Certification Catalogue, and Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988.","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Addiction (Substance Use Disorder)","Addiction (Substance Use Disorder) Registered Nurse","Definition to come...","163WA0400X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Administrator","Administrator Registered Nurse","Definition to come...","163WA2000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Ambulatory Care","Ambulatory Care Registered Nurse","Definition to come...","163WP2201X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Cardiac Rehabilitation","Cardiac Rehabilitation Registered Nurse","Definition to come...","163WC3500X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Case Management","Case Management Registered Nurse","Definition to come...","163WC0400X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","College Health","College Health Registered Nurse","Definition to come...","163WC1400X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Community Health","Community Health Registered Nurse","Definition to come...","163WC1500X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Continence Care","Continence Care Registered Nurse","Definition to come...","163WC2100X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Continuing Education/Staff Development","Continuing Education/Staff Development Registered Nurse","Definition to come...","163WC1600X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Critical Care Medicine","Critical Care Medicine Registered Nurse","Definition to come...","163WC0200X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Diabetes Educator","Diabetes Educator Registered Nurse","Definition to come...","163WD0400X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Dialysis, Peritoneal","Peritoneal Dialysis Registered Nurse","Definition to come...","163WD1100X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Emergency","Emergency Registered Nurse","Definition to come...","163WE0003X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Enterostomal Therapy","Enterostomal Therapy Registered Nurse","Definition to come...","163WE0900X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Flight","Flight Registered Nurse","Definition to come...","163WF0300X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Gastroenterology","Gastroenterology Registered Nurse","Definition to come...","163WG0100X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","General Practice","General Practice Registered Nurse","Definition to come...","163WG0000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Gerontology","Gerontology Registered Nurse","Definition to come...","163WG0600X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Hemodialysis","Hemodialysis Registered Nurse","Definition to come...","163WH0500X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Home Health","Home Health Registered Nurse","Definition to come...","163WH0200X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Hospice","Hospice Registered Nurse","Definition to come...","163WH1000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Infection Control","Infection Control Registered Nurse","Definition to come...","163WI0600X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Infusion Therapy","Infusion Therapy Registered Nurse","Definition to come...","163WI0500X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Lactation Consultant","Lactation Consultant (Registered Nurse)","Definition to come...","163WL0100X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Maternal Newborn","Maternal Newborn Registered Nurse","Definition to come...","163WM0102X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Medical-Surgical","Medical-Surgical Registered Nurse","Definition to come...","163WM0705X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Neonatal Intensive Care","Neonatal Intensive Care Registered Nurse","Definition to come...","163WN0002X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Neonatal, Low-Risk","Low-Risk Neonatal Registered Nurse","Definition to come...","163WN0003X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Nephrology","Nephrology Registered Nurse","Definition to come...","163WN0300X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Neuroscience","Neuroscience Registered Nurse","Definition to come...","163WN0800X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Nurse Massage Therapist (NMT)","Nurse Massage Therapist (NMT)","Definition to come...","163WM1400X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Nutrition Support","Nutrition Support Registered Nurse","Definition to come...","163WN1003X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Obstetric, High-Risk","High-Risk Obstetric Registered Nurse","Definition to come...","163WX0002X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Obstetric, Inpatient","Inpatient Obstetric Registered Nurse","Definition to come...","163WX0003X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Occupational Health","Occupational Health Registered Nurse","Definition to come...","163WX0106X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Oncology","Oncology Registered Nurse","Definition to come...","163WX0200X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Ophthalmic","Ophthalmic Registered Nurse","Definition to come...","163WX1100X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Orthopedic","Orthopedic Registered Nurse","Definition to come...","163WX0800X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Ostomy Care","Ostomy Care Registered Nurse","Definition to come...","163WX1500X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Otorhinolaryngology & Head-Neck","Otorhinolaryngology & Head-Neck Registered Nurse","Definition to come...","163WX0601X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Pain Management","Pain Management Registered Nurse","Definition to come...","163WP0000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Pediatric Oncology","Pediatric Oncology Registered Nurse","Definition to come...","163WP0218X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Pediatrics","Pediatric Registered Nurse","Definition to come...","163WP0200X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Perinatal","Perinatal Registered Nurse","Definition to come...","163WP1700X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Plastic Surgery","Plastic Surgery Registered Nurse","Definition to come...","163WS0121X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Psychiatric/Mental Health","Psychiatric/Mental Health Registered Nurse","Definition to come...","163WP0808X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Psychiatric/Mental Health, Adult","Adult Psychiatric/Mental Health Registered Nurse","Definition to come...","163WP0809X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Psychiatric/Mental Health, Child & Adolescent","Child & Adolescent Psychiatric/Mental Health Registered Nurse","Definition to come...","163WP0807X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Registered Nurse First Assistant","Registered Nurse First Assistant","A perioperative registered nurse who works in collaboration with the surgeon and other health care team members to achieve optimal outcomes.  The RNFA has acquired the necessary knowledge, judgment, and skills specific to the expanded role of RNFA clinical practice.  Intraoperatively, the RNFA assists the surgeon.","163WR0006X","Source:  AORN Official Statement on RNFAs ratified by the AORN House of Delegates in 2004. [7/1/2006: new]","2006-10-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Rehabilitation","Rehabilitation Registered Nurse","Definition to come...","163WR0400X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Reproductive Endocrinology/Infertility","Reproductive Endocrinology/Infertility Registered Nurse","Definition to come...","163WR1000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","School","School Registered Nurse","Definition to come...","163WS0200X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Urology","Urology Registered Nurse","Definition to come...","163WU0100X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Women's Health Care, Ambulatory","Ambulatory Women's Health Care Registered Nurse","Definition to come...","163WW0101X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Providers","Registered Nurse","Wound Care","Wound Care Registered Nurse","Definition to come...","163WW0000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Rehabilitation Counselor",null,"Rehabilitation Counselor","An individual trained and educated in a systematic process of assisting persons with physical, mental, developmental, cognitive, and emotional disabilities to achieve their personal, career, and independent living goals assessment and appraisal, diagnosis and treatment planning, career (vocational) counseling, individual and group counseling interventions for adjustments to the medical and psychosocial impact of disability, case management, program evaluation and research, job analysis and placement counseling, and consultation on rehabilitation resources and technology. Certification generally requires a Master's degree with specialized courses in rehabilitation processes and technology.","225C00000X","Sources: Commission on Rehabilitation Counselor Certification and Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988.","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Rehabilitation Counselor","Assistive Technology Practitioner","Assistive Technology Practitioner Rehabilitation Counselor","Definition to come...","225CA2400X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Rehabilitation Counselor","Assistive Technology Supplier","Assistive Technology Supplier Rehabilitation Counselor","Definition to come...","225CA2500X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Rehabilitation Counselor","Orientation and Mobility Training Provider","Orientation and Mobility Training Rehabilitation Counselor","Orientation and Mobility (O&M) specialists teach children and adults who have visual impairments the specific orientation skills used to find one's way in the environment and the mobility skills needed to travel safely and efficiently at home, school, work, and in the community. Instruction is usually provided one-on-one and can include skills such as how to use a long cane, the operation of low vision devices and electronic travel aids when appropriate, how to orient oneself to new environments, navigate public transportation systems, how to cross streets safely, and traveling by using hearing, remaining vision, and other senses.  In addition, O&M Specialists help children to develop fundamental skills such as fine and gross motor skills, concept development and problem solving skills. Adult clients can also benefit from an O&M specialist evaluating their current use of travel-related skills, discussing their future goals, and helping them select a program of instruction that will allow them to reach their greatest travel potential.","225CX0006X","Source:  San Francisco State University Orientation and Mobility Program web site http://online.sfsu.edu/~mobility/ [7/1/2006: new]","2006-10-01",null,null,"Delete - not a DPP measure","No"]
["Hospitals","Rehabilitation Hospital",null,"Rehabilitation Hospital","A hospital or facility that provides health-related, social and/or vocational services to disabled persons to help them attain their maximum functional capacity.","283X00000X","Source: Joint Commission on Accreditation of Healthcare Organizations, Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Oakbrook Terrace, IL: 1994, p. 323","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Hospitals","Rehabilitation Hospital","Children","Children's Rehabilitation Hospital","Definition to come...","283XC2000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Rehabilitation Practitioner",null,"Rehabilitation Practitioner","A health care practitioner who trains or retrains individuals disabled by disease or injury to help them attain their maximum functional capacity.","225400000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Hospital Units","Rehabilitation Unit",null,"Rehabilitation Hospital Unit","In general, a distinct unit of a general acute care hospital that provides care encompassing a comprehensive array of restoration services for the disabled and all support services necessary to help patients attain their maximum functional capacity. Source: AHA Annual Survey p. A10 1996 AHA Guide. For Medicare, a distinct part of a general acute care hospital providing inpatient rehabilitation services that meets the following requirements. Rehabilitation Units have in effect a preadmission screening procedure under which each prospective patient's condition and medical history are reviewed to determine whether the patient is likely to benefit significantly from an intensive inpatient program or assessment; ensure that the patients receive close medical supervision and furnish, through the use of qualified personnel, rehabilitation nursing, physical therapy and occupational therapy, plus, as needed, speech therapy, social services or psychological services and orthotic and prosthetic services; have a plan of treatment for each inpatient that is established, reviewed, and revised as needed by a physician in consultation with other professional personnel who provide services to the patient; use a coordinated multidisciplinary team approach in the rehabilitation of each inpatient, as documented by periodic clinical entries made in the patient's medical record to note the patient's status in relationship to goal attainment, and that team conferences are held at least every two weeks to determine the appropriateness of treatment; have a director of rehabilitation who provides services to the unit and its inpatients for at least 20 hours a week, is a doctor of medicine or osteopathy, is licensed under State law to practice medicine or surgery, and has had, after completing a one-year hospital internship at least two years of training or experience in the medical management of inpatients requiring rehabilitation services.","273Y00000X","Source: Code of Federal Regulations #42, Section 412.29.","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Hospital Units","Rehabilitation, Substance Use Disorder Unit",null,"Substance Use Disorder Rehabilitation Hospital Unit","A distinct part of a hospital that provides medically monitored, interdisciplinary addiction-focused treatment to patients/clients who have psychoactive substance use disorders (commonly referred to as alcohol and drug abuse or substance abuse.)","276400000X","Source: Department of Defense Regulation 6010.8-R, Chapter 6.","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Hospitals","Religious Nonmedical Health Care Institution",null,"Religious Nonmedical Health Care Institution","Furnishes only nonmedical nursing items and services to patients who choose to rely solely upon a religious method of healing, and for whom the acceptance of medical services would be inconsistent with their religious beliefs.  Furnishes nonmedical items and services exclusively through nonmedical nursing personnel who are experienced in caring for the physical needs of nonmedical patients.  For example, caring for the physical needs such as assistance with activities of daily living; assistance in moving, positioning, and ambulation; nutritional needs; and comfort and support measures.  Furnishes nonmedical items and services to inpatients on a 24-hour basis.  Does not furnish, on the basis of religious beliefs, through its personnel or otherwise, medical items and services (including any medical screening, examination, diagnosis, prognosis, treatment, or the administration of drugs) for its patients.","282J00000X","Source:  Centers for Medicare & Medicaid Services, http://www.cms.hhs.gov/CertificationandComplianc/19_RNHCIs.asp#TopOfPage [7/1/2006: new]","2006-10-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Related Providers","Religious Nonmedical Nursing Personnel",null,"Religious Nonmedical Nursing Personnel","Religious nonmedical nursing personnel are experienced in caring for the physical needs of nonmedical patients.  For example, caring for the physical needs such as assistance with activities of daily living; assistance with moving, positioning, and ambulation; nutritional needs; and comfort and support measures.","374T00000X","Source:  Centers for Medicare & Medicaid Services [7/1/2009: title modified, definition modified]  Additional Resources: www.cms.hhs.gov/CertificationandComplianc/19_RNHCIs.asp   2005 Code of Federal Regulations, Title 42, Chapter IV, Part 403, Subpart G, 403.702 Definitions and Terms","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing Service Related Providers","Religious Nonmedical Practitioner",null,"Religious Nonmedical Practitioner","A religious nonmedical practitioner offers spiritually-based care.  Services may be rendered in an office, home, or care facility or by phone, email, or written correspondence.","374K00000X","Source: National Uniform Claim Committee , 2009 [7/1/2009: new]","2009-10-01",null,null,"Delete - not a DPP measure","No"]
["Residential Treatment Facilities","Residential Treatment Facility, Emotionally Disturbed Children",null,"Emotionally Disturbed Childrens' Residential Treatment Facility","A residential facility that provides habilitation services and other care and treatment to children diagnosed with mental health illness, behavioral issues, and intellectual disabilities and are not able to live independently.","322D00000X","Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. [1/1/2021: modified definition]","2002-04-01",null,"2021-01-01","Delete - not a DPP measure","No"]
["Residential Treatment Facilities","Residential Treatment Facility, Intellectual and/or Developmental Disabilities",null,"Intellectual and/or Developmental Disabilities Residential Treatment Facility","A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently.","320600000X","[7/1/2003: new. 1/1/2021: modified title and definition]","2003-10-01",null,"2021-01-01","Delete - not a DPP measure","No"]
["Residential Treatment Facilities","Residential Treatment Facility, Physical Disabilities",null,"Physical Disabilities Residential Treatment Facility","A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with physical disabilities and are not able to live independently.","320700000X","[7/1/2003: new, 1/1/2021: modified definition]","2003-10-01",null,"2021-01-01","Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Respiratory Therapist, Certified",null,"Certified Respiratory Therapist","A Certified Respiratory Therapist (CRT) is a an entry level therapist who has passed a standardized written examination administered by the National Board for Respiratory Care (NBRC).  CRTs provide diagnostic testing, therapeutics, monitoring, rehabilitation, and education to patients with disorders of the cardiopulmonary system.  They provide these respiratory care services in all health care facilities and in the home.  A CRT is a graduate of an associate degree program approved by the Commission on Accreditation of Allied Health Educational Programs (CAAHEP) and where applicable, is licensed by the state and is practicing within the scope of the license.","227800000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Respiratory Therapist, Certified","Critical Care","Critical Care Certified Respiratory Therapist","Respiratory emergencies are commonplace in the treatment of critical care patients.  Included in the assessment measurements conducted by the respiratory therapist in the critical care settings are arterial blood gas puncture and analysis, intrarterial monitoring, bedside measurements of lung mechanics, hemodynamic monitoring, and inspired and expired gas measurements.  This is coupled with the initiation and management of mechanical ventilation patients.","2278C0205X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Respiratory Therapist, Certified","Educational","Educational Certified Respiratory Therapist","The focus of patient and family education activities is to promote knowledge of disease process, medical therapy, and self help.  Respiratory therapists are uniquely qualified to provide this service in regard to cardiopulmonary diseases and injury.","2278E1000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Respiratory Therapist, Certified","Emergency Care","Emergency Care Certified Respiratory Therapist","The immediate availability of diagnostic and therapeutic cardiopulmonary services in the assessment and management of trauma victims, patients requiring airway management and others requiring emergency care.","2278E0002X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Respiratory Therapist, Certified","General Care","General Care Certified Respiratory Therapist","This level of care includes diagnostics testing, therapeutics, monitoring, rehabilitation of patients with disorders of the cardiopulmonary system, as well as, education of the patient and family in regard to those disorders.","2278G1100X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Respiratory Therapist, Certified","Geriatric Care","Geriatric Care Certified Respiratory Therapist","Care of older patients who have age and/or disease related decremental pulmonary changes.  Diagnosis and treatment is very important for this group since chronic lung disease is the major cause of morbidity and mortality among them.  Furthermore, as this segment of the population increases, life expectancy is being extended.","2278G0305X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Respiratory Therapist, Certified","Home Health","Home Health Certified Respiratory Therapist","Home care fosters individual responsibility for self-management of chronic respiratory conditions.  It includes individualized assessment based plans of care service developed to promote safe, proper, and sustained use of prescribed respiratory therapy medications, equipment, and techniques in the home.","2278H0200X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Respiratory Therapist, Certified","Neonatal/Pediatrics","Neonatal/Pediatric Certified Respiratory Therapist","The care and treatment of premature infants, newborns and children.  This includes management of mechanical ventilation, assessment, diagnostics and generalized respiratory treatments.","2278P3900X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Respiratory Therapist, Certified","Palliative/Hospice","Palliative/Hospice Certified Respiratory Therapist","A coordinated plan of care to help dying patients and their families handle the burden of terminal care.  Effective secretion management and relief of dyspnea are paramount in caring for patients with end-stage pulmonary disease.","2278P3800X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Respiratory Therapist, Certified","Patient Transport","Patient Transport Certified Respiratory Therapist","Transport respiratory therapist provide patient assessment, initiation of treatment modalities and continued monitoring of patient status of the critically ill and injured patients with special attention to advanced airway and ventilator management.  The transport respiratory therapist knowledge and experience with complex neonatal, pediatric and adult patient care issues provides them with an expertise to assist with any patient care issue in a variety of transport modes.","2278P4000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Respiratory Therapist, Certified","Pulmonary Diagnostics","Pulmonary Diagnostics Certified Respiratory Therapist","Included in the area of pulmonary diagnostics are the following; collection and analysis of physiological specimens, interpretation of physiological data, administration of tests of the cardiopulmonary system, and the conduct of both neurophysiological and sleep disorders studies.","2278P1004X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Respiratory Therapist, Certified","Pulmonary Function Technologist","Pulmonary Function Technologist Certified Respiratory Therapist","An individual who is trained and qualified to perform pulmonary diagnostic tests.  In the course of conducting these tests, the Pulmonary Function Technologist is able to setup, calibrate, maintain, and ensure the quality assurance of the pulmonary function testing equipment.  In the laboratory, clinical or patient care setting the technologist instructs patients, elicits cooperation, performs procedures, monitors patient response, and evaluates patient performance.  Tests results are calculated, compared with predicted normal ranges, and evaluated for reliability.  The technologist collects clinical history data and evaluates the clinical implications of the test results.","2278P1006X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Respiratory Therapist, Certified","Pulmonary Rehabilitation","Pulmonary Rehabilitation Certified Respiratory Therapist","The respiratory therapist can assist the chronic pulmonary patient in returning to an optimal role in society by providing an effective program.  It includes bronchopulmonary drainage, exercise therapy, and patient education.","2278P1005X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Respiratory Therapist, Certified","SNF/Subacute Care","SNF/Subacute Care Certified Respiratory Therapist","Care of residents in a long-term care environment.  Respiratory modalities delivered include those similar in the general care and critical care areas but provided to less critical patients.","2278S1500X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Respiratory Therapist, Registered",null,"Registered Respiratory Therapist","A Registered Respiratory Therapist (RRT) is an advanced therapist who has passed standardized written and clinical simulation examinations administered by the National Board for Respiratory Care (NBRC).  In addition, to the certified therapist (CRT) entry level skills, RRTs have advanced education and training in patient assessment, in the development and modification of patient care plans, and in assuring the appropriate utilization of respiratory care resources.  An RRT is a graduate of an associate or baccalaureate degree producing educational programs approved by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) and where applicable, is licensed by the state and is practicing within the scope of that license.","227900000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Respiratory Therapist, Registered","Critical Care","Critical Care Registered Respiratory Therapist","Respiratory emergencies are commonplace in the treatment of critical care patients.  Included in the assessment measurements conducted by the respiratory therapist in the critical care settings are arterial blood gas puncture and analysis, intrarterial monitoring, bedside measurements of lung mechanics, hemodynamic monitoring, and inspired and expired gas measurements.  This is coupled with the initiation and management of mechanical ventilation patients.","2279C0205X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Respiratory Therapist, Registered","Educational","Educational Registered Respiratory Therapist","The focus of patient and family education activities is to promote knowledge of disease process, medical therapy, and self help.  Respiratory therapists are uniquely qualified to provide this service in regard to cardiopulmonary diseases and injury.","2279E1000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Respiratory Therapist, Registered","Emergency Care","Emergency Care Registered Respiratory Therapist","The immediate availability of diagnostic and therapeutic cardiopulmonary services in the assessment and management of trauma victims, patients requiring airway management and others requiring emergency care.","2279E0002X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Respiratory Therapist, Registered","General Care","General Care Registered Respiratory Therapist","This level of care includes diagnostics testing, therapeutics, monitoring, rehabilitation of patients with disorders of the cardiopulmonary system, as well as, education of the patient and family in regard to those disorders.","2279G1100X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Respiratory Therapist, Registered","Geriatric Care","Geriatric Care Registered Respiratory Therapist","Care of older patients who have age and/or disease related decremental pulmonary changes.  Diagnosis and treatment is very important for this group since chronic lung disease is the major cause of morbidity and mortality among them.  Furthermore, as this segment of the population increases, life expectancy is being extended.","2279G0305X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Respiratory Therapist, Registered","Home Health","Home Health Registered Respiratory Therapist","Home care fosters individual responsibility for self-management of chronic respiratory conditions.  It includes individualized assessment based plans of care service developed to promote safe, proper, and sustained use of prescribed respiratory therapy medications, equipment, and techniques in the home.","2279H0200X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Respiratory Therapist, Registered","Neonatal/Pediatrics","Neonatal/Pediatric Registered Respiratory Therapist","The care and treatment of premature infants, newborns and children.  This includes management of mechanical ventilation, assessment, diagnostics and generalized respiratory treatments.","2279P3900X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Respiratory Therapist, Registered","Palliative/Hospice","Palliative/Hospice Registered Respiratory Therapist","A coordinated plan of care to help dying patients and their families handle the burden of terminal care.  Effective secretion management and relief of dyspnea are paramount in caring for patients with end-stage pulmonary disease.","2279P3800X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Respiratory Therapist, Registered","Patient Transport","Patient Transport Registered Respiratory Therapist","Transport respiratory therapist provide patient assessment, initiation of treatment modalities and continued monitoring of patient status of the critically ill and injured patients with special attention to advanced airway and ventilator management.  The transport respiratory therapist knowledge and experience with complex neonatal, pediatric and adult patient care issues provides them with an expertise to assist with any patient care issue in a variety of transport modes.","2279P4000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Respiratory Therapist, Registered","Pulmonary Diagnostics","Pulmonary Diagnostics Registered Respiratory Therapist","Included in the area of pulmonary diagnostics are the following; collection and analysis of physiological specimens, interpretation of physiological data, administration of tests of the cardiopulmonary system, and the conduct of both neurophysiological and sleep disorders studies.","2279P1004X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Respiratory Therapist, Registered","Pulmonary Function Technologist","Pulmonary Function Technologist Registered Respiratory Therapist","An individual who is trained and qualified to perform pulmonary diagnostic tests.  In the course of conducting these tests, the Pulmonary Function Technologist is able to setup, calibrate, maintain, and ensure the quality assurance of the pulmonary function testing equipment.  In the laboratory, clinical or patient care setting the technologist instructs patients, elicits cooperation, performs procedures, monitors patient response, and evaluates patient performance.  Tests results are calculated, compared with predicted normal ranges, and evaluated for reliability.  The technologist collects clinical history data and evaluates the clinical implications of the test results.","2279P1006X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Respiratory Therapist, Registered","Pulmonary Rehabilitation","Pulmonary Rehabilitation Registered Respiratory Therapist","The respiratory therapist can assist the chronic pulmonary patient in returning to an optimal role in society by providing an effective program.  It includes bronchopulmonary drainage, exercise therapy, and patient education.","2279P1005X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Respiratory Therapist, Registered","SNF/Subacute Care","SNF/Subacute Care Registered Respiratory Therapist","Care of residents in a long-term care environment.  Respiratory modalities delivered include those similar in the general care and critical care areas but provided to less critical patients.","2279S1500X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Group","Single Specialty",null,"Single Specialty Group","A business group of one or more individual practitioners, all of who practice with the same area of specialization.","193400000X","[7/1/2003: new]","2003-10-01",null,null,"Delete - not a DPP measure","No"]
["Nursing & Custodial Care Facilities","Skilled Nursing Facility",null,"Skilled Nursing Facility","(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.","314000000X","Source: (1) \"Glossary of terms used in managed care\" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey.","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Nursing & Custodial Care Facilities","Skilled Nursing Facility","Nursing Care, Pediatric","Pediatric Skilled Nursing Facility","A nursing care facility designed and staffed for the provision of nursing care and appropriate educational and habilitative/rehabilitative services to children with multiple, complex or profound disabilities that can not be cared for in a less restrictive environment.","3140N1450X","[7/1/2003: new]","2003-10-01",null,null,"Delete - not a DPP measure","No"]
["Other Service Providers","Sleep Specialist, PhD",null,"Sleep Specialist (PhD)","Sleep medicine is a clinical specialty with a focus on clinical problems that require accurate diagnosis and treatment. The knowledge base of sleep medicine is derived from many disciplines including neuroanatomy, neurophysiology, respiratory physiology, pharmacology, psychology, psychiatry, neurology, general internal medicine, pulmonary medicine, and pediatrics as well as others.","173F00000X","Source: National Uniform Claim Committee (based on American Board of Sleep Medicine), 2007 [1/1/2008: new]    Additional resources: www.absm.org","2008-04-01",null,null,"Delete - not a DPP measure","No"]
["Behavioral Health & Social Service Providers","Social Worker","Intentionally left blank","Social Worker","A social worker is a person who is qualified by a Social Work degree, and licensed, certified or registered by the state as a social worker to practice within the scope of that license.  A social worker provides assistance and counseling to clients and their families who are dealing with social, emotional and environmental problems. Social work services may be rendered to individuals, families, groups, and the public.","104100000X","Source: National Association of Social Workers, 2009 [7/1/2009: definition modified]","2002-04-01",null,null,"Keep - No Change","Yes"]
["Behavioral Health & Social Service Providers","Social Worker","Clinical","Clinical Social Worker","A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.","1041C0700X","Source: National Association of Social Workers, 2008 [7/1/2009: definition modified]","2002-04-01",null,null,"Keep - No Change","Yes"]
["Behavioral Health & Social Service Providers","Social Worker","School","School Social Worker","Definition to come...","1041S0200X",null,"2002-04-01",null,null,"Keep - Add somewhere that for TIPPS program, whenever a Definition is listed as \"Definition to come.\" by NUCC, then the Definition at the Classification level should be used as possible.","Yes"]
["Hospitals","Special Hospital",null,"Special Hospital","A designation by the AHA of a hospital whose primary function of the institution is to provide diagnostic and treatment services for patients who have specified medical conditions, both surgical and nonsurgical.","284300000X","Source: AHA Guide, Registration section, p. A5.","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Other Service Providers","Specialist",null,"Specialist","An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.","174400000X","Source: Expanded from Webster's II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974.","2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Other Service Providers","Specialist","Graphics Designer","Graphics Designer","Definition to come...","1744G0900X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Other Service Providers","Specialist","Prosthetics Case Management"," Prosthetics Case Management","Definition to come...","1744P3200X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Other Service Providers","Specialist","Research Data Abstracter/Coder","Research Study Abstracter/Coder","Definition to come...","1744R1103X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Other Service Providers","Specialist","Research Study","Research Study Specialist","Definition to come...","1744R1102X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Specialist/Technologist",null,"Respiratory/Developmental/Rehabilitative Specialist/Technologist","General classification identifying individuals who are trained on a specific piece of equipment or technical procedure.","225500000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Specialist/Technologist","Athletic Trainer","Athletic Trainer","Athletic trainers are allied health care professionals who work in consultation with or under the direction of physicians, and specialize in the prevention, assessment, treatment and rehabilitation of injuries and illnesses.  Currently, the entry-level employment requirements are a bachelor's degree with a major in athletic training from an accredited university or college. A majority of athletic trainers hold advanced degrees.  National board certification is generally required as a condition of state licensure and employment. Most states regulate athletic trainers, and they practice within the scope of that license or regulation.  Clinical practice includes emergency care, rehabilitation, reconditioning, therapeutic exercise, wellness programs, exercise physiology, kinesiology, biomechanics, nutrition, psychology and health care administration.","2255A2300X","Source: National Athletic Trainers' Association (www.NATA.org) [1/1/2006: modified definition, modified source]","2002-04-01",null,"2006-01-01","Delete - not a DPP measure","No"]
["Respiratory, Developmental, Rehabilitative and Restorative Service Providers","Specialist/Technologist","Rehabilitation, Blind","Blind Rehabilitation Specialist/Technologist","Definition to come...","2255R0406X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Speech, Language and Hearing Service Providers","Specialist/Technologist",null,"Speech/Language/Hearing Specialist/Technologist","General classification identifying individuals who are trained on a specific piece of equipment or technical procedure.","235500000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Speech, Language and Hearing Service Providers","Specialist/Technologist","Audiology Assistant","Audiology Assistant","Definition to come...","2355A2700X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Technologists, Technicians & Other Technical Service Providers","Specialist/Technologist Cardiovascular","Vascular Specialist","Vascular Specialist/Technologist","Definition to come...","246XC2903X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Technologists, Technicians & Other Technical Service Providers","Specialist/Technologist, Other","Nephrology","Nephrology Specialist/Technologist","Definition to come...","246ZN0300X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Technologists, Technicians & Other Technical Service Providers","Specialist/Technologist, Other","Orthopedic Assistant","Orthopedic Assistant","An Orthopaedic Assistant is a person who has been trained to work as a physician extender in both clinical and surgical environments. An Orthopaedic Assistant assists with aspects of patient care as determined by the supervising surgeon including, but not limited to, obtaining patient history, assisting with examinations, injections, recording of office notes, and application/adjustment/removal of splints, casts, and other immobilization devices.  Acting as a surgical first assistant for orthopaedic surgery cases includes providing aid in exposure, hemostasis, positioning of the patient, suturing and closure of body planes and skin, application of wound dressings or immobilization devices, and other technical functions that will help the surgeon carry out a safe operation with optimal results for the patient.  An Orthopaedic Assistant may be licensed, registered, or certified depending on the state in which the individual practices.","246ZX2200X","Source:  American Society of Orthopaedic Assistants (ASOA), 2014 [7/1/2014: new]  Additional Resources: National Board for Certification of Orthopaedic Assistants","2014-10-01",null,null,"Delete - not a DPP measure","No"]
["Technologists, Technicians & Other Technical Service Providers","Specialist/Technologist, Other","Surgical Assistant","Surgical Assistant","A surgical assistant is a skilled practitioner who has undergone formalized education and training as a surgical assistant. The surgical assistant performs surgical functions that include, but are not limited to: retracting, manipulating, suturing, clamping, cauterizing, litigating, and tying tissue; suctioning, irrigating and sponging; positioning the patient; closure of body planes and skin; and participating in hemostasis and volume replacement. Surgical assistants are certified and registered or licensed by the state, or, in states without licensure, certified as surgical assistants by completing appropriate education and training.","246ZC0007X","Source: Association of Surgical Assistants, 2014. [7/1/2007: new, 7/1/2014: title modified, definition modified]    http://www.surgicalassistant.org/index.php/surgical-assisting  Additional Resources: National Surgical Assistant Association, www.nsaa.net.","2007-10-01",null,"2014-07-01","Delete - not a DPP measure","No"]
["Technologists, Technicians & Other Technical Service Providers","Specialist/Technologist, Other","Surgical Technologist","Surgical Technologist","Surgical technologists are allied health professionals, who are an integral part of the team of medical practitioners providing surgical care to patients. Surgical technologists work under the supervision of a surgeon to facilitate the safe and effective conduct of invasive surgical procedures, ensuring that the operating room environment is safe, that equipment functions properly, and that the operative procedure is conducted under conditions that maximize patient safety. Surgical technologists possess expertise in the theory and application of sterile and aseptic technique and combine the knowledge of human anatomy, surgical procedures, and implementation tools and technologies to facilitate a physician's performance of invasive therapeutic and diagnostic procedures.","246ZS0410X","Source:  Association of Surgical Technologists, \"Job Description: Surgical Technologist,\" 2014. [7/1/2014: code modified, title modified, definition added]","2002-04-01",null,"2014-07-01","Delete - not a DPP measure","No"]
["Technologists, Technicians & Other Technical Service Providers","Specialist/Technologist, Pathology",null,"Pathology Specialist/Technologist","(1) An individual educated and trained in clinical chemistry, microbiology or other biological sciences; and in gathering data on the blood, tissues, and fluids in the human body. Tests and procedures performed or supervised center on major areas of hematology, microbiology, immunohematology, immunology, clinical chemistry and urinalysis. Education and certification requires the equivalent of an associate degree and alternative combinations of accredited training and experience. (2) A specially trained individual who works under the direction of a pathologist, other physician, or scientist, and performs specialized chemical, microscopic, and bacteriological tests of human blood, tissue, and fluids. Also known as medical technologists, they perform and supervise tests and procedures in clinical chemistry, immunology, serology, bacteriology, hematology, parasitology, mycology, urinalysis, and blood banking. The work requires the correlation of test results with other data, interpretation of test findings, and exercise of independent judgment. The minimum educational requirement (for one of several certification programs in medical technology) is a baccalaureate degree with appropriate science course requirements, plus a twelve-month, structured, AMA approved medical technology program and an examination; or a baccalaureate degree with appropriate science course requirements and experience.","246Q00000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Technologists, Technicians & Other Technical Service Providers","Specialist/Technologist, Pathology","Blood Banking","Blood Banking Specialist/Technologist","Definition to come...","246QB0000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Technologists, Technicians & Other Technical Service Providers","Specialist/Technologist, Pathology","Chemistry","Chemistry Pathology Specialist/Technologist","Definition to come...","246QC1000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Technologists, Technicians & Other Technical Service Providers","Specialist/Technologist, Pathology","Cytotechnology","Cytotechnology Specialist/Technologist","Definition to come...","246QC2700X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Technologists, Technicians & Other Technical Service Providers","Specialist/Technologist, Pathology","Hemapheresis Practitioner","Hemapheresis Practitioner","Definition to come...","246QH0401X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Technologists, Technicians & Other Technical Service Providers","Specialist/Technologist, Pathology","Hematology","Hematology Specialist/Technologist","Definition to come...","246QH0000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Technologists, Technicians & Other Technical Service Providers","Specialist/Technologist, Pathology","Histology","Histology Specialist/Technologist","Definition to come...","246QH0600X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Technologists, Technicians & Other Technical Service Providers","Specialist/Technologist, Pathology","Immunology","Immunology Pathology Specialist/Technologist","Definition to come...","246QI0000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Technologists, Technicians & Other Technical Service Providers","Specialist/Technologist, Pathology","Laboratory Management","Laboratory Management Specialist/Technologist","Definition to come...","246QL0900X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Technologists, Technicians & Other Technical Service Providers","Specialist/Technologist, Pathology","Laboratory Management, Diplomate","Diplomate Laboratory Management Specialist/Technologist","Definition to come...","246QL0901X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Technologists, Technicians & Other Technical Service Providers","Specialist/Technologist, Pathology","Medical Technologist","Medical Technologist","Definition to come...","246QM0706X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Technologists, Technicians & Other Technical Service Providers","Specialist/Technologist, Pathology","Microbiology","Microbiology Specialist/Technologist","Definition to come...","246QM0900X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Speech, Language and Hearing Service Providers","Speech-Language Pathologist","Intentionally left blank","Speech-Language Pathologist","The speech-language pathologist is the professional who engages in clinical services, prevention, advocacy, education, administration, and research in the areas of communication and swallowing across the life span from infancy through geriatrics. Speech-language pathologists address typical and atypical impairments and disorders related to communication and swallowing in the areas of speech sound production, resonance, voice, fluency, language (comprehension and expression), cognition, and feeding and swallowing.","235Z00000X","\"Scope of Practice in Speech-Language Pathology\", American Speech-Language-Hearing Association, 2013.","2002-04-01",null,"2014-01-01","Keep - No Change","Yes"]
["Residential Treatment Facilities","Substance Abuse Rehabilitation Facility",null,"Substance Abuse Rehabilitation Facility","A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.","324500000X","[7/1/2003: modified title, modified definition]","2002-04-01",null,"2003-07-01","Delete - not a DPP measure","No"]
["Residential Treatment Facilities","Substance Abuse Rehabilitation Facility","Substance Abuse Treatment, Children","Children's Substance Abuse Rehabilitation Facility","A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of children with disorders in the use of drugs, alcohol, and other substances.  Medical and supportive counseling services and education services are included.","3245S0500X","[7/1/2003: new]","2003-10-01",null,null,"Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Surgery","Intentionally left blank","Surgery Physician","A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.","208600000X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Surgery, 2007.  http://www.absurgery.org/.   American Osteopathic Board of Surgery, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery.","2003-04-01",null,"2011-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Surgery","Hospice and Palliative Medicine","Hospice and Palliative Medicine (Surgery) Physician","A surgeon with special knowledge and skills to prevent and relieve the suffering experienced by patients with life-limiting illnesses. This specialist works with an interdisciplinary hospice or palliative care team to maximize quality of life while addressing physical, psychological, social and spiritual needs of both patient and family throughout the course of the disease, through the dying process, and beyond for the family.  This specialist has expertise in the assessment of patients with advanced disease; the relief of distressing symptoms; the coordination of interdisciplinary patient and family-centered care in diverse venues; the use of specialized care systems including hospice; the management of the imminently dying patient; and legal and ethical decision making in end-of-life care.","2086H0002X","Source: American Academy of Hospice and Palliative Medicine, www.aahpm.org [1/1/2007: new]","2007-04-01",null,null,"Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Surgery","Pediatric Surgery","Pediatric Surgery Physician","A surgeon with expertise in the management of surgical conditions in premature and newborn infants, children and adolescents.","2086S0120X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added]    Additional Resources: American Board of Surgery, 2007.  http://www.absurgery.org/.    Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery.","2003-04-01",null,"2007-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Surgery","Plastic and Reconstructive Surgery","Plastic and Reconstructive Surgery Physician","A surgeon who specializes in plastic and reconstructive surgery.","2086S0122X","Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added]    Additional Resources: A General Certificate is issued by the American Osteopathic Board of Surgery.","2003-04-01",null,"2010-01-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Surgery","Surgery of the Hand","Surgery of the Hand (Surgery) Physician","A surgeon with expertise in the investigation, preservation and restoration by medical, surgical and rehabilitative means, of all structures of the upper extremity directly affecting the form and function of the hand and wrist.","2086S0105X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added]    Additional Resources: American Board of Surgery, 2007.  http://www.absurgery.org/.    Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery.","2003-04-01",null,"2007-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Surgery","Surgical Critical Care","Surgical Critical Care Physician","A surgeon with expertise in the management of the critically ill and postoperative patient, particularly the trauma victim, who specializes in critical care medicine diagnoses, treats and supports patients with multiple organ dysfunction. This specialist may have administrative responsibilities for intensive care units and may also facilitate and coordinate patient care among the primary physician, the critical care staff and other specialists.","2086S0102X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Surgery, 2007.  http://www.absurgery.org/.   American Osteopathic Board of Surgery, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery.","2003-04-01",null,"2011-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Surgery","Surgical Oncology","Surgical Oncology Physician","A surgical oncologist is a well-qualified surgeon who has obtained additional training and experience in the multidisciplinary approach to the prevention, diagnosis, treatment, and rehabilitation of cancer patients, and devotes a major portion of his or her professional practice to these activities and cancer research.","2086X0206X","Source: Society of Surgical Oncology, 2007 [1/1/2008: definition added, source added, 7/1/2009: definition reformatted]    Additional Resources: http://www.surgonc.org/ ; American Board of Medical Specialties, 2007, www.abms.org ; American Board of Surgery, 2007, http://www.absurgery.org/     Surgical oncology is a recognized fellowship subspecialty program of surgery. Separate board certification is not currently offered.","2003-04-01",null,"2008-01-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Surgery","Trauma Surgery","Trauma Surgery Physician","Trauma surgery is a recognized subspecialty of general surgery. Trauma surgeons are physicians who have completed a five-year general surgery residency and usually continue with a one to two year fellowship in trauma and/or surgical critical care, typically leading to additional board certification in surgical critical care. There is no trauma surgery board certification at this point. To obtain board certification in surgical critical care, a fellowship in surgical critical care or anesthesiology critical care must be completed during or after general surgery residency.","2086S0127X","Source: American Board of Surgery, 2007  [1/1/2008: definition added, source added]    Additional Resources: http://www.absurgery.org/.","2003-04-01",null,"2008-01-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Surgery","Vascular Surgery","Vascular Surgery Physician","A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart.","2086S0129X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]<br><br>Additional Resources: American Board of Surgery, 2007.  http://www.absurgery.org/.   American Osteopathic Board of Surgery, 2007.  http://www.osteopathic.org/certification<br><br>Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery.  Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery.","2003-04-01",null,"2011-07-01","Keep - Clarify in Specs FAQ or Stakeholder Feedback, etc. that the eligible physician or clinician is at the Classification level, and any subspecialization can be found under the Area of Specialization level. For example, a physician may have a pediatric subspecialty (Area of Specialization) but not necessarily be a pediatrics physician (Classification).","Yes"]
["Technologists, Technicians & Other Technical Service Providers","Technician, Pathology",null,"Pathology Technician","An individual with knowledge of specific techniques and instruments who performs all of the routine tests in a medical laboratory and who has the ability to discriminate between similar factors that directly affect procedures and results.","246R00000X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Technologists, Technicians & Other Technical Service Providers","Technician, Pathology","Clinical Laboratory Director, Non-physician","Clinical Laboratory Director (Non-physician)","An individual who is state-licensed as a clinical laboratory director and meets the qualifications in the Clinical Laboratory Improvement Amendments of 1988 for non-physicians (non-MD/DO) as defined in the CFR 42 Part 493.1405.","247ZC0005X","Source: National Uniform Claim Committee [1/1/2007: new]","2007-04-01",null,null,"Delete - not a DPP measure","No"]
["Technologists, Technicians & Other Technical Service Providers","Technician, Pathology","Histology","Histology Technician","Definition to come...","246RH0600X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Technologists, Technicians & Other Technical Service Providers","Technician, Pathology","Medical Laboratory","Medical Laboratory Technician","Definition to come...","246RM2200X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Technologists, Technicians & Other Technical Service Providers","Technician, Pathology","Phlebotomy","Phlebotomy Technician","Definition to come...","246RP1900X",null,"2002-04-01",null,null,"Delete - not a DPP measure","No"]
["Allopathic & Osteopathic Physicians","Thoracic Surgery (Cardiothoracic Vascular Surgery)","Intentionally left blank","Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician","A thoracic surgeon provides the operative, perioperative and critical care of patients with pathologic conditions within the chest. Included is the surgical care of coronary artery disease, cancers of the lung, esophagus and chest wall, abnormalities of the trachea, abnormalities of the great vessels and heart valves, congenital anomalies, tumors of the mediastinum and diseases of the diaphragm. The management of the airway and injuries of the chest is within the scope of the specialty.","208G00000X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added]    Additional Resources: American Board of Thoracic Surgery, 2007.  http://www.abts.org/.    Board certification for Medical Doctors (MDs) is provided by the American Board of Thoracic Surgery.    Thoracic surgeons have the knowledge, experience and technical skills to accurately diagnose, operate upon safely, and effectively manage patients with thoracic diseases of the chest. This requires substantial knowledge of cardiorespiratory physiology and oncology, as well as capability in the use of heart assist devices, management of abnormal heart rhythms and drainage of the chest cavity, respiratory support systems, endoscopy and invasive and noninvasive diagnostic techniques.  ","2003-04-01",null,"2007-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Urology","Intentionally left blank","Urology Physician","A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures.","208800000X","Source: American Board of Medical Specialties, 2007.  www.abms.org [7/1/2007: definition added, source added]    Additional Resources: American Board of Urology, 2007.  http://www.abu.org/.    Board certification for Medical Doctors (MDs) is provided by the American Board of Urology.","2003-04-01",null,"2007-07-01","Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Urology","Female Pelvic Medicine and Reconstructive Surgery","Female Pelvic Medicine and Reconstructive Surgery (Urology) Physician","A subspecialist in Female Pelvic Medicine and Reconstructive Surgery is a physician in Urology or Obstetrics and Gynecology who, by virtue of education and training, is prepared to provide consultation and comprehensive management of women with complex benign pelvic conditions, lower urinary tract disorders, and pelvic floor dysfunction. Comprehensive management includes those diagnostic and therapeutic procedures necessary for the total care of the patient with these conditions and complications resulting from them.","2088F0040X","Source: American Board of Medical Specialties, 2011. [1/1/2012: new]  Resources:  www.abms.org","2012-04-01",null,null,"Keep - No Change","Yes"]
["Allopathic & Osteopathic Physicians","Urology","Pediatric Urology","Pediatric Urology Physician","Surgeons who can diagnose, treat, and manage children's urinary and genital problems. A pediatric urologist devotes a minimum of 50% of his or her practice to the urologic problems of infants, children, and adolescents.  Pediatric urologists generally provide the following services:  the evaluation and management of voiding disorders; vesicoureteral reflux, and urinary tract infections that require surgery; surgical reconstruction of the urinary tract (kidneys, ureters, and bladder) including genital abnormalities, hypospadias, and intersex conditions; surgery for groin conditions in childhood and adolescence (undescended testes, hydrocele/hernia, varicocele).","2088P0231X","Source: American Academy of Pediatrics [7/1/2006: new]","2006-10-01",null,null,"Keep - Clarify in Specs FAQ or Stakeholder Feedback, etc. that the eligible physician or clinician is at the Classification level, and any subspecialization can be found under the Area of Specialization level. For example, a physician may have a pediatric subspecialty (Area of Specialization) but not necessarily be a pediatrics physician (Classification).","Yes"]

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[null,{"$f":"IF(OR(E22=\"NA\", E22=0, $E$7=\"Structure\"), 1, 0)","v":0},null,"Attributed Population Inclusion Criteria",{"$f":"IFERROR(VLOOKUP($E$5, 'Attribution Methodology SFY23'!$C:$L, 3, FALSE), \"\")","v":"The participating provider's attributed population includes any individual that meets at least one of the criteria below:\na) One encounter during the measurement period"}]
[null,0,null,"Primary Care Service - HCPCS Codes",{"$f":"IFERROR(VLOOKUP($E$5, 'Attribution Methodology SFY23'!$C:$L, 4, FALSE), \"\")","v":"N/a"}]
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[null,0,null,"Ambulator Encounter - Value Sets",{"$f":"IFERROR(VLOOKUP($E$5, 'Attribution Methodology SFY23'!$C:$L, 6, FALSE), \"\")","v":"N/a"}]
[null,0,"Attribution Step 2","Measure-Specific Denominator Population Definition",{"$f":"IFERROR(VLOOKUP($E$5, 'Attribution Methodology SFY23'!$C:$L, 7, FALSE), \"\")","v":"The measure-specific denominator population (Step 2) includes the individuals or encounters from the CHIRP attributed population (Step 1) that meet all criteria under the \"Eligible Physician Specialties and Other Clinicians\", \"Denominator Inclusions\", and \"Denominator Exclusions\" as applicable for each quality measure, as defined in the \"Measure Specifications SFY23\" tab. \n\nParticipating providers may refer to the most recent NUCC Health Care Provider Taxonomy Code Set (https://taxonomy.nucc.org/) for the definitions and taxonomy codes for physician specialties, physician subspecialties, and other clinicians, as defined by the National Uniform Claim Committee (NUCC). The NUCC provider taxonomy definitions and codes for physician subspecialties that are nested within an eligible physician specialty may be included if these subspecialists perform the quality actions described in the measure based on the services provided and the measure specific-denominator coding. Nurse Practitioners and Physician Assistants, as defined by NUCC, practicing under the listed eligible physician specialties or practicing equivalent services may also be included."}]
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[null,0,null,"Measure Specs Source (Version)",{"$f":"IFERROR(VLOOKUP($E$2, 'Measure Specifications SFY23'!$A:$AK, 21, FALSE), \"\")","v":"CDC/NHSN (January 2022)"}]
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[null,1,null,"Additional Information",{"$f":"IFERROR(VLOOKUP($E$2, 'Measure Specifications SFY23'!$A:$AK, 33, FALSE), \"\")","v":0}]
[null,{"$f":"IF(OR(E42=\"NA\", E42=0, $E$7=\"Structure\"), 1, 0)","v":0},"Attribution Step 3","Reporting Payer Types*",{"$f":"IFERROR(VLOOKUP($E$5, 'Attribution Methodology SFY23'!$C:$L, 8, FALSE), \"\")","v":"*Measures must be stratified by the required reporting payer types as specified under \"Required Reporting Payer Types\" in the \"Measure Specifications SFY23\" tab. For example, some measures may only require reporting by one or more of the following reporting payer types below.\n\nPlease note unlike in SFY22 (Year 1), there are no reporting exceptions for the \"Medicaid Managed Care\" payer type in SFY23 (Year 2). In SFY23 (Year 2), measures with the required reporting payer type of \"Medicaid Managed Care\" must be reported by \"Medicaid Managed Care\" as described below.\n\n• Medicaid Managed Care (includes STAR and STAR+PLUS)\n• Other Medicaid (includes other Medicaid Managed Care programs and Medicaid Fee-For-Service (FFS))\n• Uninsured (includes No insurance; County-based or other public medical assistance)\n• All Payer (includes Medicaid Managed Care, Other Medicaid, Uninsured, and all other payer types such as CHIP, Medicare, Medicare/Medicaid Dual Eligibles, and Commercial Insurance)"}]
[null,{"$f":"IF(OR(E43=\"NA\", E43=0, $E$7=\"Structure\"), 1, 0)","v":0},null,"Payer Type Assignment Methodology",{"$f":"IFERROR(VLOOKUP($E$5, 'Attribution Methodology SFY23'!$C:$L, 9, FALSE), \"\")","v":"The payer type assignment methodology depends on the “Denominator Unit of Measurement” (e.g., “Individual” or “Encounter”) of the measure-specific denominator (Step 2), as defined in the “Measure Specifications SFY23” tab.\n\n1. Individual: If a person can only be counted once in the denominator in a given measurement period, then the unit of measurement is an “individual”. For measures with “Individual” as the “Denominator Unit of Measurement”, the payer type assignment will be determined either by the most recent payer type on record for the individual at the end of the measurement period OR as any individual with a Medicaid Managed Care-enrolled service at any point in the measurement period, even if their most recent payer type of record is not Medicaid Managed Care. The same assignment methodology for determining Medicaid Managed Care must be applied consistently across the measurement period.\n\n2. Encounter: If a person can be counted in the denominator more than once in a given measurement period, then the unit of measurement is an “encounter”. For measures with “Encounter” as the “Denominator Unit of Measurement”, the payer type assignment will be determined by the payer type on record for the qualifying encounter (e.g., visit or admission)."}]
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[null,1,null,"Blank Field (intentionally left blank)",{"$f":"IFERROR(VLOOKUP($E$2, 'Measure Specifications SFY23'!$A:$AK, 35, FALSE), \"\")","v":0}]
[null,1,null,"Blank Field (intentionally left blank)",{"$f":"IFERROR(VLOOKUP($E$2, 'Measure Specifications SFY23'!$A:$AK,36, FALSE), \"\")","v":0}]
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[null,null,null,"Public Notes",{"$f":"IFERROR(VLOOKUP($E$2, 'Measure Specifications SFY23'!$A:$AS,45, FALSE), \"\")","v":"Measure is reported as a Standardized Infection Ratios (SIR), where the numerator is reported as the number of actual observed infections, and the denominator is reported as the number of predicted infections (as calculated by National Healthcare Safety Network [NHSN]). Do not report the denominator using rounding."}]

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["Additional Reporting Information"]
["Measure Stewards","The measures proposed are drawn from measures developed by authoritative agencies of outcome measurement such as the National Committee for Quality Assurance (NCQA), Centers for Disease Control (CDC), and American Medical Association's Physician Consortium for Performance Improvement (AMA-PCPI). These agencies are referred to as the \"Measure Steward\". These measures have been validated and tested to ensure that the outcomes are measuring what they aim to measure. In some cases, where validated measures did not previously exist, measures were adapted based on evidence-based guidelines and practices and experience from the Texas Delivery System Reform Incentive Payment Program. The outcomes are salient to aspects of patient care that reflect better health and satisfaction with services, improved efficiencies in health care delivery and cost savings."]
["Data Sources","Included measures have been specified using electronic health record (EHR) and claims data available to healthcare providers. In certain cases, measures have been adapted from measures specified for health plans. Providers should use the most complete data available and ensure that the rates reported are representative of the entire population served.\n\nProviders are responsible for adhering to measure specifications and in cases where a variance from a designated measure source is required due to variances in data sources, providers should keep a record of and such variances to ensure consistency, and make a note of such variances when reporting each measurement year. Providers may opt to use local or proprietary codes or values mapped to the standard codes included in the measure specifications. Providers that use local or proprietary codes must maintain documentation that includes a crosswalk of relevant codes, descriptions, and clinical information if applicable. "]
["Data Measurement Periods","The data measurement period required for a given reporting period is identified under \"Data Measurement Period\" in the Measure Specifications SFY23 Tab. Additionally, measure-specific denominator specifications may place additional limitations on the measurement period used for denominator inclusion. This may include using only a portion of the measurement period for denominator inclusion or identifying encounters and/or diagnosis that occur before the measurement period for denominator inclusion (a lookback period). \n\nAll measures are specified for a 12-month Data Measurement Period, unless otherwise specified under \"Data Measurement Period\". In those cases where the Data Measurement Period is not specified for 12 months (e.g., a data measurement period instead of 6 months of data), providers should include all denominator cases that meet the denominator inclusion requirements for the 12-month data measurement period that will eventually be reported, including any lookback requirements. This means that when reporting 6 months of data, providers should be able to use the same logic that they will use when reporting 12 months of data, reporting all data as of the end date of the 6-month data measurement period. \n"]
["Sampling Requirements","Participating providers should use the most complete data available and ensure that the rate reported is representative of the entire population attributed to the participant. All cases that meet the eligible population per measure denominator specifications must be included. However, for measures in which all required data elements are not available to the participant electronically (E.H.R., claims data, or registry) or are of poor quality, participants may conduct a sample to determine the rate for a given performance year. \n\nParticipants should follow the sampling methodology included in the measure specifications by the measure steward, or if no sampling methodology is specified by the measure steward, participants should follow the HHSC sampling methodology identified below:\n\nHHSC Sampling Methodology\nFirst, participants must use available administrative data to determine the initial denominator population (e.g., the denominator specifications must still first be applied to determine the initial pool of eligible denominator cases). Then, from the initial denominator population, a minimum sample size of cases will be randomly selected such that all initially eligible cases have an equal chance of being selected for the sample and the resulting sample is representative of the entire initial denominator population for the measure. In the reporting template, participants will indicate if the data being reported used a sampling methodology, and in the qualitative responses, participants should clarify whether the measure steward's or HHSC's sampling methodology is being used when describing the sampled reporting. Participants should maintain records of sampling methodology and random selection.\n\nHHSC Minimum Sample Size for All Payer\n•  For a measurement period where the denominator size is less than or equal to 75, participants must report on all cases. No sampling is allowed.\n•  For a measurement period where the denominator size is less than or equal to 380 but greater than 75, participants must report on a random sample of not less than 76 cases.\n•  For a measurement period where the denominator size is greater than 380, participants must report on a random sample of cases that is not less than 20% of all cases; however, participants may cap the total sample size at 411 cases.\n\nIt is recommended to select an oversample of 10-15% of the sample size for substitution in the event that cases in the original sample are excluded from the measure."]