OM: CMS Previews Core Set Of Health Home Quality Measures

NYAPRS Note: The following comes from Open Minds’ Monica Oss, one of the behavioral health service community’s ‘go to’ strategic consultants and advisors. Monica will bring her expertise to New York as part of a stellar presenter line up at NYAPRS’ April 25-6 Executive Seminar. For program and registration details, please go to

See CMS’ State Medicaid Director letter at

CMS Previews Medicaid Core Set Of Health Home Quality Measures

Open Minds February 11, 2013

Developed by OPEN MINDS, 163 York Street, Gettysburg PA 17325, All rights reserved.

On January 15, 2013, the Centers for Medicare & Medicaid (CMS) issued a letter to state Medicaid directors providing information on CMS’ recommended core set of health care quality measures for use in assessing health home service delivery to complex consumers. There are eight recommended measures focused on measurement of overall health and mental health services. These measures will be mandatory when the final rule is enacted.

CMS Recommended Health Home Quality Measures

Measure Title

Measure Description

NQF Number

Alignment with Other CMS Programs

1. Adult Body Mass Index (BMI) Assessment

Percentage of members 18-74 years of age who had an outpatient visit and who had their BMI documented during the measurement year or the year prior to the measurement year


Medicaid Adult Core Set, HEDIS

2. Ambulatory Care-Sensitive Condition Admission

Ambulatory care sensitive conditions: age-standardized acute care hospitalization rate for conditions where appropriate ambulatory care prevents or reduces the need for admission to the hospital, per 100,000 population under age 75 years.



3. Care Transition - Transition Record Transmitted to Health care Professional

Care transitions: percentage of patients, regardless of age, discharged from an inpatient facility to home or any other site of care for whom a transition record was transmitted to the facility or primary physician or other health care professional designated for follow-up care within 24 hours of discharge.


Medicaid Adult Core set

4. Follow-Up After Hospitalization for Mental Illness

Percentage of discharges for members 6 years of age and older who were hospitalized for treatment of selected mental health disorders and who had an outpatient visit, an intensive outpatient encounter, or partial hospitalization with a mental health practitioner within 7 days of discharge.


Children’s Core Set, Medicaid Adult Core Set, HEDIS

5. Plan- All Cause Readmission

For members 18 years of age and older, the number of acute inpatient stays during the measurement year that were followed by an acute readmission for any diagnosis within 30 days and the predicted probability of an acute readmission.


Adult Core set, HEDIS

6. Screening for Clinical Depression and Follow-up Plan

Percentage of patients aged 18 years and older screened for clinical depression using a standardized tool AND follow-up documented


PQRS, CMS QIP, Medicare Shared Savings Program, Medicaid Adult Core set, Meaningful Use

7. Initiation and Engagement of Alcohol and Other Drug Dependence Treatment

Percentage of adolescents and adults members with a new episode of alcohol or other drug (AOD) dependence who received the following: Initiation of AOD treatment; and Engagement of AOD treatment.


Meaningful Use 1 and 2, Medicaid Adult Core set, HEDIS

8. Controlling High Blood Pressure

The percentage of patients 18–85 years of age who had a diagnosis of hypertension (HTN) and whose blood pressure (BP) was adequately controlled (<140/90) during the measurement year.


Million Hearts, Medicaid Adult Core set, Meaningful Use 2, ACO Measure

Unlike the 26 quality measures CMS released for Medicaid-eligible adultsin January 2012-which are voluntary-adoption of the health homes core quality measures will be mandatory once published as a final rule. All but one of the eight health home measures-ambulatory care sensitive condition admission-were included among the 26 health care quality measures. The CMS quality measures are in addition to any goals and measures identified by individual states. CMS will use the quality measures in 2014 and 2017 health home evaluation reports to Congress as required under section 2703 of the Patient Protection and Affordable Care Act of 2010 (PPACA). There is no timeframe for final rule promulgation.

A health home is defined by CMS as a health care delivery approach focused on the whole person, and provides coordination for an integrated array of primary and acute physical health services (including prevention and wellness promotion), behavioral health care, and long-term community-based services and supports. Health homes are authorized under the PPACA person-centered health home service delivery model for beneficiaries with chronic conditions. As of December 2012, CMS has approved health home State Plan Amendments for eight states: Idaho, Iowa, Missouri, New York, North Carolina, Ohio, Oregon, and Rhode Island.

…For more information, contact: Office of External Affairs, Centers for Medicare & Medicaid Services, Department of Health and Human Services, 7500 Security Boulevard, Baltimore, Maryland 21244; 202-690-6145; Fax: 202-690-7159;; CMS invited state Medicaid directors to contact Barbara Edwards, Director, Disabled and Elderly Health Programs Group, Centers for Medicare & Medicaid Services, Department of Health and Human Services, 7500 Security Boulevard, Baltimore, Maryland 21244; 410-786-0325;