both Frequency Monitoring Control of diabetes for B % of members with a diagnosis of HbA1c STAR service tracking Annual individuals with a type 1 or type 2 diabetes mellitus value diagnosis of type 1 or with a hemoglobin A1c (HbA1c) > type 2 diabetes 9.0% mellitus % of members with a diagnosis of type 1 or type 2 diabetes mellitus with a hemoglobin A1c (HbA1c) < 8.0 Follow-up plan for B QOC % of members with a plan y/n Star service & care Monthly positive suicide risk documented in care plan plan auto fill screening Follow-up plan for B QOC % of members ages 12 & > w a plan y/n Star care plan auto Monthly positive depression Ages 12 & > documented on date of positive fill screen (see above; depression screen part of CMS Criterion) Treatment plan for B QOC % of members with BMI > 30 who Star service auto fill Quarterly BMI >30 have a treatment plan to address obesity Treatment plan for BMI B QOC % of members with BMI < 17.5 w a Star service auto fill Quarterly < 17.5 treatment plan to address weight & nutrition Controlling high blood A OC Annual % of members age 18 to 85 who Actual MCO Quarterly pressure HEDIS had a diagnosis of hypertension value (Source: NCQA) (HTN) and whose blood pressure [CBP] (BP) was adequately controlled CMS criterion (<140/90) during the measurement year based on three specific criteria related to age and whether there is a diagnosis of diabetes Initiation and B QOC Annual y/n MCO Monthly % members age 13 and older with a engagement of alcohol Ages 13 & > HEDIS new episode of alcohol or other and other drug drug (AOD) dependence who: dependence treatment initiated treatment through an CMS criterion inpatient AOD admission,
both Frequency Monitoring Control of diabetes for individuals with a diagnosis of type 1 or type 2 diabetes mellitus B % of members with a diagnosis of type 1 or type 2 diabetes mellitus with a hemoglobin A1c (HbA1c) > 9.0% % of members with a diagnosis of type 1 or type 2 diabetes mellitus with a hemoglobin A1c (HbA1c) < 8.0 HbA1c value STAR service tracking Annual Follow-up plan for positive suicide risk screening B QOC % of members with a plan documented in care plan y/n Star service & care plan auto fill Monthly Follow-up plan for positive depression screen (see above; part of CMS Criterion) B Ages 12 & > QOC % of members ages 12 & > w a plan documented on date of positive depression screen y/n Star care plan auto fill Monthly Treatment plan for BMI >30 B QOC % of members with BMI > 30 who have a treatment plan to address obesity Star service auto fill Quarterly Treatment plan for BMI < 17.5 B QOC % of members with BMI < 17.5 w a treatment plan to address weight & nutrition Star service auto fill Quarterly Controlling high blood pressure (Source: NCQA) [CBP] CMS criterion A OC HEDIS Annual % of members age 18 to 85 who had a diagnosis of hypertension (HTN) and whose blood pressure (BP) was adequately controlled (<140/90) during the measurement year based on three specific criteria related to age and whether there is a diagnosis of diabetes Actual value MCO Quarterly Initiation and engagement of alcohol and other drug dependence treatment CMS criterion B Ages 13 & > QOC HEDIS Annual % members age 13 and older with a new episode of alcohol or other drug (AOD) dependence who: initiated treatment through an inpatient AOD admission, y/n MCO Monthly
Provider%20Pol%20Manual%20MP%20SW%2011_30_17.docx