Appendix C - CLNM Evaluation Criteria Domains to be evaluated: Clinical & social determinants of health outcomes (OC) Experience of care (EOC) Quality of care (QOC) Utilization of services (SU) Cost of care ($) Goal I: Prevent Risk Behaviors Screen for common chronic conditions and risk behaviors in individuals with SMI or SED Adult/child/ Reporting Quality Intermediate Actions Domain Measure Value Data source both Frequency Monitoring Screening for B QOC Annual % of members with immunizations +/- Star service Annual recommended in a reporting year immunizations Screening for alcohol B QOC Annual % of members screened +/- Star assessment auto Annual use Ages 8 & > fill Screening for tobacco B QOC Annual % of members screened +/- Star assessment Annual use Ages 8 & > Other substance use B QOC Annual % of members screened for +/- Star service auto fill Quarterly screening Ages 8 & > substance use Suicide risk assessment B QOC Semi-annual % of members screened for suicide +/- Star service auto fill Quarterly risk Major depressive B QOC Semi-annual % of members with Depression +/- Star service auto fill Monthly disorder (MDD) suicide Survey score of 15 or above screening screened for suicide risk Screening for clinical B QOC Semi-annual +/- Star service auto fill Quarterly % of members age 12 and older depression and follow Ages 12 & > screened for clinical depression up plan using an age-appropriate [CDF] standardized depression screening CMS criterion tool, and if positive, had a plan documented on the date of
Appendix C - CLNM Evaluation Criteria Domains to be evaluated: Clinical & social determinants of health outcomes (OC) Experience of care (EOC) Quality of care (QOC) Utilization of services (SU) Cost of care ($) Goal I: Prevent Risk Behaviors Screen for common chronic conditions and risk behaviors in individuals with SMI or SED Intermediate Actions Adult/child/ both Domain Reporting Frequency Measure Value Data source Quality Monitoring Screening for recommended immunizations B QOC Annual % of members with immunizations in a reporting year +/- Star service Annual Screening for alcohol use B Ages 8 & > QOC Annual % of members screened +/- Star assessment auto fill Annual Screening for tobacco use B Ages 8 & > QOC Annual % of members screened +/- Star assessment Annual Other substance use screening B Ages 8 & > QOC Annual % of members screened for substance use +/- Star service auto fill Quarterly Suicide risk assessment B QOC Semi-annual % of members screened for suicide risk +/- Star service auto fill Quarterly Major depressive disorder (MDD) suicide screening B QOC Semi-annual % of members with Depression Survey score of 15 or above screened for suicide risk +/- Star service auto fill Monthly Screening for clinical depression and follow up plan [CDF] CMS criterion B Ages 12 & > QOC Semi-annual % of members age 12 and older screened for clinical depression using an age-appropriate standardized depression screening tool, and if positive, had a plan documented on the date of +/- Star service auto fill Quarterly
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