Children's

Value Based Payment Quality Measure Set
Measurement Year 2023

  • Measure Set is also available in Portable Document Format (PDF)

February 8, 2023                     NYS Medicaid Value Based Payment

INTRODUCTION

The Measurement Year (MY) 2023 Children's Quality Measure Set was created in collaboration with the Children's Health, the Primary Care (Physical Health), the Maternity Care, and the Behavioral Health/HARP Clinical Advisory Groups (CAGs), as well as the New York State Department of Health (NYS DOH) CAG Strategy team. The goal of this measure set is to align with measures put forth in the NYS Quality Assurance Reporting Requirements (QARR), the Healthcare Effectiveness Data and Information Set® (HEDIS)1 Technical Specifications for Health Plans, the CMS Core measure set, and the Merit-based Incentive Payment System (MIPS), where applicable. The measure set is designed to encourage providers to meet high standards of patient-centered clinical care and coordination across multiple care settings.

MEASURE SELECTION AND FEASIBILITY

Upon receiving recommendations from the CAGs, the release of guidelines from national measure stewards, such as National Committee for Quality Assurance (NCQA)/HEDIS®, and in accordance with the NYS VBP Roadmap,2 the State defined a final list of measures to be included in the TCGP Measure Set for MY2023. For MY2023, fourteen measures have remained unchanged, four measures' reporting requirements/specifications were revised, one measure has been removed, and four measures have been added. This culminates in a total of twenty-two Category 1 and 2 Children's Quality Measures (QM).

VBP ARRANGEMENT REQUIREMENTS FOR MY2023 - HEALTH EQUITY

In MY2022, NCQA added race and ethnicity stratification for five HEDIS measures to help promote transparency into health plan performance. By doing so, NCQA hopes to better identify where disparities exist, so they can be addressed. They also hope to identify and learn from top performers in areas where disparities don't exist. To align with this initiative, NYS required payers and providers to incorporate race and ethnicity measure stratification in Value-Based Payment (VBP) arrangements starting in July 2022. For MY2023 HEDIS® is adding eight additional measures.

Stratification Specifications:

  1. Payers are required to include at least one of the following measures in all level 1 or higher VBP contracts and stratify results by race and ethnicity categories as outlined in the HEDIS MY2023 specifications.3 The table below depicts available quality measures by arrangement type.
NQCA Measure Name Measure Inclusion by Arrangement Type
TCGP HARP/BH Maternity HIV/AIDs Children's
Adult Immunization Status (AIS-E)*          
Asthma Medication Ratio (AMR)* ✓ ✓   ✓ ✓
Breast Cancer Screening (BCS-E)* ✓ ✓   ✓  
Child and Adolescent Well-Care Visits (WCV) ✓       ✓
Colorectal Cancer Screening (COL; COL-E) ✓ ✓   ✓  
Controlling High Blood Pressure (CBP) ✓ ✓   ✓  
Follow-Up After Emergency Department Visit for Substance Use (FUA)* ✓ ✓      
Hemoglobin A1c Control for Patients with Diabetes (HBD) ✓ ✓   ✓  
Immunizations for Adolescents (IMA, IMA-E)* ✓       ✓
Initiation and Engagement of Substance Use Disorder Treatment (IET)* ✓   ✓ ✓  
Pharmacotherapy for Opioid Use Disorder (POD)* ✓ ✓      
Prenatal and Postpartum Care (PPC) ✓   ✓    
Well-Child Visits in the First 30 Months of Life (W30)* ✓       ✓

*Added for MY2023

  1. Stratification of selected measures will be classified as pay-for-reporting (P4R).
  2. Payers are required to include the following detail in the Provider Contract Statement and Certification form and Contract language:
    1. Indicate what measure(s) will be included for race and ethnicity stratification.
    2. Indicate how the stratified measure results for applicable measures will be shared with the VBP contractor.
  3. Plans are required to include the race and ethnicity data submitted to NYS using the following method:
Race and ethnicity fields will be added to the annual VBP member attribution submission file specifications. This will allow the State to stratify measure performance by race and ethnicity categories for applicable performance measures at the VBP contract and VBP Contractor levels.

All new contracts submitted on or after July 1, 2023, must meet this requirement. All other existing contracts must be updated at the end of the contract's current measurement period and before the contract's next measurement period begins, or no later than April 1, 2023.

MEASURE CLASSIFICATION

Each measure has been designated by the State as Category 1, 2, or 3 with associated recommendations for implementation and testing for future use in VBP Arrangements. The measures below are classified by category based on an assessment of reliability, validity, and feasibility, and according to suggested method of use (either Pay for Reporting (P4R) or Pay for Performance (P4P)).

Category 1

Category 1 quality measures as identified by the CAGs and accepted and deemed reportable by the State are to be reported by VBP Contractors to the MCOs. These measures are also intended to be used to determine the amount of shared savings for which VBP contractors are eligible4. At least one Category 1 P4P measure must be included in a VBP contract.

The State classified each Category 1 measure as either P4P or P4R:

  • P4P measures are intended to be used in the determination of shared savings amounts for which VBP Contractors are eligible. In other words, these are the measures on which payments in VBP contracts may be based. Measures can be included in both the determination of the target budget and in the calculation of shared savings for VBP Contractors.
  • P4R measures are intended to be used by the MCOs to incentivize VBP Contractors for reporting data to monitor quality of care delivered to members under a VBP contract. Incentives for reporting should be based on timeliness, accuracy, and completeness of data. Measures can be reclassified from P4R to P4P or vice versa through annual CAG and State review or as determined by the MCO and VBP Contractor.

Not all Category 1 measures will be reportable for the measurement year, as reporting on some of these measures will be phased in over the next few years. Please refer to the 2023-2024 Value-Based Payment Reporting Requirements Technical Specifications Manual (MY2023) for details as to which measures must be reported for the measurement year. This manual will be updated annually each fall, in line with the release of the final VBP measure sets for the subsequent year.

Categories 2 and 3

Category 2 measures have been accepted by the State based on agreement of clinical importance, validity, and reliability, but flagged as presenting concerns regarding implementation feasibility.

Measures designated as Category 3 were identified as unfeasible at this time or as presenting additional concerns including accuracy or reliability when applied to the attributed member population for an arrangement, therefore Category 3 measures are not included in the measure set.

MY2023 CHILDREN'S QUALITY MEASURE SET

The measures provided on the following pages are recommendations for MY2023. Note that measure classification is a State recommendation and implementation is to be determined between the MCO and VBP Contractor.

Measure sets and classifications are considered dynamic and will be reviewed annually. Updates will include measure additions, deletions, recategorizations, and/or reclassifications from P4R to P4P or vice versa, based on experience with measure implementation in the prior year. Please see Appendix A for a full list of these changes.

Category 1 Measures

The table below displays the Category 1 MY2023 Children's Quality Measure Set, arranged alphabetically and includes measure title, measure steward, the National Quality Forum (NQF) number (if applicable), and the measure classification. The measure set is redlined to highlight changes made between MY2022 and MY2023; please refer to the key at the end of this table for an explanation of redlined formatting.

Children's Measures Measure Steward Measure Identifier Classification
Annual Dental Visit NCQA NQF 1388 P4R
Asthma Admission Rate (PDI 14) AHRQ NQF 0728 P4R
Asthma Medication Ratio (AMR)^ NCQA NQF 1800 P4P
Child and Adolescent Well-Care Visits (WCV)^ NCQA   P4P
Childhood Immunization Status – Combination 3 (CIS; CIS-E) NCQA NQF 0038 P4P
Chlamydia Screening in Women (CHL) NCQA NQF 0033 P4P
COVID-19 Immunization Measure (CVS)* NYS   P4P
Depression Remission or Response for Adolescents and Adults (DRR-E) NCQA   P4P
Depression Screening and Follow-Up for Adolescents and Adults (DSF-E) NCQA   P4P
Developmental Screening in the First Three Years of Life (DEV-CH) Oregon Health & Science University NQF 1448 P4R
Follow-Up Care for Children Prescribed ADHD Medication (ADD) NCQA NQF 0108 P4R
Immunizations for Adolescents – Combination 2 (IMA)^ NCQA NQF 1407 P4P
Oral Evaluation, Dental Services (OED)* NCQA   P4R
Social Need Screening and Intervention (SNS-E)* NCQA   P4R
Topical Fluoride for Children (TFC)* NCQA   P4R
Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC) NCQA NQF 0024 P4R
Well-Child Visits in the First 30 Months of Life (W30)^ NCQA   P4P

Measure removed from HEDIS/NYS 2023 Measure Set
*New Measure for MY2023/Measure revised for 2023
^ HEDIS Stratified Measure - new for MY2023
*Measures' reporting specifications/requirements revised for MY2023
^HEDIS Stratified Measure

CATEGORY 2

The table below displays the Category 2 MY2023 Children's Quality Measure Set and includes measure title, measure steward, and the NQF number (where applicable). All Category 2 measures are classified as P4R in MY2023. The measure set is redlined to highlight changes made between MY2022 and MY2023; please refer to the key at the end of this table for an explanation of redlined formatting.

Children's Measures Measure Steward Measure Identifier
Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence (FUA)^ NCQA NQF3488
Follow-up After Emergency Department Visit for Mental Illness (FUM) NCQA NQF 3489
Maternal Depression Screening NCQA NQF 1401
Screening for Reduced Visual Acuity and Referral in Children CMS NQF 2721
Topical Fluoride for Children at Elevated Caries Risk, Dental Services ADA NQF 2528
Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics NCQA NQF 2801

Measure removed from HEDIS/NYS 2023 Measure Set
*New Measure for MY2023/Measure revised for 2023
^ HEDIS Stratified Measure - new for MY2023
*Measures' reporting specifications/requirements revised for MY2023
^HEDIS Stratified Measure

Appendix A

The table below identifies the changes to the Category 1 and 2 measures for the MY2023 Children's Quality Measure Set.

Category 1 Measure Changes from 2022 to 2023

Measure Name Change Rationale for Change
Annual Dental Visit (ADV) Removed Measure removed from HEDIS 2023 Measure Set
Asthma Medication Ratio (AMR) HEDIS Stratified Measure Added to NCQA list of Race and Ethnicity measures – New for MY2023.
COVID-19 Immunization Measure (CVS) New Measure added to NCQA list of required reporting.
Immunizations for Adolescents (IMA, IMA-E) HEDIS Stratified Measure Added to NCQA list of Race and Ethnicity measures – New for MY2023.
Oral Evaluation, Dental Services (OED) New Measure added to NCQA list of required reporting – New for MY2023.
Social Need Screening and Intervention (SNS-E) New Measure added to NCQA list of required reporting.
Topical Fluoride for Children (TFC) New Measure added to NCQA list of required reporting.
Well-Child Visits in the First 30 Months of Life (W30) HEDIS Stratified Measure Added to NCQA list of Race and Ethnicity measures – New for MY2023.
Follow-Up After Emergency Department Visit for Alcohol and Other Drug Dependence HEDIS Stratified Measure Added to NCQA list of Race and Ethnicity measures – New for MY2023.

__________________________________________________________

1. HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).1
2. New York State Department of Health, Medicaid Redesign Team, A Path Toward Value-Based Payment: Annual Update, May 2022. (Link) 2
3. HEDIS® Measurement Year 2023 Volume 2 Technical Specification for Heath Plans, General Guidelines section 33.3
4. New York State Department of Health, Medicaid Redesign Team, A Path Toward Value-Based Payment: Annual Update, May 2022. (Link) 4

|top of page|