Measure Title: All-cause inpatient admission rate for Medicaid beneficiaries with complex care needs and high costs (BCNs)
NQF Measure Number: 3445
NQF Form Version:
Measure Steward: Centers for Medicare & Medicaid Services
Measure Description: All-cause inpatient admission rate for adult Medicaid beneficiaries who meet BCN population eligibility criteria. The measure is calculated as the number of inpatient admissions per 1,000 beneficiary months and is intended to be reported at the state level.
For the purpose of this measure, the BCN population is defined as Medicaid beneficiaries who are age 18 to 64 during the lookback year (the 12 months prior to the measurement year) and the measurement year and have at least one inpatient admission and at least two chronic conditions, as defined by the Chronic Conditions Data Warehouse (CCW), during the lookback year. Beneficiaries dually enrolled in Medicaid and Medicare and beneficiaries who had fewer than 10 months of Medicaid eligibility in the lookback year are not included in the analytic sample because we did not have enough utilization data to include them in testing. We further limited the analytic file to beneficiaries that met the BCN definition criteria described above.
Numerator Statement: The sum of unique inpatient admissions and observation stays in the measurement year among adult Medicaid beneficiaries who meet BCN population eligibility criteria.
Numerator Details: ${NumeratorDetails}
Denominator Statement: Number of Medicaid-eligible months ("beneficiary months") among adult Medicaid beneficiaries who meet BCN population eligibility criteria.
Denominator Details: ${DenominatorDetails}
Exclusions: Not applicable
Exclusion Details: ${DenominatorExclusionDetails}
Risk Adjustment: Statistical risk model
Corresponding Measures: Not Available
Endorsement Type: New
Initial Endorsement: N/A
Endorsement Date: N/A
Next Planned Maintenance Review: N/A
Measure Type: Outcome
Measure Format: measure
Condition:
Non-Condition Specific:
Care Setting: Inpatient/Hospital
National Quality Strategy Priorities:
Current Use: Quality Improvement (Internal to the specific organization)
Planned Use: Quality Improvement (internal to the specific organization)
Data Source: Claims
Level of Analysis: Population: Regional and State
Target Population:
Measure Selection Attributes:
Measure Steward Organization: Centers for Medicare & Medicaid Services
Primary Measure Steward Contact: Roxanne.Dupert-Frank@cms.hhs.gov
The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) is published by the World Health Organization (WHO). ICD-10-CM is an official Health Insurance Portability and Accountability Act standard.
The International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS) is published by the World Health Organization (WHO). ICD-10-PCS is an official Health Insurance Portability and Accountability Act standard.
Current Procedural Terminology (CPT)® codes copyright 2018 American Medical Association (AMA). All rights reserved. CPT is a trademark of the American Medical Association. No fee schedules, basic units, relative values or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.
Healthcare Common Procedure Coding System (HCPCS) Level II codes and descriptors are approved and maintained jointly by the alpha-numeric editorial panel (consisting of the Centers for Medicare & Medicaid Services, America´s Health Insurance Plans, and Blue Cross and Blue Shield Association).
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Healthcare Effectiveness Data and Information Set (HEDIS) Value Sets
This measure contains HEDIS® Value Sets that were developed, are owned by and are included with the permission of the National Committee for Quality Assurance (“NCQA”). Proprietary coding is contained in the HEDIS Value Sets. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. NCQA disclaims all liability for use or accuracy of any coding contained in the HEDIS Value Sets. The HEDIS Value Sets are provided “as is” without warranty of any kind. Users shall not have the right to alter, enhance or otherwise modify the HEDIS Value Sets, and shall not disassemble, recompile or reverse engineer the HEDIS Value Sets. All uses of the HEDIS Value Sets outside the measure must be approved by NCQA and are subject to a license at the discretion of NCQA. ©2015 NCQA, all rights reserved.