Technical Resources
MAC QRS Measure Set
The table below lists the MAC QRS Mandatory Measure Set established in the final rule.
TABLE 1: MAC QRS MANDATORY MEASURE SET
| CMIT#* | Measure Steward | Measure Name | Measure Description | Data Collection Method |
| 743 | NCQA | Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics (APP) | The percentage of members who had a new prescription for an antipsychotic medication and had documentation of psychosocial care as first-line treatment. Ages: 1 to 17 | Administrative |
| 394 | NCQA | Initiation and Engagement of Substance Use Disorder Treatment (IET) | The percentage of new substance use disorder (SUD) episodes that result in treatment initiation and engagement. Two rates are reported: • Initiation of SUD Treatment. The percentage of new SUD episodes that result in treatment initiation through an inpatient SUD admission, outpatient visit, intensive outpatient encounter, partial hospitalization, telehealth, or medication treatment within 14 days. • Engagement of SUD Treatment. The percentage of new SUD episodes that have evidence of treatment engagement within 34 days of initiation. Ages: 13 and older | Administrative or EHR |
| 672 | CMS | Preventive Care and Screening: Screening for Depression and Follow-Up Plan (CDF) | The percentage of members screened for depression on the date of the encounter or 14 days prior to the date of the encounter using an age-appropriate standardized depression screening tool, and if positive, a follow-up plan is documented on the date of the qualifying encounter. Ages: 12 and older | Administrative or EHR |
| 268 | NCQA | Follow-Up After Hospitalization for Mental Illness (FUH) | The percentage of discharges for members who were hospitalized for treatment of selected mental illness or intentional self-harm diagnoses and who had a follow-up visit with a mental health provider. Two rates are reported: • The percentage of discharges for which the member received follow-up within 30 days after discharge. • The percentage of discharges for which the member received follow-up within 7 days after discharge. Ages: 6 and older | Administrative |
| 761 | NCQA | Well-Child Visits in the First 30 Months of Life (W30) | The percentage of members who had the following number of well-child visits with a primary care practitioner (PCP) during the last 15 months. The following rates are reported: • Well-Child Visits in the First 15 Months. Children who turned age 15 months during the measurement year: Six or more well-child visits. • Well-Child Visits for Age 15 Months to 30 Months. Children who turned age 30 months during the measurement year: Two or more well-child visits. Ages: 0 to 15 months | 15 to 30 months | Administrative |
| 24 | NCQA | Child and Adolescent Well-Care Visits (WCV) | The percentage of members who had at least one comprehensive well-care visit with a primary care practitioner (PCP) or an obstetrician/gynecologist (OB/GYN) during the measurement year. Ages: 3 to 21 | Administrative |
| 93 | NCQA | Breast Cancer Screening (BCS-E) | The percentage of members who were recommended for routine breast cancer screening and had a mammogram to screen for breast cancer. Ages: 50 to 74 | Electronic Clinical Data System (ECDS)w |
| 118 | NCQA | Cervical Cancer Screening (CCS, CCS-E) | The percentage of members who were recommended for routine cervical cancer screening who were screened for cervical cancer using any of the following criteria: • Members 21 to 64 years of age who were recommended for routine cervical cancer screening and had cervical cytology performed within the last 3 years. • Members 30 to 64 years of age who were recommended for routine cervical cancer screening and had cervical high-risk human papillomavirus (hrHPV) testing performed within the last 5 years. • Members 30 to 64 years of age who were recommended for routine cervical cancer screening and had cervical cytology/high-risk human papillomavirus (hrHPV) co-testing within the last 5 years. Ages: 21 to 64 | Administrative, hybrid, EHR, or ECDS |
| 139 | NCQA | Colorectal Cancer Screening (COL-E) | The percentage of members who had appropriate screening for colorectal cancer. Ages: 45 to 75 | ECDS |
| 897 | DQA | Oral Evaluation, Dental Services (OEV) | The percentage of members who received a comprehensive or periodic oral evaluation within the reporting year. Ages: 0 to 20 | Administrative |
| 166 | OPA | Contraceptive Care - Postpartum Women (CCP) | Among women who had a live birth, the percentage that: 1. Were provided a most effective or moderately effective method of contraception within 3 days of delivery and 90 days of delivery. 2. Were provided a long-acting reversible method of contraception (LARC) within 3 days of delivery and 90 days of delivery. Ages: 15 to 44 | Administrative |
| 581 | NCQA | Prenatal and Postpartum Care (PPC) | Percentage of deliveries of live births on or between October 8 of the year prior to the measurement year and October 7 of the measurement year. For these members, the measure assesses the following facets of prenatal and postpartum care: 1. Timeliness of Prenatal Care. The percentage of deliveries that received a prenatal care visit in the first trimester, on or before the enrollment start date, or within 42 days of enrollment in the organization. 2. Postpartum Care Rate. The percentage of deliveries that had a postpartum visit on or between 7 and 84 days after delivery. Ages: All Ages | Administrative or hybrid |
| 1820 | NCQA | Glycemic Status Assessment for Patients with Diabetes (GSD) | The percentage of members with diabetes (types 1 and 2) whose most recent glycemic status (hemoglobin A1c [HbA1c] was at the following levels during the measurement year: • Glycemic Status <8.0%. • Glycemic Status >9.0%. Ages: 18 to 75 | Administrative or hybrid |
| 167 | NCQA | Controlling High Blood Pressure (CBP) | The percentage of members who had a diagnosis of hypertension and whose blood pressure was adequately controlled (< 140/90 mm Hg) during the measurement year. Ages: 18 to 85 | Administrative, hybrid, or EHR |
| 151/152 | AHRQv | CAHPS – How people rated their health plan | The percentage of members who rated their health plan a 9 or 10, where 0 is the worst health plan possible and 10 is the best health plan possible. Ages: 0 to 17 | 18 and older | Consumer survey |
| 151/152 | AHRQv | CAHPS – Getting care quickly | Composite of the following items: • The percentage of members who indicated that they always got care for illness, injury, or condition as soon as they needed, in the last six months. • The percentage of members who indicated they always got check-up or routine care as soon as they needed, in the last six months. Ages: 0 to 17 | 18 and older | Consumer survey |
| 151/152 | AHRQv | CAHPS – Getting needed care | Composite of the following items: • The percentage of members who indicated that it was always easy to get necessary care, tests, or treatment, in the last six months. • The percentage of members who indicated that they always got an appointment with a specialist as soon as needed, in the last six months. Ages: 0 to 17 | 18 and older | Consumer survey |
| 151/152 | AHRQv | CAHPS – How well doctors communicate | Composite of the following items: • The percentage of members who indicated that their doctor always noted things in a way that was easy to understand. • The percentage of members who indicated that their doctor always listened carefully to enrollee. • The percentage of members who indicated that their doctor always showed respect for what enrollee had to say. • The percentage of members who indicated that their doctor always spent enough time with enrollee. Ages: 0 to 17 | 18 and older | Consumer survey |
| 151/152 | AHRQv | CAHPS – Health plan customer service | Composite of the following items: • The percentage of members who indicated that customer service always gave necessary information or help, in the last six months. • The percentage of members who indicated that customer service always was courteous and respectful, in the last six months. Ages: 0 to 17 | 18 and older | Consumer survey |
Technical Resource Manuals
The Medicaid and CHIP Quality Rating System Technical Resource Manual (TRM) is updated annually for each measurement year (MY). The TRM presents the set of MAC QRS mandatory measures, describes updates to the measurement set, and provides guidance on stratifying mandatory measures and calculating mandatory measures with multiple rates.