HEDIS July Report the Care You Give It Pays!

Transcription

1 HEDIS 2012 July 2012 Report the Care You Give It Pays!

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3 HEDIS Reference Introduction... 1 Provider Incentives Summary... 5 How Providers Can Improve Their Well-Child Visits HEDIS Scores... 6 HEDIS 2012 Report the Care You Give Well-Baby Visits... 8 HEDIS 2012 Report the Care You Give Well-Child Visits HEDIS 2012 Report the Care You Give Adolescent Well-Care Visits HEDIS 2012 Report the Care You Give Prenatal Care Visits HEDIS 2012 Report the Care You Give Postpartum Check-up Visits HEDIS 2012 Report the Care You Give Breast Cancer Screening HEDIS 2012 Report the Care You Give Chlamydia Screening HEDIS 2012 Report the Care You Give Asthma Medication Management Member Incentive Validation Member Incentive Summary Well-Child Care Member Incentive Letter Example Postpartum Care Member Incentive Letter Example Mammogram Member Incentive Letter Example Diabetic Eye Exam Member Incentive Letter Example Pap Smear Member Incentive Letter Example HEDIS 2012 Data Collection HEDIS 2012 Measures Utilizing Medical Record Review HEDIS 2012 Measures Utilizing Administrative or Survey Data Tips for Submitting Appropriate HEDIS Documentation Confidentiality and Release of Medical Information... 58

4 TABLE OF CONTENTS Report the Care You Give It Pays

5 Introduction Thank you for your participation in Community Health Group s Project HEDIS. As you review the attached results, you will see improvement in most of the measures, all thanks to you, our physicians. Due to our previous success, we are now rolling out the HEDIS project for 2012, which incorporates most of last year s incentives. We have assembled this HEDIS reference guide to answer questions you and/or your staff may have on the specific HEDIS measurements, proper coding and documentation of the measurements and Community Health Group s prior HEDIS results. While we are thrilled that the majority of our scores increased, we thank you for the great effort to improve our Healthy Families child/adolescent access to PCPs. Now we need your assistance in scheduling mammogram and postpartum visits in order to increase these scores as well. Together we are certain we can become a HEDIS leader in the State and look forward to working closely with you and your staff on these exciting programs. Please feel free to contact Gabriela Rubalcava, HEDIS Manager at (619) or our Provider Relations Department at (619) with any questions or to coordinate HEDIS trainings. Page 1

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7 HEDIS 2012 Report the Care You Give It Pays! How to Improve Your HEDIS Scores Page 3

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9 Report the Care You Give It Pays 2012 Practitioner Incentives Prenatal Care Medi-Cal 1 st Trimester Visit Postpartum Care Medi-Cal w/in days post delivery What You Need to Do Report Assess pregnant Medi-Cal members within the first trimester of pregnancy Submit claim with the following code indicating prenatal care: Z1032 with modifier ZL and Box 14 MUST contain the LMP Assess pregnant Medi-Cal members within days post delivery Submit claim with the following code indicating postpartum follow-up: Z What You Get It Pays An incentive of $100 per claim for eligible members receiving prenatal assessment occurring in the first trimester of their pregnancy An incentive of $100 per claim for eligible members receiving postpartum assessment occurring within days post delivery Also, please submit all of your encounter data ASAP! Thanks for your assistance. For questions, contact Gabriela Rubalcava, (619) Page 5

10 How Providers Can Improve Their Well Child Visits HEDIS Scores The easiest way for Community Health Group and our providers to improve HEDIS results is for providers to report these services to Community Health Group on a PM-160 or HCFA (CMS) 1500 form when they are provided. Because these services are capitated, some providers may believe they do not have to report them. This is incorrect. All services must be reported to us. There are three ways your claims/encounter data will count for HEDIS results that measure Well Child Visits. You may use 1) CPT codes or 2) ICD-9 codes or 3) the PM-160 form. Any of these three reporting methods will count as a positive result if you use the coding and reporting detailed in the chart below. If we have these codes for services in your claims/encounter data, we will NOT have to request medical records for these members from you. For babies under 1 year old For children ages years For children ages years 9939 For adolescents years For adolescents years HCFA (CMS) 1500 with Or CPT Codes ICD-9 Codes V20.2 V70.0 V70.3 V70.5 V70.6 V70.8 V70.9 Or PM-160 Form With 01 History & Physical 04 Anticipatory Guidance 05 Developmental Assessment fields checked Immunizations and blood lead levels should also be reported, either on the HFCA (CMS) 1500 or PM-160 form. Note: Use the PM-160 form for Medi-Cal members and the HFCA (CMS) 1500 for Healthy Families. Page 6

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12 HEDIS 2012 Report the Care You Give It Pays! Well-Baby Visits (0 through 15 months) Question: How can you improve your Well-Baby Visits HEDIS scores? Proof of Visit: Completed CHDP (PM 160) Form indicating: 01 History & Physical 03 Nutritional Assessment 04 Anticipatory Guidance 05 Developmental Assessment Comments: Add Counseled on Physical Activity Completed HFCA (CMS) 1500 Form indicating well care visit Codes to Identify Well-Baby Visits Age CPT Codes ICD-9-CM Codes < 1 year 99381, V20.2, V70.0, V70.3, V70.5, V70.6, V70.8, V months 99382, V20.2, V70.0, V70.3, V70.5, V70.6, V70.8, V70.9 Note: Use the PM-160 form for Medi-Cal members and the HFCA (CMS) 1500 for Healthy Families. Page 8

13 PLEASE DO NOT STAPLE IN THIS AREA. HEALTH INSURANCE CLAIM FORM 1. MEDICARE MEDICAID CHAMPUS CHAMPUS VA GROUP FECA OTHER HEALTH PLAN BLK LUNG (Medicare #) (Medicaid #) (Sponsor SSN) (VA File #) (SSN or ID) (SSN) (ID) 2. PATIENT S NAME (Last Name, First Name, Middle Initial) 3. PATIENT S BIRTH DATE SEX M F Report the Care You Give It Pays HEDIS 2012 Report the Care You Give It Pays! Well-Baby Visit 0 through 15 months 1a. INSURED S I.D. NUMBER (FOR PROGRAM IN ITEM 1) 4. INSURED S NAME (Last Name, First Name, Middle Initial) 5. PATIENT S ADDRESS (No., Street) 6. PATIENT S RELATIONSHIP TO INSURED 7. INSURED S ADDRESS (No., Street) Self Spouse Child Other CITY STATE 7. PATIENT STATUS ZIP CODE TELEPHONE (Includes Area Code) ( ) Single Married Other Employed Full-Time Part-Time Student Student 9. OTHER INSURED S NAME (Last Name, First Name, Middle Initial) 10. IS PATIENT S CONDITION RELATED TO: CITY ZIP CODE STATE TELEPHONE (Includes Area Code) ( ) a. EMPLOYMENT? (CURRENT OR a. OTHER INSURED S POLICY GORUP OR FECA NUMBER PREVIOUS) a. INSURED S DATE OF BIRTH SEX b. OTHER INSURED S DATE OF BIRTH SEX YES NO b. AUTO ACCIDENT? PLACE (State) YES NO M F c. OTHER ACCIDENT? c. EMPLOYER S NAME OR PROGRAM NAME c. INSURANCE PLAN NAME OR PROGRAM NAME YES NO 11. INSURED S POLICY GORUP OR FECA NUMBER M F b. EMPLOYER S NAME OR PROGRAM NAME d. INSRANCE PLAN NAME OR PROGRAM NAME 10d. RESERVED FOR LOCAL USE d. IS THERE ANOTHER HEALTH BENEFIT PLAN? READ BACK OF FORM BEFORE COMPLETING & SIGNING THIS FORM. 12. PATIENT S OR AUTHORIZED PERSON S SIGNATURE. I authorize the release of any medical or other information necessary to process this claim. I also request payment of government benefits either to myself or to the party who accepts assignment below. SIGNED 14. DATE OF CURRENT: ILLNESS (First symptoms) OR INJURY (Accident) OR PREGNANCY (LMP) DATE 15. IF PATIENT HAS HAD SAME OR SIMILAR ILLNESS, GIVE FIRST DATE YES NO If yes, return to and complete items 9 a-d. 13. INSURSED S OR AUTHORIZED PERSON S SIGNATURE. I authorize payment of medical benefits to the undersigned physician or supplier for services described below. SIGNED 16. DATES PATIENT UNABLE TO WORK IN CURRENT OCCUMAPTION FROM TO 17. NAME OF REFERRING PHYSICIAN OR OTHER SOURCE 17A. I.D. NUMBER OF REFERRING PHYSICIAN 18. HOSPITALIZATION DATES RELATED TO CURRENT SERVICES FROM TO 19. RESERVED FOR LOCAL USE 20. OUTSIDE LAB? $CHARGES 21. DIAGNOSIS OR NATURE OF ILLNESS OR INJURY. (RELATE ITEMS 1, 2, 3 OR 4 TO ITEM 24E BY LINE) 1. _ V YES NO 22. MEDICAID RESUBMISSION CODE 23. PRIOR AUTHORIZATION NUMBER ORIGINAL REF. NO. 24. A B C D E F G H I J K DATES OF SERVICE Place Type PROCEDURES, SERVICES, OR SUPPLIES DAYS EPSD EMG CDE RESERVED FOR From To of of DIAGNOSIS (Explain Unusual Circumstances) established OR T Service Service CODE patients LOCAL USE $CHARGES UNITS Family Plan For New Patient, 1 y.o. Well Baby Visit FEDERAL TAX I.D. NUMBER SSN EIN 26. PATIENT ACCOUNT NO. 27. ACCEPT ASSIGNMENT? 31. SIGNATURE OF PHYSICIAN OR SUPPLIER INCLUDING DEGREES OR CREDENTIALS (I certify that the statements on the reverse apply to this bill and are made a part thereof.) For 1 st Well Baby Visit YES 32. NAME AND ADDRESS OF FACILITY WHERE SERVICES WERE RENDERED (If other than home or office.) NO For <1 year old 28. TOTAL 29. AMOUNT PAID 30. BALANCE DUE CHARGE $ $ $ 33. PHYSICIAN S, SUPPLIER S BILLING NAME, ADDRESS, ZIP CODE & PHONE # For 1 year old established patients SIGNED DATE PIN# GRP# Page 9

14 HEDIS 2012 Report the Care You Give It Pays! Well-Child Visits (3 through 6 Year Olds) Question: Solution: How can you improve your Well-Child Visits HEDIS scores? Completed CHDP (PM 160) Form indicating: 01 History & Physical 03 Nutritional Assessment 04 Anticipatory Guidance 05 Developmental Assessment Comments: Add Counseled on Physical Activity or Completed HFCA (CMS) 1500 Form indicating wellcare visit Codes to Identify Well-Child Visits Age CPT Codes ICD-9-CM Codes 3 4 years 99382, V20.2, V70.0, V70.3, V70.5, V70.6, V70.8, V years 99383, V20.2, V70.0, V70.3, V70.5, V70.6, V70.8, V70.9 Note: Use the PM-160 form for Medi-Cal members and the HFCA (CMS) 1500 for Healthy Families. Page 10

15 PLEASE DO NOT STAPLE IN THIS AREA Well-Child Visit. 3 through 6 year olds. HEALTH INSURANCE CLAIM FORM 1. MEDICARE MEDICAID CHAMPUS CHAMPUS VA GROUP FECA OTHER HEALTH PLAN BLK LUNG (Medicare #) (Medicaid #) (Sponsor SSN) (VA File #) (SSN or ID) (SSN) (ID) 4. PATIENT S NAME (Last Name, First Name, Middle Initial) 5. PATIENT S BIRTH DATE SEX HEDIS 2012 Report the Care You Give It Pays! 1a. INSURED S I.D. NUMBER (FOR PROGRAM IN ITEM 1) 4. INSURED S NAME (Last Name, First Name, Middle Initial) M F 8. PATIENT S ADDRESS (No., Street) 9. PATIENT S RELATIONSHIP TO INSURED 7. INSURED S ADDRESS (No., Street) Self Spouse Child Other CITY STATE 10. PATIENT STATUS Single Married Other ZIP CODE Employed Full-Time Part-Time Student Student TELEPHONE (Includes Area Code) ( ) CITY ZIP CODE STATE TELEPHONE (Includes Area Code) ( ) 9. OTHER INSURED S NAME (Last Name, First Name, Middle Initial) 10. IS PATIENT S CONDITION RELATED TO: 11. INSURED S POLICY GORUP OR FECA NUMBER a. OTHER INSURED S POLICY GORUP OR FECA NUMBER a. EMPLOYMENT? (CURRENT OR PREVIOUS) c. INSURED S DATE OF BIRTH SEX YES NO M F d. OTHER INSURED S DATE OF BIRTH SEX b. AUTO ACCIDENT? PLACE (State) b. EMPLOYER S NAME OR PROGRAM NAME M F YES NO c. EMPLOYER S NAME OR PROGRAM NAME c. OTHER ACCIDENT? c. INSURANCE PLAN NAME OR PROGRAM NAME YES NO d. INSRANCE PLAN NAME OR PROGRAM NAME 10d. RESERVED FOR LOCAL USE d. IS THERE ANOTHER HEALTH BENEFIT PLAN? YES NO If yes, return to and complete items 9 a-d. READ BACK OF FORM BEFORE COMPLETING & SIGNING THIS FORM. 12. PATIENT S OR AUTHORIZED PERSON S SIGNATURE. I authorize the release of any medical or other information necessary to process this claim. I also request payment of government benefits either to myself or to the party who accepts assignment below. 14. INSURSED S OR AUTHORIZED PERSON S SIGNATURE. I authorize payment of medical benefits to the undersigned physician or supplier for services described below. SIGNED 14. DATE OF CURRENT: ILLNESS (First symptoms) OR INJURY (Accident) OR PREGNANCY (LMP) 17. NAME OF REFERRING PHYSICIAN OR OTHER SOURCE DATE 15. IF PATIENT HAS HAD SAME OR SIMILAR ILLNESS, GIVE FIRST DATE SIGNED 16. DATES PATIENT UNABLE TO WORK IN CURRENT OCCUMAPTION FROM TO 17A. I.D. NUMBER OF REFERRING PHYSICIAN 18. HOSPITALIZATION DATES RELATED TO CURRENT SERVICES FROM TO 19. RESERVED FOR LOCAL USE 20. OUTSIDE LAB? $CHARGES 21. DIAGNOSIS OR NATURE OF ILLNESS OR INJURY. (RELATE ITEMS 1, 2, 3 OR 4 TO ITEM 24E BY LINE) 1. V For 3 year old YES NO 22. MEDICAID RESUBMISSION CODE 23. PRIOR AUTHORIZATION NUMBER ORIGINAL REF. NO A B C D E F G H I J K DATES established OF SERVICE patient Place Type PROCEDURES, SERVICES, OR SUPPLIES DAYS EPSD EMG CDE RESERVED From To of of DIAGNOSIS (Explain Unusual Circumstances) OR T FOR LOCAL Service Service CODE $CHARGES UNITS Family USE Plan FEDERAL TAX I.D. NUMBER SSN EIN 26. PATIENT ACCOUNT NO. 27. ACCEPT ASSIGNMENT? 31. SIGNATURE OF PHYSICIAN OR SUPPLIER INCLUDING DEGREES OR CREDENTIALS (I certify that the statements on the reverse apply to this bill and are made a part thereof.) YES 32. NAME AND ADDRESS OF FACILITY WHERE SERVICES WERE RENDERED (If other than home or office.) For 5-11 year old NO established patients 28. TOTAL 29. AMOUNT PAID 30. BALANCE DUE CHARGE $ $ $ 33. PHYSICIAN S, SUPPLIER S BILLING NAME, ADDRESS, ZIP CODE & PHONE # SIGNED DATE PIN# GRP# Page 11

16 HEDIS 2012 Report the Care You Give It Pays! Adolescent Well-Care Visits (12 through 20 year olds) Physician or Clinic Incentive: $20.00 for Annual Well Care Visit Proof of Visit: Completed CHDP (PM 160) Form indicating: 01 History & Physical 03 Nutritional Assessment 04 Anticipatory Guidance 05 Developmental Assessment Comments: Add Counseled on Physical Activity Completed HFCA (CMS) 1500 Form indicating well care visit Codes to Identify Adolescent Well-Care Visits Age CPT Codes ICD-9-CM Codes years 99384, V20.2, V70.0, V70.3, V70.5, V70.6, V70.8, V years 99385, V20.2, V70.0, V70.3, V70.5, V70.6, V70.8, V70.9 Note: Use the PM-160 form for Medi-Cal members and the HFCA (CMS) 1500 for Healthy Families. Page 12

17 PLEASE DO NOT STAPLE IN THIS AREA Adolescent Well-Care Visit. 12 through 20 year olds. HEALTH INSURANCE CLAIM FORM 1. MEDICARE MEDICAID CHAMPUS CHAMPUS VA GROUP FECA OTHER HEALTH PLAN BLK LUNG (Medicare #) (Medicaid #) (Sponsor SSN) (VA File #) (SSN or ID) (SSN) (ID) 6. PATIENT S NAME (Last Name, First Name, Middle Initial) 7. PATIENT S BIRTH DATE SEX HEDIS 2012 Report the Care You Give It Pays! 1a. INSURED S I.D. NUMBER (FOR PROGRAM IN ITEM 1) 4. INSURED S NAME (Last Name, First Name, Middle Initial) M F 11. PATIENT S ADDRESS (No., Street) 12. PATIENT S RELATIONSHIP TO INSURED 7. INSURED S ADDRESS (No., Street) Self Spouse Child Other CITY STATE 13. PATIENT STATUS Single Married Other ZIP CODE Employed Full-Time Part-Time Student Student TELEPHONE (Includes Area Code) ( ) CITY ZIP CODE STATE TELEPHONE (Includes Area Code) ( ) 9. OTHER INSURED S NAME (Last Name, First Name, Middle Initial) 10. IS PATIENT S CONDITION RELATED TO: 11. INSURED S POLICY GORUP OR FECA NUMBER a. OTHER INSURED S POLICY GORUP OR FECA NUMBER a. EMPLOYMENT? (CURRENT OR PREVIOUS) e. INSURED S DATE OF BIRTH SEX YES NO M F f. OTHER INSURED S DATE OF BIRTH SEX b. AUTO ACCIDENT? PLACE (State) b. EMPLOYER S NAME OR PROGRAM NAME M F YES NO c. EMPLOYER S NAME OR PROGRAM NAME c. OTHER ACCIDENT? c. INSURANCE PLAN NAME OR PROGRAM NAME YES NO d. INSRANCE PLAN NAME OR PROGRAM NAME 10d. RESERVED FOR LOCAL USE d. IS THERE ANOTHER HEALTH BENEFIT PLAN? READ BACK OF FORM BEFORE COMPLETING & SIGNING THIS FORM. 12. PATIENT S OR AUTHORIZED PERSON S SIGNATURE. I authorize the release of any medical or other information necessary to process this claim. I also request payment of government benefits either to myself or to the party who accepts assignment below. YES NO If yes, return to and complete items 9 a-d. 15. INSURSED S OR AUTHORIZED PERSON S SIGNATURE. I authorize payment of medical benefits to the undersigned physician or supplier for services described below. SIGNED 14. DATE OF CURRENT: ILLNESS (First symptoms) OR INJURY (Accident) OR PREGNANCY (LMP) 17. NAME OF REFERRING PHYSICIAN OR OTHER SOURCE DATE 15. IF PATIENT HAS HAD SAME OR SIMILAR ILLNESS, GIVE FIRST DATE SIGNED 16. DATES PATIENT UNABLE TO WORK IN CURRENT OCCUMAPTION FROM TO 17A. I.D. NUMBER OF REFERRING PHYSICIAN 18. HOSPITALIZATION DATES RELATED TO CURRENT SERVICES FROM TO 19. RESERVED FOR LOCAL USE 20. OUTSIDE LAB? $CHARGES YES NO 21. DIAGNOSIS OR NATURE OF ILLNESS OR INJURY. (RELATE ITEMS 1, 2, 3 OR 4 TO ITEM 24E BY LINE) 1. V MEDICAID RESUBMISSION CODE 23. PRIOR AUTHORIZATION NUMBER ORIGINAL REF. NO A B C D E F G H I J K DATES OF SERVICE From To Place of Service Type of Service PROCEDURES, SERVICES, OR SUPPLIES (Explain Unusual Circumstances) FEDERAL TAX I.D. NUMBER SSN EIN 26. PATIENT ACCOUNT NO. 27. ACCEPT ASSIGNMENT? 31. SIGNATURE OF PHYSICIAN OR SUPPLIER INCLUDING DEGREES OR CREDENTIALS (I certify that the statements on the reverse apply to this bill and are made a part thereof.) YES 32. NAME AND ADDRESS OF FACILITY WHERE SERVICES WERE RENDERED (If other than home or office.) NO DIAGNOSIS CODE $CHARGES DAYS OR UNITS EPSD T Family Plan EMG CDE RESERVED FOR LOCAL USE 28. TOTAL 29. AMOUNT PAID 30. BALANCE DUE CHARGE $ $ $ 33. PHYSICIAN S, SUPPLIER S BILLING NAME, ADDRESS, ZIP CODE & PHONE # SIGNED DATE PIN# GRP# (APPROVED BY AMA COUNCIL ON MEDICAL SERVICE 8/88) PLEASE PRINT OR TYPE FORM HCFA 1500, CMS 1500 Page 13

18 HEDIS 2012 Report the Care You Give It Pays! Prenatal Care Visits (To qualify for HEDIS the prenatal visit must occur in the 1 st trimester.) Private Physician*/Clinic Incentive: Proof of Visit: $100 for Prenatal Check-up Visit completed in the 1 st trimester Completed HFCA (CMS) 1500 Form/submit encounter data indicating prenatal visit Codes to Identify Prenatal Visits Z1032 with modifier ZL and Box 14 MUST contain the LMP Note: Effective 8/1/10 if using global billing you are required to submit itemization of all prenatal care. *Visits to OB/GYN or primary care physicians qualify. The incentive will be paid to the FIRST proof of visit received. Page 14

19 HEDIS Documentation for Prenatal Care Visit Documentation in medical record must identify one of the following. Prenatal care visits to an OB/GYN practitioner or midwife. Documentation in the medical record must include a note indicating the date on which the prenatal care visits occurred and evidence of one of the following. A basic physical obstetrical examination that includes auscultation for fetal heart tone, or pelvic exam with obstetric observations, or measurement of fundus height (a standardized prenatal flow sheet may be used) Evidence that a prenatal care procedure was performed, such as: Screening test in the form of an obstetric panel (e.g., hematocrit, differential WBC count, platelet count, hepatitis B surface antigen, rubella antibody, syphilis test, RBC antibody screen, Rh[D] and ABO blood typing), or TORCH antibody panel alone or a rubella antibody test/titer with an Rh incompatibility (ABO/Rh) blood typing, or Echography of a pregnant uterus Documentation of LMP or EDD in conjunction with either of the following. Prenatal risk assessment and counseling/education, or Complete obstetrical history Prenatal care visits to a family practitioner or other PCP. Documentation in the medical record must include a note indicating the date on which the prenatal care visits occurred, with diagnosis of pregnancy and evidence of one of the following. A basic physical obstetrical examination that includes auscultation for fetal heart tone, or pelvic exam with obstetric observations or measurement of fundus height (a prenatal flow sheet may be used) Evidence that a prenatal care procedure was performed, such as: Screening test in the form of an obstetric panel, or Rubella antibody test/titer with an Rh incompatibility (ABO/Rh) blood typing, or TORCH antibody panel, or Echography of a pregnant uterus Evidence that a diagnosis of pregnancy has been established in the form of a documented LMP or EDD in conjunction with either: Complete obstetrical history, or Prenatal risk assessment and counseling/education Note: For members whose last enrollment segment was after 219 days prior to delivery, count any documentation of a visit to an OB/GYN, family practitioner or other PCP with a principal diagnosis of pregnancy. Page 15

20 HEDIS 2012 Report the Care You Give It Pays! Postpartum Check-up Visits (To qualify for HEDIS the postpartum visit must occur on or between 21 days and 56 days after delivery.) Private Physician*/Clinic Incentive: Proof of Visit: $100 for Postpartum Check-up Visit completed between 21 and 56 days after delivery Completed HFCA (CMS) 1500 Form indicating postpartum check-up visit Codes to Identify Postpartum Visits Z1038, Note: Effective 8/1/10 if using global billing you are required to submit itemization of all postpartum care. *Visits to OB/GYN or primary care physicians qualify. The incentive will be paid to the FIRST proof of visit received. Page 16

21 HEDIS Documentation for Postpartum Checkups As participating providers, your offices may have assisted our data-collection nurses with chart reviews during HEDIS evaluations conducted each spring. There are three HEDIS measures related to maternity care: The first measure looks at the percentage of women within a random sample of our pregnant membership who received prenatal care during the first trimester of their pregnancy. The second measure documents the number of women who received prenatal care within 42 days of enrollment in their plan. The third measure demonstrates the percentage of women in a random sample who received a postpartum visit between 21 and 56 days after delivering. Please be sure to include the following information in your documentation of the postpartum visit: Note visit type: Postpartum Visit or Postpartum Check or Postpartum Care. Weight. Blood pressure. Breast assessment. Abdominal assessment. Pelvic exam. Continue to encourage our new mothers to schedule and maintain appointments for follow up care between 4 6 weeks after delivery. Remember to clearly and completely document your postpartum visit and medical care. Page 17

22 HEDIS 2012 Report the Care You Give It Pays! Breast Cancer Screening (Women years of age) Question: Solution: How can you improve your Breast Cancer Screening HEDIS scores? Encourage and recommend for women years of age to get a mammogram at a minimum once every two years. If directly contracted with Community Health Group, you can send your members for mammograms without prior authorization. Refer to the list of approved mammogram centers in the network. If your contract is through an IPA, please refer to the IPA s authorization process. Also, please remind your members to return the form validated by the center after they get their mammograms to receive a $25.00 gift card. Page 18

23 PREFERRED MAMMOGRAPHY CENTERS NORTH COUNTY Report the Care You Give It Pays Cassidy Medical Group (X-Ray Department) 145 Thunder Drive Vista, CA Phone Gateway Radiology (VRC) Pomerado Road #101 Poway, CA Phone Garden View Imaging Center (RMG) 1200 Garden View Road, Suite 110 Encinitas, CA Phone Encinitas Imaging Center (RMG) 477 N. El Camino Real # A-102 Encinitas, CA Phone Parkway Radiology Center (VRC) 488 E. Valley Parkway #100 Escondido, CA Phone San Clemente Imaging Center (RMG) 675 Camino De Los Mares, Suite 101 San Clemente, CA Phone CENTRAL COUNTY Alvarado Breast Center (PRMG) 6386 Alvarado Court #121 San Diego, CA Phone First & Laurel Imaging Center (RMG) 2466 First Avenue San Diego, CA Phone EAST COUNTY Alvarado Breast Center (PRMG) 6386 Alvarado Court #121 San Diego, CA Phone Grossmont Imaging 9640 Mission Gorge Road, Suite H Santee, CA Phone Grossmont Imaging 8881 Fletcher Parkway, Suite 102 La Mesa, CA Phone Physicians Radiology Medical Group 6386 Alvarado Court San Diego, CA Phone SOUTH BAY Western Diagnostic Imaging Center 1660 Broadway, Suite 9 Chula Vista, CA Phone Page 19

24 HEDIS 2012 Report the Care You Give It Pays! Chlamydia Screening (Women years of age) Question: Solution: How can you improve your Chlamydia Screening HEDIS scores? Women years of age who are identified as sexually active, must have at least one Chlamydia screening test annually. Submit a completed HFCA (CMS) 1500 or PM 160 Form indicating Chlamydia screening performed. Codes to Identify Chlamydia Screening CPT Codes 87110, 87270, 87320, 87490, 87491, 87492, PM 160 Code 20 Page 20

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26 HEDIS 2012 Report the Care You Give It Pays! Asthma Medication Management (Members 5 64 years of age) Question: Solution: How can you improve your Asthma Medication Management HEDIS scores? Members 5 64 years of age, who are identified having persistent asthma, should be prescribed medications that are considered appropriate for long-term control of asthma. Codes to Identify Asthmatics CPT Codes Outpatient visit , , , , Preferred therapy Add-on therapy Asthma Medications Cromolyn sodium Inhaled corticosteroids Prescriptions Leukotriene modifiers Methylanthines Long-acting, inhaled beta-2 agonists Nedocromil Page 22

27 Asthma Medication Management Persistent Asthmatics must meet one of the following criteria for both 2011 & One ED visit with asthma as principal diagnosis or One inpatient hospitalization with asthma as principal diagnosis or Four outpatient visits with asthma as one of the diagnosis & two medication dispensing events or Four asthma medication dispensing events Page 23

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29 Member Incentive Validation When members complete their well-child and request for you to validate that the visit has occurred, please have your staff place your office stamp in the box indicated on the following examples. Page 25

30 2012 Member Incentives Report the Care You Give It Pays What the Member Gets It Pays Adolescent Well Medi-Cal & Healthy Families Annual Visit Breast Cancer Screening Medi-Cal year old women Cervical Cancer Screen Medi-Cal year old women Diabetic Eye Exams Medi-Cal year old diabetics Complete VSP vision exam Chlamydia Screening -Medi-Cal & Healthy Families -Women ages years Prenatal Care Medi-Cal & Healthy Families 1 st Trimester Visit Postpartum Care Medi-Cal & Healthy Families within days post delivery Well-Child Care Visit Medi-Cal & Healthy Families Annual Visit for 3 6 years of age Well-Child Care Visit Healthy Families Six (6) well exams during the first 15 months of life. Choice = $20: AMC gift card Regal Theater gift card. $25 Gift Card to Target $25 Gift Card to Target $25 Wal-Mart Gift Card for proof of eye exam $25 Wal-Mart Gift Card for proof of purchase of new prescription eyeglasses $20.00 Gift Card to Target $25 Gift Card to Target Schedule Appointment & Provide Taxi to & from $25.00 Gift Card to Sear s Photo Center & a CHG baby T-shirt. Schedule Appointment & Provide Taxi to & from $20 Gift Card to Target $ Gift Card to Target Thanks for your assistance. For questions, contact Gabriela Rubalcava, (619) Page 26

31 Well-Child Care Member Incentive Letter February 2012 To the Parents of: [Member Name] [Member Address] [City, State, Zip Code] [Subscriber ID number] Dear Parent: We know you are a good parent and care about your child s health, so do we! Community Health Group (CHG) is starting a new program that rewards you for taking your 3 to 6 year old child to the doctor for a well-child visit. Here is how you can receive a $20 Gift Card for Target! Take your child in for a well-child exam with their primary care physician by December 31, Have the doctor stamp this form during your visit (you must be an active member of CHG). Return the completed form to Community Health Group by January 15, Once a claim is received for this visit, we will send you the gift card. If you need help making an appointment, call our Member Services Department at TO RECEIVE YOUR $20.00 GIFT CARD FOR TARGET: Please Check: The patient listed above had a well-physical exam on: Initial Comprehensive Preventive Visit Periodic Comprehensive Preventive Visit (age 1-4) on (age 1-4) on. (Exam Date) (Exam Date) (age 5-11) on (age 5-11) on. (Exam Date) (Exam Date) Doctor s Name:. (Please Print) Doctor s Signature:. Send this completed form to: Community Health Group HEDIS Department 740 Bay Boulevard Chula Vista, CA Have Doctor Place Their Office Ink Stamp Here Page 27

32 February 2012 <Member s Name> <Street Address> <City, State, Zip Code> <Subscriber ID number> Postpartum Care Member Incentive Letter Dear Ms. : TO DO LIST Have a postpartum checkup 21 to 56 days after my baby is born. Get my $25 Target gift card. Take care of my health. All of the above. Take time for good health..we will reward you for this. Women who have just had a baby need to see their doctor for a postpartum checkup 21 to 56 days after the baby is born. Community Health Group has a program that rewards you for taking care of yourself. Here is how you can receive a $25 gift card for Target: Have a postpartum checkup within 21 to 56 days after your baby is born. Ask the staff at the doctor s office to stamp the form below after your visit. Return the form to Community Health Group by June 30, Once a claim is received for your post-partum visit, we will send you the gift card. =============================================================================== TO RECEIVE YOUR $50 GIFT CARD FOR TARGET OR TOYS R US/BABIES R US: Please have the staff at the doctor s office complete this form after your visit. Have Doctor Place Their Office Ink Stamp Here Please Check: The patient listed above had a postpartum visit (CPT Z1038 or 59430) on. Doctor s Name :. (Please Print) Doctor s Signature: Tax ID:. Send this completed form to: Community Health Group HEDIS Department 740 Bay Boulevard Chula Vista, CA Page 28

33 Mammogram Member Incentive Letter TO DO LIST February 2012 <Member s Name> <Street Address> <City, State, Zip Code> <Subscriber ID number> Have a mammogram before December 31, Get my $25 Target gift card. Take care of my health. All of the above. Dear Ms. <Member s Name>: Our number one job at Community Health Group is to keep our members healthy. Community Health Group will begin a new program that rewards you for taking care of yourself. Here is how you can receive a $25 gift card for Target: Call Member Services at 1(800) for the telephone number to the mammography center nearest you. No doctor order required if performed at San Diego Imaging or Western Diagnostic. San Diego Imaging (866) for all of San Diego County Western Diagnostic (619) for South San Diego Schedule and have a mammogram before December 01, Ask the mammography center staff to stamp the form below after your mammogram and return this to Community Health Group by January 15, Please include your address and cell phone number: Cell Phone: Please have the staff at the mammography center complete this form after your mammogram. The patient listed above had a mammogram (77056) on. (Date of Visit) Mammography Center Name (Please Print):. Send this completed form to: Community Health Group HEDIS Department 740 Bay Boulevard Chula Vista, CA Have Mammography Center Place Their Office Ink Stamp Here Page 29

34 Diabetic Eye Exam Member Incentive Letter <Name> <Street Address> <City, State, Zip Code> <Subscriber ID number> Dear <Member s Name>: April 2012 U N E E D A N E Y E E x a m We will give you a $25.00 Walmart gift card if you have an eye exam before December 31, 2012, and another $25.00 Walmart gift card for proof of purchase of new prescription eyeglasses. This is what you have to do: Schedule an appointment with the Optometrist for an exam as soon as possible and before December 31, After the exam, be sure to have the Optometrist or the office staff stamp this form in the box below. Mail your envelope with the stamped form to Community Health Group before January 15, Please include your address and cell phone #: ( ) Have Optometrist Office Place Their Office Ink Stamp Here (cell) Please Check: The patient listed above had a diabetic eye exam on. (Date of Visit) Vision Service Plan Optometrist Office Name: Vision Service Plan Optometrist Telephone Number: Send this completed form to: Community Health Group HEDIS Department 740 Bay Boulevard Chula Vista, CA Page 30

35 Pap Smear Member Incentive Letter February 2012 <Member s Name> <Street Address> <City, State, Zip Code> <Subscriber ID number> TO DO LIST Have a pap smear before December 31, Get my $25 Target gift card. Take care of my health. All of the above. Dear Ms. <Member s Name>: We will give you a $25 Target gift card! Our number one job at Community Health Group is to keep our members healthy. Community Health Group began a new program that rewards you for taking care of yourself. Here is how you can receive a $25 Target gift card: Schedule and have a pap smear before December 31, 2012 with a Community Health Group contracted physician. Ask the staff at your doctor s office to stamp the form below after your pap smear and return this to Community Health Group by January 15, To receive your $25.00 target gift card please have the staff from your doctor s office complete this form: Have Doctor Place Their Office Ink Stamp Here The patient listed above had a pap smear (CPT CODE 88141) on and it was (Date of Visit) sent to laboratory. Physician Name (Please Print):. Physician Telephone Number:. Send this completed form to: Community Health Group HEDIS Department 740 Bay Boulevard Chula Vista, CA Page 31

36 HEDIS 2012 Data Collection In addition to our regular medical record pursuit for HEDIS data, Community Health Group will contact individual physicians who are identified as non-collectors (as defined below) to request charts. Community Health Group will send HEDIS Medical Chart Pull List to individual physicians identified as a non-collector. A non-collector is an individual physician who has elected not to participate in the coordination of collecting medical records on behalf of Community Health Group. Community Health Group will initiate telephone calls to all individual physicians identified as non- Collectors beginning February Community Health Group, HEDIS Medical Record Abstractors will follow these steps: 1. Initiate direct contact with responsible party at individual physician offices identified as non- Collectors. 2. Assess how individual physician offices identified as non-collector will submit charts: a. Copy and mail charts directly to Community Health Group b. Community Health Group abstractors - offices with more than 5 charts for review 3. Fax Community Health Group/HEDIS Medical Chart Pull List to direct contact. 4. Follow-up with direct contact to assure receipt of Community Health Group/HEDIS Medical Chart Pull List. Page 32

37 HEDIS 2012 Measures Utilizing Medical Record Documentation: Adolescent Well-Care Visits AWC (M/Cal, HF) The percentage of enrolled members who were years of age who had at least one comprehensive well-care visit with a primary care practitioner or OB/GYN practitioner during the measurement year. Adult BMI Assessment ABA (SNP, NCQA) The percentage of members years of age who had an outpatient visit and who had their body mass index (BMI) documented during the measurement year or the year prior the measurement year. Care for Older Adults COA (SNP) The percentage of adults 66 years and older who had each of the following during the measurement year. Advance care planning The presence of an advanced care plan in the medical record, or Documentation of an advance care planning discussion with the provider and the date on which it was discussed. The documentation of discussion must be noted in the measurement year, or Notation that the member has previously executed an advance care plan. Medication review At least one medication review conducted by a prescribing practitioner or clinical pharmacist during the measurement year and the presence of a medication list in the medical record. Functional status assessment Documentation in the medical record must include evidence of a complete functional status assessment and the date on which it was performed. Notations for a complete physical functional status assessment include the following. Notation that Instrumental Activities of Daily Living (IADL) was assessed (includes shopping for groceries, driving or using public transportation, using the telephone, meal preparation, housework, home repair, laundry, taking medications, handling finances), or Notation that Activities of Daily Living (ADL),was assessed (includes bathing, dressing, eating, transferring [e.g., getting in and out of chairs], using toilet, walking), or Result of assessment using a standardized functional status assessment tool, or Notation that the following components (at least three of four) were assessed: Cognition status Ambulation status Sensory ability (hearing, vision, speech) Other functional independence (e.g., exercise, ability to perform job) The components of the functional status assessment numerator may take place during separate visits within the measurement year. Pain screening Documentation in the medical record must include evidence of a comprehensive pain screening or a pain management plan and the date on which it was performed. Evidence of a comprehensive pain screening may include the following. Notation of a comprehensive pain assessment Pain assessment limited to a single condition, event or body system (e.g., toothache, earache, localized pain from trauma) does not meet criteria for a comprehensive pain assessment. Results of a screening using a standardized pain screening tool, as in but not limited to: Multidimensional Pain Inventory Page 33

38 Faces Pain Scale 0 10 Numeric Rating Scales, verbal or visual Verbal Descriptor Scale Brief Pain Inventory (Short Form) Evidence of a pain management plan may include the following. Notation of no pain intervention and the rationale Notation of plan for treatment of pain, which may include use of pain medications, psychological support and patient/family education Notation of a pain management plan limited to a single condition, event or body system (e.g., toothache, earache, localized pain from trauma) does not meet criteria for a comprehensive pain management plan Notation of plan for reassessment of pain, including reassessment time interval Cervical Cancer Screening CCS (NCQA, M/Cal) Percentage of women, years of age who received a Pap smear screening test during the measurement year and 2 years prior to the measurement year. Childhood Immunization CIS (NCQA, M/Cal, HF) The percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV); one measles, mumps and rubella (MMR); three H influenza type B (HiB); three hepatitis B (HepB), one chicken pox (VZV); four pneumococcal conjugate (PCV); two hepatitis A (HepA); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday. If the child has a history of having the chicken pox, please document the date on the immunization record. Cholesterol Management for Patients with CVD CMC (SNP, NCQA) The percentage of members years of age who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous transluminal coronary angioplasty (PTCA) from January 1 November 1 of the year prior to the measurement year, or who had a diagnosis of ischemic vascular disease (IVD) during the measurement year and the year prior to measurement year, who had LDL-C screening during the measurement year and with LDL-C control (<100 mg/dl). Colorectal Cancer Screening COL (SNP) The measure is the percentage of members years of age who had appropriate screening for colorectal cancer. Appropriate screenings are defined by one of the following criteria. Fecal occult blood test (FOBT) during the measurement year. Regardless of FOBT type, guaiac (gfobt) or immunochemical (ifobt), assume that the required number of samples was returned. Flexible sigmoidoscopy during the measurement year or the four years prior to the measurement year. Colonoscopy during the measurement year or the nine years prior to the measurement year. Comprehensive Diabetes Care CDC (SNP, NCQA, M/Cal) Percentage of members with diabetes age 18 through 75 years old who had each of the following: Hemoglobin A1c (HbA1c) testing LDL-C screening HbA1c poor control (>9.0%) LDL-C control (<100 mg/dl) HbA1c control (<8.0%) Medical attention for nephropathy Eye exam (retinal) performed BP control (<140/80 mm Hg) BP control (<140/90 mm Hg) Page 34

39 Controlling High Blood Pressure CBP (SNP, NCQA) The percentage of members years of age who had a diagnosis of hypertension (HTN) and whose BP was adequately controlled (<140/90) during the measurement year. Immunizations for Adolescents IMA (NCQA, HF) The percentage of adolescents 13 years of age who had one dose of meningococcal vaccine and one tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap) or one tetanus, diphtheria toxoids vaccine (Td) by their 13th birthday. Lead Screening in Children LSC (HF) The percentage of children 2 years of age who had one or more capillary or venous lead blood tests for lead poisoning by their second birthday. Medication Reconciliation Post-Discharge MRP (SNP) The percentage of discharges from January 1 to December 1 of the measurement year for members 66 years of age and older for whom medications were reconciled on or within 30 days of discharge. Documentation in the medical record must include evidence of medication reconciliation and the date when it was performed. The following evidence meets criteria. Notation that the medications prescribed or ordered upon discharged were reconciled with the current medications (in the outpatient record) by the appropriate practitioner type, or A medication list in a discharge summary that is present in the outpatient chart and evidence of a reconciliation with the current medications conducted by a prescribing practitioner or clinical pharmacist, registered nurse or Notation that no medications were prescribed or ordered upon discharge Only documentation in the outpatient chart meets the intent of the measure, but an outpatient visit is not required. Prenatal and Postpartum Care PPC (NCQA, M/Cal) Prenatal Care This is the measure of the percentage of women who delivered and received a prenatal care visit in the first trimester or within 42 days of enrollment. Postpartum Care This is the measure of a postpartum visit on or between 21 days and 56 days after delivery. Weight Assessment/Counseling for Nutrition & Physical Activity for Children/Adolescents WCC (NCQA, M/Cal) During the measurement year the percentage of members 2 17 years of age who had an outpatient visit with a PCP or OB/GYN and who had evidence of: BMI percentile documentation For members who are younger than 16 years of age on the date of service, only evidence of the BMI percentile or BMI percentile plotted on an age-growth chart meets criteria. A BMI value is not acceptable for this age range. For adolescents years of age on the date of service, documentation of a BMI value expressed as kg/m 2 is acceptable. Counseling for nutrition Documentation must include a note indicating the date and at least one of the following. Discussion of current nutrition behaviors (e.g., eating habits, dieting behaviors) Checklist indicating nutrition was addressed Counseling or referral for nutrition education Member received educational materials on nutrition Anticipatory guidance for nutrition Page 35

40 and Report the Care You Give It Pays Counseling for physical activity - Documentation must include a note indicating the date and at least one of the following. Discussion of current physical activity behaviors (e.g., exercise routine, participation in sports activities, exam for sports participation) Checklist indicating physical activity was addressed Counseling or referral for physical activity Member received educational materials on physical activity Anticipatory guidance for physical activity Well-Baby Visits (Well-Child Visit in 1st 15 months) W15 (HF) The percentage of enrolled members who turned 15 months old during the measurement year and who had six or more well-child visits with a primary care practitioner during their first 15 months of life. Well-Child Visits W34 (M/Cal, HF) The percentage of members who are 3, 4, 5, or 6 years old during the measurement year and received one or more well-child visits with a primary care practitioner during the measurement year. Page 36

41 HEDIS 2012 Measures Utilizing Administrative Data: Adults Access to Preventive/Ambulatory Health Services AAP (SNP) The percentage of members 20 years and older who had an ambulatory or preventive care visit during the measurement year. Annual Monitoring for Patients on Persistent Medications MPM (SNP) The percentage of members 18 years of age and older who received at least a 180-days supply of ambulatory medication therapy for a select therapeutic agent during the measurement year and at least one therapeutic monitoring event for the therapeutic agent in the measurement year. Annual monitoring for members on angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB) At least one serum potassium and either a serum creatinine or a blood urea nitrogen therapeutic monitoring test in the measurement year Annual monitoring for members on digoxin At least one serum potassium and either a serum creatinine or a blood urea nitrogen therapeutic monitoring test in the measurement year Annual monitoring for members on diuretics At least one serum potassium and either a serum creatinine or a blood urea nitrogen therapeutic monitoring test in the measurement year Annual monitoring for members on anticonvulsants At least one drug serum concentration level monitoring test for the prescribed drug in the measurement year Antidepressant Medication Management AMM (SNP, NCQA) The percentage of members 18 years of age and older who were diagnosed with a new episode of major depression and treated with antidepressant medication, and who remained on an antidepressant medication treatment. Two rates are reported. Effective Acute Phase Treatment. The percentage of newly diagnosed and treated members who remained on an antidepressant medication for at least 84 days (12 weeks). Effective Continuation Phase Treatment. The percentage of newly diagnosed and treated members who remained on an antidepressant medication for at least 180 days (6 months). Appropriate Testing for Children with Pharyngitis CWP (NCQA, HF) The percentage of children 2 18 years of age, who were diagnosed with pharyngitis, prescribed an antibiotic and received a group A streptococcus (strep) test for the episode. Appropriate Treatment for Children with Upper Respiratory Infection URI (NCQA, M/Cal, HF) This measure assesses the percentage of children 3 months 18 years who were given a diagnosis of upper respiratory infection (URI) and were not dispensed an antibiotic prescription on or within three days after the diagnosis. Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis AAB (NCQA, M/Cal,) The percentage of adults years of age with a diagnosis of acute bronchitis who were not dispensed an antibiotic prescription. Breast Cancer Screening BSC (SNP, NCQA, M/Cal) This is the percentage of women, age who received a mammogram during the measurement year or the year prior to the measurement year. Page 37

42 Children and Adolescent s Access to Primary Care Practitioners CAP (HF) The is the measure of the percentage of members 12 months 19 years of age who had a visit with a primary care practitioner (PCP) during the measurement year. Chlamydia Screening in Women CHL (SNP, HF) This measure evaluates the percentage of women age years old who were identified as sexually active and who had at least one test for Chlamydia during the measurement year. Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis ART (SNP) The percentage of members 18 years and older who were diagnosed with rheumatoid arthritis and who were dispensed at least one ambulatory prescription for a disease modifying anti-rheumatic drug (DMARD). Follow-Up After Hospitalization for Mental Illness FUH (SNP, NCQA) The percentage of discharges for members 6 years of age and older who were hospitalized for treatment of selected mental health disorders and who had an outpatient visit, an intensive outpatient encounter or partial hospitalization with a mental health practitioner. Two rates are reported. The percentage of members who received follow-up within 30 days of discharge The percentage of members who received follow-up within 7 days of discharge Follow-up for Children Prescribed ADHD Medication ADD (NCQA) The percentage of children newly prescribed attention-deficit/hyperactivity disorder (ADHD) medication who had at least three follow-up care visits within a 10-month period, one of which was within 30 days of when the first ADHD medication was dispensed. Two rates are reported. Initiation Phase. The percentage of members 6 12 years of age as of the IPSD with an ambulatory prescription dispensed for ADHD medication, who had one follow-up visit with practitioner with prescribing authority during the 30-day Initiation Phase. Continuation and Maintenance (C&M) Phase. The percentage of members 6 12 years of age as of the IPSD with an ambulatory prescription dispensed for ADHD medication, who remained on the medication for at least 210 days and who, in addition to the visit in the Initiation Phase, had at least two follow-up visits with a practitioner within 270 days (9 months) after the Initiation Phase ended. Glaucoma Screening in Older Adults GSO (SNP) The percentage of Medicare members 65 years and older, without a prior diagnosis of glaucoma or glaucoma suspect, who received a glaucoma eye exam by an eye care professional for early identification of glaucomatous conditions. Initiation and Engagement of Alcohol and Other Drug Dependence Treatment IET (SNP) The percentage of adolescent and adult members with a new episode of alcohol or other drug (AOD) dependence who received the following. Initiation of AOD Treatment. The percentage of members who initiate treatment through an inpatient AOD admission, outpatient visit, intensive outpatient encounter or partial hospitalization within 14 days of the diagnosis. Engagement of AOD Treatment. The percentage of members who initiated treatment and who had two or more additional services with a diagnosis of AOD within 30 days of the initiation visit. Language Diversity of Membership LDM (SNP) An unduplicated count and percentage of members enrolled at any time during the measurement year by spoken language preferred for health care and preferred language for written materials. Page 38