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6.6.4907    PATIENT-CENTERED MEDICAL HOME REPORTING—SPECIFIC QUALITY MEASURES REQUIRED

(1) A qualified or provisionally qualified patient-centered medical home (PCMH) shall report annually to the commissioner on its performance related to certain standards and health care quality measures, as prescribed by the commissioner. A PCMH health care provider that provides care to adults only, or both children and adults, shall choose at least three of the five quality measures listed in (3)(a) through (e) to report to the commissioner. A PCMH shall choose four out of five measures for the 2016 reporting year, for the report due in March 2017 and all subsequent years.

(2) A PCMH health care provider that provides care only to children, referred to as a pediatric practice, shall choose at least the child immunization performance measure in (3)(c). Reporting on depression screening in (3)(e) is optional for pediatric practices until the 2017 reporting year, for the report due in March 2018. At that time and for subsequent years, all pediatric clinics shall report on both the depression and immunization measures.

(3) The following are the quality measures to be reported as specified in (1):

(a) control of blood pressure among adults with diagnosed hypertension;

(b) screening for tobacco use and tobacco cessation intervention for adults;

(c) age appropriate immunization for children who turned age three during the reporting year;

(d) poor control of A1C levels in adults with diagnosed diabetes; and

(e) screening for clinical depression and follow-up plan for individuals age 12 and older.

(4) If a PCMH health care provider has no patient data regarding a particular quality measure, the provider may indicate, "not applicable."

(5) A PCMH health care provider may not change the reporting measures the provider chose for the 2014 reporting year until after the 2016 reporting year for the report due in March of 2017, or until otherwise instructed by the commissioner. However, a provider may report on additional measures at any time.

(6) Annually, the data on standards and quality measures are due to the commissioner on March 31 for the previous calendar year.

(7) The commissioner shall provide detailed instructions on the agency web site for reporting by qualified and provisionally qualified PCMHs on the quality measures described in (3). Data reporting requirements must be aligned with the federal Physician Quality Reporting System (PQRS), except for childhood immunizations, and the instructions provided on the commissioner's web site.

(8) The report referenced in ARM 6.6.4906 is separate from the report required for the quality measures in (3).

(9) The commissioner may report to the public only aggregate information about quality measures.

(10) Payers who choose to participate in the Montana PCMH program, and who require reporting on quality measures in their contract with PCMH health care providers shall also use the same data reporting requirements prescribed by the commissioner, if the payer collects data on the measures described in (3).

History: 33-40-104, MCA; IMP, 33-40-104, 33-40-105, MCA; NEW, 2014 MAR p. 3045, Eff. 12/25/14; AMD, 2015 MAR p. 2250, Eff. 12/25/15.

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