HEDIS® 2005 (Summary) Documentation for Reporting Year 2004

General Information

This documentation presents (1) a description of each HEDIS® measure that CMS collected for 205 Medicare managed care contract markets on health care provided in calendar year 2004 to Medicare beneficiaries and (2) the location of the rates associated with each HEDIS measure within the HEDIS workbook (HEDIS2005.XLS). CMS took the description and additional information for each measure from HEDIS 2005 Volume 2: Technical Specifications. This release contains only those rates, percentages, or averages for each measure and not the numerator or denominator used to create those measures. CMS has made minor modifications to the original data. CMS confirmed that all reported rates are commensurate with the HEDIS general guidelines. For example, the HEDIS guidelines advise plans to report "not applicable" for measures that rely on a small number of observations, and CMS appropriately suppressed these rates. CMS also added two variables to the database. A brief discussion of each issue identified here appears below.

For this measurement year, CMS required that all managed care organizations undergo an audit on all HEDIS measures. The summary data file includes all submitted data.

The HEDIS measure descriptions reprinted here are done so with the permission of the National Committee for Quality Assurance ("NCQA"). HEDIS (R) is a registered trademark of NCQA, and a copyright for HEDIS (R) 2005 is held by the National Committee for Quality Assurance, 2000 L Street, NW, Suite 500, Washington, DC 20036. All rights reserved.

The Medicare HEDIS reporting unit is the contract

In 2005, CMS collected data from 204 Medicare managed care contracts for health care delivered in 2004. CMS considers the reporting unit for a health plan as the equivalent to a contract. CMS signs a contract with health plans to provide health care for a given geographic service area. One contract still divides its geographic service area in two and reports at the "market area" level. This makes the total number of reported submissions 205.

The "Service_Area" sheet in the HEDIS workbook identifies the state and counties for each submission. If the contract that reports at the "market area" level is shown with the market area after the state (CA: Northern California" and "CA: Southern California.")

CMS copied the description of each measure from the HEDIS Technical Specifications

The description and related information provided for each measure in this documentation are taken from the HEDIS 2005 Technical Specifications, which are the specific instructions for calculating HEDIS measures that NCQA provides to Medicare managed care plans. For each measure, the Technical Specifications detail the precise method for sampling (when appropriate), identification of the numerator and denominator, measure calculation, and any other important considerations specific to that measure. The technical specifications also contain general guidelines that apply to all measures, such as the use of medical records and when a plan should not report a measure because its eligible membership is too small. Some measures require more detailed specifications than others. As opposed to the Beta Blocker measure described below, the calculation of the measure for the number of years a plan has had a commercial product is fairly straightforward. The technical specifications necessary to produce HEDIS measures are available from NCQA in HEDIS 2005, Volume 2: Technical Specifications."

The specifications for Beta Blocker Treatment After Heart Attack demonstrate the extent of detailed instructions provided for many measures. For this measure, the specifications describe the unit of measurement (members vs. procedures or discharges); data sources used to identify the numerator and denominator (membership, claims/encounter, hospital discharge, and pharmacy data); the period of time under consideration (the reporting year); age ranges for member inclusion in the measure (35 and older); diagnosis codes to identify acute myocardial infarction (AMI); diagnosis codes to identify exclusions for beta blocker; a list of beta blocker prescriptions; appropriate sample size if the plan chooses to use a sample; and other instructions, such as the appropriate interpretation of two AMI episodes for an individual member.


 

HEDIS Guidelines identify two types of missing values: NA and NR

The HEDIS guidelines distinguish between two different types of missing values in the rate field: Not Applicable (NA) and Not Report (NR). Health plans report NA when they: do not have a large enough population to calculate a representative rate (e.g., many measures require that rates be based on at least 30 members) or are not eligible for a measure (e.g., a health plan cannot calculate outpatient drug utilization if it does not offer an outpatient drug benefit; a health plan cannot calculate a measure requiring a year of continuous enrollment if its first enrollment began mid-way through the reporting year.)

Health plans report NR when: they choose not to calculate and report a rate, or the health plan’s HEDIS Compliance Auditor determines that a rate is materially biased (applicable only to audited measures).

For measures reported as a percentage, material bias is defined as a deviation of more than five percentage points from the true rate. For other measures (e.g., procedures per 1000 member years), material bias exists if the number of counted procedures deviates by more than ten percent from the true number of procedures.

CMS suppressed a small number of rates to meet privacy requirements.

Under the Privacy Act, CMS cannot publish or otherwise disclose the data in a form raising unacceptable possibilities that an individual could be identified (i.e., the data must not be beneficiary-specific and must be aggregated to a level where no data cells have 10 or fewer beneficiaries). To ensure that no beneficiary can be identified, CMS has chosen not to report certain measures, specifically reported enrollment by age category, and has suppressed an extremely small number of rates. CMS has replaced suppressed rates with a ‘NA.' Please see the section on missing values above for an explanation of missing value designations.

CMS has added variables to the HEDIS data.

CMS includes our record of enrollment as of December of the measurement year in the "GENERAL" sheet in the HEDIS workbook. The HEDIS reported value is adjusted for individuals with partial-year enrollment and reflects the entire contract's enrollment. CMS's enrollment is now broken down by the number enrolled in the CMS approved contract market area.

We have also changed the way we are reporting the area served by each contract. The states served by each contract used to be reported within every measure. Since this data is constant for the measurement year and the size of the areas covered by each contract have increased dramatically, we have moved the area served into its own separate reports. You will find a separate sheet called "Service Area" in the HEDIS workbook which contains the contract, state(s) and counties served by the contracts reporting HEDIS. There is additional field "EGHP" which indicates if the county is available only to beneficiaries in Employer Groups. The old "Service State" field in each measure now just lists the Market Area served by the contract for the contracts still reporting by market area.

National Enrollment Weighted Average Score

CMS has calculated and included a weighted National average for all of the Effectiveness of Care (EOC) measures. These rates are reported on a separate sheet called "National Rates" in the HEDIS Workbook. The rate for each of the EOC measures was calculated using the following formula:

((En1/TotE)*Sn1)+((En2/TotE)*Sn2)+…+((Enx/TotE)*Snx)=National Enrollment Weighted Average Score

Where:   TotE = Total enrollment for all contracts with a valid numeric rate in the measure
En1 = Enrollment in the first contract with a valid numeric rate
Sn1 = Reported rate for the first contract with a valid numeric rate
Enx = Enrollment in the last contract with a valid numeric rate
Snx = Reported rate for the last contract with a valid numeric rate


Measure   Measure Name/Measure Description/Field Name/Field Description

AOC201 – Adults' Access to Preventive/Ambulatory Health Services

     DESCRIPTION - The percentage of enrollees age 20 through 44, 45 through 64 and 65 years and older who had an ambulatory or preventive-care visit. Nine separate rates are calculated, one for each of the three product lines for each of the three age groups. MCOs report the percentage of:

     - Medicaid and Medicare enrollees who were continuously enrolled during the measurement year and who had an ambulatory or preventive-care visit during the measurement year

     - Commercial enrollees who were continuously enrolled during the measurement year and the two years prior to the measurement year and who had an ambulatory or preventive-care visit during the measurement year or the two years prior to the measurement year. (HEDIS 2005, Volume 2: Technical Specification, Pg. 156)

       REPORTING LEVEL - Contract Market

             AOC201-0010     Rate (Ages 20-44)

             AOC201-0020     Rate (Ages 45-64)

             AOC201-0030     Rate (Ages 65 and older)

             AOC201-0040     Lower Confidence Interval - 20-44

             AOC201-0050     Upper Confidence Interval - 20-44

             AOC201-0060     Lower Confidence Interval - 45-64

             AOC201-0070     Upper Confidence Interval - 45-64

             AOC201-0080     Lower Confidence Interval - 65+

             AOC201-0090     Upper Confidence Interval - 65+

             AOC201-0095     Combined Total

             AOC201-0100     Lower Confidence Interval - All

             AOC201-0110     Upper Confidence Interval - All

AOC220 – Call Abandonment

     DESCRIPTION - The percentage of calls received by the MCO's member services call centers (during member services operating hours) during the measurement year that were abandoned by the caller before being answered by a live voice. (HEDIS 2005, Volume 2: Technical Specification, Pg. 183)

     REPORTING LEVEL - Contract Market

             AOC220-0010     Reported rate

             AOC220-0020     Lower Confidence Interval

             AOC220-0030     Upper Confidence Interval

AOC225 – Call Answer Timeliness

     DESCRIPTION - The percentage of calls received by the MCO's member services call centers (during member services operating hours) during the measurement year that were answered by a live voice within 30 seconds. (HEDIS 2005, Volume 2: Technical Specification, Pg. 180)

     REPORTING LEVEL - Contract Market

             AOC225-0010     Reported rate

             AOC225-0020     Lower Confidence Interval

             AOC225-0030     Upper Confidence Interval

AOC230 – Claims Timeliness

     DESCRIPTION - The percentage of all claims received by the MCO or its claims processing centers, January 1 through December 1 of the measurement year, that were paid or denied within 30 calendar days of receipt. This includes all MCO claims delegates (e.g., keying centers, clearinghouses). (HEDIS 2005, Volume 2: Technical Specification, Pg. 177)

     REPORTING LEVEL - Contract Market

             AOC230-0010     Reported rate

             AOC230-0020     Lower Confidence Interval

             AOC230-0030     Upper Confidence Interval


 

AOC235 – Initiation and Engagement of Alcohol and Other Drug Dependence Treatmen

      DESCRIPTION - This measure calculates two rates using the same population of members with Alcohol and Other Drug (AOD) dependence:Initiation of AOD Dependence Treatment: The percentage of adults diagnosed with AOD dependence who initiate treatment through either:

      -an inpatient AOD admission, or

      -an outpatient service for AOD abuse or dependence and any additional AOD services within 14 days.

      Engagement of AOD Treatment is an intermediate step between initially accessing care (in the initiation treatment) and completing a full course of treatement. This measure is designed to assess the degree to which members engage in treatment with two additional AOD services within 30 days after initiation. (HEDIS 2005, Volume 2: Technical Specification, Pg. 173)

     REPORTING LEVEL - Contract Market

             AOC235-0010     Rate - Engagement

             AOC235-0020     Lower Confidence Interval - Engagement

             AOC235-0030     Upper Confidence Interval - Engagement

EOC003 – Breast Cancer Screening

      DESCRIPTION - The percentage of women age 50 through 69 years, who were continuously enrolled during the measurement year and the year prior to the measurement year, and who had a mammogram during the measurement year or year prior to the measurement year. (HEDIS 2005, Volume 2: Technical Specification, Pg. 87)

       REPORTING LEVEL - Contract Market

             EOC003-0010     Rate

             EOC003-0020     Lower 95% confidence interval

             EOC003-0030     Upper 95% confidence interval

EOC008 – Beta Blocker Treatment

      DESCRIPTION - The percentage of enrolled members age 35 years and older during the measurement year, who were hospitalized and discharged alive from January 1–December 24 of the measurement year with a diagnosis of acute myocardial infarction (AMI) and who received an ambulatory prescription for beta blockers upon discharge. The intent of this measure is to assess whether appropriate follow-up care has been rendered to members who suffer a heart attack. (HEDIS 2005, Volume 2: Technical Specification, Pg. 106)

     REPORTING LEVEL - Contract Market

             EOC008-0010     Rate

             EOC008-0020     Lower 95% confidence interval

             EOC008-0030     Upper 95% confidence interval

EOC010 – Followup after Hospitalization for Mental Illness

      DESCRIPTION - The percentage of members age six years and older who were hospitalized for treatment of selected mental health disorders who were seen on an ambulatory basis or who were in intermediate treatment with a mental health provider.

      Six separate calculations are required—one for each of the three product lines for both of the following:

      - the percentage of discharges for members who had an ambulatory or intermediate mental health visit on the date of discharge, up to 30 days after hospital discharge, and

      - the percentage of discharges for members who had an ambulatory or intermediate mental health visit on the date of discharge, up to 7 days after hospital discharge. (HEDIS 2005, Volume 2: Technical Specification, Pg. 131)

     REPORTING LEVEL - Contract Market

             EOC010-0011     Rate within 7days

             EOC010-0012     Rate within 30days

             EOC010-0021     Lower 95% confidence interval within 7days

             EOC010-0022     Lower 95% confidence interval within 30days

             EOC010-0031     Upper 95% confidence interval within 7days

             EOC010-0032     Upper 95% confidence interval within 30days

EOC020 – Comprehensive Diabetes Care

     DESCRIPTION - The percentage of members 18-75 years with diabetes (type 1 and type 2) who had each of the following:

     - Hemoglobin A1c (HbA1c) tested

     - HbA1c poorly controlled (> 9.0%)

     - eye exam (retinal) performed

     - LDL-C screening performed

     - LDL-C controlled (LDL less than 130 mg/dL)

     - LDL-C controlled (LDL less than 100 mg/dL)

Measure   Measure Name/Measure Description/Field Name/Field Description

     - kidney disease (nephropathy) monitored.

     The MCO will report seven separate rates (one for each aspect of diabetes care identified) for each product line. These measures are consistent with the Diabetes Quality Improvement Project (DQIP) set of measures (excluding hypertension and foot care). (HEDIS 2005, Volume 2: Technical Specifications, Pg. 117)

     REPORTING LEVEL - Contract Market

             EOC020-0010     Rate - HbA1c Testing

             EOC020-0020     Lower Confidence Interval - HbA1c Testing

             EOC020-0030     Upper Confidence Interval - HbA1c Testing

             EOC020-0040     Rate - Poor HbA1c Control

             EOC020-0050     Lower Confidence Interval - Poor HbA1c Control

             EOC020-0060     Upper Confidence Interval - Poor HbA1c Control

             EOC020-0070     Rate - Eye Exams

             EOC020-0080     Lower Confidence Interval - Eye Exams

             EOC020-0090     Upper Confidence Interval - Eye Exams

             EOC020-0100     Rate - Lipid Profile

             EOC020-0110     Lower Confidence Interval -Lipid Profile

             EOC020-0120     Upper Confidence Interval -Lipid Profile

             EOC020-0160     Rate - Nephropathy Monitor

             EOC020-0170     Lower Confidence Interval - Nephropathy Monitor

             EOC020-0180     Upper Confidence Interval - Nephropathy Monitor

             EOC020-0190     Rate <130 LDL-C Level

             EOC020-0200     Lower Confidence Interval <130 LDL-C Level

             EOC020-0210     Upper Confidence Interval <130 LDL-C Level

             EOC020-0220     Rate <100 LDL-C Level

             EOC020-0230     Lower Confidence Interval <100 LDL-C Level

             EOC020-0240     Upper Confidence Interval <100 LDL-C Level

EOC025 – Cholesterol Management After Acute Cardiovascular Events

      DESCRIPTION - The percentage of members age 18 - 75 years old as of December 31 of the measurement year who were discharged alive in the year prior to the measurement year for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous transluminal coronary angioplasty (PTCA) and had evidence of LDL-C control below specified thresholds (<130mg/dL; <100mg/dL). (HEDIS 2005, Volume 2: Technical Specifications, Pg. 113)

       REPORTING LEVEL - Contract Market

             EOC025-0010     Rate - LDL-C Screening

             EOC025-0020     Lower Confidence Interval - LDL-C Screening

             EOC025-0030     Upper Confidence Interval - LDL-C Screening

             EOC025-0070     Rate <130 LDL-C Level

             EOC025-0080     Lower Confidence Interval <130 LDL-C Level

             EOC025-0090     Upper Confidence Interval <130 LDL-C Level

             EOC025-0100     Rate <100 LDL-C Level

             EOC025-0110     Lower Confidence Interval <100 LDL-C Level

             EOC025-0120     Upper Confidence Interval <100 LDL-C Level

EOC030 – Antidepressant Medication Management

      DESCRIPTION - The following components of this measure assess different facets of the successful pharmacological management of depression:

      1. Optimal Practitioner Contacts for Medication Management. The percentage of members 18 years and older as of the 120th day of the measurement year who were diagnosed with a new episode of depression and treated with antidepressant medication and had at least three follow-up contacts with a non-mental-health practitioner or mental health practitioner coded with a mental health diagnosis during the 84-day (12-week) Acute Treatment Phase.

      At least one of the three follow-up contacts must be with a prescribing practitioner (e.g., licensed physician, physician assistant of other practitioner with prescribing privileges). This process measure assesses the adequacy of clinical management of new treatment episodes for adult members with a major depressive disorder.

      2. Effective Acute Phase Treatment. The percentage of members 18 years and older as of the 120th day of the measurement year who were diagnosed with a new episode of depression and treated with antidepressant medication and remained on an antidepressant drug during the entire 84-day (12-week) Acute Treatment Phase.

      This intermediate outcome measure assesses the percentage of adult members initiated on an antidepressant drug who received a continuous trial of medication treatment during the Acute Treatment Phase.

Measure   Measure Name/Measure Description/Field Name/Field Description

      3. Effective Continuation Phase Treatment. The percentage of members 18 years and older as of the 120th day of the measurement year who were diagnosed with a new episode of depression and treated with antidepressant medication and remained on an antidepressant drug for at least 180 days (6 months).

      This intermediate-outcome measure assesses the effectiveness of clinical management in achieving medication compliance and the likely effectiveness of the established dosage regimen by determining if adult members completed a period of Continuation Phase Treatment adequate for defining a recovery according to Agency for Healthcare Research and Quality (AHRQ, formerly AHCPR) Depression in Primary Care.

      (HEDIS 2005, Volume 2: Technical Specifications, Pg. 134)

     REPORTING LEVEL - Contract Market

             EOC030-0010     Rate - Effective Continuation Phase Treatment

             EOC030-0020     Lower Confidence Interval - Effective Continuation Phase Treatment

             EOC030-0030     Upper Confidence Interval - Effective Continuation Phase Treatment

             EOC030-0040     Rate - Effective Acute Phase Treatment

             EOC030-0050     Lower Confidence Interval - Effective Acute Phase Treatment

             EOC030-0060     Upper Confidence Interval - Effective Acute Phase Treatment

             EOC030-0070     Rate-Practitioner Contacts for Medication Management

             EOC030-0080     Lower Confidence Interval - Practitioner Contacts for Medication Management

             EOC030-0090     Upper Confidence Interval - Practitioner Contacts for Medication Management

EOC035 – Controlling High Blood Pressure

     DESCRIPTION -The percentage of enrolled members 45-85 years of age who had a diagnosis of hypertension (HTN) and whose blood pressure (BP) was adequately controlled (≤140/90) during the measurement year. This intermediate outcome measure assess if BP was controlled among adults with diagnosed HTN. The MCO must use the hybrid method for this measure. (HEDIS 2005, Volume 2: Technical Specification, Pg. 101)

     REPORTING LEVEL - Contract Market

             EOC035-0010     Rate - Effective Control of Hypertension

             EOC035-0020     Lower Confidence Interval - Effective Control of Hypertension

             EOC035-0030     Upper Confidence Interval - Effective Control of Hypertension

EOC040 – Colorectal Cancer Screening

     DESCRIPTION -The percentage of adults 50–80 years of age who had appropriate screening for colorectal cancer (CRC). The hybrid method is recommended to calculate this measure. (HEDIS 2005, Volume 2: Technical Specification, Pg. 83

     REPORTING LEVEL - Contract Market

             EOC040-0010     Rate

             EOC040-0020     Lower Confidence Interval

             EOC040-0030     Upper Confidence Interval

EOC045 – Osteoporosis Management in Women Who Had a Fracture

     DESCRIPTION -The percentage of women 67 years of age and older who suffered a fracture, and who had either a bone mineral density (BMD) test or prescription for a drug to treat or prevent osteoporosis in the six months after date of the fracture. Because women who suffer a fracture are at an increased risk of additional fractures and are more likely to have osteoporosis, this measure assesses how well plans manage women at high risk for a second fracture. (HEDIS 2005, Volume 2: Technical Specification, Pg. 97)

     REPORTING LEVEL - Contract Market

             EOC045-0010     Reported rate

             EOC045-0020     Lower Confidence Interval

             EOC045-0030     Upper Confidence Interval

EOC050 – Glaucoma Screening in Older Adults

     DESCRIPTION - The percentage of Medicare members 65 years and older without a prior diagnosis of glaucoma or glaucoma suspect who received a glaucoma eye exam in the last two years by an eye-care professional for early identification of persons with glaucomatous conditions. An eye-care professional is an ophthalmologist or optometrist. (HEDIS 2005, Volume 2: Technical Specification, Pg. 141)

     REPORTING LEVEL - Contract Market

             EOC050-0010     Reported rate

             EOC050-0020     Lower Confidence Interval

             EOC050-0030     Upper Confidence Interval

Measure   Measure Name/Measure Description/Field Name/Field Description

EOC055 – Persistence of Beta-Blocker Treatment After a Heart Attack

      DESCRIPTION - The percentage of enrolled members 35 years of age and older during the measurement year who were hospitalized and discharged alive from July 1 of the year prior to the measurement year to June 30 of the measurement year with a diagnosis of acute myocardial infarction (AMI) and who received persistent beta-blocker treatment.

      MCOs will report the percentage of members who receive treatment with beta-blockers for six months after discharge. The intent of this measure is to assess if appropriate follow-up care has been rendered to members who suffer a heart attack. (HEDIS 2005, Volume 2: Technical Specification, Pg. 110)

     REPORTING LEVEL - Contract Market

             EOC055-0010     Reported rate

             EOC055-0020     Lower Confidence Interval

             EOC055-0030     Upper Confidence Interval

EOC060 – Management of Urinary Incontinence in Older Adults

      DESCRIPTION - The following components of this measure assess the management of urinary incontinence (UI) in older adults.

      Discussing Urinary Incontinence - The percentage of Medicare members 65 years of age and older who reported having a problem with urine leakage in the last six months and who discussed their urine leakage problem with their current practitioner.

      Receiving Urinary Incontinence Treatment - The percentage of Medicare members 65 years of age and older who reported having a urine leakage problem in the last six months and who received treatment for their current urine leakage problem.

      (HEDIS 2005, Volume 2: Technical Specification, Pg. 151)

     REPORTING LEVEL - Contract Market

             EOC060-0010     Discussing Urinary Incontinence Rate

             EOC060-0020     Receiving Urinary Incontinence Treatment Rate

General – General Information

      DESCRIPTION - General MCO Information. These fields are not explicitly identified in the HEDIS Technical Specifications.

       REPORTING LEVEL - N/A

             General-0010      Type of Plan (Risk, Cost)

             General-0011      Type of Plan (Post Balanced Buget Amendment Naming)

             General-0012      M+C Plan Type (Yes or No)

             General-0013      Coordinated Care Plan Type (Yes or No)

             General-0020      Line of Business (HMO, POS)

             General-0030      Model Type (Group, IPA, Mixed, Network, Other, Staff)

             General-0050      2000 Enrollment as Reported by HCFA's Plan Information Control System (PICS)

             General-0060      HCFA Region Number

             General-0070      HCFA Region Name

             General-0080      Patient Population

             General-0085      Submitted summary level HEDIS 2008 data to NCQA

             General-0087      Included in HOS data from NCQA

HPS402 – Practitioner Turnover

      DESCRIPTION - From the MCO provider database:

      • the percentage of primary care physicians affiliated with the MCO as of December 31 of the year prior to the measurement year who were not affiliated with the MCO as of December 31 of the measurement year

      • the percentage of nonphysician primary care practitioners affiliated with the MCO as of December 31 of the year prior to the measurement year who were not affiliated with the MCO as of December 31 of the measurement year.

      (HEDIS 2005, Volume 2: Technical Specification, Pg. 195)

     REPORTING LEVEL - Contract Market

             HPS402-0010     Provider Turnover- Primary Care Physicians

             HPS402-0020     Provider Turnover- Non-Physicians Primary Care Providers


 

Measure   Measure Name/Measure Description/Field Name/Field Description

HPS403 – Years In Business/Total Membership

      DESCRIPTION - The number of years since licensure (the number of years that each product line has existed) and the number of members enrolled as of December 31 of the measurement year. The number of years of operation should be considered when evaluating the MCO’s financial profile. For example, a new MCO may have a greater level of debt than a more mature MCO, and financial profiles may vary according to MCO type (e.g., staff model HMO, POS, IPA). (HEDIS 2005, Volume 2: Technical Specification, Pg. 200)

       REPORTING LEVEL - Contract Market

             HPS403-0010     HMO Total (Years In Business)

             HPS403-0020     HMO Medicaid (Years In Business)

             HPS403-0030     HMO Commercial (Years In Business)

             HPS403-0040     HMO Medicare Risk (Years In Business)

             HPS403-0060     HMO Self-insured (Years In Business)

             HPS403-0070     HMO Other (Years In Business)

             HPS403-0080     PPO Total (Years In Business)

             HPS403-0090     PPO Commercial (Years In Business)

             HPS403-0100     PPO Medicare Risk (Years In Business)

             HPS403-0120     PPO Self-insured (Years In Business)

             HPS403-0130     PPO Other (Years In Business)

             HPS403-0140     POS Total (Years In Business)

             HPS403-0150     POS Commercial (Years In Business)

             HPS403-0160     POS Medicare Risk (Years In Business)

             HPS403-0180     POS Self-insured (Years In Business)

             HPS403-0190     POS Other (Years In Business)

             HPS403-0210     HMO Total (Members)

             HPS403-0220     HMO Medicaid (Members)

             HPS403-0230     HMO Commercial (Members)

             HPS403-0240     HMO Medicare Risk (Members)

             HPS403-0260     HMO Self-insured (Members)

             HPS403-0270     HMO Other (Members)

             HPS403-0280     PPO Total (Members)

             HPS403-0290     PPO Commercial (Members)

             HPS403-0300     PPO Medicare Risk (Members)

             HPS403-0320     PPO Self-insured (Members)

             HPS403-0330     PPO Other (Members)

             HPS403-0340     POS Total (Members)

             HPS403-0350     POS Commercial (Members)

             HPS403-0360     POS Medicare Risk (Members)

             HPS403-0380     POS Self-insured (Members)

             HPS403-0390     POS Other (Members)

             HPS403-0400     Total Product Lines/Payers (Members)

PDI801 – Board Certification/Residency Completion

      DESCRIPTION - The percentage of the following physicians who are board certified:

      • primary care physicians

      • OB/GYN physicians

      • pediatric physician specialists

      • geriatricians

      • all other physician specialists.

      Board certification refers to the various specialty certification programs of the American Board of Medical Specialties and the American Osteopathic Association. The MCO should report separately for each product as of December 31 of the measurement year. (HEDIS 2005, Volume 2: Technical Specification, Pg. 285)

     REPORTING LEVEL - Contract Market

             PDI801-0010       Board Certification - Primary Care Physicians (Percentage)

             PDI801-0030       Board Certification - Physician Specialists (Percentage)

             PDI801-0050       Board Certification - Geriatricians (Percentage)

Measure   Measure Name/Measure Description/Field Name/Field Description

PDI805 – Total Enrollment by Percentage

     DESCRIPTION - This measure provides an overview of the mix of MCO membership. The MCO reports the percentage of total member months contributed by each product by age and sex during the measurement year.(HEDIS 2005, Volume 2: Technical Specification, Pg. 290)

     REPORTING LEVEL - Contract

          PDI805-0010     Percent of Plan's Total Member Months (Male - Commercial - Age < 1)

          PDI805-0020     Percent of Plan's Total Member Months (Male - Medicaid - Age < 1)

          PDI805-0030     Percent of Plan's Total Member Months (Male - Medicare - Age < 1)

          PDI805-0040     Percent of Plan's Total Member Months (Male - Other - Age < 1)

          PDI805-0050     Percent of Plan's Total Member Months (Male - Commercial - Age 1-4)

          PDI805-0060     Percent of Plan's Total Member Months (Male - Medicaid - Age 1-4)

          PDI805-0070     Percent of Plan's Total Member Months (Male - Medicare - Age 1-4)

          PDI805-0080     Percent of Plan's Total Member Months (Male - Other - Age 1-4)

          PDI805-0090     Percent of Plan's Total Member Months (Male - Commercial - Age 5-9)

          PDI805-0100     Percent of Plan's Total Member Months (Male - Medicaid - Age 5-9)

          PDI805-0110     Percent of Plan's Total Member Months (Male - Medicare - Age 5-9)

          PDI805-0120     Percent of Plan's Total Member Months (Male - Other - Age 5-9)

          PDI805-0130     Percent of Plan's Total Member Months (Male - Commercial - Age 10-14)

          PDI805-0140     Percent of Plan's Total Member Months (Male - Medicaid - Age 10-14)

          PDI805-0150     Percent of Plan's Total Member Months (Male - Medicare - Age 10-14)

          PDI805-0160     Percent of Plan's Total Member Months (Male - Other - Age 10-14)

          PDI805-0170     Percent of Plan's Total Member Months (Male - Commercial - Age 15-17)

          PDI805-0180     Percent of Plan's Total Member Months (Male - Medicaid - Age 15-17)

          PDI805-0190     Percent of Plan's Total Member Months (Male - Medicare - Age 15-17)

          PDI805-0200     Percent of Plan's Total Member Months (Male - Other - Age 15-17)

          PDI805-0210     Percent of Plan's Total Member Months (Male - Commercial - Age 18-19)

          PDI805-0220     Percent of Plan's Total Member Months (Male - Medicaid - Age 18-19)

          PDI805-0230     Percent of Plan's Total Member Months (Male - Medicare - Age 18-19)

          PDI805-0240     Percent of Plan's Total Member Months (Male - Other - Age 18-19)

          PDI805-0250     Percent of Plan's Total Member Months (Male - Commercial - Subtotal: Age 0-19)

          PDI805-0260     Percent of Plan's Total Member Months (Male - Medicaid - Subtotal: Age 0-19)

          PDI805-0270     Percent of Plan's Total Member Months (Male - Medicare - Age 0-19)

          PDI805-0280     Percent of Plan's Total Member Months (Male - Other - Age 0-19)

          PDI805-0290     Percent of Plan's Total Member Months (Male - Commercial - Age 20-24)

          PDI805-0300     Percent of Plan's Total Member Months (Male - Medicaid - Age 20-24)

          PDI805-0310     Percent of Plan's Total Member Months (Male - Medicare - Age 20-24)

          PDI805-0320     Percent of Plan's Total Member Months (Male - Other - Age 20-24)

          PDI805-0330     Percent of Plan's Total Member Months (Male - Commercial - Age 25-29)

          PDI805-0340     Percent of Plan's Total Member Months (Male - Medicaid - Age 25-29)

          PDI805-0350     Percent of Plan's Total Member Months (Male - Medicare - Age 25-29)

          PDI805-0360     Percent of Plan's Total Member Months (Male - Other - Age 25-29)

          PDI805-0370     Percent of Plan's Total Member Months (Male - Commercial - Age 30-34)

          PDI805-0380     Percent of Plan's Total Member Months (Male - Medicaid - Age 30-34)

          PDI805-0390     Percent of Plan's Total Member Months (Male - Medicare - Age 30-34)

          PDI805-0400     Percent of Plan's Total Member Months (Male - Other - Age 30-34)

          PDI805-0410     Percent of Plan's Total Member Months (Male - Commercial - Age 35-39)

          PDI805-0420     Percent of Plan's Total Member Months (Male - Medicaid - Age 35-39)

          PDI805-0430     Percent of Plan's Total Member Months (Male - Medicare - Age 35-39)

          PDI805-0440     Percent of Plan's Total Member Months (Male - Other - Age 35-39)

          PDI805-0450     Percent of Plan's Total Member Months (Male - Commercial - Age 40-44)

          PDI805-0460     Percent of Plan's Total Member Months (Male - Medicaid - Age 40-44)

          PDI805-0470     Percent of Plan's Total Member Months (Male - Medicare - Age 40-44)

          PDI805-0480     Percent of Plan's Total Member Months (Male - Other - Age 40-44)

          PDI805-0490     Percent of Plan's Total Member Months (Male - Commercial - Subtotal: Age 20-44)

          PDI805-0500     Percent of Plan's Total Member Months (Male - Medicaid - Subtotal: Age 20-44)

          PDI805-0510     Percent of Plan's Total Member Months (Male - Medicare - Age 20-44)

Measure   Measure Name/Measure Description/Field Name/Field Description

          PDI805-0520     Percent of Plan's Total Member Months (Male - Other - Age 20-44)

          PDI805-0530     Percent of Plan's Total Member Months (Male - Commercial - Age 45-49)

          PDI805-0540     Percent of Plan's Total Member Months (Male - Medicaid - Age 45-49)

             PDI805-0550       Percent of Plan's Total Member Months (Male - Medicare - Age 45-49)

             PDI805-0560       Percent of Plan's Total Member Months (Male - Other - Age 45-49)

             PDI805-0570       Percent of Plan's Total Member Months (Male - Commercial - Age 50-54)

             PDI805-0580       Percent of Plan's Total Member Months (Male - Medicaid - Age 50-54)

             PDI805-0590       Percent of Plan's Total Member Months (Male - Medicare - Age 50-54)

             PDI805-0600       Percent of Plan's Total Member Months (Male - Other - Age 50-54)

             PDI805-0610       Percent of Plan's Total Member Months (Male - Commercial - Age 55-59)

             PDI805-0620       Percent of Plan's Total Member Months (Male - Medicaid - Age 55-59)

             PDI805-0630       Percent of Plan's Total Member Months (Male - Medicare - Age 55-59)

             PDI805-0640       Percent of Plan's Total Member Months (Male - Other - Age 55-59)

             PDI805-0650       Percent of Plan's Total Member Months (Male - Commercial - Age 60-64)

             PDI805-0660       Percent of Plan's Total Member Months (Male - Medicaid - Age 60-64)

             PDI805-0670       Percent of Plan's Total Member Months (Male - Medicare - Age 60-64)

             PDI805-0680       Percent of Plan's Total Member Months (Male - Other - Age 60-64)

             PDI805-0690       Percent of Plan's Total Member Months (Male - Commercial - Subtotal: Age 45-64)

             PDI805-0700       Percent of Plan's Total Member Months (Male - Medicaid - Subtotal: Age 45-64)

             PDI805-0710       Percent of Plan's Total Member Months (Male - Medicare - Age 45-64)

             PDI805-0720       Percent of Plan's Total Member Months (Male - Other - Age 45-64)

             PDI805-0730       Percent of Plan's Total Member Months (Male - Commercial - Age 65-69)

             PDI805-0740       Percent of Plan's Total Member Months (Male - Medicaid - Age 65-69)

             PDI805-0750       Percent of Plan's Total Member Months (Male - Medicare - Age 65-69)

             PDI805-0760       Percent of Plan's Total Member Months (Male - Other - Age 65-69)

             PDI805-0770       Percent of Plan's Total Member Months (Male - Commercial - Age 70-74)

             PDI805-0780       Percent of Plan's Total Member Months (Male - Medicaid - Age 70-74)

             PDI805-0790       Percent of Plan's Total Member Months (Male - Medicare - Age 70-74)

             PDI805-0800       Percent of Plan's Total Member Months (Male - Other - Age 70-74)

             PDI805-0810       Percent of Plan's Total Member Months (Male - Commercial - Age 75-79)

             PDI805-0820       Percent of Plan's Total Member Months (Male - Medicaid - Age 75-79)

             PDI805-0830       Percent of Plan's Total Member Months (Male - Medicare - Age 75-79)

             PDI805-0840       Percent of Plan's Total Member Months (Male - Other - Age 75-79)

             PDI805-0850       Percent of Plan's Total Member Months (Male - Commercial - Age 80-84)

             PDI805-0860       Percent of Plan's Total Member Months (Male - Medicaid - Age 80-84)

             PDI805-0870       Percent of Plan's Total Member Months (Male - Medicare - Age 80-84)

             PDI805-0880       Percent of Plan's Total Member Months (Male - Other - Age 80-84)

             PDI805-0890       Percent of Plan's Total Member Months (Male - Commercial - Age 85-89)

             PDI805-0900       Percent of Plan's Total Member Months (Male - Medicaid - Age 85-89)

          PDI805-0910     Percent of Plan's Total Member Months (Male - Medicare - Age 85-89)

          PDI805-0920     Percent of Plan's Total Member Months (Male - Other - Age 85-89)

          PDI805-0930     Percent of Plan's Total Member Months (Male - Commercial - Age >=90)

          PDI805-0940     Percent of Plan's Total Member Months (Male - Medicaid - Age >=90)

          PDI805-0950     Percent of Plan's Total Member Months (Male - Medicare - Age >=90)

          PDI805-0960     Percent of Plan's Total Member Months (Male - Other - Age >=90)

          PDI805-0970     Percent of Plan's Total Member Months (Male - Commercial - Subtotal: Age >=65)

          PDI805-0980     Percent of Plan's Total Member Months (Male - Medicaid - Subtotal: Age >=65)

          PDI805-0990     Percent of Plan's Total Member Months (Male - Medicare - Age >=65)

          PDI805-1000     Percent of Plan's Total Member Months (Male - Other - Age >=65)

          PDI805-1010     Percent of Plan's Total Member Months (Female - Commercial - Age < 1)

          PDI805-1020     Percent of Plan's Total Member Months (Female - Medicaid - Age < 1)

          PDI805-1030     Percent of Plan's Total Member Months (Female - Medicare - Age < 1)

          PDI805-1040     Percent of Plan's Total Member Months (Female - Other - Age < 1)

          PDI805-1050     Percent of Plan's Total Member Months (Female - Commercial - Age 1-4)

          PDI805-1060     Percent of Plan's Total Member Months (Female - Medicaid - Age 1-4)

          PDI805-1070     Percent of Plan's Total Member Months (Female - Medicare - Age 1-4)

Measure   Measure Name/Measure Description/Field Name/Field Description

          PDI805-1080     Percent of Plan's Total Member Months (Female - Other - Age 1-4)

          PDI805-1090     Percent of Plan's Total Member Months (Female - Commercial - Age 5-9)

          PDI805-1100     Percent of Plan's Total Member Months (Female - Medicaid - Age 5-9)

          PDI805-1110     Percent of Plan's Total Member Months (Female - Medicare - Age 5-9)

          PDI805-1120     Percent of Plan's Total Member Months (Female - Other - Age 5-9)

          PDI805-1130     Percent of Plan's Total Member Months (Female - Commercial - Age 10-14)

          PDI805-1140     Percent of Plan's Total Member Months (Female - Medicaid - Age 10-14)

          PDI805-1150     Percent of Plan's Total Member Months (Female - Medicare - Age 10-14)

          PDI805-1160     Percent of Plan's Total Member Months (Female - Other - Age 10-14)

          PDI805-1170     Percent of Plan's Total Member Months (Female - Commercial - Age 15-17)

          PDI805-1180     Percent of Plan's Total Member Months (Female - Medicaid - Age 15-17)

          PDI805-1190     Percent of Plan's Total Member Months (Female - Medicare - Age 15-17)

          PDI805-1200     Percent of Plan's Total Member Months (Female - Other - Age 15-17)

          PDI805-1210     Percent of Plan's Total Member Months (Female - Commercial - Age 18-19)

          PDI805-1220     Percent of Plan's Total Member Months (Female - Medicaid - Age 18-19)

          PDI805-1230     Percent of Plan's Total Member Months (Female - Medicare - Age 18-19)

          PDI805-1240     Percent of Plan's Total Member Months (Female - Other - Age 18-19)

          PDI805-1250     Percent of Plan's Total Member Months (Female - Commercial - Subtotal: Age 0-19)

          PDI805-1260     Percent of Plan's Total Member Months (Female - Medicaid - Subtotal: Age 0-19)

          PDI805-1270     Percent of Plan's Total Member Months (Female - Medicare - Age 0-19)

          PDI805-1280     Percent of Plan's Total Member Months (Female - Other - Age 0-19)

          PDI805-1290     Percent of Plan's Total Member Months (Female - Commercial - Age 20-24)

          PDI805-1300     Percent of Plan's Total Member Months (Female - Medicaid - Age 20-24)

          PDI805-1310     Percent of Plan's Total Member Months (Female - Medicare - Age 20-24)

          PDI805-1320     Percent of Plan's Total Member Months (Female - Other - Age 20-24)

          PDI805-1330     Percent of Plan's Total Member Months (Female - Commercial - Age 25-29)

          PDI805-1340     Percent of Plan's Total Member Months (Female - Medicaid - Age 25-29)

          PDI805-1350     Percent of Plan's Total Member Months (Female - Medicare - Age 25-29)

          PDI805-1360     Percent of Plan's Total Member Months (Female - Other - Age 25-29)

          PDI805-1370     Percent of Plan's Total Member Months (Female - Commercial - Age 30-34)

          PDI805-1380     Percent of Plan's Total Member Months (Female - Medicaid - Age 30-34)

          PDI805-1390     Percent of Plan's Total Member Months (Female - Medicare - Age 30-34)

          PDI805-1400     Percent of Plan's Total Member Months (Female - Other - Age 30-34)

          PDI805-1410     Percent of Plan's Total Member Months (Female - Commercial - Age 35-39)

          PDI805-1420     Percent of Plan's Total Member Months (Female - Medicaid - Age 35-39)

          PDI805-1430     Percent of Plan's Total Member Months (Female - Medicare - Age 35-39)

          PDI805-1440     Percent of Plan's Total Member Months (Female - Other - Age 35-39)

          PDI805-1450     Percent of Plan's Total Member Months (Female - Commercial - Age 40-44)

          PDI805-1460     Percent of Plan's Total Member Months (Female - Medicaid - Age 40-44)

          PDI805-1470     Percent of Plan's Total Member Months (Female - Medicare - Age 40-44)

          PDI805-1480     Percent of Plan's Total Member Months (Female - Other - Age 40-44)

          PDI805-1490     Percent of Plan's Total Member Months (Female - Commercial - Subtotal: Age 20-44)

          PDI805-1500     Percent of Plan's Total Member Months (Female - Medicaid - Subtotal: Age 20-44)

          PDI805-1510     Percent of Plan's Total Member Months (Female - Medicare - Age 20-44)

          PDI805-1520     Percent of Plan's Total Member Months (Female - Other - Age 20-44)

          PDI805-1530     Percent of Plan's Total Member Months (Female - Commercial - Age 45-49)

          PDI805-1540     Percent of Plan's Total Member Months (Female - Medicaid - Age 45-49)

          PDI805-1550     Percent of Plan's Total Member Months (Female - Medicare - Age 45-49)

          PDI805-1560     Percent of Plan's Total Member Months (Female - Other - Age 45-49)

          PDI805-1570     Percent of Plan's Total Member Months (Female - Commercial - Age 50-54)

          PDI805-1580     Percent of Plan's Total Member Months (Female - Medicaid - Age 50-54)

          PDI805-1590     Percent of Plan's Total Member Months (Female - Medicare - Age 50-54)

          PDI805-1600     Percent of Plan's Total Member Months (Female - Other - Age 50-54)

          PDI805-1610     Percent of Plan's Total Member Months (Female - Commercial - Age 55-59)

          PDI805-1620     Percent of Plan's Total Member Months (Female - Medicaid - Age 55-59)

          PDI805-1630     Percent of Plan's Total Member Months (Female - Medicare - Age 55-59)

Measure   Measure Name/Measure Description/Field Name/Field Description

          PDI805-1640     Percent of Plan's Total Member Months (Female - Other - Age 55-59)

          PDI805-1650     Percent of Plan's Total Member Months (Female - Commercial - Age 60-64)

          PDI805-1660     Percent of Plan's Total Member Months (Female - Medicaid - Age 60-64)

          PDI805-1670     Percent of Plan's Total Member Months (Female - Medicare - Age 60-64)

          PDI805-1680     Percent of Plan's Total Member Months (Female - Other - Age 60-64)

          PDI805-1690     Percent of Plan's Total Member Months (Female - Commercial - Subtotal: Age 45-64)

          PDI805-1700     Percent of Plan's Total Member Months (Female - Medicaid - Subtotal: Age 45-64)

          PDI805-1710     Percent of Plan's Total Member Months (Female - Medicare - Age 45-64)

          PDI805-1720     Percent of Plan's Total Member Months (Female - Other - Age 45-64)

          PDI805-1730     Percent of Plan's Total Member Months (Female - Commercial - Age 65-69)

          PDI805-1740     Percent of Plan's Total Member Months (Female - Medicaid - Age 65-69)

          PDI805-1750     Percent of Plan's Total Member Months (Female - Medicare - Age 65-69)

          PDI805-1760     Percent of Plan's Total Member Months (Female - Other - Age 65-69)

          PDI805-1770     Percent of Plan's Total Member Months (Female - Commercial - Age 70-74)

          PDI805-1780     Percent of Plan's Total Member Months (Female - Medicaid - Age 70-74)

          PDI805-1790     Percent of Plan's Total Member Months (Female - Medicare - Age 70-74)

          PDI805-1800     Percent of Plan's Total Member Months (Female - Other - Age 70-74)

          PDI805-1810     Percent of Plan's Total Member Months (Female - Commercial - Age 75-79)

          PDI805-1820     Percent of Plan's Total Member Months (Female - Medicaid - Age 75-79)

          PDI805-1830     Percent of Plan's Total Member Months (Female - Medicare - Age 75-79)

          PDI805-1840     Percent of Plan's Total Member Months (Female - Other - Age 75-79)

          PDI805-1850     Percent of Plan's Total Member Months (Female - Commercial - Age 80-84)

          PDI805-1860     Percent of Plan's Total Member Months (Female - Medicaid - Age 80-84)

          PDI805-1870     Percent of Plan's Total Member Months (Female - Medicare - Age 80-84)

          PDI805-1880     Percent of Plan's Total Member Months (Female - Other - Age 80-84)

          PDI805-1890     Percent of Plan's Total Member Months (Female - Commercial - Age 85-89)

          PDI805-1900     Percent of Plan's Total Member Months (Female - Medicaid - Age 85-89)

          PDI805-1910     Percent of Plan's Total Member Months (Female - Medicare - Age 85-89)

          PDI805-1920     Percent of Plan's Total Member Months (Female - Other - Age 85-89)

          PDI805-1930     Percent of Plan's Total Member Months (Female - Commercial - Age >=90)

          PDI805-1940     Percent of Plan's Total Member Months (Female - Medicaid - Age >=90)

          PDI805-1950     Percent of Plan's Total Member Months (Female - Medicare - Age >=90)

          PDI805-1960     Percent of Plan's Total Member Months (Female - Other - Age >=90)

          PDI805-1970     Percent of Plan's Total Member Months (Female - Commercial - Subtotal: Age >=65)

          PDI805-1980     Percent of Plan's Total Member Months (Female - Medicaid - Subtotal: Age >=65)

          PDI805-1990     Percent of Plan's Total Member Months (Female - Medicare - Age >=65)

          PDI805-2000     Percent of Plan's Total Member Months (Female - Other - Age >=65)

          PDI805-2010     Percent of Plan's Total Member Months (Total - Commercial - Subtotal: Age 0-19)

          PDI805-2020     Percent of Plan's Total Member Months (Total - Medicaid - Subtotal: Age 0-19)

          PDI805-2030     Percent of Plan's Total Member Months (Total - Medicare - Subtotal: Age 0-19)

          PDI805-2040     Percent of Plan's Total Member Months (Total - Other - Subtotal: Age 0-19)

          PDI805-2050     Percent of Plan's Total Member Months (Total - Commercial - Subtotal: Age 20-44)

          PDI805-2060     Percent of Plan's Total Member Months (Total - Medicaid - Subtotal: Age 20-44)

          PDI805-2070     Percent of Plan's Total Member Months (Total - Medicare - Subtotal: Age 20-44)

             PDI805-2080       Percent of Plan's Total Member Months (Total - Other - Subtotal: Age 20-44)

             PDI805-2090       Percent of Plan's Total Member Months (Total - Commercial - Subtotal: Age 45-64)

             PDI805-2100       Percent of Plan's Total Member Months (Total - Medicaid - Subtotal: Age 45-64)

             PDI805-2110       Percent of Plan's Total Member Months (Total - Medicare - Subtotal: Age 45-64)

             PDI805-2120       Percent of Plan's Total Member Months (Total - Other - Subtotal: Age 45-64)

             PDI805-2130       Percent of Plan's Total Member Months (Total - Commercial - Subtotal: Age >=65)

             PDI805-2140       Percent of Plan's Total Member Months (Total - Medicaid - Subtotal: Age >=65)

             PDI805-2150       Percent of Plan's Total Member Months (Total - Medicare - Subtotal: Age >=65)

             PDI805-2160       Percent of Plan's Total Member Months (Total - Other - Subtotal: Age >=65)

             PDI805-2170       Percent of Plan's Total Member Months (Total - Commercial - Subtotal: Age Unknown)

             PDI805-2180       Percent of Plan's Total Member Months (Total - Medicaid - Subtotal: Age Unknown)

             PDI805-2190       Percent of Plan's Total Member Months (Total - Medicare - Subtotal: Age Unknown)

Measure   Measure Name/Measure Description/Field Name/Field Description

             PDI805-2200       Percent of Plan's Total Member Months (Total - Other - Subtotal: Age Unknown)

             PDI805-2210       Percent of Plan's Total Member Months (Total - Commercial)

             PDI805-2220       Percent of Plan's Total Member Months (Total - Medicaid)

             PDI805-2230       Percent of Plan's Total Member Months (Total - Medicare)

             PDI805-2240       Percent of Plan's Total Member Months (Total - Other)

PDI806 – Enrollment by Product Line

     DESCRIPTION - This measure reports the total number of members enrolled for each product line stratified by age and sex.

      - Medicaid is reported in the member months contributed by enrollees during the measurement year, it is stratified by Medicaid eligibility category, age and sex. MCOs can report this information only if it is provided by their state Medicaid agencies.

      - Commercial and Medicare are reported in the number of member years contributed by enrollees during the measurement year, stratified by product line, age and sex. (HEDIS 2005, Volume 2: Technical Specification, Pg. 298)

     REPORTING LEVEL - Contract

             PDI806-0010       Member Years of Enrollment: Medicare Risk (Male)

             PDI806-0020       Member Years of Enrollment: Medicare Risk (Female)

             PDI806-0030       Member Years of Enrollment: Medicare Risk (Total)

Service_Area – Contract Service Area

     DESCRIPTION - The area where the contract provides services to Medicare care beneficiaries. This data comes from the Health Plan Management System (HPMS) as reported by the contract.

       REPORTING LEVEL - N/A

          SA-0010            Market Area Name

          SA-0020            Market Area Code

          SA-0030            Social Security Administration (SSA) State/County Code

          SA-0040            American National Standards Institute (ANSI) State/County Code INCITS 31-2009 (formerly Federal Information Processing Standard [FIPS] State/County codes)

          SA-0050            State Abbreviation (United States Postal Service (USPS) State Code)

          SA-0060            County Name

          SA-0070            County serves only beneficiaries in an Employer Group Health Plan (Y = Yes, N = No)

UOS505 – Frequency of Selected Procedures

      DESCRIPTION - This measure provides a summary of the number and rate of several frequently performed procedures. These procedures often show wide regional variation and have generated concern regarding potentially inappropriate utilization.

      For Medicaid members, MCOs report the absolute number of procedures and the number of procedures per 1,000 member months.

      For commercial and Medicare members, MCOs report the absolute number of procedures and the number of procedures per 1,000 members per year. (HEDIS 2005, Volume 2: Technical Specification, Pg. 224)

     REPORTING LEVEL - Contract Market

          UOS505-0010    CABG <65 (Male)

          UOS505-0020    CABG 65-74 (Male)

          UOS505-0030    CABG 75-84 (Male)

          UOS505-0040    CABG 85+ (Male)

          UOS505-0050    Angioplasty(PTCA) <65  (Male)

          UOS505-0060    Angioplasty(PTCA) 65-74 (Male)

          UOS505-0070    Angioplasty(PTCA) 75-84 (Male)

          UOS505-0080    Angioplasty(PTCA) 85+  (Male)

          UOS505-0090    Carotid Endarterectomy <65  (Male)

          UOS505-0100    Carotid Endarterectomy 65-74 (Male)

          UOS505-0110    Carotid Endarterectomy 75-84 (Male)

          UOS505-0120    Carotid Endarterectomy 85+  (Male)

          UOS505-0130    Reduction of Fracture of Femur <65  (Male)

          UOS505-0140    Reduction of Fracture of Femur 65-74 (Male)

          UOS505-0150    Reduction of Fracture of Femur 75-84 (Male)

          UOS505-0160    Reduction of Fracture of Femur 85+  (Male)

          UOS505-0170    Total Hip Replacement <65  (Male)

          UOS505-0180    Total Hip Replacement 65-74 (Male)

          UOS505-0190    Total Hip Replacement 75-84 (Male)

          UOS505-0200    Total Hip Replacement 85+  (Male)

Measure   Measure Name/Measure Description/Field Name/Field Description

          UOS505-0210    Total Knee Replacement <65  (Male)

          UOS505-0220    Total Knee Replacement 65-74 (Male)

          UOS505-0230    Total Knee Replacement 75-84 (Male)

          UOS505-0240    Total Knee Replacement 85+  (Male)

          UOS505-0250    Partial Excision of Large Intestine <65  (Male)

          UOS505-0260    Partial Excision of Large Intestine 65-74 (Male)

          UOS505-0270    Partial Excision of Large Intestine 75-84 (Male)

          UOS505-0280    Partial Excision of Large Intestine 85+  (Male)

          UOS505-0290    Cholecystectomy -open <65 (Male)

          UOS505-0300    Cholecystectomy -open 65-74  (Male)

          UOS505-0310    Cholecystectomy -open 75-84  (Male)

          UOS505-0320    Cholecystectomy -open 85+ (Male)

          UOS505-0330    Cholecystectomy -closed(laparoscopic) <65  (Male)

          UOS505-0340    Cholecystectomy -closed(laparoscopic) 65-74 (Male)

          UOS505-0350    Cholecystectomy -closed(laparoscopic) 75-84 (Male)

          UOS505-0360    Cholecystectomy -closed(laparoscopic) 85+  (Male)

          UOS505-0370    Prostatectomy <65  (Male)

          UOS505-0380    Prostatectomy 65-74 (Male)

          UOS505-0390    Prostatectomy 75-84 (Male)

          UOS505-0400    Prostatectomy 85+  (Male)

          UOS505-0410    CABG <65 (Female)

          UOS505-0420    CABG 65-74 (Female)

          UOS505-0430    CABG 75-84 (Female)

          UOS505-0440    CABG 85+ (Female)

          UOS505-0450    Angioplasty(PTCA) <65  (Female)

          UOS505-0460    Angioplasty(PTCA) 65-74 (Female)

          UOS505-0470    Angioplasty(PTCA) 75-84 (Female)

          UOS505-0480    Angioplasty(PTCA) 85+  (Female)

          UOS505-0490    Carotid Endarterectomy <65  (Female)

          UOS505-0500    Carotid Endarterectomy 65-74 (Female)

          UOS505-0510    Carotid Endarterectomy 75-84 (Female)

          UOS505-0520    Carotid Endarterectomy 85+  (Female)

          UOS505-0530    Reduction of Fracture of Femur <65  (Female)

          UOS505-0540    Reduction of Fracture of Femur 65-74 (Female)

          UOS505-0550    Reduction of Fracture of Femur 75-84 (Female)

          UOS505-0560    Reduction of Fracture of Femur 85+  (Female)

          UOS505-0570    Total Hip Replacement <65  (Female)

          UOS505-0580    Total Hip Replacement 65-74 (Female)

          UOS505-0590    Total Hip Replacement 75-84 (Female)

          UOS505-0600    Total Hip Replacement 85+  (Female)

          UOS505-0610    Total Knee Replacement <65  (Female)

          UOS505-0620    Total Knee Replacement 65-74 (Female)

          UOS505-0630    Total Knee Replacement 75-84 (Female)

          UOS505-0640    Total Knee Replacement 85+  (Female)

          UOS505-0650    Partial Excision of Large Intestine <65  (Female)

          UOS505-0660    Partial Excision of Large Intestine 65-74 (Female)

          UOS505-0670    Partial Excision of Large Intestine 75-84 (Female)

          UOS505-0680    Partial Excision of Large Intestine 85+  (Female)

          UOS505-0690    Cholecystectomy -open <65 (Female)

          UOS505-0700    Cholecystectomy -open 65-74  (Female)

             UOS505-0710     Cholecystectomy -open 75-84  (Female)

             UOS505-0720     Cholecystectomy -open 85+ (Female)

             UOS505-0730     Cholecystectomy -closed(laparoscopic) <65  (Female)

             UOS505-0740     Cholecystectomy -closed(laparoscopic) 65-74 (Female)

             UOS505-0750     Cholecystectomy -closed(laparoscopic) 75-84 (Female)

             UOS505-0760     Cholecystectomy -closed(laparoscopic) 85+  (Female)

Measure   Measure Name/Measure Description/Field Name/Field Description

             UOS505-0771     Hysterectomy - Abdominal <65 (Female)

             UOS505-0772     Hysterectomy - Vaginal <65 (Female)

             UOS505-0781     Hysterectomy - Abdominal 65-74 (Female)

             UOS505-0782     Hysterectomy - Vaginal 65-74 (Female)

             UOS505-0791     Hysterectomy - Abdominal 75-84 (Female)

             UOS505-0792     Hysterectomy - Vaginal 75-84 (Female)

             UOS505-0801     Hysterectomy - Abdominal 85+ (Female)

             UOS505-0802     Hysterectomy - Vaginal 85+ (Female)

             UOS505-0810     Cardiac Catherterization - <65 (Male)

             UOS505-0820     Cardiac Catherterization - 65-74 (Male)

             UOS505-0830     Cardiac Catherterization - 75-84 (Male)

             UOS505-0840     Cardiac Catherterization - 85+ (Male)

             UOS505-0850     Cardiac Catherterization - <65 (Female)

             UOS505-0860     Cardiac Catherterization - 65-74 (Female)

             UOS505-0870     Cardiac Catherterization - 75-84 (Female)

             UOS505-0880     Cardiac Catherterization - 85+ (Female)

UOS506 – Inpatient Utilization-General Hospital/Acute Care

      DESCRIPTION - This measure summarizes utilization of acute inpatient services in the following categories: total services, medicine, surgery and maternity.

      Nonacute care, mental health and chemical dependency services, as well as newborn care, are excluded. Medical and surgical services are reported separately because the factors influencing utilization in these two categories vary. This also facilitates comparisons between ambulatory surgery utilization (refer to the Ambulatory Care measure) and inpatient surgery utilization.

      (HEDIS 2005, Volume 2: Technical Specification, Pg. 234)

     REPORTING LEVEL - Contract Market

          UOS506-0010    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Total Inpatient - Age < 1)

          UOS506-0020    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Total Inpatient - Age < 1)

          UOS506-0030    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Total Inpatient - Age < 1)

          UOS506-0040    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Total Inpatient - Age 1-9)

          UOS506-0050    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Total Inpatient - Age 1-9)

          UOS506-0060    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Total Inpatient - Age 1-9)

          UOS506-0070    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Total Inpatient - Age 10-19)

          UOS506-0080    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Total Inpatient - Age 10-19)

          UOS506-0090    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Total Inpatient - Age 10-19)

          UOS506-0100    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Total Inpatient - Age 20-44)

          UOS506-0110    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Total Inpatient - Age 20-44)

          UOS506-0120    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Total Inpatient - Age 20-44)

          UOS506-0130    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Total Inpatient - Age 45-64)

          UOS506-0140    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Total Inpatient - Age 45-64)

          UOS506-0150    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Total Inpatient - Age 45-64)

          UOS506-0160    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Total Inpatient - Age 65-74)

          UOS506-0170    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Total Inpatient - Age 65-74)

          UOS506-0180    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Total Inpatient - Age 65-74)

          UOS506-0190    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Total Inpatient - Age 75-84)

          UOS506-0200    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Total Inpatient - Age 75-84)


 

Measure   Measure Name/Measure Description/Field Name/Field Description

          UOS506-0210    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Total Inpatient - Age 75-84)

          UOS506-0220    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Total Inpatient - Age 85+)

          UOS506-0230    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Total Inpatient - Age 85+)

          UOS506-0240    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Total Inpatient - Age 85+)

          UOS506-0270    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Total Inpatient - Age Unknown)

          UOS506-0280    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Total Inpatient - Total)

          UOS506-0290    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Total Inpatient - Total)

          UOS506-0300    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Total Inpatient - Total)

          UOS506-0310    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Medicine - Age < 1)

          UOS506-0320    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Medicine - Age < 1)

          UOS506-0330    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Medicine - Age < 1)

          UOS506-0340    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Medicine - Age 1-9)

          UOS506-0350    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Medicine - Age 1-9)

          UOS506-0360    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Medicine - Age 1-9)

          UOS506-0370    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Medicine - Age 10-19)

          UOS506-0380    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Medicine - Age 10-19)

          UOS506-0390    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Medicine - Age 10-19)

          UOS506-0400    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Medicine - Age 20-44)

          UOS506-0410    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Medicine - Age 20-44)

          UOS506-0420    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Medicine - Age 20-44)

          UOS506-0430    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Medicine - Age 45-64)

          UOS506-0440    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Medicine - Age 45-64)

          UOS506-0450    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Medicine - Age 45-64)

          UOS506-0460    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Medicine - Age 65-74)

          UOS506-0470    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Medicine - Age 65-74)

          UOS506-0480    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Medicine - Age 65-74)

          UOS506-0490    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Medicine - Age 75-84)

          UOS506-0500    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Medicine - Age 75-84)

          UOS506-0510    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Medicine - Age 75-84)

          UOS506-0520    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Medicine - Age 85+)

          UOS506-0530    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Medicine - Age 85+)

          UOS506-0540    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Medicine - Age 85+)

          UOS506-0570    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Medicine - Age Unknown)

          UOS506-0580    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Medicine - Total)

          UOS506-0590    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Medicine - Total)

          UOS506-0600    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Medicine - Total)

          UOS506-0610    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Surgery - Age < 1)

          UOS506-0620    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Surgery - Age < 1)

          UOS506-0630    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Surgery - Age < 1)

          UOS506-0640    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Surgery - Age 1-9)

          UOS506-0650    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Surgery - Age 1-9)

          UOS506-0660    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Surgery - Age 1-9)

          UOS506-0670    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Surgery - Age 10-19)

          UOS506-0680    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Surgery - Age 10-19)

Measure   Measure Name/Measure Description/Field Name/Field Description

          UOS506-0690    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Surgery - Age 10-19)

          UOS506-0700    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Surgery - Age 20-44)

          UOS506-0710    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Surgery - Age 20-44)

          UOS506-0720    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Surgery - Age 20-44)

          UOS506-0730    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Surgery - Age 45-64)

          UOS506-0740    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Surgery - Age 45-64)

          UOS506-0750    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Surgery - Age 45-64)

          UOS506-0760    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Surgery - Age 65-74)

          UOS506-0770    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Surgery - Age 65-74)

          UOS506-0780    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Surgery - Age 65-74)

          UOS506-0790    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Surgery - Age 75-84)

          UOS506-0800    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Surgery - Age 75-84)

          UOS506-0810    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Surgery - Age 75-84)

          UOS506-0820    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Surgery - Age 85+)

          UOS506-0830    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Surgery - Age 85+)

          UOS506-0840    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Surgery - Age 85+)

          UOS506-0870    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Surgery - Age Unknown)

          UOS506-0880    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Surgery - Total)

          UOS506-0890    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Surgery - Total)

          UOS506-0900    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Surgery - Total)

          UOS506-0910    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Maternity - Age 10-19)

          UOS506-0920    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Maternity - Age 10-19)

          UOS506-0930    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Maternity - Age 10-19)

          UOS506-0940    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Maternity - Age 20-44)

          UOS506-0950    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Maternity - Age 20-44)

          UOS506-0960    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Maternity - Age 20-44)

          UOS506-0970    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Maternity - Age 45-64)

          UOS506-0980    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Maternity - Age 45-64)

          UOS506-0990    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Maternity - Age 45-64)

          UOS506-1020    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Maternity - Age Unknown)

          UOS506-1030    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Maternity - Total)

          UOS506-1040    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Maternity - Total)

          UOS506-1050    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Maternity - Total)

          UOS506-1090    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Maternity - Ages 65+)

          UOS506-1100    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Maternity - Ages 65+)

          UOS506-1110    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Maternity - Ages 65+)

UOS507 – Ambulatory Care

      DESCRIPTION - This measure summarizes utilization of ambulatory services in the following categories: Outpatient Visits, Emergency Department Visits, Ambulatory Surgery/Procedures performed in hospital outpatient facilities or freestanding surgical centers and Observation Room Stays that result in discharge. (observation room stays resulting in an inpatient admission are counted in the Inpatient Utilization—General Hospital/Acute Care measure.) (HEDIS 2005, Volume 2: Technical Specification, Pg. 241)

     REPORTING LEVEL - Contract Market

             UOS507-0010     Ambulatory Care- Total Outpatient Visits/1000 (Age < 1)

             UOS507-0020     Ambulatory Care- Total Emergency Room Visits/1000  (Age < 1)

Measure   Measure Name/Measure Description/Field Name/Field Description

             UOS507-0030     Ambulatory Care- Total Ambulatory Surgery Procedures/1000 (Age < 1)

             UOS507-0040     Ambulatory Care- Observation Room Stays Resulting in Discharge/1000 (Age < 1)

             UOS507-0050     Ambulatory Care- Total Outpatient Visits/1000 (Age 1-9)

             UOS507-0060     Ambulatory Care- Total Emergency Room Visits/1000  (Age 1-9)

             UOS507-0070     Ambulatory Care- Total Ambulatory Surgery Procedures/1000 (Age 1-9)

             UOS507-0080     Ambulatory Care- Observation Room Stays Resulting in Discharge/1000 (Age 1-9)

             UOS507-0090     Ambulatory Care- Total Outpatient Visits/1000 (Age 10-19)

             UOS507-0100     Ambulatory Care- Total Emergency Room Visits/1000  (Age 10-19)

             UOS507-0110     Ambulatory Care- Total Ambulatory Surgery Procedures/1000 (Age 10-19)

             UOS507-0120     Ambulatory Care- Observation Room Stays Resulting in Discharge/1000 (Age 10-19)

             UOS507-0130     Ambulatory Care- Total Outpatient Visits/1000 (Age 20-44)

             UOS507-0140     Ambulatory Care- Total Emergency Room Visits/1000  (Age 20-44)

             UOS507-0150     Ambulatory Care- Total Ambulatory Surgery Procedures/1000 (Age 20-44)

             UOS507-0160     Ambulatory Care- Observation Room Stays Resulting in Discharge/1000 (Age 20-44)

             UOS507-0170     Ambulatory Care- Total Outpatient Visits/1000 (Age 45-64)

             UOS507-0180     Ambulatory Care- Total Emergency Room Visits/1000  (Age 45-64)

             UOS507-0190     Ambulatory Care- Total Ambulatory Surgery Procedures/1000 (Age 45-64)

             UOS507-0200     Ambulatory Care- Observation Room Stays Resulting in Discharge/1000 (Age 45-64)

             UOS507-0210     Ambulatory Care- Total Outpatient Visits/1000 (Age 65-74)

             UOS507-0220     Ambulatory Care- Total Emergency Room Visits/1000  (Age 65-74)

             UOS507-0230     Ambulatory Care- Total Ambulatory Surgery Procedures/1000 (Age 65-74)

             UOS507-0240     Ambulatory Care- Observation Room Stays Resulting in Discharge/1000 (Age 65-74)

             UOS507-0250     Ambulatory Care- Total Outpatient Visits/1000 (Age 75-84)

             UOS507-0260     Ambulatory Care- Total Emergency Room Visits/1000  (Age 75-84)

             UOS507-0270     Ambulatory Care- Total Ambulatory Surgery Procedures/1000 (Age 75-84)

             UOS507-0280     Ambulatory Care- Observation Room Stays Resulting in Discharge/1000 (Age 75-84)

             UOS507-0290     Ambulatory Care- Total Outpatient Visits/1000 (Age 85+)

             UOS507-0300     Ambulatory Care- Total Emergency Room Visits/1000  (Age 85+)

             UOS507-0310     Ambulatory Care- Total Ambulatory Surgery Procedures/1000 (Age 85+)

             UOS507-0320     Ambulatory Care- Observation Room Stays Resulting in Discharge/1000 (Age 85+)

             UOS507-0370     Ambulatory Care- Total Outpatient Visits/1000 (Total)

             UOS507-0380     Ambulatory Care- Total Emergency Room Visits/1000  (Total)

             UOS507-0390     Ambulatory Care- Total Ambulatory Surgery Procedures/1000 (Total)

             UOS507-0400     Ambulatory Care- Observation Room Stays Resulting in Discharge/1000 (Total)

UOS508 – Inpatient Utilization-NonAcute Care

      DESCRIPTION - This measure summarizes utilization of nonacute inpatient care in the following facilities: hospice, nursing home, rehabilitation, SNF, transitional care and respite. These data exclude services with a principal diagnosis of mental health and chemical dependency. (HEDIS 2005, Volume 2: Technical Specification, Pg. 248)

     REPORTING LEVEL - Contract Market

             UOS508-0010     Inpatient Utilization - Non-Acute Care- Total Inpatient Discharges/1000 (Age < 1)

             UOS508-0020     Inpatient Utilization - Non-Acute Care- Total Inpatient Days/1000  (Age < 1)

             UOS508-0030     Inpatient Utilization - Non-Acute Care- Total Inpatient Average Length of Stay  (Age < 1)

             UOS508-0040     Inpatient Utilization - Non-Acute Care- Total Inpatient Discharges/1000 (Age 1-9)

             UOS508-0050     Inpatient Utilization - Non-Acute Care- Total Inpatient Days/1000  (Age 1-9)

             UOS508-0060     Inpatient Utilization - Non-Acute Care- Total Inpatient Average Length of Stay  (Age 1-9)

             UOS508-0070     Inpatient Utilization - Non-Acute Care- Total Inpatient Discharges/1000 (Age 10-19)

             UOS508-0080     Inpatient Utilization - Non-Acute Care- Total Inpatient Days/1000  (Age 10-19)

             UOS508-0090     Inpatient Utilization - Non-Acute Care- Total Inpatient Average Length of Stay  (Age 10-19)

             UOS508-0100     Inpatient Utilization - Non-Acute Care- Total Inpatient Discharges/1000 (Age 20-44)

             UOS508-0110     Inpatient Utilization - Non-Acute Care- Total Inpatient Days/1000  (Age 20-44)

             UOS508-0120     Inpatient Utilization - Non-Acute Care- Total Inpatient Average Length of Stay  (Age 20-44)

             UOS508-0130     Inpatient Utilization - Non-Acute Care- Total Inpatient Discharges/1000 (Age 45-64)

             UOS508-0140     Inpatient Utilization - Non-Acute Care- Total Inpatient Days/1000  (Age 45-64)

             UOS508-0150     Inpatient Utilization - Non-Acute Care- Total Inpatient Average Length of Stay  (Age 45-64)

             UOS508-0160     Inpatient Utilization - Non-Acute Care- Total Inpatient Discharges/1000 (Age 65-74)

             UOS508-0170     Inpatient Utilization - Non-Acute Care- Total Inpatient Days/1000  (Age 65-74)

Measure   Measure Name/Measure Description/Field Name/Field Description

             UOS508-0180     Inpatient Utilization - Non-Acute Care- Total Inpatient Average Length of Stay  (Age 65-74)

             UOS508-0190     Inpatient Utilization - Non-Acute Care- Total Inpatient Discharges/1000 (Age 75-84)

             UOS508-0200     Inpatient Utilization - Non-Acute Care- Total Inpatient Days/1000  (Age 75-84)

             UOS508-0210     Inpatient Utilization - Non-Acute Care- Total Inpatient Average Length of Stay  (Age 75-84)

             UOS508-0220     Inpatient Utilization - Non-Acute Care- Total Inpatient Discharges/1000 (Age 85+)

             UOS508-0230     Inpatient Utilization - Non-Acute Care- Total Inpatient Days/1000  (Age 85+)

             UOS508-0240     Inpatient Utilization - Non-Acute Care- Total Inpatient Average Length of Stay  (Age 85+)

             UOS508-0270     Inpatient Utilization - Non-Acute Care- Total Inpatient Average Length of Stay  (Age Unknown)

             UOS508-0280     Inpatient Utilization - Non-Acute Care- Total Inpatient Discharges/1000 (Total)

             UOS508-0290     Inpatient Utilization - Non-Acute Care- Total Inpatient Days/1000  (Total)

             UOS508-0300     Inpatient Utilization - Non-Acute Care- Total Inpatient Average Length of Stay  (Total)

UOS512 – Mental Health Utilization-Inpatient Discharges/Average Length of Stay

      DESCRIPTION - This measure summarizes utilization of inpatient mental health services, stratified by age and sex. (HEDIS 2005, Volume 2: Technical Specification, Pg. 258)

       REPORTING LEVEL - Contract Market

             UOS512-0010     Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Male - Age 0-12)

             UOS512-0020     Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Male - Age 0-12)

             UOS512-0030     Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Male - Age 13-17)

             UOS512-0040     Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Male - Age 13-17)

             UOS512-0050     Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Male - Age 18-64)

             UOS512-0060     Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Male - Age 18-64)

             UOS512-0070     Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Male - Age 65+)

             UOS512-0080     Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Male - Age 65+)

             UOS512-0100     Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Male - Age Uknown)

             UOS512-0110     Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Male - Total)

             UOS512-0120     Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Male - Total)

             UOS512-0130     Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Female - Age 0-12)

             UOS512-0140     Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Female - Age 0-12)

             UOS512-0150     Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Female - Age 13-17)

             UOS512-0160     Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Female - Age 13-17)

             UOS512-0170     Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Female - Age 18-64)

             UOS512-0180     Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Female - Age 18-64)

             UOS512-0190     Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Female - Age 65+)

             UOS512-0200     Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Female - Age 65+)

             UOS512-0220     Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Female - Age Uknown)


 

Measure   Measure Name/Measure Description/Field Name/Field Description

             UOS512-0230     Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Female - Total)

             UOS512-0240     Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Female - Total)

             UOS512-0250     Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Total - Age 0-12)

             UOS512-0260     Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Total - Age 0-12)

             UOS512-0270     Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Total - Age 13-17)

             UOS512-0280     Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Total - Age 13-17)

             UOS512-0290     Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Total - Age 18-64)

             UOS512-0300     Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Total - Age 18-64)

             UOS512-0310     Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Total - Age 65+)

             UOS512-0320     Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Total - Age 65+)

             UOS512-0340     Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Total - Age Uknown)

             UOS512-0350     Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Total - Total)

             UOS512-0360     Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Total - Total)

UOS513 – Mental Health Utilization-% of Members Receiving Inpatient, Day/Night, and Ambulatory Services

      DESCRIPTION - This measure reports the number and percentage of members receiving mental health services during the measurement year in the following categories:

      Any Mental Health Services (inpatient, intermediate, ambulatory)

      Report in each category the number of members who received the respective service and, of all enrollees with a mental health benefit, the percentage who received the respective service; report this information by age and sex. This measure is intended to give an overview of the extent to which the MCO uses the different levels of mental health care. (HEDIS 2005, Volume 2: Technical Specification, Pg. 261)

     REPORTING LEVEL - Contract Market

          UOS513-0010    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Male - Age 0-12)

          UOS513-0020    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Male - Age 0-12)

          UOS513-0030    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Male - Age 0-12)

          UOS513-0040    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Male - Age 0-12)

          UOS513-0050    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Male - Age 13-17)

          UOS513-0060    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Male - Age 13-17)

          UOS513-0070    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Male - Age 13-17)

          UOS513-0080    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Male - Age 13-17)

          UOS513-0090    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Male - Age 18-64)

          UOS513-0100    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Male - Age 18-64)

Measure   Measure Name/Measure Description/Field Name/Field Description

          UOS513-0110    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Male - Age 18-64)

          UOS513-0120    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Male - Age 18-64)

          UOS513-0130    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Male - Age 65+)

          UOS513-0140    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Male - Age 65+)

          UOS513-0150    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Male - Age 65+)

          UOS513-0160    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Male - Age 65+)

          UOS513-0170    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Male - Age Unknown)

          UOS513-0180    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Male - Age Unknown)

          UOS513-0190    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Male - Age Unknown)

          UOS513-0200    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Male - Age Unknown)

          UOS513-0210    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Male - Total)

          UOS513-0220    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Male - Total)

          UOS513-0230    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Male - Total)

          UOS513-0240    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Male -Total)

          UOS513-0250    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Female - Age 0-12)

          UOS513-0260    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Female - Age 0-12)

          UOS513-0270    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Female - Age 0-12)

          UOS513-0280    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Female - Age 0-12)

          UOS513-0290    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Female - Age 13-17)

          UOS513-0300    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Female - Age 13-17)

          UOS513-0310    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Female - Age 13-17)

          UOS513-0320    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Female - Age 13-17)

          UOS513-0330    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Female - Age 18-64)

          UOS513-0340    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Female - Age 18-64)

          UOS513-0350    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Female - Age 18-64)

          UOS513-0360    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Female - Age 18-64)

          UOS513-0370    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Female - Age 65+)

          UOS513-0380    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Female - Age 65+)

          UOS513-0390    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Female - Age 65+)

Measure   Measure Name/Measure Description/Field Name/Field Description

          UOS513-0400    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Female - Age 65+)

          UOS513-0410    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Female - Age Unknown)

          UOS513-0420    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Female - Age Unknown)

          UOS513-0430    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Female - Age Unknown)

          UOS513-0440    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Female - Age Unknown)

          UOS513-0450    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Female - Total)

          UOS513-0460    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Female - Total)

          UOS513-0470    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Female - Total)

          UOS513-0480    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Female -Total)

          UOS513-0490    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Total - Age 0-12)

          UOS513-0500    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Total - Age 0-12)

          UOS513-0510    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Total - Age 0-12)

          UOS513-0520    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Total - Age 0-12)

          UOS513-0530    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Total - Age 13-17)

          UOS513-0540    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Total - Age 13-17)

          UOS513-0550    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Total - Age 13-17)

          UOS513-0560    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Total - Age 13-17)

          UOS513-0570    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Total - Age 18-64)

          UOS513-0580    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Total - Age 18-64)

          UOS513-0590    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Total - Age 18-64)

          UOS513-0600    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Total - Age 18-64)

          UOS513-0610    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Total - Age 65+)

          UOS513-0620    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Total - Age 65+)

          UOS513-0630    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Total - Age 65+)

          UOS513-0640    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Total - Age 65+)

          UOS513-0650    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Total - Age Unknown)

          UOS513-0660    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Total - Age Unknown)

          UOS513-0670    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Total - Age Unknown)

          UOS513-0680    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Total - Age Unknown)

Measure   Measure Name/Measure Description/Field Name/Field Description

          UOS513-0690    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Total - Total)

          UOS513-0700    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Total - Total)

          UOS513-0710    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Total - Total)

          UOS513-0720      Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Total -Total)

UOS515 – Chemical Dependency utilization-Inpatient Discharges/Average Length of Stay

     DESCRIPTION - This measure summarizes utilization of inpatient chemical dependency services, stratified by age and sex.. (HEDIS 2005, Volume 2: Technical Specification, Pg. 265)

     REPORTING LEVEL - Contract Market

          UOS515-0010    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Male - Age 0-12)

          UOS515-0020    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Male - Age 0-12)

          UOS515-0030    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Male - Age 13-17)

          UOS515-0040    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Male - Age 13-17)

          UOS515-0050    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Male - Age 18-64)

          UOS515-0060    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Male - Age 18-64)

          UOS515-0070    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Male - Age 65+)

          UOS515-0080    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Male - Age 65+)

          UOS515-0100    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Male - Age Unknown)

          UOS515-0110    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Male - Total)

          UOS515-0120    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Male - Total)

          UOS515-0130    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Female - Age 0-12)

          UOS515-0140    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Female - Age 0-12)

          UOS515-0150    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Female - Age 13-17)

          UOS515-0160    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Female - Age 13-17)

          UOS515-0170    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Female - Age 18-64)

          UOS515-0180    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Female - Age 18-64)

          UOS515-0190    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Female - Age 65+)

          UOS515-0200    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Female - Age 65+)

          UOS515-0220    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Female - Age Unknown)

          UOS515-0230    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Female - Total)

          UOS515-0240    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Female - Total)

Measure   Measure Name/Measure Description/Field Name/Field Description

          UOS515-0250    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Total - Age 0-12)

          UOS515-0260    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Total - Age 0-12)

          UOS515-0270    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Total - Age 13-17)

          UOS515-0280    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Total - Age 13-17)

          UOS515-0290    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Total - Age 18-64)

          UOS515-0300    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Total - Age 18-64)

          UOS515-0310    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Total - Age 65+)

          UOS515-0320    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Total - Age 65+)

          UOS515-0340    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Total - Age Unknown)

          UOS515-0350    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Total - Total)

          UOS515-0360    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Total - Total)

UOS518 – Outpatient Drug Utilization

      DESCRIPTION - This measure summarizes data on outpatient utilization of drug prescriptions (total cost of prescriptions; average cost of prescriptions per member per month, total number of prescriptions and average number of prescriptions per member per year) during the measurement year, stratified by age. (HEDIS 2005, Volume 2: Technical Specification, Pg. 272)

     REPORTING LEVEL - Contract Market

             UOS518-0010     Outpatient Drug Utilization- Total Average Cost of Prescriptions Per Member Per Month (Age 0-9)

             UOS518-0020     Outpatient Drug Utilization- Total Average Number of Prescriptions Per Member Per Year (Age 0-9)

             UOS518-0030     Outpatient Drug Utilization- Total Average Cost of Prescriptions Per Member Per Month (Age 10-19)

             UOS518-0040     Outpatient Drug Utilization- Total Average Number of Prescriptions Per Member Per Year (Age 10-19)

             UOS518-0050     Outpatient Drug Utilization- Total Average Cost of Prescriptions Per Member Per Month (Age 20-44)

             UOS518-0060     Outpatient Drug Utilization- Total Average Number of Prescriptions Per Member Per Year (Age 20-44)

             UOS518-0070     Outpatient Drug Utilization- Total Average Cost of Prescriptions Per Member Per Month (Age 45-64)

             UOS518-0080     Outpatient Drug Utilization- Total Average Number of Prescriptions Per Member Per Year (Age 45-64)

             UOS518-0090     Outpatient Drug Utilization- Total Average Cost of Prescriptions Per Member Per Month (Age 65-74)

             UOS518-0100     Outpatient Drug Utilization- Total Average Number of Prescriptions Per Member Per Year (Age 65-74)

             UOS518-0110     Outpatient Drug Utilization- Total Average Cost of Prescriptions Per Member Per Month (Age 75-84)

             UOS518-0120     Outpatient Drug Utilization- Total Average Number of Prescriptions Per Member Per Year (Age 75-84)

             UOS518-0130     Outpatient Drug Utilization- Total Average Cost of Prescriptions Per Member Per Month (Age 85+)

             UOS518-0140     Outpatient Drug Utilization- Total Average Number of Prescriptions Per Member Per Year (Age 85+)

             UOS518-0170     Outpatient Drug Utilization- Total Average Cost of Prescriptions Per Member Per Month (Total)

             UOS518-0180     Outpatient Drug Utilization- Total Average Number of Prescriptions Per Member Per Year (Total)

UOS520 – Identification of Alcohol and Other Drug Services

      DESCRIPTION - This measure reports the number and percentage of members with an alcohol and other drug (AOD) claim. AOD claims contain a diagnosis of AOD abuse or dependence and a specific AOD-related service during the measurement year, in the following categories:

      -any chemical dependency services (inpatient, intermediate, ambulatory)

      Report by age and sex:

      -the number of members in each category who received the service

      -from all enrollees with a chemical dependency benefit, the percentage of members who received the service.

      This measure provides an overview of members with an AOD dependence diagnosis and the extent to which the different levels of chemical dependency services are utilized. (HEDIS 2005, Volume 2: Technical Specification, Pg. 268)

     REPORTING LEVEL - Contract Market

          UOS520-0010    Identification of Alcohol and Other Drug Services: Any, Age:0-12, Percent of Males

Measure   Measure Name/Measure Description/Field Name/Field Description

          UOS520-0020    Identification of Alcohol and Other Drug Services: Any, Age:0-12, Percent of Females

          UOS520-0030    Identification of Alcohol and Other Drug Services: Any, Age:0-12, Total Percent

          UOS520-0040    Identification of Alcohol and Other Drug Services: Any, Age:13-17, Percent of Males

          UOS520-0050    Identification of Alcohol and Other Drug Services: Any, Age:13-17, Percent of Females

          UOS520-0060    Identification of Alcohol and Other Drug Services: Any, Age:13-17, Total Percent

          UOS520-0070    Identification of Alcohol and Other Drug Services: Any, Age:18-64, Percent of Males

          UOS520-0080    Identification of Alcohol and Other Drug Services: Any, Age:18-64, Percent of Females

          UOS520-0090    Identification of Alcohol and Other Drug Services: Any, Age:18-64, Total Percent

          UOS520-0100    Identification of Alcohol and Other Drug Services: Any, Age:65+, Percent of Males

          UOS520-0110    Identification of Alcohol and Other Drug Services: Any, Age:65+, Percent of Females

          UOS520-0120    Identification of Alcohol and Other Drug Services: Any, Age:65+, Total Percent

          UOS520-0130    Identification of Alcohol and Other Drug Services: Any, Age:Unk, Percent of Males

          UOS520-0140    Identification of Alcohol and Other Drug Services: Any, Age:Unk, Percent of Females

          UOS520-0150    Identification of Alcohol and Other Drug Services: Any, Age:Unk, Total Percent

          UOS520-0160    Identification of Alcohol and Other Drug Services: Any, Total Percent of Males

          UOS520-0170    Identification of Alcohol and Other Drug Services: Any, Total Percent of Females

          UOS520-0180    Identification of Alcohol and Other Drug Services: Any, Total Percent

          UOS520-0190    Identification of Alcohol and Other Drug Services: Inpatient, 0-12, Percent of Males

          UOS520-0200    Identification of Alcohol and Other Drug Services: Inpatient, 0-12, Percent of Females

          UOS520-0210    Identification of Alcohol and Other Drug Services: Inpatient, 0-12, Total Percent

          UOS520-0220    Identification of Alcohol and Other Drug Services: Inpatient, 13-17, Percent of Males

          UOS520-0230    Identification of Alcohol and Other Drug Services: Inpatient, 13-17, Percent of Females

          UOS520-0240    Identification of Alcohol and Other Drug Services: Inpatient, 13-17, Total Percent

          UOS520-0250    Identification of Alcohol and Other Drug Services: Inpatient, 18-64,, Percent of Males

          UOS520-0260    Identification of Alcohol and Other Drug Services: Inpatient, 18-64, Percent of Females

          UOS520-0270    Identification of Alcohol and Other Drug Services: Inpatient, 18-64, Total Percent

          UOS520-0280    Identification of Alcohol and Other Drug Services: Inpatient, 65+, Percent of Males

          UOS520-0290    Identification of Alcohol and Other Drug Services: Inpatient, 65+, Percent of Females

          UOS520-0300    Identification of Alcohol and Other Drug Services: Inpatient, 65+, Total Percent

          UOS520-0310    Identification of Alcohol and Other Drug Services: Inpatient, Unk, Percent of Males

          UOS520-0320    Identification of Alcohol and Other Drug Services: Inpatient, Unk, Percent of Females

          UOS520-0330    Identification of Alcohol and Other Drug Services: Inpatient, Unk, Total Percent

          UOS520-0340    Identification of Alcohol and Other Drug Services: Inpatient, Total Percentber of Males

          UOS520-0350    Identification of Alcohol and Other Drug Services: Inpatient, Total Percentber of Females

          UOS520-0360    Identification of Alcohol and Other Drug Services: Inpatient, Total Percent

          UOS520-0370    Identification of Alcohol and Other Drug Services: Day/Night, 0-12, Percent of Males

          UOS520-0380    Identification of Alcohol and Other Drug Services: Day/Night, 0-12, Percent of Females

          UOS520-0390    Identification of Alcohol and Other Drug Services: Day/Night, 0-12, Total Percent

          UOS520-0400    Identification of Alcohol and Other Drug Services: Day/Night, 13-17, Percent of Males

          UOS520-0410    Identification of Alcohol and Other Drug Services: Day/Night, 13-17, Percent of Females

          UOS520-0420    Identification of Alcohol and Other Drug Services: Day/Night, 13-17, Total Percent

          UOS520-0430    Identification of Alcohol and Other Drug Services: Day/Night, 18-64, Percent of Males

          UOS520-0440    Identification of Alcohol and Other Drug Services: Day/Night, 18-64, Percent of Females

          UOS520-0450    Identification of Alcohol and Other Drug Services: Day/Night, 18-64, Total Percent

          UOS520-0460    Identification of Alcohol and Other Drug Services: Day/Night, 65+, Percent of Males

          UOS520-0470    Identification of Alcohol and Other Drug Services: Day/Night, 65+, Percent of Females

          UOS520-0480    Identification of Alcohol and Other Drug Services: Day/Night, 65+, Total Percent

          UOS520-0490    Identification of Alcohol and Other Drug Services: Day/Night, Unk, Percent of Males

          UOS520-0500    Identification of Alcohol and Other Drug Services: Day/Night, Unk, Percent of Females

          UOS520-0510    Identification of Alcohol and Other Drug Services: Day/Night, Unk, Total Percent

          UOS520-0520    Identification of Alcohol and Other Drug Services: Day/Night, Total Percentber of Males

          UOS520-0530    Identification of Alcohol and Other Drug Services: Day/Night, Total Percentber of Females

          UOS520-0540    Identification of Alcohol and Other Drug Services: Day/Night, Total Percent

          UOS520-0550    Identification of Alcohol and Other Drug Services: Ambulatory, 0-12, Percent of Males

          UOS520-0560    Identification of Alcohol and Other Drug Services: Ambulatory, 0-12, Percent of Females

          UOS520-0570    Identification of Alcohol and Other Drug Services: Ambulatory, 0-12, Total Percent

Measure   Measure Name/Measure Description/Field Name/Field Description

          UOS520-0580    Identification of Alcohol and Other Drug Services: Ambulatory, 13-17, Percent of Males

          UOS520-0590    Identification of Alcohol and Other Drug Services: Ambulatory, 13-17, Percent of Females

          UOS520-0600    Identification of Alcohol and Other Drug Services: Ambulatory, 13-17, Total Percent

          UOS520-0610    Identification of Alcohol and Other Drug Services: Ambulatory, 18-64, Percent of Males

          UOS520-0620    Identification of Alcohol and Other Drug Services: Ambulatory, 18-64, Percent of Females

          UOS520-0630    Identification of Alcohol and Other Drug Services: Ambulatory, 18-64, Total Percent

          UOS520-0640    Identification of Alcohol and Other Drug Services: Ambulatory, 65+, Percent of Males

          UOS520-0650    Identification of Alcohol and Other Drug Services: Ambulatory, 65+, Percent of Females

          UOS520-0660    Identification of Alcohol and Other Drug Services: Ambulatory, 65+, Total Percent

          UOS520-0670    Identification of Alcohol and Other Drug Services: Ambulatory, Unk, Percent of Males

          UOS520-0680    Identification of Alcohol and Other Drug Services: Ambulatory, Unk, Percent of Females

          UOS520-0690    Identification of Alcohol and Other Drug Services: Ambulatory, Unk, Total Percent

          UOS520-0700    Identification of Alcohol and Other Drug Services: Ambulatory, Total, Percent of Males

          UOS520-0710    Identification of Alcohol and Other Drug Services: Ambulatory, Total, Percent of Females

          UOS520-0720    Identification of Alcohol and Other Drug Services: Ambulatory, Total Percent