At a glance
Find guidelines and quality measures that establish standards for care and help measure the quality of HIV, STD, viral hepatitis and tuberculosis-related health care services. Where applicable, their use in public and select private quality measurement programs is also indicated.
Quality measures overview
Introduction to Quality Measures
Quality measures are also referred to as Clinical Quality Measures (CQMs) and electronic Clinical Quality Measures (eCQMs). They are tools measuring healthcare processes, outcomes, patient perceptions, and organizational structures associated with the ability to provide high-quality health care. Measurement is a step towards improving health care quality. Quality measures help drive that improvement through a consistent and accountable approach. Please access the CMS Quality Measures webpage for more information.
Select Quality Reporting and Payment Programs
Quality measures are used within a wide variety of quality reporting, accreditation, and payment programs and initiatives. Programs and associated measure sets frequently used to evaluate the quality of care provided by clinicians, health plans, and states include some of the following:
- Merit-Based Incentive Payment System (MIPS) Program
- Medicaid Adult Core Set
- Medicaid Child Core Set
- Healthcare Effectiveness Data and Information Set (HEDIS)
- Qualified Health Plan Quality Rating System (QHP QRS)
- HRSA Uniform Data System – Health Center Data Reporting Requirements (UDS)
- HRSA HIV/AIDS Bureau (HAB) – Ryan White HIV/AIDS Program
Quality measure summary tables
Summary table details
A Summary Table is available for HIV, viral hepatitis, STD, and TB related measures. Each table includes the following:
- Measure Name: Lists the name of the measure as it appears in the quality program(s).
- Brief Description: Describes the population and activity that the measure is monitoring.
- ID: Provides the IDs in the table.
- Steward: Entity that created the quality measure and manages periodic updates. The stewards included in the summary tables are the following:
- American Academy of Dermatology (AAD)
- American College of Rheumatology (ACR)
- American Gastroenterological Association (AGA)
- Centers for Disease Control and Prevention (CDC)
- Health Resources and Services Administration (HRSA)
- National Committee for Quality Assurance (NCQA)
- Programs Currently Using: Lists some of the quality programs that use the quality measure. (See Quality Measures Overview above.)
HIV quality measures table
| Measure Name | Brief Description | ID | Steward | Programs Currently Using |
|---|---|---|---|---|
| HIV Screening | Percentage of patients aged 15-65 at the start of the measurement period who were between 15-65 years old when tested for HIV. | MIPS: 475
eCQM: CMS349 CMIT: 324 |
CDC | MIPS Program |
| Sexually Transmitted Infection (STI) Testing for People with HIV | Percentage of patients 13 years of age and older with a diagnosis of Human Immunodeficiency Virus (HIV) who had tests for syphilis, gonorrhea, and chlamydia performed within the measurement period. | MIPS: 205
eCQM: CMS1188 CMIT: 327 |
HRSA | MIPS Program |
| HIV Viral Suppression | Percentage of patients, regardless of age, diagnosed with HIV prior to or during the first 90 days of the performance period, with an eligible encounter in the first 240 days of the performance period, whose last HIV viral load test result was less than 200 copies/mL during the performance period. | MIPS: 338
eCQM: CMS314 CMIT: 325 |
HRSA | MIPS Program |
| HIV Annual Retention in Care | Percentage of patients, regardless of age, with a diagnosis of Human Immunodeficiency Virus (HIV) before or during the first 240 days of the performance period who had at least two eligible encounters or at least one eligible encounter and one HIV viral load test that were at least 90 days apart within the performance period. | MIPS: 340
eCQM: CMS1157 |
HRSA | HAB Core Performance Measures (HRSA) |
| HIV Linkage to Care | Percentage of patients whose first-ever HIV diagnosis was made by health center personnel between December 1 of the prior year and November 30 of the measurement period and who were seen for follow up treatment within 30 days of that first-ever diagnosis. | HRSA | Uniform Data System – Health Center Data Reporting Requirements (HRSA) | |
| Prescription of HIV Antiretroviral Therapy | Percentage of patients, regardless of age, with a diagnosis of HIV prescribed antiretroviral therapy for the treatment of HIV infection during the measurement year. | HRSA | HAB Core Performance Measures (HRSA) | |
| Pneumocystis Jjiroveci pneumonia (PCP) Prophylaxis | Percentage of patients with a diagnosis of HIV, who were prescribed pneumocystis jiroveci pneumonia (PCP) prophylaxis. | NCQA | HAB Core Performance Measures (HRSA)
MIPS Program (until 2019) |
Viral hepatitis quality measures table
| Measure Name | Brief Description | ID | Steward | Programs Currently Using |
|---|---|---|---|---|
| Evaluation of Hepatitis B and C (EHBC-AD) | Assess the number and percentage of adult, non-dually eligible Medicaid beneficiaries who were tested for hepatitis B, tested for hepatitis C, and treated for hepatitis C. | CMIT: 1852 | MODRN | Medicaid Adult Core Set (2027) |
| One-Time Screening for Hepatitis C Virus (HCV) and Treatment Initiation | Percentage of patients age ≥ 18 years who have never been tested for Hepatitis C Virus (HCV) infection who receive an HCV infection test AND who have treatment initiated within three months or who are referred to a clinician who treats HCV infection within one month if tested positive for HCV. | MIPS: 400
CMIT: 476 |
AGA | MIPS Program |
| Hepatitis C Virus (HCV): Sustained Virological Response (SVR) | Percentage of patients aged >= 18 years with active hepatitis C (HCV) with negative/undetectable HCV ribonucleic acid (RNA) at least 20 weeks to 12 months after positive/detectable HCV RNA test result. | MIPS: 516
CMIT: 1433 |
AGA | MIPS Program |
| Annual Hepatitis C Virus (HCV) Screening for Patients who are Active Injection Drug Users | Percentage of patients, regardless of age, who are active injection drug users who received screening for HCV infection within the 12-month reporting period. | MIPS: 387
CMIT: 58 |
AGA | MIPS Program |
| Hepatitis C: Screening for Hepatocellular Carcinoma (HCC) in Patients with Cirrhosis | Percentage of patients aged 18 years and older with a diagnosis of chronic hepatitis C cirrhosis who underwent imaging with either ultrasound, contrast enhanced CT or MRI for hepatocellular carcinoma (HCC) at least once within the 12-month submission period. | MIPS: 401
CMIT: 319 |
AGA | MIPS Program |
| Adult Immunization Status | Percentage of patients 19 years of age and older who are up-to-date on recommended routine vaccines for influenza; tetanus and diphtheria (Td) or tetanus, diphtheria and acellular pertussis (Tdap); zoster; pneumococcal; and hepatitis B. | MIPS: 493
CMIT: 26 |
NCQA | MIPS Program |
| Childhood Immunization Status | Percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV), one measles, mumps and rubella (MMR); three or four H influenza type B (HiB); three hepatitis B (HepB); one chicken pox (VZV); four pneumococcal conjugate (PCV); one hepatitis A (HepA); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday. | MIPS: 240
eCQM: CMS117 CMIT: 124 |
NCQA | MIPS Program |
STD quality measures table
| Measure Name | Brief Description | ID | Steward | Programs Currently Using |
|---|---|---|---|---|
| Immunizations for Adolescents | The percentage of adolescents 13 years of age who had one dose of meningococcal vaccine, one tetanus, diphtheria toxoids and acellular pertussis (Tdap) vaccine, and have completed the human papillomavirus (HPV) vaccine series by their 13th birthday. | CMS 394 | NCQA | MIPS Program |
| Chlamydia Screening in Women | The percentage of women 16-24 years of age who were identified as sexually active and who had at least one test for chlamydia during the measurement period. | CMS153 | NCQA | MIPS Program |
| HIV/AIDS: Sexually Transmitted Diseases – Screening for Chlamydia, Gonorrhea, and Syphilis | Percentage of patients aged 13 years and older with a diagnosis of HIV/AIDS for whom chlamydia, gonorrhea, and syphilis screenings were performed at least once since the diagnosis of HIV infection. | CMS205 | HRSA | MIPS Program |
* The child core set measure is specific to ages 16-20.
Tuberculosis quality measures table
| Measure Name | Brief Description | ID | Steward | Programs Currently Using |
|---|---|---|---|---|
| Tuberculosis Screening Prior to First Course Biologic and/or Immune Response Modifier Therapy | If a patient has been newly prescribed a biologic and/or immune response modifier that includes a warning for potential reactivation of a latent infection, then the medical record should indicate TB testing in the preceding 12-month period. | CMS176 | ACR | MIPS Program
|
| Psoriasis: Tuberculosis (TB) Prevention for Patients with Psoriasis, Psoriatic Arthritis and Rheumatoid Arthritis on a Biological Immune Response Modifier | Percentage of patients, regardless of age, with psoriasis, psoriatic arthritis and/or rheumatoid arthritis on a biological immune response modifier whose providers are ensuring active tuberculosis prevention either through negative standard tuberculosis screening tests or are reviewing the patient’s history to determine if they have had appropriate management for a recent or prior positive test. | AAD | MIPS Program (2021) | |
| Rheumatoid Arthritis (RA): Tuberculosis Screening | Percentage of patients aged 18 years and older with a diagnosis of rheumatoid arthritis who have documentation of a tuberculosis (TB) screening performed within 6 months prior to receiving a first course of therapy using a biologic disease-modifying anti-rheumatic drug (DMARD). | 2522** | ACR | MIPS Program (2020) |
** Approved for trial use