Product Lines:
EHP, Priority Partners, and USFHP.

Measurement Period: January 1 - December 31

Description:
The percentage of persons 13 years of age who had one-dose of meningococcal vaccine, one-dose tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap) and have completed the human papillomavirus (HPV) vaccine series by their 13th birthday.

The measure calculates a rate for each vaccine and two combination rates.

Stratifications: 
Report stratification by race and ethnicity.

Measure Reporting:
HealthChoice Performance Measure reporting for Priority Partners. 

Improvement Notation:
Increased score indicates improvement.

Data Collection:

• ECDS. 

Initial Population:

• Measure Item Count: Person.
• Age: Persons who turn 13 years of age during the measurement period.
• Benefits: Medical.
• Continuous Enrollment: 365 days prior to the person’s 13th birthday and the 13th birthday.
• Allowable Gap: No more than one gap of ≤45 days during the measurement period. No gap on 13th birthday.

Denominator:
The initial population minus denominator exclusions.

Numerator:
Numerator 1: Immunization status— Meningococcal serogroups A, C, W, Y. 
Persons who meet either of the following criteria:

• At least one meningococcal vaccine with a date of service on or between the 10th and 13th birthdays.
• Anaphylaxis due to the meningococcal vaccine any time on or before the 13th birthday.

Numerator 2: Immunization status—Tdap. 
Persons who meet any of the following criteria: 

• At least one tetanus, diphtheria toxoids and acellular pertussis (Tdap) vaccine with a date of service on or between the 10th and 13th birthdays.
• Anaphylaxis due to the tetanus, diphtheria or pertussis vaccine any time on or before the 13th birthday.
• Encephalitis due to the tetanus, diphtheria or pertussis vaccine any time on or before the 13th birthday.

Numerator 3: Immunization status—HPV. 
Persons who meet any of the following criteria:

• At least two HPV vaccines on or between the 9th and 13th birthdays and with dates of service at least 146 days apart.
• At least three HPV vaccines with different dates of service on or between the 9th and 13th birthdays.
• Anaphylaxis due to the HPV vaccine any time on or before the 13th birthday.

Numerator 4: Immunization status—Combination 1. 
Persons who are numerator compliant for both the meningococcal and Tdap indicators.

Numerator 5: Immunization status—Combination 2. 
Persons who are numerator compliant for all three indicators (meningococcal, Tdap, HPV).

Best Practice and Measure Tips

• Immunization must occur on or prior to the member’s 13th birthday.
• Document any parent refusal for immunizations, as well as anaphylactic reactions. There must be a note indicating the date of the event occurring by the member’s 13th birthday. This will not exclude the member from this measure.
• The below count towards compliance. There must be a note indicating the date of the event occurring by the member’s 13th birthday.
  • For ALL vaccines:
    • Anaphylaxis due to the vaccine.
    • Evidence of the antigen or combination vaccine.
  • Tdap: Encephalopathy
• For the two-dose HPV vaccination series, there must be at least 146 days (5 months) between the first and second dose of the HPV vaccine.
• For meningococcal vaccination only the quadrivalent meningococcal vaccine (serogroups A, C, W, Y) is included in the measure, but allows meningococcal B when both meningococcal B and meningococcal A, C, W and Y are indicated. 

Acceptable documentation:

• A note indicating the name of the specific antigen and the date of the immunization.
• A certificate of immunization prepared by an authorized health care provider or agency including the specific dates and types of immunizations administered.

Not acceptable:

• A note the "member is up to date" with all immunizations but does not list the dates and names of all immunizations.
• Meningococcal recombinant (serogroup B) (MenB) vaccines.

Measure Exclusions

Denominator Exclusion:

• Persons in hospice or using hospice services any time during the measurement period.
• Persons who died any time during the measurement period.

Measure Codes

• Meningococcal-serogroup A,C,W, and Y(1 dose) 
  • CPT: 90619, 90623, 90624, 90733, 90734 
  • CVX: 32, 108, 114, 136, 147, 167, 203, 316, 328
  • Anaphylaxis due to the meningococcal vaccine SNOMED CT code: 428301000124106
• Tdap (1 dose) 
  • CPT: 90715
  • CVX: 115
  • Anaphylaxis Due to Diphtheria, Tetanus or Pertussis Vaccine SNOMED CT code: 428281000124107, 428291000124105
  • Encephalitis Due to Diphtheria, Tetanus or Pertussis Vaccine SNOMED CT code: 192710009, 192711008, 192712001
• HPV (2 or 3 dose series) 
  • CPT: 90649, 90650, 90651
  • CVX: 62, 118, 137, 165
  • Anaphylaxis due to the HPV vaccine SNOMED CT code: 428241000124101