Gaps in Care Specification Documents
The medical and pharmacy specification documents in the links below provide a high-level explanation of each measure's purpose. The member and provider data is used to determine whether the member has a gap in care. At the bottom of each specification, there is a link to the companion document that details the coding criteria for each measure.
Asthma
- Asthma controller therapy (PDF)
- Asthma medication adherence (PDF)
- Asthma medication management (PDF)
- STA - Inhaled corticosteroid (PDF)
Cardiovascular
- ACEI/ARB therapy (CAD) (PDF)
- ACEI/ARB therapy (HF) (PDF)
- ACS ACE-ARB therapy (PDF)
- ACS aspirin therapy (PDF)
- ACS beta blocker therapy (PDF)
- ACS Plavix therapy (PDF)
- ACS statin therapy (PDF)
- Anti-coagulant therapy (HF) (PDF)
- Antiplatelet therapy (CAD) (PDF)
- Beta-blocker therapy (CAD) (PDF)
- Beta blocker therapy (HF) (PDF)
- Controlling high blood pressure (PDF)
- Controlling high blood pressure - Medication adherence (PDF)
- Dyslipidemia lipid therapy (PDF)
- Event cholesterol test (CAD) (PDF)
- LDL lowering drug therapy (CAD) (PDF)
- Lipid test (CMC) - for coronary artery disease (CAD) (PDF)
- LVF assessment (HF) (PDF)
- STA - Renin inhibitors (PDF)
- STA - Statins (PDF)
Diabetes
- Diabetes eye exam (PDF)
- Diabetes HbA1c test (PDF)
- Diabetes macroalbumin Test (PDF)
- Lipid test (CDC) - for diabetes (PDF)
- Diabetes screening for people w/diagnosis or medication that requires diabetes screening (PDF)
- Diabetes ACE-ARB therapy (PDF)
- Diabetes testing (PDF)
- STA - Oral diabetes medicines (PDF)
Preventive care
- Adolescent well care (PDF)
- Adult access to care (PDF)
- Annual dental visit (PDF)
- Anti-rheumatic drug therapy (PDF)
- Breast cancer screening (PDF)
- Cervical cancer screening (PDF)
- Chicken pox vaccination (PDF)
- Colorectal cancer screening (PDF)
- Diphtheria, tetanus, and pertussis vaccination (DTaP) (PDF)
- EPSDT - Developmental screening (PDF)
- EPSDT - Hearing (PDF)
- EPSDT - Vision (PDF)
- Glaucoma screening in older adults (GSO) (PDF)
- Haemophilus influenzae type B vaccination (HiB) (PDF)
- Hepatitis A vaccination (HBV) (PDF)
- Hepatitis B vaccination (HBV) (PDF)
- Hepatitis C SVR-12 (SVR) (PDF)
- Influenza vaccination (PDF)
- Lead screening in children (LSC) (PDF)
- Measles, mumps, and rubella vaccination (MMR) (PDF)
- Osteoporosis management in women who had a fracture (OMW) (PDF)
- Pneumococcal conjugate vaccination (PCV) (PDF)
- Pneumococcal vaccination (PDF)
- Primary care visit 1 to 2 years (12 months to 24 months of age) (PDF)
- Primary care visit 3 to 6 years (25 months to 6 years of age) (PDF)
- Primary care visit 7 to 11 years (PDF)
- Well child visit 18 months and younger (PDF)
- Well child visit 30 months and younger (PDF)