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Follow-Up Care for Children Prescribed ADHD Medication (ADD)

Compare Versions of: "Follow-Up Care for Children Prescribed ADHD Medication (ADD)"

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Measure Information 2022 Performance Period 2023 Performance Period 2024 Performance Period
Title Follow-Up Care for Children Prescribed ADHD Medication (ADD) Follow-Up Care for Children Prescribed ADHD Medication (ADD) Follow-Up Care for Children Prescribed ADHD Medication (ADD)
CMS eCQM ID CMS136v11 CMS136v12 CMS136v13
CBE ID Not Applicable Not Applicable Not Applicable
MIPS Quality ID 366 366 366
Description

Percentage of children 6-12 years of age and newly dispensed a medication for attention-deficit/hyperactivity disorder (ADHD) who had appropriate follow-up care. Two rates are reported.

a. Percentage of children who had one follow-up visit with a practitioner with prescribing authority during the 30-Day Initiation Phase.

b. Percentage of children who remained on ADHD medication for at least 210 days and who, in addition to the visit in the Initiation Phase, had at least two additional follow-up visits with a practitioner within 270 days (9 months) after the Initiation Phase ended.

Percentage of children 6-12 years of age and newly prescribed a medication for attention-deficit/hyperactivity disorder (ADHD) who had appropriate follow-up care. Two rates are reported.

a. Percentage of children who had one follow-up visit with a practitioner with prescribing authority during the 30-Day Initiation Phase.

b. Percentage of children who remained on ADHD medication for at least 210 days and who, in addition to the visit in the Initiation Phase, had at least two additional follow-up visits with a practitioner within 270 days (9 months) after the Initiation Phase ended.

Percentage of children 6-12 years of age and newly prescribed a medication for attention-deficit/hyperactivity disorder (ADHD) who had appropriate follow-up care. Two rates are reported.

a. Percentage of children who had one follow-up visit with a practitioner with prescribing authority during the 30-Day Initiation Phase.

b. Percentage of children who remained on ADHD medication for at least 210 treatment days and who, in addition to the visit in the Initiation Phase, had at least two additional follow-up visits with a practitioner within 270 days (9 months) after the Initiation Phase ended.

Definition *See CMS136v11.html *See CMS136v12.html

Intake Period: The twelve-month period starting March 1 of the year prior to the measurement period and ending the last calendar day of February of the measurement period.

Index Prescription Start Date (IPSD): The earliest prescription date for an ADHD medication where the date is in the Intake Period and the patient is not actively on ADHD medication during the 120 days prior.

Initiation Phase: The 30 days following the IPSD.

Continuation and Maintenance Phase: The 300 days following the IPSD.

Treatment days (covered days): The actual number of calendar days covered with prescriptions during the 301-day period.

Use the following steps to identify and calculate covered days.

Step 1: For same medications that are prescribed on the same day or on different days with overlapping days supply, the days supply is summed. The start and end dates are then identified. The start date is the date of service of the earliest prescription event and the first covered day. The end date is the calendar day when the days supply runs out. The start date through the end date are considered covered days. This rule assumes that the patient will take one prescription at a time (and start taking the next prescription after exhausting the previous prescription). For example:

- If there are three 7-days supply prescription events for the same medication on January 1, the start date is January 1 and the end date is January 21. Covered days include January 1–21.

- If there are two 7-days supply prescription events for the same medication on January 1 and January 5, the start date is January 1 and the end date is January 14. Covered days include January 1–14.

- If there are three 7-days supply prescription events for the same medication on January 1, a 7-days supply prescription event on January 20 and a 7-days supply prescription event on January 28, the start date is January 1 and the end date is February 4. Covered days include January 1–February 4.

Step 2: For all other events (multiple prescriptions for the same medication on different days without overlap, multiple prescriptions for different medications on the same or different days, with or without overlap), the covered days are identified by the start and end dates for each prescription event individually. The start date through the end date are considered covered days. This rule assumes the member will take the different medications concurrently.

Step 3: Each calendar day covered by one or more medications is considered one covered day.

Initial Population

Initial Population 1: Children 6-12 years of age who were dispensed an ADHD medication during the Intake Period and who had a visit during the measurement period.

Initial Population 2: Children 6-12 years of age who were dispensed an ADHD medication during the Intake Period and who remained on the medication for at least 210 days out of the 300 days following the IPSD, and who had a visit during the measurement period.

Initial Population 1: Children 6-12 years of age as of the Intake Period who were prescribed an ADHD medication during the Intake Period and who had a visit during the measurement period. Children are removed if they were actively on ADHD medication in the 120 days prior to the IPSD, or had an acute inpatient stay with a principal diagnosis of mental, behavioral or neurodevelopmental disorder during the Initiation Phase.

Initial Population 2: Children 6-12 years of age as of the Intake Period who were prescribed an ADHD medication during the Intake Period and remained on the medication for at least 210 days during the 301-day period, beginning on the IPSD through 300 days after the IPSD, and who had a visit during the measurement period. Children are removed if they were actively on ADHD medication in the 120 days prior to the IPSD, or had an acute inpatient stay with a principal diagnosis of mental, behavioral or neurodevelopmental disorder during the Continuation and Maintenance Phase.

Initial Population 1: Children 6-12 years of age as of the Intake Period who had an IPSD and who had a visit within 6 months prior to the IPSD including the IPSD. Children are removed if they had an acute inpatient stay with a principal diagnosis of mental, behavioral or neurodevelopmental disorder during the Initiation Phase.

Initial Population 2: Children 6-12 years of age as of the Intake Period who had an IPSD and remained on the medication for at least 210 treatment days during the 301-day period, beginning on the IPSD through 300 days after the IPSD, and who had a visit within 6 months prior to the IPSD including the IPSD. Children are removed if they had an acute inpatient stay with a principal diagnosis of mental, behavioral or neurodevelopmental disorder during the Continuation and Maintenance Phase.

Numerator

Numerator 1: Patients who had at least one visit with a practitioner with prescribing authority within 30 days after the IPSD.

 

Numerator 2: Patients who had at least one visit with a practitioner with prescribing authority during the Initiation Phase, and at least two follow-up visits during the Continuation and Maintenance Phase.

Numerator 1: Patients who had at least one visit with a practitioner with prescribing authority during the Initiation Phase.

 

Numerator 2: Patients who had at least one visit with a practitioner with prescribing authority during the Initiation Phase, and at least two follow-up visits during the 31-300 days after the IPSD.

Numerator 1: Patients who had at least one visit with a practitioner with prescribing authority during the Initiation Phase.

 

Numerator 2: Patients who had at least one visit with a practitioner with prescribing authority during the Initiation Phase, and at least two follow-up visits on different dates of service during the 31-300 days after the IPSD.

Numerator Exclusions

Not Applicable

Not Applicable

Not Applicable

Denominator

Equals Initial Population

Equals Initial Population

Equals Initial Population

Denominator Exclusions

Denominator Exclusion 1: Exclude patients diagnosed with narcolepsy at any point in their history or during the measurement period.

Exclude patients who had an acute inpatient stay with a principal diagnosis of mental health or substance abuse during the 30 days after the IPSD.

Exclude patients who were actively on an ADHD medication in the 120 days prior to the Index Prescription Start Date.

Exclude patients who are in hospice care for any part of the measurement period.

Denominator Exclusion 2: Exclude patients diagnosed with narcolepsy at any point in their history or during the measurement period.

Exclude patients who had an acute inpatient stay with a principal diagnosis of mental health or substance abuse during the 300 days after the IPSD.

Exclude patients who were actively on an ADHD medication in the 120 days prior to the Index Prescription Start Date.

Exclude patients who are in hospice care for any part of the measurement period.

Exclude patients diagnosed with narcolepsy at any point in their history or during the measurement period.

Exclude patients who are in hospice care for any part of the measurement period.

Exclude patients diagnosed with narcolepsy at any point in their history or during the measurement period.

Exclude patients who are in hospice care for any part of the measurement period.

Denominator Exceptions

None

None

None

Measure Steward National Committee for Quality Assurance National Committee for Quality Assurance National Committee for Quality Assurance
Measure Scoring Proportion measure Proportion measure Proportion measure
Measure Type Process measure Process measure Process measure
Improvement Notation

Higher score indicates better quality

Higher score indicates better quality

Higher score indicates better quality

Guidance

This eCQM is a patient-based measure.

 

This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center for more information on the QDM.

This eCQM is a patient-based measure.

 

This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.

This eCQM is a patient-based measure.

 

This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.

Telehealth Eligible Yes Yes Yes
Rationale *See CMS136v11.html *See CMS136v12.html

ADHD is one of the more common chronic conditions of childhood. Children with ADHD may experience significant functional problems, such as school difficulties; academic underachievement; troublesome relationships with family members and peers; and behavioral problems (AAP, 2000). Given the high prevalence of ADHD among school-aged children (4%–12%), primary care clinicians will regularly encounter children with ADHD and should have a strategy for diagnosing and long-term management of this condition (AAP, 2001).

Practitioners can convey the efficacy of pharmacotherapy to their patients. American Academy of Pediatrics (AAP) guidelines recommend that once a child is stable, an office visit every three to six months allows assessment of learning and behavior (AAP, 2001). Follow-up appointments should be made at least monthly until the child’s symptoms have been stabilized (AACAP, 2007).

Providers have an opportunity to track medication use in patients and provide the appropriate follow-up care to monitor clinical symptoms and potential adverse events.

Stratification *See CMS136v11.html *See CMS136v12.html

None

Risk Adjustment *See CMS136v11.html *See CMS136v12.html

None

Clinical Recommendation Statement *See CMS136v11.html *See CMS136v12.html

American Academy of Pediatrics Clinical Practice Guideline for the Diagnosis, Evaluation and Treatment of ADHD in Children and Adolescents (2019)

- Key Action Statement (KAS) 1: The pediatrician or other primary care clinicians (PCC) should initiate an evaluation for ADHD for any child or adolescent age 4 years to the 18th birthday who presents with academic or behavioral problems and symptoms of inattention, hyperactivity, or impulsivity. Grade B: Strong Recommendation

- KAS 4: ADHD is a chronic condition; therefore, the PCC should manage children and adolescents with ADHD in the same manner that they would children and youth with special health care needs, following the principles of the chronic care model and the medical home. Grade B: Strong Recommendation

- KAS 5b: For elementary and middle school-aged children (age 6 years to the 12th birthday) with ADHD, the PCC should prescribe FDA-approved medications for ADHD, along with parent training in behavior management (PTBM) and/or behavioral classroom intervention (preferably both PTBM and behavioral classroom interventions). Educational interventions and individualized instructional supports, including school environment, class placement, instructional placement, and behavioral supports, are a necessary part of any treatment plan and often include an IEP or a rehabilitation plan (504 plan). Grade A: Strong Recommendation

- KAS 6. “The PCC should titrate doses of medication for ADHD to achieve maximum benefit with tolerable side effects”. Grade B, strong recommendation

American Academy of Child and Adolescent Psychiatry (AACAP) Practice Parameter for the Assessment and Treatment of Children and Adolescents with ADHD (2007)

- Overall Guideline: The key to effective long-term management of the patient with ADHD is continuity of care with a clinician experienced in the treatment of ADHD. The frequency and duration of follow-up sessions should be individualized for each family and patient, depending on the severity of ADHD symptoms; the degree of comorbidity of other psychiatric illness; the response to treatment; and the degree of impairment in home, school, work, or peer-related activities. The clinician should establish an effective mechanism for receiving feedback from the family and other important informants in the patient's environment to be sure symptoms are well controlled and side effects are minimal. Although this parameter does not seek to set a formula for the method of follow-up, significant contact with the clinician should typically occur two to four times per year in cases of uncomplicated ADHD and up to weekly sessions at times of severe dysfunction or complications of treatment.

- Recommendation 6: A Well-Thought-Out and Comprehensive Treatment Plan Should Be Developed for the Patient With ADHD. The treatment plan should be reviewed regularly and modified if the patient's symptoms do not respond. Minimal Standard [MS]

- Recommendation 9. During a Psychopharmacological Intervention for ADHD, the Patient Should Be Monitored for Treatment-Emergent Side Effects. Minimal Standard [MS]

- Recommendation 12. Patients Should Be Assessed Periodically to Determine Whether There Is Continued Need for Treatment or If Symptoms Have Remitted. Treatment of ADHD Should Continue as Long as Symptoms Remain Present and Cause Impairment. Minimal Standard [MS]

Next Version No Version Available
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Specifications
Attachment Size
CMS136v12.html 114.38 KB
CMS136v12.zip 156.27 KB
CMS136v12-TRN.xlsx 23.73 KB
eCQM Jira Issue Tracker
*Note there may be more tickets in the eCQM Tracker - ONC Project Tracking System (Jira) for this measure. Only tickets tagged with their associated CMS measure ID appear.

Header

  • Updated copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Updated the rationale with more recent evidence to support the measure.

    Measure Section: Rationale

    Source of Change: Measure Lead

  • Updated the clinical recommendation statement with more recent evidence to support the measure.

    Measure Section: Clinical Recommendation Statement

    Source of Change: Measure Lead

  • Updated references.

    Measure Section: Reference

    Source of Change: Measure Lead

  • Extended the intake period from 5 months to 12 months to ensure assessment of follow-up for patients newly prescribed ADHD medication at any point within a year rather than only in the fall or winter.

    Measure Section: Definition

    Source of Change: Measure Lead

  • Updated version number of the Quality Data Model (QDM) used in the measure specification to v5.6.

    Measure Section: Guidance

    Source of Change: Standards/Technical Update

  • Added age anchor narrative specifications to reflect revised logic and clarify measure requirements.

    Measure Section: Initial Population

    Source of Change: Measure Lead

  • Updated the initial population language to clarify that index prescription start date can be included in the count of 210 days of continuous treatment.

    Measure Section: Initial Population

    Source of Change: Measure Lead

  • Replaced 'mental health or substance abuse' with 'mental, behavioral or neurodevelopmental disorder' to reflect current terminology.

    Measure Section: Denominator Exclusions

    Source of Change: ONC Project Tracking System (JIRA): CQM-4789

  • Moved non-clinical conditions exclusion criteria from the denominator exclusions and re-designated them as removals from the initial population. This change allows a distinction between methodological removals and clinical condition exclusions and aligns with the measure intent.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Updated language from 'dispensed' to 'prescribed' to reflect revised logic.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Updated the term 'Continuation and Maintenance Phase' to improve clarity and applied terms defined in the Definitions section, including 'Initiation Phase', across the specification.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

Logic

  • Updated the timing precision in the definitions from datetime to date by adding 'day of', 'date from', and/or function 'ToDateInterval' to align with the measure intent.

    Measure Section: Definitions

    Source of Change: Measure Lead

  • Added QDM datatypes 'Encounter, Performed' and 'Assessment, Performed' and associated logic to the Hospice.'Has Hospice Services' definition to provide additional approaches for identifying patients receiving hospice services.

    Measure Section: Definitions

    Source of Change: Measure Lead

  • Updated the timing precision in the definitions to align with the measure intent by adding or removing the syntax 'on or'.

    Measure Section: Definitions

    Source of Change: Measure Lead

  • Replaced the Global.CalendarAgeInYearsAt function with the native CQL function AgeInYearsAt to take advantage of existing CQL features and increase human readability. As a result of this change, the LOINC code 21112-8 is no longer required and has been removed from the Terminology section of the human readable specification.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Extended the intake period from 5 months to 12 months to ensure assessment of follow-up for patients newly prescribed ADHD medication at any point within a year rather than only in the fall or winter.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Updated the logic to exclude patients who start ADHD medication during the 120-day lookback period as well as patients who start ADHD medication before and continue the medication into the 120-day lookback period.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Revised numerator 2 logic to require at least two synchronous follow-up visits, or one synchronous follow-up visit and one online assessment visit, to meet numerator compliance and align with measure intent.

    Measure Section: Multiple Sections

    Source of Change: ONC Project Tracking System (JIRA): CQM-4772

  • Revised initial population age anchor from the start of the measurement period to age 6 or greater at start of intake period and age 12 or less at end of intake period to align with the measure intent.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Replaced QDM datatype Medication, Active' with Medication, Order and additional logic to accurately compute medication duration based on stakeholder feedback.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Moved non-clinical conditions exclusion criteria from the denominator exclusions and re-designated them as removals from the initial population. This change allows a distinction between methodological removals and clinical conditions exclusions and aligns with the measure intent.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Replaced QDM datatype Medication, Dispensed' with Medication, Order for determining an index prescription dispensing event to improve the measure's clinical relevance.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Updated the version number of the Hospice Library to v4.0.000.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Added Cumulative Medication Duration Library v1.0.000.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Updated the version number of the Measure Authoring Tool (MAT) Global Common Functions Library to v7.0.000.

    Measure Section: Multiple Sections

    Source of Change: Standards/Technical Update

  • Updated the term 'Continuation and Maintenance Phase' to improve clarity and applied terms defined in the Definitions section, including 'Initiation Phase', across the specification.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Updated the names of CQL definitions, functions, and/or aliases for clarification and to align with the CQL Style Guide.

    Measure Section: Multiple Sections

    Source of Change: Standards/Technical Update

  • Updated the version of the Quality Data Model (QDM) to 5.6 and Clinical Quality Language (CQL) to 1.5.

    Measure Section: Multiple Sections

    Source of Change: Standards/Technical Update

Value set

The VSAC is the source of truth for the value set content, please visit the VSAC for downloads of current value sets.

  • Added direct reference code SNOMED CT code (396127008) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code SNOMED CT code (307470009) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code SNOMED CT code (396125000) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code SNOMED CT code (225752000) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code SNOMED CT code (307439001) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code SNOMED CT code (229799001) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code SNOMED CT code (229797004) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code SNOMED CT code (396109005) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code SNOMED CT code (396108002) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code SNOMED CT code (396107007) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code SNOMED CT code (229798009) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code SNOMED CT code (225754004) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code LOINC code (45755-6) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code SNOMED CT code (396126004) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code SNOMED CT code (307469008) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code SNOMED CT code (307468000) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code SNOMED CT code (396143001) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code SNOMED CT code (225756002) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code SNOMED CT code (396131002) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code SNOMED CT code (396140003) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Removed direct reference code LOINC code (21112-8) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Mental Behavioral and Neurodevelopmental Disorders (2.16.840.1.113883.3.464.1003.105.12.1203): Added 28 SNOMED CT codes based on review by technical experts, SMEs, and/or public feedback. Deleted 20 SNOMED CT codes based on validity of code during timing of look back period. Deleted 5 SNOMED CT codes (225479002, 309279000, 56194001, 70655008, 95635002) based on review by technical experts, SMEs, and/or public feedback. Added 3 ICD-10-CM codes (F32.A, F78.A1, F78.A9) based on review by technical experts, SMEs, and/or public feedback. Deleted 1 ICD-10-CM code (F78) based on validity of code during timing of look back period.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set ADHD Medications (2.16.840.1.113883.3.464.1003.196.12.1171): Added 11 RxNorm codes (2119559, 2119563, 2119567, 2119571, 2119574, 2119577, 2168857, 2168861, 2168864, 2168866, 2168868) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Removed value set Telehealth Services (2.16.840.1.113883.3.464.1003.101.12.1031) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added value set Hospice Encounter (2.16.840.1.113883.3.464.1003.1003) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set (2.16.840.1.113883.3.464.1003.101.12.1002): Renamed to Initial Hospital Observation Care based on recommended value set naming conventions.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Replaced value set Hospice Care Ambulatory (2.16.840.1.113762.1.4.1108.15) with value set Hospice Care Ambulatory (2.16.840.1.113883.3.526.3.1584) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code SNOMED CT code (396111001) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code SNOMED CT code (396139000) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code SNOMED CT code (373066001) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

Last Updated: Mar 04, 2024