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

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

The Compare function compares two years of the measure specifications found in the header of the measure's HTML. It does not include a comparison of any information in the body of the HTML, e.g., population criteria, Clinical Quality Language, or value sets.

Strikethrough text highlighted in red indicates information changed from the previous version. Text highlighted in green indicates information updated in the new eCQM version.

Compare 2023 version to

Table Options

Download

Measure Information	2023 Performance Period	2024 Performance Period	2025 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	CMS136v12	CMS136v13	CMS136v14
CBE ID*	Not Applicable	Not Applicable	Not Applicable
MIPS Quality ID	366	366	366
Measure Steward	National Committee for Quality Assurance	National Committee for Quality Assurance	National Committee for Quality Assurance
Description	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. Show more > 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. Show less	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. Show more > 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. Show less	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. Show more > 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. Show less
Measure Scoring	Proportion measure	Proportion measure	Proportion measure
Measure Type	Process	Process	Process
Stratification	*See CMS136v12.html	None	None
Risk Adjustment	*See CMS136v12.html	None	None
Rationale	*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. Show more > 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. Show less	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, 2019). Given... the high prevalence of ADHD among school-aged children (11 percent), primary care clinicians will regularly encounter children with ADHD and should have a strategy for diagnosing and long-term management of this condition (Visser et al., 2014). Reports indicate that the use of ADHD medication among children rose 28 percent between 2007 and 2011 (Visser et al., 2014). 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, 2019). 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. Show more > 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, 2019). Given the high prevalence of ADHD among school-aged children (11 percent), primary care clinicians will regularly encounter children with ADHD and should have a strategy for diagnosing and long-term management of this condition (Visser et al., 2014). Reports indicate that the use of ADHD medication among children rose 28 percent between 2007 and 2011 (Visser et al., 2014). 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, 2019). 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. Show less
Clinical Recommendation Statement	*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] Show more > 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] Show less	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 Individualized Education Program (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] Show more > 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 Individualized Education Program (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] Show less
Improvement Notation	Higher score indicates better quality	Higher score indicates better quality	Higher score indicates better quality
Definition	*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. Show more > 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. Show less	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. Show more > 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. Show less
Guidance	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.	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.
Initial Population	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. Show more > 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. Show less	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. Show more > 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. Show less	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. Show more > 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. Show less
Denominator	Equals Initial Population	Equals Initial Population	Equals Initial Population
Denominator Exclusions	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.	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.
Numerator	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. Show more > 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. Show less	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. Show more > 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. Show less	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. Show more > 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. Show less
Numerator Exclusions	Not Applicable	Not Applicable	Not Applicable
Denominator Exceptions	None	None	None
Telehealth Eligible	Yes	Yes	Yes
Next Version	CMS136v13	CMS136v14	No Version Available
Previous Version	No Version Available	CMS136v12	CMS136v13

Download XML

Download CSV

Specifications

Additional Resources for CMS136v12

CMS136v12-TRN.xlsx

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