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

Measure Information	2023 Performance Period
CMS eCQM ID	CMS136v12
NQF Number	Not Applicable
MIPS Quality ID	366
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.
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.
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.
Numerator Exclusions	Not Applicable
Denominator	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.
Denominator Exceptions	None
Steward	National Committee for Quality Assurance
Measure Scoring	Proportion measure
Measure Type	Process measure
Improvement Notation	Higher score indicates better quality
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.
Telehealth Eligible	Yes
Next Version	CMS136v13
Previous Version	CMS136v11

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Measure Information	2021 Performance Period	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)	Follow-Up Care for Children Prescribed ADHD Medication (ADD)
CMS eCQM ID	CMS136v10	CMS136v11	CMS136v12	CMS136v13
NQF Number	Not Applicable	Not Applicable	Not Applicable	Not Applicable
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 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.
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 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.
Denominator	Equals Initial Population	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 whose hospice care overlaps 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 whose hospice care overlaps the measurement period.	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.
Numerator	Numerator 1: Patients who had at least one face-to-face visit with a practitioner with prescribing authority within 30 days after the IPSD. Numerator 2: Patients who had at least one face-to-face visit with a practitioner with prescribing authority during the Initiation Phase, and at least two follow-up visits during the Continuation and Maintenance Phase. One of the two visits during the Continuation and Maintenance Phase may be a telephone visit with a practitioner.	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	Not Applicable
Denominator Exceptions	None	None	None	None
Measure Steward	National Committee for Quality Assurance	National Committee for Quality Assurance	National Committee for Quality Assurance	National Committee for Quality Assurance
Measure Scoring	Proportion measure	Proportion measure	Proportion measure	Proportion measure
Measure Type	Process measure	Process measure	Process measure	Process measure
Improvement Notation	Higher score indicates better quality	Higher score indicates better quality	Higher score indicates better quality	Higher score indicates better quality
Guidance	CUMULATIVE MEDICATION DURATION is an individual's total number of medication days over a specific period; the period counts multiple prescriptions with gaps in between, but does not count the gaps during which a medication was not dispensed. To determine the cumulative medication duration, determine first the number of the medication Days for each prescription in the period: the number of doses divided by the dose frequency per day. Then add the Medication Days for each prescription without counting any days between the prescriptions. For example, there is an original prescription for 30 days with 2 refills for thirty days each. After a gap of 3 months, the medication was prescribed again for 60 days with 1 refill for 60 days. The cumulative medication duration is (30 x 3) + (60 x 2) = 210 days over the 10 month period. 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 5.5. 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.
MIPS Quality ID	366	366	366	366
Telehealth Eligible	Yes	Yes	Yes	Yes
Next Version	CMS136v11	CMS136v12	CMS136v13	No Version Available
Previous Version	No Version Available	CMS136v10	CMS136v11	CMS136v12
Notes

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Data Element Repository

Data Elements contained within CMS136v12

Value Sets

Value Sets to be used with 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