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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
NQF Number 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 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 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

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.
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 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.

MIPS Quality ID 366 366 366
Telehealth Eligible Yes Yes Yes
Next Version No Version Available
Previous Version No Version Available

Header

  • Updated method for calculating medication treatment covered days required for Initial Population 2 to better align with measure intent.

    Measure Section: Description

    Source of Change: Measure Lead

  • Updated copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Updated grammar, wording, and/or formatting to improve readability and consistency.

    Measure Section: Clinical Recommendation Statement

    Source of Change: Annual Update

  • Updated Index Prescription Start Date to better align with measure intent.

    Measure Section: Definition

    Source of Change: Measure Lead

  • Updated method for calculating medication treatment covered days required for Initial Population 2 to better align with measure intent.

    Measure Section: Definition

    Source of Change: Measure Lead

  • Updated Index Prescription Start Date to better align with measure intent.

    Measure Section: Initial Population

    Source of Change: Measure Lead

  • Updated timing of the qualifying encounter from during the measurement period to 6 months prior to or during the Index Prescription Start Date (IPSD) to improve clinical accuracy.

    Measure Section: Initial Population

    Source of Change: ONC Project Tracking System (JIRA): CQM-5527

  • Updated numerator 2, requiring two follow-up visits be on different days and only one may be an online assessment to better align with measure intent.

    Measure Section: Numerator

    Source of Change: ONC Project Tracking System (JIRA): CQM-5568

Logic

  • Updated Index Prescription Start Date to better align with measure intent.

    Measure Section: Initial Population

    Source of Change: Measure Lead

  • Updated numerator 2 logic, requiring two follow-up visits be on different days and only one may be an online assessment to better align with measure intent.

    Measure Section: Numerator

    Source of Change: ONC Project Tracking System (JIRA): CQM-5568

  • Updated Index Prescription Start Date to better align with measure intent.

    Measure Section: Definitions

    Source of Change: Measure Lead

  • Added a definition for Index Prescription Start Date (IPSD) to simplify and improve logic readability.

    Measure Section: Definitions

    Source of Change: Measure Lead

  • Added 'day of' specificity to hospice expressions for consistency.

    Measure Section: Definitions

    Source of Change: Measure Lead

  • Added QDM datatype 'Diagnosis' to the Hospice.'Has Hospice Services' definition referencing a new value set containing SNOMED finding codes to provide an additional approach for identifying patients receiving hospice care.

    Measure Section: Definitions

    Source of Change: Measure Lead

  • Removed direct reference code CPT code 99217 from the 'Qualifying Numerator Encounter' definition due to terminology update.

    Measure Section: Definitions

    Source of Change: Measure Lead

  • Updated method for calculating medication treatment covered days required for Initial Population 2 to better align with measure intent.

    Measure Section: Definitions

    Source of Change: Measure Lead

  • Updated the version number of the Cumulative Medication Duration Library to v2.0.000.

    Measure Section: Definitions

    Source of Change: Annual Update

  • Updated the version number of the Hospice Library to v5.0.000.

    Measure Section: Definitions

    Source of Change: Annual Update

  • Updated timing of the qualifying encounter from during the measurement period to 6 months prior to or during the Index Prescription Start Date (IPSD) to improve clinical accuracy.

    Measure Section: Definitions

    Source of Change: ONC Project Tracking System (JIRA): CQM-5527

  • Updated the version number of the Hospice Library to v5.0.000.

    Measure Section: Functions

    Source of Change: Annual Update

  • Updated the version number of the Cumulative Medication Duration Library to v2.0.000.

    Measure Section: Functions

    Source of Change: Annual Update

  • Updated method for calculating medication treatment covered days required for Initial Population 2 to better align with measure intent.

    Measure Section: Functions

    Source of Change: Measure Lead

  • Reversed priority of data elements used to calculate medication duration in function 'MedicationOrderPeriod' to improve precision of calculation.

    Measure Section: Functions

    Source of Change: Measure Lead

  • Updated the 'CodeToDaily' function so that highest dose is calculated consistently.

    Measure Section: Functions

    Source of Change: Measure Lead

  • Updated the 'CumulativeDuration' function to account for null instances.

    Measure Section: Functions

    Source of Change: Measure Lead

Value Set

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

  • Deleted direct reference code CPT code (99217) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code RxNorm code (977860) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Removed value set ADHD Medications (2.16.840.1.113883.3.464.1003.196.12.1171) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added value set Atomoxetine (2.16.840.1.113883.3.464.1003.1170) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added value set Clonidine (2.16.840.1.113883.3.464.1003.1171) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added value set Dexmethylphenidate (2.16.840.1.113883.3.464.1003.1172) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added value set Dextroamphetamine (2.16.840.1.113883.3.464.1003.1173) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added value set Guanfacine (2.16.840.1.113883.3.464.1003.196.11.1252) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Hospice Care Ambulatory (2.16.840.1.113883.3.526.3.1584): Deleted 3 SNOMED CT codes (170935008, 170936009, 305911006) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added value set Hospice Diagnosis (2.16.840.1.113883.3.464.1003.1165) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Hospice Encounter (2.16.840.1.113883.3.464.1003.1003): Added 2 SNOMED CT codes (305911006, 385765002) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added value set Lisdexamfetamine (2.16.840.1.113883.3.464.1003.1174) 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 115 SNOMED CT codes based on review by technical experts, SMEs, and/or public feedback. Deleted 2 SNOMED CT codes (70932007, 71328000) based on review by technical experts, SMEs, and/or public feedback. Added 1 ICD-10-CM code (F78) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added value set Methylphenidate (2.16.840.1.113883.3.464.1003.1176) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Online Assessments (2.16.840.1.113883.3.464.1003.101.12.1089): Added 4 CPT codes (98980, 98981, 99444, 99457) based on review by technical experts, SMEs, and/or public feedback. Added 3 HCPCS codes (G2250, G2251, G2252) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Payer (2.16.840.1.114222.4.11.3591): Added 5 SOP codes (1111, 1112, 142, 344, 141) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

Last Updated: Jan 22, 2024