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

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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

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Specifications

Additional Resources for CMS136v13

CMS136v13-TRN.xlsx

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