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

Last updated: May 3, 2018

CMS Measure ID: CMS136v7
Version: 7
NQF Number: 0108
Measure 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.

Initial Patient 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.

Denominator Statement:

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 were in hospice care during the measurement year.

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 were in hospice care during the measurement year.

Numerator Statement:

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 Exclusions:

Not Applicable

Denominator Exceptions:

None

Measure Steward: National Committee for Quality Assurance
Domain: Effective Clinical Care
Next Version:
Previous Version:
Improvement Notation:

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.

Notes: Value Set content updated Sept 2017, TRNs updated Oct 2017

Specifications

Release Notes

Header

  • Updated the eMeasure Title from 'Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication' to 'Follow-Up Care for Children Prescribed ADHD Medication (ADD)' to align with the HEDIS parent measure.

    Measure Section: eMeasure Title

    Source of Change: Measure Lead

  • ​Incremented eMeasure Version number.

    Measure Section: eMeasure Version number

    Source of Change: Measure Lead

  • ​Updated Copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • ​Updated Disclaimer.

    Measure Section: Disclaimer

    Source of Change: Measure Lead

  • ​Updated the exclusion statement in the header to exclude patients in hospice care from the Denominator. Measures that focus on screenings and procedures may not be appropriate or a priority for those who are at end of life (ie, on hospice).

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

Logic

  • Added new lines of logic to the Denominator Exclusions for all NCQA-stewarded measures (except CMS82) to ensure patients in hospice care are excluded from the Denominator.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

  • Updated the timing operators for ADHD medications from 'ends after end of' to 'starts after end of' to better reflect the measure intent.

    Measure Section: Numerator

    Source of Change: JIRA (CQM-1240)

Value Set

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

  • Value set Inpatient Encounter (2.16.840.1.113883.3.464.1003.101.12.1060): Added 17 SNOMEDCT codes and deleted 1 SNOMEDCT code (305335007).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Substance Abuse (2.16.840.1.113883.3.464.1003.106.12.1004): Deleted 108 ICD9CM codes. Added 1 SNOMEDCT code (713775002).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set ADHD Medications (2.16.840.1.113883.3.464.1003.196.12.1171): Added 24 RXNORM codes and deleted 7 RXNORM codes (1091137, 1091161, 1091176, 1091191, 1091202, 1091218, 885882).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Telehealth Services (2.16.840.1.113883.3.464.1003.101.12.1031): Added 4 CPT codes (98966, 98967, 98968, 98969).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Mental Health Diagnoses (2.16.840.1.113883.3.464.1003.105.12.1004): Added 180 SNOMEDCT codes and deleted 22 SNOMEDCT codes. Deleted 365 ICD9CM codes. Deleted 13 ICD10CM codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Encounter Inpatient (2.16.840.1.113883.3.666.5.307): Added Encounter Inpatient.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Hospice care ambulatory (2.16.840.1.113762.1.4.1108.15): Added Hospice care ambulatory.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Discharged to Health Care Facility for Hospice Care (2.16.840.1.113883.3.117.1.7.1.207): Added Discharged to Health Care Facility for Hospice Care.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Discharged to Home for Hospice Care (2.16.840.1.113883.3.117.1.7.1.209): Added Discharged to Home for Hospice Care.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Inpatient Encounter (2.16.840.1.113883.3.464.1003.101.12.1060): Added 1 SNOMEDCT code (305335007).

    Measure Section: QDM Data Elements

    Source of Change: 2018 Addendum

  • Value set Substance Abuse (2.16.840.1.113883.3.464.1003.106.12.1004): Added 9 ICD10CM codes (F10.11, F11.11, F12.11, F13.11, F14.11, F15.11, F16.11, F18.11, F19.11).

    Measure Section: QDM Data Elements

    Source of Change: 2018 Addendum

  • Value set Ambulatory (2.16.840.1.113883.3.464.1003.122.12.1003): Added 1 SNOMEDCT code (722171005).

    Measure Section: QDM Data Elements

    Source of Change: 2018 Addendum

  • Value set ADHD Medications (2.16.840.1.113883.3.464.1003.196.12.1171): Added 6 RXNORM codes (1871456, 1871460, 1871462, 1871464, 1871466, 1871468) and deleted 6 RXNORM codes (1087322, 1310588, 884192, 884198, 884203, 885878).

    Measure Section: QDM Data Elements

    Source of Change: 2018 Addendum

  • Value set Mental Health Diagnoses (2.16.840.1.113883.3.464.1003.105.12.1004): Added 69 SNOMEDCT codes and deleted 3 SNOMEDCT codes (21061000119107, 231457005, 231535000). Added 1 ICD10CM code (F50.82).

    Measure Section: QDM Data Elements

    Source of Change: 2018 Addendum

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