Product Lines:
Advantage MD, Dual Eligible Special Needs Plans (D-SNP), EHP, Priority Partners and USFHP.

Eligible Population:
Members 6 years and older as of December 31 of the measurement year.

Definition:
The percent of discharges for members age 6 and older who were hospitalized for treatment of selected mental illness diagnoses or intentional self-harm diagnoses and who had a follow-up visit with a mental health practitioner.

Two rates are reported:

• Discharges for which the member received follow-up within 7 days after discharge.
• Discharges for which the member received follow-up within 30 days after discharge

Report three age stratifications and a total rate:

• 6–17 years.
• 18–64 years. 
• 65 years and older.
• Total. The total is the sum of the age stratifications.

Provider Specialty: Mental Health Practitioner.

New for Measure: Stratification by race and ethnicity.

Continuous Enrollment:

• Date of discharge through 30 days after discharge.

Best Practice and Measure Tips

• The denominator for this measure is based on discharges, not on members. If members have more than one discharge, include all discharges on or between January 1 and December 1 of the measurement year.
• Visits that occur on the date of discharge will not count toward compliance.
• This measure focuses on follow-up treatment, which must be with a mental health provider.
• The following visit types do not have to be with a mental health provider to count for numerator compliance: 
  • Intensive outpatient encounters, partial hospitalizations, community mental health centers and electroconvulsive therapy settings.
• Refer patient to a mental health provider to be seen within seven days of discharge.
  • To refer your patient to a behavioral health specialist or to request coordination of care, please call the number on the back of the patient’s health plan ID card or view hopkinshealthplans.org.
• While patient is in inpatient care help them coordinate care with a mental health provider by:
  • Helping them schedule an appointment
  • Verify if the mental health provider is a good fit by considering location, transportation and time.
  • Identify and address any barriers that may prevent member keeping the appointment.
  • Making sure member has a good support system by engaging parents/guardian or significant others in the treatment plan, stressing the importance of treatment, and attending to their appointment.
  • Ensure member received an appointment with 7 days of discharge.
  • Share all transition of care with the member’s Primary Care Physician (PCP) to ensure members follows-up with the treatment plan. Ensure member has a PCP.
• Educate member on:
  • Importance of consistency and adherence to the medication regiment.
  • Medication side effect, what to do if the side effect are severe and can potentially result in lack of adherence to the medication regiment and treatment plan.
  • Crisis Intervention options.
• Even patients receiving medication from their primary care provider still need post-discharge supportive therapy with a licensed mental health clinician such as a therapist or social worker.
• Maintain appointment availability for members with recent inpatient discharge.
• Provider should provide reminder calls to confirm appointment within 24 hours.
• If member is unable to keep scheduled appointment, reschedule it or offer.
• Telehealth visits with a behavioral health provider are acceptable.
• Behavioral Health visits count toward compliance.
• Psychiatric collaborative care management count toward compliance. 
• Submit all claims with correct service coding and principal diagnosis timely.

Measure Exclusions

Required Exclusions:

• Members in hospice or using hospice services anytime during the measurement year.
• Members who died any time during the measurement year.

Measure Codes

• Behavioral Healthcare Setting
  • UBREV: 0513, 0900, 0901, 0902, 0903, 0904, 0905, 0907, 0911, 0912, 0913, 0914, 0915, 0916, 0917, 0919
• Electroconvulsive Therapy
  • CPT: 90870
  • ICD-10-PCS: GZB0ZZZ, GZB1ZZZ, GZB2ZZZ, GZB3ZZZ, GZB4ZZZ
  • Electroconvulsive Therapy Value Set with any of the following place of service (POS):
    • Ambulatory Surgical Center POS: 24
    • Community Mental Health Center POS: 53
    • Partial Hospitalization POS: 52 
    • Outpatient POS: 

• BH Outpatient Visit with a Mental Health Provider 
  • CPT: 98960-98962, 99078, 99202-99205, 99211-99215, 99242-99245, 99341, 99344, 99345, 99347-99350, 99381-99387, 99391-99397, 99401-99404, 99411, 99412, 99483, 99492, 99493, 99494, 99510 
  • HCPCS: G0155, G0176, G0177, G0409, G0463, G0512, H0002, H0004, H0031, H0034, H0036, H0037, H0039, H0040, H2000, H2010, H2011, H2013-H2020, T1015**
    • NOTE: **T1015 HCPCS code which identifies an all-inclusive clinic visit for services rendered at a Federally Qualified Health Center (FQHC) 
  • UBREV: 0510, 0513, 0515, 0516, 0517, 0519, 0520, 0521, 0522, 0523, 0526, 0527, 0528, 0529, 0900, 0902, 0903, 0904, 0911, 0914, 0915, 0916, 0917, 0919, 0982, 0983
• Outpatient Visit (Visit Setting Unspecified) 
  • CPT: 90791, 90792, 90832–90834, 90836–90840, 90845, 90847, 90849, 90853, 90875, 90876, 99221–99223, 99231–99233, 99238, 99239, 99252–99255
  • Visit Setting Unspecified Value Set with any of the following Place of Service (POS): 
    • Community Mental Health Center POS: 53
    • Partial Hospitalization POS: 52 
    • Telehealth POS with a Mental Health Provider:
      • Telehealth Provided Other than in Patient’s Home: 02
      • Telehealth Provided in Patient’s Home:10
    • Outpatient POS with a Mental Health Provider:

• Partial Hospitalization or Intensive Outpatient
  • HCPCS: G0410, G0411, H0035, H2001, H2012, S0201, S9480, S9484, S9485
  • UBREV: 0905, 0907, 0912, 0913
• Psychiatric Collaborative Care Management
  • CPT: 99492, 99493, 99494
  • HCPCS: G0512
• Telephone Visits with a Mental Health Provider
  • CPT: 98966, 98967, 98968, 99441, 99442, 99443
• Transitional Care Management with a Mental Health Provider
  • CPT: 99495, 99496
• Community mental health center visit with place of service (POS) 53 with any of the previously listed codes above:
  • Visit Setting Unspecified
  • BH Outpatient 
  • Transitional Care Management Services