Product Lines:
EHP, Priority Partners, and USFHP.

Eligible Population:
Members 1-17 years of age as of December 31 of the measurement year (MY).

Definition:
The percentage of children and adolescents 1–17 years of age who had a new prescription for an antipsychotic medication and had documentation of psychosocial care as first-line treatment.

Report two age stratifications and a total rate:

• 1–11 years.
• 12–17 years.
• Total. The total is the sum of the age stratifications.

Intake period: January 1 through December 1 of the measurement year.

IPSD: Index prescription start date. The earliest prescription dispensing date for an antipsychotic medication where the date is in the intake period and there is a negative medication history.

Negative medication history: A period of 120 days prior to the IPSD when the member had no antipsychotic medications dispensed for either new or refill prescriptions.

Continuous Enrollment:

• 120 days prior to the IPSD through 30 days after the IPSD.

Best Practice and Measure Tips

• New for measure, residential behavioral health treatment is acceptable.
• Ensure coordinated care such as behavioral interventions, psychological therapies and skills training.
• Assess members for alcohol and drug abuse dependence and refer if necessary.
• Periodically review the ongoing need for continued therapy with antipsychotic medication.
• Assess the need for Case Management and refer if necessary.
• Medication regiment adherence is essential for the patient’s treatment.

Measure Exclusions

Required Exclusion:

• Members in hospice or using hospice services anytime during the measurement year.
• Members who died any time during the measurement year.
• Members for whom first-line antipsychotic medications may be clinically appropriate: members with a diagnosis of schizophrenia, schizoaffective disorder, bipolar disorder, other psychotic disorder, autism or other developmental disorder on at least two different dates of service during the measurement year.

Measure Codes

• Psychosocial Care
  • CPT: 90832, 90833, 90834, 90836, 90837, 90838, 90839, 90840, 90845, 90846, 90847, 90849, 90853, 90875, 90876, 90880
  • HCPCS: G0176, G0177, G0409, G0410, G0411, H0004, H0035, H0036, H0037, H0038, H0039, H0040, H2000, H2001, H2011, H2012, H2013, H2014, H2017, H2018, H2019, H2020, S0201, S9480, S9484, S9485

Measure Medications

Antipsychotic Medications

Antipsychotic Combination Medications