CMS 136 - Follow-Up Care for Children Prescribed ADHD Medication (ADD)

Overview

CMS136v9 (2020)

CMS136v10 (2021)

CMS136v11 (2022)

Identifiers

CMS eCQM IDNQF eCQM IDNQFMIPS Quality ID
CMS136v11366

*MIE only supports data collection and reporting using eCQM specifications

Definitions

DescriptionPercentage 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.
Percentage of children who had one follow-up visit with a practitioner with prescribing authority during the 30-Day Initiation Phase.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 PopulationChildren 6-12 years of age who were dispensed an ADHD medication during the Intake Period and who had a visit during the measurement period.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.
DenominatorEquals Initial Population
Denominator Exclusions
  • 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.
  • 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.
NumeratorPatients who had at least one visit with a practitioner with prescribing authority within 30 days after the IPSD.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 Exclusions
Denominator Exceptions

Additional Information

Measure TypeProcess measure
Measure ScoringProportion measure
GranularityPatient
Improvement NotationHigher score indicates better quality
DomainEffective Clinical Care

Clinical Instructions

New UI Visit Encounter (valid RC202109+)

Original Visit Encounter

Track children ages 6-12 that have been newly dispensed a medication for ADHD and ensure they receive appropriate follow-up care.

  1. Provide a follow-up with children prescribed ADHD medication during the 30-Day Initiation Phase
  2. For children remaining on the medication for 7+ months, provide two additional follow-up visits and ensure these are completed within 9 months of the Initiation Phase ending.

Evidence

Initial Patient Population

NameValue Set
Encounter, Performed: Home Healthcare Services2.16.840.1.113883.3.464.1003.101.12.1016
Encounter, Performed: Office Visit2.16.840.1.113883.3.464.1003.101.12.1001
Encounter, Performed: Preventive Care Services, Initial Office Visit, 0 to 172.16.840.1.113883.3.464.1003.101.12.1022
Encounter, Performed: Preventive Care, Established Office Visit, 0 to 172.16.840.1.113883.3.464.1003.101.12.1024
Medication, Active: ADHD Medications2.16.840.1.113883.3.464.1003.196.12.1171

Denominator Exclusions

NameValue Set
Diagnosis: Narcolepsy2.16.840.1.113883.3.464.1003.114.12.1011
Encounter, Performed: Encounter Inpatient2.16.840.1.113883.3.666.5.307
Intervention, Order: Hospice care ambulatory2.16.840.1.113762.1.4.1108.15
Intervention, Performed: Hospice care ambulatory2.16.840.1.113762.1.4.1108.15

Numerator

NameValue Set
Encounter, Performed: Behavioral Health Follow-up Visit2.16.840.1.113883.3.464.1003.101.12.1054
Encounter, Performed: Hospital Observation Care - Initial2.16.840.1.113883.3.464.1003.101.12.1002
Encounter, Performed: Observation care discharge day management (This code is to be utilized to report all services provided to a patient on discharge from outpatient hospital observation status if the discharge is on other than the initial date of observation status. To report services to a patient designated as observation status or inpatient status and discharged on the same date, use the codes for Observation or Inpatient Care Services [including Admission and Discharge Services, 99234-99236 as appropriate.])CPT Code 99217
Encounter, Performed: Online Assessments2.16.840.1.113883.3.464.1003.101.12.1089
Encounter, Performed: Outpatient Consultation2.16.840.1.113883.3.464.1003.101.12.1008
Encounter, Performed: Preventive Care Services - Group Counseling2.16.840.1.113883.3.464.1003.101.12.1027
Encounter, Performed: Preventive Care Services-Individual Counseling2.16.840.1.113883.3.464.1003.101.12.1026
Encounter, Performed: Psych Visit - Diagnostic Evaluation2.16.840.1.113883.3.526.3.1492
Encounter, Performed: Psych Visit - Psychotherapy2.16.840.1.113883.3.526.3.1496
ncounter, Performed: Psychotherapy and Pharmacologic Management2.16.840.1.113883.3.464.1003.101.12.1055
Encounter, Performed: Telehealth Services2.16.840.1.113883.3.464.1003.101.12.1031
Encounter, Performed: Telephone Visits2.16.840.1.113883.3.464.1003.101.12.1080

Source(s)

eCQI CMS136


WebChart Documentation

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