Brief Description of Measure:

CMS136: Follow-Up Care for Children Prescribed ADHD Medication (ADD):
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.

Description of Issue:

​This measure has requirements that either look for events during the full 300-day period after Index Prescription Start Date (IPSD), or the 31-300 day period after Index Prescription Start Date. The measure developer would like to set the 300-day period as the definition for the "Continuation and Maintenance Phase" and use the term consistently across the measure specification. The developer would also like to incorporate and make use of the term "Initiation Phase", as defined as 30 days after IPSD, throughout the measure specification.

Proposed Solution:

​Before

//Header: Definition
Continuation and Maintenance Phase: The 31-300 days following the IPSD.

//Header: Denominator Exclusions
Denominator Exclusion 1: 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.
Denominator Exclusion 2: 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.

//Header: Numerator
Numerator 1: Patients who had at least one visit with a practitioner with prescribing authority within 30 days after the IPSD.
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 Continuation and Maintenance Phase.

After

//Header: Definition
Continuation and Maintenance Phase: The 300 days following the IPSD.

//Header: Denominator Exclusions
Denominator Exclusion 1: Exclude patients who had an acute inpatient stay with a principal diagnosis of mental health or substance abuse during Initiation Phase.
Denominator Exclusion 2: Exclude patients who had an acute inpatient stay with a principal diagnosis of mental health or substance abuse during Continuation and Maintenance Phase.

//Header: 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.

Below are changes that will be made in the logic, including updating definition names and timing constraints:

//Population Criteria 1

Before
define "Inpatient Stay with Qualifying Diagnosis within 30 Days of Initial ADHD Dispense": ...

define "Numerator 1":
exists ( "Encounter 30 Days after Initial Phase ADHD Medication" )

define "Encounter 30 Days after Initial Phase ADHD Medication": ...

After
define "Inpatient Stay with Qualifying Diagnosis during Initiation Phase": ...

define "Numerator 1":
exists ( "Encounter during Initiation Phase" )

define "Encounter during Initiation Phase": ...

//Population Criteria 2

Before
define "Inpatient Stay with Qualifying Diagnosis within 300 Days of Initial ADHD Dispense": ...

define "Has ADHD Cumulative Medication Duration Greater Than or Equal to 210 Days":
... ("ADHD Medications Taken within 300 Days after First ADHD Medication Dispensed")>= 210

define "ADHD Medications Taken within 300 Days after First ADHD Medication Dispensed": ...

define "Numerator 2":
exists ( "Encounter 30 Days after Initial Phase ADHD Medication" )
  and ( ( "Two or More Followup Encounters" )
      or ( exists ( "Encounters 300 Days after Initial Phase ADHD Medication" )
          and exists ( "Telehealth Services or Telephone Management Encounter" )      )  )

define "Two or More Followup Encounters": Count("Encounters 300 Days after Initial Phase ADHD Medication")>= 2

define "Encounters 300 Days after Initial Phase ADHD Medication": ...

define "Telehealth Services or Telephone Management Encounter":...

After

define "Inpatient Stay with Qualifying Diagnosis during Continuation and Maintenance Phase": ...

define "Has ADHD Cumulative Medication Duration Greater Than or Equal to 210 Days":
... ("ADHD Medications Taken on IPSD or during Continuation and Maintenance Phase")>= 210

define "ADHD Medications Taken on IPSD or during Continuation and Maintenance Phase": ...

define "Numerator 2":
exists ( "Encounter during Initiation Phase" )
  and ( ( "Two or More Encounters 31 to 300 Days into Continuation and Maintenance Phase" )
      or ( exists ( "Encounter 31 to 300 Days into Continuation and Maintenance Phase" )
          and exists ( "Online Assessment 31 to 300 Days into Continuation and Maintenance Phase" )     )  )

define "Two or More Encounters 31 to 300 Days into Continuation and Maintenance Phase":
Count("Encounters 31 to 300 Days into Continuation and Maintenance Phase")>= 2

define "Encounter 31 to 300 Days into Continuation and Maintenance Phase": ...

define "Online Assessment 31 to 300 Days into Continuation and Maintenance Phase": ...

Rationale for Change:

​The goal of this change is to ensure consistent use of terms across the measure specification.