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:
​The intent of the negative medication history requirement is to exclude any patient with an ADHD medication treatment during any part of the 120-day lookback period prior to the index prescription start date. The current specification excludes patients who started ADHD medication treatment during this timeframe but does not account for patients whose treatment started before and continues into the 120-day lookback period. Therefore, the measure developer proposes updating the logic to account for patients who started ADHD medication before the 120-day lookback period.

Proposed Solution:
Before

define "Previously on ADHD Medication Exclusion":
["Medication, Active": "ADHD Medications"] ActiveADHDMedication
  with "First ADHD Medication Dispensed during Intake Period" InitialADHDMedication
    such that Global."NormalizeInterval" ( ActiveADHDMedication.relevantDatetime, ActiveADHDMedication.relevantPeriod ) starts 120 days or less before InitialADHDMedication.relevantDatetime

After

define "Previously on ADHD Medication Exclusion":
["Medication, Active": "ADHD Medications"] ActiveADHDMedication
  with "First ADHD Medication Prescribed during Intake Period" InitialADHDMedication
    such that Global."NormalizeInterval" ( ActiveADHDMedication.relevantDatetime, ActiveADHDMedication.relevantPeriod ) overlaps Interval[date from InitialADHDMedication.authorDatetime - 120 days, date from InitialADHDMedication.authorDatetime )

Rationale for Change:
​The goal of this change is to improve accuracy of excluding patients who may be on ADHD medication during the 120-day lookback period timeframe before the index prescription start date.