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  2. CQM-6020

CMS2 Referral to Primary Care Service follow-up

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      ​​Thank you for your inquiry regarding CMS2v12: Preventive Care and Screening: Screening for Depression and Follow-Up Plan. The intent of the depression follow-up value sets are for the patient to receive further evaluation, assessment, or intervention for a positive depression screening within the timeframe specified in the measure. Based on the measure guidance, a referral should be made to a practitioner who is qualified to diagnose and treat depression. Self-referral to the same primary care physician (PCP) that completed the positive depression screen without documenting a follow-up plan to address the positive screen does not meet numerator criteria. Documented follow-up plans for a positive depression screening must include one or more of the following:

      * Referral to a provider for additional evaluation and assessment to formulate a follow-up plan for a positive depression screen

      * Pharmacological interventions

      * Other interventions or follow-up for the diagnosis or treatment of depression, such as, but not limited to behavioral health evaluation, psychotherapy, family or group therapy, support group, depression management program.

      Therefore, the scenario you provided, in which a PCP screens a patient for depression, the screening is positive for depression, and the PCP documents a self-referral, does not meet the intent of the measure.
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      ​​Thank you for your inquiry regarding CMS2v12: Preventive Care and Screening: Screening for Depression and Follow-Up Plan. The intent of the depression follow-up value sets are for the patient to receive further evaluation, assessment, or intervention for a positive depression screening within the timeframe specified in the measure. Based on the measure guidance, a referral should be made to a practitioner who is qualified to diagnose and treat depression. Self-referral to the same primary care physician (PCP) that completed the positive depression screen without documenting a follow-up plan to address the positive screen does not meet numerator criteria. Documented follow-up plans for a positive depression screening must include one or more of the following: * Referral to a provider for additional evaluation and assessment to formulate a follow-up plan for a positive depression screen * Pharmacological interventions * Other interventions or follow-up for the diagnosis or treatment of depression, such as, but not limited to behavioral health evaluation, psychotherapy, family or group therapy, support group, depression management program. Therefore, the scenario you provided, in which a PCP screens a patient for depression, the screening is positive for depression, and the PCP documents a self-referral, does not meet the intent of the measure.
    • CMS0002v12
    • Follow-up post positive depression screening could possibly not count.

      For CMS2, if the patient sees their primary care provider and scores a positive during the depression screening, if that primary care provider enters a referral to themselves would that suffice as follow-up?  Value set: Referral for Adolescent Depression (2.16.840.1.113883.3.526.3.1570) contains "referral to primary care service (procedure)" [SNOMED 703978000]. We are looking for confirmation that a primary care provider could refer the patient to themselves after a positive depression screening score and it would count as follow-up.

            edave Mathematica EC eCQM Team
            adunn Amanda Dunn
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