CMS136v11 – Follow-Up Care for Children Prescribed ADHD Medication (ADD)

Children 6-12 years of age who were dispensed an ADHD medication during the Intake Period and who had a visit during the measurement period.

All patients of 6-12 years of age:

• Who were dispensed an ADHD medication during the Intake Period
• Who had a visit during the measurement period.

Patients who had at least one visit with a practitioner with prescribing authority within 30 days after the IPSD.

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.

All patients of 6-12 years of age:

• Who were dispensed an ADHD medication during the Intake Period.
• Who remained on the medication for at least 210 days out of the 300 days following the IPSD.
• Who had a visit during the measurement period.

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.

1. Exclude patients diagnosed with narcolepsy at any point in their history or during the measurement period.
2. 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.
3. Exclude patients who were actively on an ADHD medication in the 120 days prior to the Index Prescription Start Date.
4. Exclude patients who were in hospice care during the measurement year.

1. Exclude patients diagnosed with narcolepsy at any point in their history or during the measurement period.
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.
3. Exclude patients who were actively on an ADHD medication in the 120 days prior to the Index Prescription Start Date.
4. Exclude patients who were in hospice care during the measurement year.

For Denominator 1:

Include patients aged 6 to 12 with a qualifying encounter during the measurement period and ‘First ADHD Medication Dispensed during Intake Period’. For ‘First ADHD Medication Dispensed during Intake Period’ the ADHD medication should be dispensed in the interval 90 days or less on or before start of measurement period and 60 days or less after start of measurement period.

To record an encounter, navigate to Patient > Provider Note > eSuperbill.

For medication dispensed, use the workflow Patient > Provider Note > Prescription. Click ‘Add’ and search for the prescription. Enter the prescription details and click ‘Save’. Then click ‘Accept’ and the prescription is added to the provider note.

For Denominator 2:

Include patients aged 6 to 12 with a qualifying encounter during the measurement period and ADHD medication dispensed in the interval 90 days or less on or before start of measurement period and 60 days or less after start of measurement period. The patient should be on the medication for at least 210 days out of the 300 days following the day ADHD medication is dispensed.

• To record an encounter, navigate to Patient > Provider Note > eSuperbill.
• To record medication dispensed, use the workflow Patient > Provider Note > Prescription.
• To record an active ADHD medication, use the workflow Patient > Provider Note > Medications. Click ‘Add’ and search for the medication. Enter the medication details and click ‘Save’. Then click ‘Accept’ and the medication is added to the provider note.

For Numerator 1:

Include patients with a qualifying numerator encounter and ADHD medication dispensed in the interval 90 days or less on or before start of measurement period and 60 days or less after start of measurement period. The encounter should start 30 days or less on or after the date the ADHD medication is dispensed.

• To record an encounter, navigate to Patient > Provider Note > eSuperbill.
• To record medication dispensed, use the workflow Patient > Provider Note > Prescription.

For Numerator 2:

Include patients fulfilling one of the following conditions:

• Patients with a qualifying encounter 30 days after initial ADHD medication and ‘Two or more followup encounters’.

To record an encounter, navigate to Patient > Provider Note > eSuperbill.

To record medication dispensed, use the workflow Patient > Provider Note > Prescription.

• Patients with a qualifying encounter 30 days after initial ADHD medication and:
  • Qualifying encounter 300 days after ‘First ADHD Medication Dispensed’
  • Telehealth services or telephone management encounter in the interval 31 to300 day after ‘First ADHD Medication Dispensed’.

To record an encounter, navigate to Patient > Provider Note > eSuperbill.

To record medication dispensed, use the workflow Patient > Provider Note > Prescription.

For Denominator Exclusions 1:

Exclude patients satisfying any of the following criteria:

1. Patients who are in hospice care during the measurement year are included in denominator exclusion. To document that patient is receiving hospice care outside of a hospital or long term care facility, navigate to Patient > Clinical > Evaluations. Click ‘+ Add’ and search for an intervention. Select ‘Order’ or ‘Performed’ from the ‘Status’ dropdown, then click ‘Sign’ or ‘Save’. Use the below mentioned codes to order or perform an intervention:
   • 385763009: Hospice Care (Regime/Therapy)
   • 385765002: Hospice Care Management (Procedure)

1. • To document an encounter inpatient, navigate to Patient > Clinical > Evaluations

2. Patients with ‘Narcolepsy’ diagnosis where the diagnosis prevalence period starts before end of the measurement period. To document the diagnosis, use the workflow Patient > Provider Note > Diagnoses, and click ‘Add’. Search for the diagnosis and add the diagnosis details. Then click ‘Save’.

3. Patients on ADHD medication 120 days or less before the ‘First ADHD Medication Dispensed’. To document the medication, navigate to Patient > Provider Note > Medications. Click ‘Add’ and search for the medication. Enter the medication details and click ‘Save’. Then click ‘Accept’ and the medication is added to the provider note.

4. Patients with ‘Inpatient stay with qualifying diagnosis’ 30 days or less on or after the ‘First ADHD Medication Dispensed’.
   • To document an encounter inpatient, navigate to Patient > Clinical > Evaluations
   • To document the ‘Mental Health’ or ‘Substance Abuse’ diagnosis, use the workflow Patient > Clinical > Diagnoses.

For Denominator Exclusions 2:

Exclude patients satisfying any of the following criteria:

1. Patients who are in hospice care during the measurement year are included in denominator exclusion. To document that patient is receiving hospice care outside of a hospital or long term care facility, navigate to Patient > Clinical > Evaluations. Click ‘+ Add’ and search for an intervention. Select ‘Order’ or ‘Performed’ from the ‘Status’ dropdown, then click ‘Sign’ or ‘Save’. Use the below mentioned codes to order or perform an intervention:

• 385763009: Hospice Care (Regime/Therapy)
• 385765002: Hospice Care Management (Procedure)
• To document an encounter inpatient, navigate to Patient > Clinical > Evaluations

2. Patients with ‘Narcolepsy’ diagnosis where the diagnosis prevalence period starts before end of the measurement period. To document the diagnosis, use the workflow Patient > Provider Note > Diagnoses, and click ‘Add’. Search for the diagnosis and add the diagnosis details. Then click ‘Save’.
3. Patients on ADHD medication 120 days or less before the ‘First ADHD Medication Dispensed’. To document the medication, navigate to Patient > Provider Note > Medications. Click ‘Add’ and search for the medication. Enter the medication details and click ‘Save’. Then click ‘Accept’ and the medication is added to the provider note.
4. Patients with ‘Inpatient stay with qualifying diagnosis’ 300 days or less on or after the ‘First ADHD Medication Dispensed’.

• To document an encounter inpatient, navigate to Patient > Clinical > Evaluations
• To document the ‘Mental Health’ or ‘Substance Abuse’ diagnosis, use the workflow Patient > Clinical > Diagnoses.