Measure: CMS136
Follow-Up Care for Children Prescribed ADHD Medication (ADD)
Measure Versions
| eMeasure Code |
Measure Year |
Full Version Number |
Title |
| CMS136v13 |
2024 |
13.0.000 |
Follow-Up Care for Children Prescribed ADHD Medication (ADD) |
| CMS136v12 |
2023 |
12 |
Follow-Up Care for Children Prescribed ADHD Medication (ADD) |
| CMS136v11 |
2022 |
11.1.000 |
Follow-Up Care for Children Prescribed ADHD Medication (ADD) |
| CMS136v10 |
2021 |
10.2.000 |
Follow-Up Care for Children Prescribed ADHD Medication (ADD) |
| CMS136v9 |
2020 |
9.1.000 |
Follow-Up Care for Children Prescribed ADHD Medication (ADD) |
| CMS136v8 |
2019 |
8.3.000 |
Follow-Up Care for Children Prescribed ADHD Medication (ADD) |
| CMS136v7 |
2018 |
7.1.000 |
Follow-Up Care for Children Prescribed ADHD Medication (ADD) |
| CMS136v6 |
2017 |
6.0.000 |
ADHD: Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication |
Description
Percentage of children 6-12 years of age and newly prescribed 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 treatment 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.
Guidance
This eCQM is a patient-based measure.
This version of the eCQM uses QDM version 5.6. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.
Patient Group Definitions
| Group |
Description |
Instructions Links |
| Initial Population | Initial Population 1: Children 6-12 years of age as of the Intake Period who had an IPSD and who had a visit within 6 months prior to the IPSD including the IPSD. Children are removed if they had an acute inpatient stay with a principal diagnosis of mental, behavioral or neurodevelopmental disorder during the Initiation Phase.
Initial Population 2: Children 6-12 years of age as of the Intake Period who had an IPSD and remained on the medication for at least 210 treatment days during the 301-day period, beginning on the IPSD through 300 days after the IPSD, and who had a visit within 6 months prior to the IPSD including the IPSD. Children are removed if they had an acute inpatient stay with a principal diagnosis of mental, behavioral or neurodevelopmental disorder during the Continuation and Maintenance Phase. | Webchart Instructions |
| Denominator | Equals Initial Population | Webchart Instructions |
| Denominator Exclusions | Exclude patients diagnosed with narcolepsy at any point in their history or during the measurement period.
Exclude patients who are in hospice care for any part of the measurement period. | Webchart Instructions |
| 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 on different dates of service during the 31-300 days after the IPSD. | Webchart Instructions |
| Numerator Exclusions | Not Applicable | Webchart Instructions |
| Denominator Exceptions | None | |
Details
| Full eMeasure Code |
eMeasure Identifier |
Measure Year |
Version |
NQF # |
GUID |
| CMS136v13 |
|
2024 |
13.0.000 |
Not Applicable |
703cc49b-b653-4885-80e8-245a057f5ae9 |
| Steward |
Developer |
Endorsed By |
| National Committee for Quality Assurance |
National Committee for Quality Assurance |
|
| Scoring Method |
Measure Type |
Stratification |
Risk Adjustment |
| Proportion |
PROCESS |
None |
None |
Rate Aggregation
None
Improvement Notation
Higher score indicates better quality
Rationale
ADHD is one of the more common chronic conditions of childhood. Children with ADHD may experience significant functional problems, such as school difficulties; academic underachievement; troublesome relationships with family members and peers; and behavioral problems (AAP, 2000). Given the high prevalence of ADHD among school-aged children (4%–12%), primary care clinicians will regularly encounter children with ADHD and should have a strategy for diagnosing and long-term management of this condition (AAP, 2001).
Practitioners can convey the efficacy of pharmacotherapy to their patients. American Academy of Pediatrics (AAP) guidelines recommend that once a child is stable, an office visit every three to six months allows assessment of learning and behavior (AAP, 2001). Follow-up appointments should be made at least monthly until the child’s symptoms have been stabilized (AACAP, 2007).
Providers have an opportunity to track medication use in patients and provide the appropriate follow-up care to monitor clinical symptoms and potential adverse events.
Clinical Recommendation Statement
American Academy of Pediatrics Clinical Practice Guideline for the Diagnosis, Evaluation and Treatment of ADHD in Children and Adolescents (2019)
- Key Action Statement (KAS) 1: The pediatrician or other primary care clinicians (PCC) should initiate an evaluation for ADHD for any child or adolescent age 4 years to the 18th birthday who presents with academic or behavioral problems and symptoms of inattention, hyperactivity, or impulsivity. Grade B: Strong Recommendation
- KAS 4: ADHD is a chronic condition; therefore, the PCC should manage children and adolescents with ADHD in the same manner that they would children and youth with special health care needs, following the principles of the chronic care model and the medical home. Grade B: Strong Recommendation
- KAS 5b: For elementary and middle school-aged children (age 6 years to the 12th birthday) with ADHD, the PCC should prescribe FDA-approved medications for ADHD, along with parent training in behavior management (PTBM) and/or behavioral classroom intervention (preferably both PTBM and behavioral classroom interventions). Educational interventions and individualized instructional supports, including school environment, class placement, instructional placement, and behavioral supports, are a necessary part of any treatment plan and often include an IEP or a rehabilitation plan (504 plan). Grade A: Strong Recommendation
- KAS 6. “The PCC should titrate doses of medication for ADHD to achieve maximum benefit with tolerable side effects”. Grade B, strong recommendation
American Academy of Child and Adolescent Psychiatry (AACAP) Practice Parameter for the Assessment and Treatment of Children and Adolescents with ADHD (2007)
- Overall Guideline: The key to effective long-term management of the patient with ADHD is continuity of care with a clinician experienced in the treatment of ADHD. The frequency and duration of follow-up sessions should be individualized for each family and patient, depending on the severity of ADHD symptoms; the degree of comorbidity of other psychiatric illness; the response to treatment; and the degree of impairment in home, school, work, or peer-related activities. The clinician should establish an effective mechanism for receiving feedback from the family and other important informants in the patient's environment to be sure symptoms are well controlled and side effects are minimal. Although this parameter does not seek to set a formula for the method of follow-up, significant contact with the clinician should typically occur two to four times per year in cases of uncomplicated ADHD and up to weekly sessions at times of severe dysfunction or complications of treatment.
- Recommendation 6: A Well-Thought-Out and Comprehensive Treatment Plan Should Be Developed for the Patient With ADHD. The treatment plan should be reviewed regularly and modified if the patient's symptoms do not respond. Minimal Standard [MS]
- Recommendation 9. During a Psychopharmacological Intervention for ADHD, the Patient Should Be Monitored for Treatment-Emergent Side Effects. Minimal Standard [MS]
- Recommendation 12. Patients Should Be Assessed Periodically to Determine Whether There Is Continued Need for Treatment or If Symptoms Have Remitted. Treatment of ADHD Should Continue as Long as Symptoms Remain Present and Cause Impairment. Minimal Standard [MS]
Definition
Intake Period: The twelve-month period starting March 1 of the year prior to the measurement period and ending the last calendar day of February of the measurement period.
Index Prescription Start Date (IPSD): The earliest prescription date for an ADHD medication where the date is in the Intake Period and the patient is not actively on ADHD medication during the 120 days prior.
Initiation Phase: The 30 days following the IPSD.
Continuation and Maintenance Phase: The 300 days following the IPSD.
Treatment days (covered days): The actual number of calendar days covered with prescriptions during the 301-day period.
Use the following steps to identify and calculate covered days.
Step 1: For same medications that are prescribed on the same day or on different days with overlapping days supply, the days supply is summed. The start and end dates are then identified. The start date is the date of service of the earliest prescription event and the first covered day. The end date is the calendar day when the days supply runs out. The start date through the end date are considered covered days. This rule assumes that the patient will take one prescription at a time (and start taking the next prescription after exhausting the previous prescription). For example:
- If there are three 7-days supply prescription events for the same medication on January 1, the start date is January 1 and the end date is January 21. Covered days include January 1–21.
- If there are two 7-days supply prescription events for the same medication on January 1 and January 5, the start date is January 1 and the end date is January 14. Covered days include January 1–14.
- If there are three 7-days supply prescription events for the same medication on January 1, a 7-days supply prescription event on January 20 and a 7-days supply prescription event on January 28, the start date is January 1 and the end date is February 4. Covered days include January 1–February 4.
Step 2: For all other events (multiple prescriptions for the same medication on different days without overlap, multiple prescriptions for different medications on the same or different days, with or without overlap), the covered days are identified by the start and end dates for each prescription event individually. The start date through the end date are considered covered days. This rule assumes the member will take the different medications concurrently.
Step 3: Each calendar day covered by one or more medications is considered one covered day.
Transmission Format
TBD
Applicable Value Sets
| Category |
Value Set |
OID |
| Diagnosis |
Hospice Diagnosis |
2.16.840.1.113883.3.464.1003.1165 |
| Diagnosis |
Narcolepsy |
2.16.840.1.113883.3.464.1003.114.12.1011 |
| Encounter, Performed |
Behavioral Health Follow-up Visit |
2.16.840.1.113883.3.464.1003.101.12.1054 |
| Encounter, Performed |
Encounter Inpatient |
2.16.840.1.113883.3.666.5.307 |
| Encounter, Performed |
Home Healthcare Services |
2.16.840.1.113883.3.464.1003.101.12.1016 |
| Encounter, Performed |
Hospice Encounter |
2.16.840.1.113883.3.464.1003.1003 |
| Encounter, Performed |
Hospital Observation Care - Initial |
2.16.840.1.113883.3.464.1003.101.12.1002 |
| Encounter, Performed |
Office Visit |
2.16.840.1.113883.3.464.1003.101.12.1001 |
| Encounter, Performed |
Online Assessments |
2.16.840.1.113883.3.464.1003.101.12.1089 |
| Encounter, Performed |
Outpatient Consultation |
2.16.840.1.113883.3.464.1003.101.12.1008 |
| Encounter, Performed |
Preventive Care - Established Office Visit, 0 to 17 |
2.16.840.1.113883.3.464.1003.101.12.1024 |
| Encounter, Performed |
Preventive Care Services - Group Counseling |
2.16.840.1.113883.3.464.1003.101.12.1027 |
| Encounter, Performed |
Preventive Care Services-Individual Counseling |
2.16.840.1.113883.3.464.1003.101.12.1026 |
| Encounter, Performed |
Preventive Care- Initial Office Visit, 0 to 17 |
2.16.840.1.113883.3.464.1003.101.12.1022 |
| Encounter, Performed |
Psych Visit - Diagnostic Evaluation |
2.16.840.1.113883.3.526.3.1492 |
| Encounter, Performed |
Psych Visit - Psychotherapy |
2.16.840.1.113883.3.526.3.1496 |
| Encounter, Performed |
Psychotherapy and Pharmacologic Management |
2.16.840.1.113883.3.464.1003.101.12.1055 |
| Encounter, Performed |
Telephone Visits |
2.16.840.1.113883.3.464.1003.101.12.1080 |
| Intervention, Order |
Hospice Care Ambulatory |
2.16.840.1.113883.3.526.3.1584 |
| Intervention, Performed |
Hospice Care Ambulatory |
2.16.840.1.113883.3.526.3.1584 |
| Medication, Active |
Atomoxetine |
2.16.840.1.113883.3.464.1003.1170 |
| Medication, Active |
Clonidine |
2.16.840.1.113883.3.464.1003.1171 |
| Medication, Active |
Dexmethylphenidate |
2.16.840.1.113883.3.464.1003.1172 |
| Medication, Active |
Dextroamphetamine |
2.16.840.1.113883.3.464.1003.1173 |
| Medication, Active |
Guanfacine |
2.16.840.1.113883.3.464.1003.196.11.1252 |
| Medication, Active |
Lisdexamfetamine |
2.16.840.1.113883.3.464.1003.1174 |
| Medication, Active |
Methylphenidate |
2.16.840.1.113883.3.464.1003.1176 |
| Medication, Order |
Atomoxetine |
2.16.840.1.113883.3.464.1003.1170 |
| Medication, Order |
Clonidine |
2.16.840.1.113883.3.464.1003.1171 |
| Medication, Order |
Dexmethylphenidate |
2.16.840.1.113883.3.464.1003.1172 |
| Medication, Order |
Dextroamphetamine |
2.16.840.1.113883.3.464.1003.1173 |
| Medication, Order |
Guanfacine |
2.16.840.1.113883.3.464.1003.196.11.1252 |
| Medication, Order |
Lisdexamfetamine |
2.16.840.1.113883.3.464.1003.1174 |
| Medication, Order |
Methylphenidate |
2.16.840.1.113883.3.464.1003.1176 |
| Patient Characteristic Ethnicity |
Ethnicity |
2.16.840.1.114222.4.11.837 |
| Patient Characteristic Payer |
Payer |
2.16.840.1.114222.4.11.3591 |
| Patient Characteristic Race |
Race |
2.16.840.1.114222.4.11.836 |
| Patient Characteristic Sex |
ONC Administrative Sex |
2.16.840.1.113762.1.4.1 |
References
CITATIONAmerican Academy of Pediatrics. (2019). Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics, 144(4), 1-25.
CITATIONAmerican Academy of Pediatrics. (2001). Clinical practice guideline: treatment of the school-aged child with attention-deficit/hyperactivity disorder. Pediatrics, 108(4), 1033–44.
CITATIONAmerican Academy of Pediatrics. (2000). Clinical practice guideline: diagnosis and evaluation of the child with attention-deficit/hyperactivity disorder. Pediatrics, 105(5), 1158-1170.
CITATIONPliszka, S., & AACAP Work Group on Quality Issues. (2007). Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry (AACAP), 46(7), 894-921.
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Source:
https://ecqi.healthit.gov/ecqm/measures/cmsv1