Follow-Up Care for Adult Medicaid Beneficiaries Who are Newly Prescribed an Antipsychotic Medication
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Percentage of new antipsychotic prescriptions for Medicaid beneficiaries who are age 18 years and older, and completed a follow-up visit with a provider with prescribing authority within 1-28 days of prescription of an antipsychotic medication. (CMS 1115 SMI DEMONSTRATION Metric #30)
Reference the Technical Specifications and Resources Manual: NQF3313, 1115 Serious Mental Illness and Serious Emotional Disturbance Demonstrations: Technical Specifications for Monitoring Metrics V4.0, HEDIS 2021 Mental Health Diagnosis value set, NCQA Measure Specifications_V4, and HEDIS General Guideline 17 Hospice.
Measure Identifier: SMI_CMS.30
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Please see Report Details below for more information on selected subgroups, organizations, and aggregation.
The Follow-Up Care for Adult Medicaid Beneficiaries Who are Newly Prescribed an Antipsychotic Medication measure is maintained by the Lewin Group under the Home and Community-Based Services (HCBS) Measures Development, Endorsement, Maintenance, and Alignment project for the Centers for Medicare & Medicaid Services (CMS), contract HHSM-500-2014-00033I, Task Order #75FCMC19F0004.
For Proprietary Codes:
Limited proprietary coding is contained in the measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. Lewin disclaims all liability for use or accuracy of any Current Procedural Terminology (CPT) © or other codes contained in the specifications. Professional organizations frequently update their codes. In this manual, we describe the value sets we used to specify and test the measure with 2020 data. In the Excel attachment, we provide value sets used to calculate the measure’s numerator and denominator. We recommend that states seek input from their clinical experts to identify current codes.
CPT codes 2021 American Medical Association (AMA). All rights reserved. CPT is a trademark of the American Medical Association. No fee schedules, basic units, relative values or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.
Healthcare Common Procedure Coding System (HCPCS) Level II codes and descriptors are approved and maintained jointly by the alpha-numeric editorial panel (consisting of the Centers for Medicare & Medicaid Services, America's Health Insurance Plans, and the Blue Cross and Blue Shield Association.)
The National Drug Code (NDC) Directory is published by the U.S. Food and Drug Administration and is made available under the Open Database License at http://opendatacommons.org/licenses/odbl/1.0/. Any rights in individual contents of the database are licensed under the Database Contents License at http://opendatacommons.org/licenses/dbcl/1.0/.
NDCs were updated using Medispan and FirstDataBank files in April 2020. NDC codes are subject to frequent changes so measure users should update these codes.
Code vocabularies other than NDC were updated in May 2020.