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Johns Hopkins Health Plans

FUH - Follow-Up After Hospitalization for Mental Illness

Product Lines:
Advantage MD, Dual Eligible Special Needs Plans (D-SNP), EHP, Priority Partners and USFHP.

Eligible Population:
Members 6 years and older as of December 31 of the measurement year.

Definition:
The percent of discharges for members age 6 and older who were hospitalized for treatment of selected mental illness diagnoses or intentional self-harm diagnoses and who had a follow-up visit with a mental health practitioner.

Two rates are reported:

  • Discharges for which the member received follow-up within 7 days after discharge.
  • Discharges for which the member received follow-up within 30 days after discharge

Report three age stratifications and a total rate:

  • 6–17 years.
  • 18–64 years. 
  • 65 years and older.
  • Total. The total is the sum of the age stratifications.

For both indicators, any of the following meet criteria for a follow-up visit:

  • Outpatient, BH outpatient visit, telehealth, telephone or transitional care management services with a mental health provider.
  • Intensive outpatient encounter, partial hospitalization, community mental health center visit with a mental health provider.
  • Electroconvulsive therapy
  • Telehealth, telephone or transitional care management services with a mental health provider.
  • Visit in a behavioral healthcare setting
  • Psychiatric collaborative care management
  • Peer support services
  • Psychiatric residential treatment

Provider Specialty: Mental Health Practitioner.

Report stratification by race and ethnicity.

Continuous Enrollment:

  • Date of discharge through 30 days after discharge.

Best Practice and Measure Tips

  • The denominator for this measure is based on discharges, not on members. If members have more than one discharge, include all discharges on or between January 1 and December 1 of the measurement year.
  • Visits that occur on the date of discharge will not count toward compliance.
  • This measure focuses on follow-up treatment, which must be with a mental health provider.
  • Refer patient to a mental health provider to be seen within seven days of discharge.
    • The Johns Hopkins Health Plans Care Management team offers a variety of services to help members who are living with mental health may receive confidential care management support and coordination of care from a Licensed Clinical Social Worker. These behavioral health clinicians help members navigate their treatment needs for conditions such as depression, anxiety disorders, addictions, and autism spectrum disorders. For Priority Partners members, we work with Carelon Behavioral Health to manage mental health needs.
  • While patient is in inpatient care help them coordinate care with a mental health provider by:
    • Helping them schedule an appointment
    • Verify if the mental health provider is a good fit by considering location, transportation and time.
    • Identify and address any barriers that may prevent member keeping the appointment.
    • Making sure member has a good support system by engaging parents/guardian or significant others in the treatment plan, stressing the importance of treatment, and attending to their appointment.
    • Ensure member received an appointment with 7 days of discharge.
    • Share all transition of care with the member’s Primary Care Physician (PCP) to ensure members follows-up with the treatment plan. Ensure member has a PCP.
  • Educate member on:
    • Importance of consistency and adherence to the medication regiment.
    • Medication side effect, what to do if the side effect are severe and can potentially result in lack of adherence to the medication regiment and treatment plan.
    • Crisis Intervention options.
  • Even patients receiving medication from their primary care provider still need post-discharge supportive therapy with a licensed mental health clinician such as a therapist or social worker.
  • Maintain appointment availability for members with recent inpatient discharge.
  • Provider should provide reminder calls to confirm appointment within 24 hours.
  • If member is unable to keep scheduled appointment, reschedule it or offer.
  • Telehealth visits with a behavioral health provider are acceptable.
  • Behavioral Health visits count toward compliance.
  • Psychiatric collaborative care management count toward compliance. 
  • Submit all claims with correct service coding and principal diagnosis timely.

Changes to the measure:

  • Modified the denominator criteria to allow intentional self-harm diagnoses to take any position on the acute inpatient discharge claim.
  • Added phobia, anxiety and additional intentional self-harm diagnoses to the denominator in the event/ diagnosis.
  • Added visits with any diagnosis of a mental health disorder to the numerator.
  • Added peer support and residential treatment services to the numerator.

Measure Exclusions

Required Exclusions:

  • Members in hospice or using hospice services anytime during the measurement year.
  • Members who died any time during the measurement year.
  • Exclude discharges followed by readmission or direct transfer to a nonacute inpatient care setting (except for psychiatric residential treatment) within the 30-day follow-up period, regardless of the diagnosis for the readmission.

Measure Codes

  • Behavioral Healthcare Setting
    • UBREV: 0513, 0900, 0901, 0902, 0903, 0904, 0905, 0907, 0911, 0912, 0913, 0914, 0915, 0916, 0917, 0919, 1001
  • Electroconvulsive Therapy
    • CPT: 90870
    • ICD-10-PCS: GZB0ZZZ, GZB1ZZZ, GZB2ZZZ, GZB3ZZZ, GZB4ZZZ
    • Electroconvulsive Therapy Value Set with any of the following place of service (POS):
      • Ambulatory Surgical Center POS: 24
      • Community Mental Health Center POS: 53
      • Partial Hospitalization POS: 52 
      • Outpatient POS: 
        • 03 School
        • 05 Indian Health Service Free-standing Facility
        • 07 Tribal 638 Free-standing Facility
        • 09 Prison/Correctional Facility
        • 11 Office
        • 12 Home
        • 13 Assisted Living Facility
        • 14 Group Home
        • 15 Mobile Unit
        • 16 Temporary Lodging
        • 17 Walk-in Retail Health Clinic
        • 18 Place of Employment-Worksite
        • 19 Off Campus-Outpatient Hospital
        • 20 Urgent Care Facility
        • 22 On Campus-Outpatient Hospital
        • 33 Custodial Care Facility
        • 49 Independent Clinic
        • 50 Federally Qualified Health Center
        • 71 Public Health Clinic
        • 72 Rural Health Clinic
  • BH Outpatient Visit with a Mental Health Provider
    • CPT: 98960-98962, 99078, 99202-99205, 99211-99215, 99242-99245, 99341, 99344, 99345, 99347-99350, 99381-99387, 99391-99397, 99401-99404, 99411, 99412, 99483, 99492, 99493, 99494, 99510
    • HCPCS: G0155, G0176, G0177, G0409, G0463, G0512, H0002, H0004, H0031, H0034, H0036, H0037, H0039, H0040, H2000, H2010, H2011, H2013-H2020, T1015**
      • NOTE: **T1015 HCPCS code which identifies an all-inclusive clinic visit for services rendered at a Federally Qualified Health Center (FQHC)
    • UBREV: 0510, 0513, 0515, 0516, 0517, 0519, 0520, 0521, 0522, 0523, 0526, 0527, 0528, 0529, 0900, 0902, 0903, 0904, 0911, 0914, 0915, 0916, 0917, 0919, 0982, 0983
  • Outpatient Visit (Visit Setting Unspecified)
    • CPT: 90791, 90792, 90832–90834, 90836–90840, 90845, 90847, 90849, 90853, 90875, 90876, 99221–99223, 99231–99233, 99238, 99239, 99252–99255
    • Visit Setting Unspecified Value Set with any of the following Place of Service (POS):
      • Community Mental Health Center POS: 53
      • Partial Hospitalization POS: 52
      • Psychiatric residential treatment center POS: 56
      • Telehealth POS with a Mental Health Provider:
      • Telehealth Provided Other than in Patient’s Home: 02
      • Telehealth Provided in Patient’s Home:10
      • Outpatient POS with a Mental Health Provider:
        • 03 School
        • 05 Indian Health Service Free-standing Facility
        • 07 Tribal 638 Free-standing Facility
        • 09 Prison/Correctional Facility
        • 11 Office
        • 12 Home
        • 13 Assisted Living Facility
        • 14 Group Home
        • 15 Mobile Unit
        • 16 Temporary Lodging
        • 17 Walk-in Retail Health Clinic
        • 18 Place of Employment-Worksite
        • 19 Off Campus-Outpatient Hospital
        • 20 Urgent Care Facility
        • 22 On Campus-Outpatient Hospital
        • 33 Custodial Care Facility
        • 49 Independent Clinic
        • 50 Federally Qualified Health Center
        • 71 Public Health Clinic
        • 72 Rural Health Clinic
    •  Partial Hospitalization or Intensive Outpatient
      • HCPCS: G0410, G0411, H0035, H2001, H2012, S0201, S9480, S9484, S9485
      • UBREV: 0905, 0907, 0912, 0913
    • Psychiatric Collaborative Care Management
      • CPT: 99492, 99493, 99494
      • HCPCS: G0512
    • Telephone Visits with a Mental Health Provider
      • CPT: 98966, 98967, 98968, 99441, 99442, 99443
    • Transitional Care Management with a Mental Health Provider
      • CPT: 99495, 99496
    • Community mental health center visit with place of service (POS) 53 with any of the previously listed codes above:
      • Visit Setting Unspecified
      • BH Outpatient
      • Transitional Care Management Services
    • Peer Support Services
      • HCPCS: G0140, G0177, H0024, H0025, H0038, H0039, H0040, H0046, H2014, H2023, S9445, T1012, T1016
    • Residential Behavioral Health Treatment
      • HCPCS: H0017, H0018, H0019, T2048
    • Mental Health Diagnosis
      • Any diagnosis of mental health disorder for any follow-up service for codes previously listed above:
        • Visit Setting Unspecified
        • BH Outpatient
        • Transitional Care Management Services
        • Telehealth visit
        • Telephone visit
        • Peer support services
      • ICD-10-CM: F03.90, F03.911, F03.918, F03.92, F03.93, F03.94, F03.A0, F03.A11, F03.A18, F03.A2, F03.A3, F03.A4, F03.B0, F03.B11, F03.B18, F03.B2, F03.B3, F03.B4, F03.C0, F03.C11, F03.C18, F03.C2, F03.C3, F03.C4, F20.0, F20.1, F20.2, F20.3, F20.5, F20.81, F20.89, F20.9, F21, F22, F23, F24, F25.0, F25.1, F25.8, F25.9, F28, F29, F30.10, F30.11, F30.12, F30.13, F30.2, F30.3, F30.4, F30.8, F30.9, F31.0, F31.10, F31.11, F31.12, F31.13, F31.2, F31.30, F31.31, F31.32, F31.4, F31.5, F31.60, F31.61, F31.62, F31.63, F31.64, F31.70, F31.71, F31.72, F31.73, F31.74, F31.75, F31.76, F31.77, F31.78, F31.81, F31.89, F31.9, F32.0, F32.1, F32.2, F32.3, F32.4, F32.5, F32.81, F32.89, F32.9, F32.A, F33.0, F33.1, F33.2, F33.3, F33.40, F33.41, F33.42, F33.8, F33.9, F34.0, F34.1, F34.81, F34.89, F34.9, F39, F40.00, F40.01, F40.02, F40.10, F40.11, F40.210, F40.218, F40.220, F40.228, F40.230, F40.231, F40.232, F40.233, F40.240, F40.241, F40.242, F40.243, F40.248, F40.290, F40.291, F40.298, F40.8, F40.9, F41.0, F41.1, F41.3, F41.8, F41.9, F42.2, F42.3, F42.4, F42.8, F42.9, F43.0, F43.10, F43.11, F43.12, F43.20, F43.21, F43.22, F43.23, F43.24, F43.25, F43.29, F43.81, F43.89, F43.9, F44.0, F44.1, F44.2, F44.4, F44.5, F44.6, F44.7, F44.81, F44.89, F44.9, F45.0, F45.1, F45.20, F45.21, F45.22, F45.29, F45.41, F45.42, F45.8, F45.9, F48.1, F48.2, F48.8, F48.9, F50.00, F50.01, F50.02, F50.2, F50.81, F50.82, F50.89, F50.9, F51.01, F51.02, F51.03, F51.04, F51.05, F51.09, F51.11, F51.12, F51.13, F51.19, F51.3, F51.4, F51.5, F51.8, F51.9, F52.0, F52.1, F52.21, F52.22, F52.31, F52.32, F52.4, F52.5, F52.6, F52.8, F52.9, F53.0, F53.1, F59, F60.0, F60.1, F60.2, F60.3, F60.4, F60.5, F60.6, F60.7, F60.81, F60.89, F60.9, F63.0, F63.1, F63.2, F63.3, F63.81, F63.89, F63.9, F64.0, F64.1, F64.2, F64.8, F64.9, F65.0, F65.1, F65.2, F65.3, F65.4, F65.50, F65.51, F65.52, F65.81, F65.89, F65.9, F66, F68.10, F68.11, F68.12, F68.13, F68.8, F68.A, F69, F80.0, F80.1, F80.2, F80.4, F80.81, F80.82, F80.89, F80.9, F81.0, F81.2, F81.81, F81.89, F81.9, F82, F84.0, F84.2, F84.3, F84.5, F84.8, F84.9, F88, F89, F90.0, F90.1, F90.2, F90.8, F90.9, F91.0, F91.1, F91.2, F91.3, F91.8, F91.9, F93.0, F93.8, F93.9, F94.0, F94.1, F94.2, F94.8, F94.9, F95.0, F95.1, F95.2, F95.8, F95.9, F98.0, F98.1, F98.21, F98.29, F98.3, F98.4, F98.5, F98.8, F98.9, F99