Product Lines:
EHP, Priority Partners, and USFHP.

Eligible Population:
Members 1-17 years of age as of December 31 of the measurement year (MY).

Definition:
The percentage of children and adolescents 1–17 years of age who had a new prescription for an antipsychotic medication and had documentation of psychosocial care as first-line treatment.

Report two age stratifications and a total rate:

• 1–11 years.
• 12–17 years.
• Total. The total is the sum of the age stratifications.

Intake period: January 1 through December 1 of the measurement year.

IPSD: Index prescription start date. The earliest prescription dispensing date for an antipsychotic medication where the date is in the intake period and there is a negative medication history.

Negative medication history: A period of 120 days prior to the IPSD when the member had no antipsychotic medications dispensed for either new or refill prescriptions.

New for Measure: Stratification by race and ethnicity.

Continuous Enrollment:

• 120 days prior to the IPSD through 30 days after the IPSD.

Best Practice and Measure Tips

• Residential behavioral health treatment is acceptable.
• Ensure coordinated care such as behavioral interventions, psychological therapies and skills training.
• Assess members for alcohol and drug abuse dependence and refer if necessary.
• Periodically review the ongoing need for continued therapy with antipsychotic medication.
• Assess the need for Case Management and refer if necessary.
  • The Johns Hopkins Health Plans Care Management team offers a variety of services to help members who are living with substance abuse and 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 Optum Maryland to manage mental health needs.
  • Please send us your referrals by contacting us at:
    Phone: 800-557-6916
    Monday through Friday: 8 a.m. to 5 p.m.
    Voicemail messages received after normal business hours will be addressed the following business day.
    EHP Behavioral Health: 410-424-4891
    EHP Behavioral Health-Secured: 410-424-4765
    USFHP Behavioral Health: 410-424-4839
    Email: [email protected]
    Website: https://www.hopkinsmedicine.org/johns-hopkins-health-plans/providers-physicians/division-of-health-services
• Medication regiment adherence is essential for the patient’s treatment.

Measure Exclusions

Required Exclusion:

• Members in hospice or using hospice services anytime during the measurement year.
• Members who died any time during the measurement year.
• Members for whom first-line antipsychotic medications may be clinically appropriate: members with a diagnosis of schizophrenia, schizoaffective disorder, bipolar disorder, other psychotic disorder, autism or other developmental disorder on at least two different dates of service during the measurement year.

Measure Codes

• Psychosocial Care
  • CPT: 90832, 90833, 90834, 90836, 90837, 90838, 90839, 90840, 90845, 90846, 90847, 90849, 90853, 90875, 90876, 90880
  • HCPCS: G0176, G0177, G0409, G0410, G0411, H0004, H0035, H0036, H0037, H0038, H0039, H0040, H2000, H2001, H2011, H2012, H2013, H2014, H2017, H2018, H2019, H2020, S0201, S9480, S9484, S9485
• Residential Behavioral Health Treatment
  • HCPCS: H0017, H0018, H0019, T2048

Measure Medications

Antipsychotic Medications

Antipsychotic Combination Medications