Product Lines:
EHP, Priority Partners, and USFHP.

Measurement Period: January 1 - December 31
 
Description:
The percentage of persons 1–17 years of age who had a new prescription for an antipsychotic medication and had documentation of psychosocial care as first-line treatment.

Stratifications:
Age as of the last day of the measurement period.

• 1–11 years.
• 12–17 years.

Improvement Notation:
Increased score indicates improvement.

Data Collection:

• Administrative.

Initial Population:

• Measure Item Count: Person.
• Age: 1–17 years of age as of the last day of the measurement period.
• Benefits: Medical, mental health, pharmacy.
• Continuous Enrollment: 120 days prior to the IPSD through 30 days after the IPSD.
• Allowable Gap: None.

Definition:

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

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.

Denominator:
Persons with a new prescription for antipsychotics.
Persons who were dispensed an antipsychotic medication during the intake period.

Numerator:
Persons who received psychosocial care or residential behavioral health treatment.
Persons who received psychosocial care or residential behavioral health treatment in the 121-day period from 90 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 Carelon Behavioral Health of 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 Mental Health: 410-424-4839
      Email: [email protected]
• Medication regiment adherence is essential for the patient’s treatment.

Measure Exclusions

Denominator Exclusion:

• Persons in hospice or using hospice services any time during the measurement period.
• Persons who died any time during the measurement period.
• Persons 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 period.

Exclusion Codes

Bipolar Disorder

• ICD-10-CM: 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
• SNOMED CT US Edition: 162004, 1499003, 3530005, 4441000, 5703000, 9340000, 10875004, 10981006, 13313007, 13581000, 13746004, 14495005, 16506000, 17782008, 21900002, 22121000, 26203008, 26530004, 28663008, 28884001, 29929003, 30935000, 31446002, 33380008, 35481005, 36583000, 38368003, 40926005, 41552001, 41832009, 41836007, 43769008, 45479006, 46229002, 49468007, 49512000, 51637008, 53049002, 53607008, 54761006, 55516002, 59617007, 61403008, 63249007, 64731001, 65042007, 66631006, 68569003, 70546001, 71984005, 73471000, 74686005, 75360000, 75752004, 78269000, 78640000, 79584002, 82998009, 85248005, 86058007, 87203005, 87950005, 111485001, 191618007, 191620005, 191621009, 191623007, 191627008, 191629006, 191630001, 191636007, 191638008, 191639000, 191641004, 191643001, 192362008, 231444002, 371596008, 371599001, 371600003, 723903001, 765176007, 767631007, 767632000, 767633005, 767635003, 767636002, 1343347009, 261000119107, 271000119101, 23741000119105, 133091000119105, 16238741000119105

Other Psychotic and Developmental Disorders

• ICD-10-CM: F22, F23, F24, F28, F29, F32.3, F33.3, F84.0, F84.2, F84.3, F84.5, F84.8, F84.9, F95.0, F95.1, F95.2, F95.8, F95.9
• SNOMED CT US Edition: 568005, 1973000, 5158005, 5464005, 5510009, 7794004, 8511007, 14144000, 18573003, 20385005, 23560001, 23772009, 26472000, 30491001, 32358001, 32552001, 33323008, 35919005, 38295006, 43614003, 44433009, 47447001, 48500005, 50722006, 50933003, 54502004, 55009008, 56573006, 60123008, 61144001, 61831009, 63649001, 65179007, 68618008, 69322001, 71961003, 73462009, 73867007, 76236006, 77475008, 89601008, 89618007, 129604005, 162313000, 191478006, 191485005, 191667009, 191668004, 191672000, 191689008, 191690004, 191692007, 191693002, 191990001, 230334008, 230335009, 230336005, 230337001, 230338006, 230539002, 231487004, 231536004, 238972008, 238973003, 238974009, 238977002, 238978007, 238979004, 268622001, 278506006, 278508007, 280949006, 371024007, 373618009, 402732001, 402733006, 402734000, 402735004, 403169003, 403170002, 403595006, 408857007, 427975003, 432091002, 442314000, 698951002, 702356009, 702450004, 702732007, 708037001, 712884004, 718393002, 719600006, 722972004, 722973009, 723122006, 723332005, 723899008, 723900003, 723901004, 723913009, 724544000, 724545004, 724673008, 724674002, 724675001, 724706006, 724718002, 724719005, 733623005, 737225007, 762327001, 762509000, 766824003, 770790004, 771448004, 771512003, 783089006, 789053008, 870260008, 870261007, 870262000, 870263005, 870264004, 870265003, 870266002, 870267006, 870268001, 870269009, 870270005, 870280009, 870282001, 870303005, 870304004, 870305003, 870306002, 870307006, 870308001, 1177001000, 1177002007, 1177006005, 1177058004, 1177060002, 1220650006, 1254652005, 1259070005, 251000119105, 281000119103, 21831000119109, 31081000119101, 39951000119105, 434451000124105

Schizophrenia

• ICD-10-CM: F20.0, F20.1, F20.2, F20.3, F20.5, F20.81, F20.89, F20.9, F25.0, F25.1, F25.8, F25.9
• SNOMED CT US Edition: 7025000, 12939007, 14291003, 16990005, 26025008, 26472000, 27387000, 29599000, 30336007, 31658008, 35218008, 35252006, 38295006, 42868002, 58214004, 64905009, 68995007, 70814008, 71103003, 76566000, 79204003, 79866005, 83746006, 85861002, 111482003, 111484002, 191526005, 191527001, 191531007, 191542003, 191547009, 191548004, 191554003, 191555002, 191577003, 247804008, 268617001, 416340002, 441833000, 1204417003, 1335862003

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
• SNOMED CT US Edition:166001, 1555005, 2619005, 3518004, 5694008, 6227009, 7133001, 8411005, 9591001, 15142007, 15558000, 15711005, 17447008, 17914007, 18512000, 19997007, 21055002, 22900004, 24172008, 24621000*

Residential Behavioral Health Treatment

• HCPCS: H0017, H0018, H0019, T2048

*Please note that not all SNOMED CT US Edition codes are listed here. For access to the complete set of codes related to APP measure, contact your Provider Engagement Liaison or email [email protected].

Measure Medications

Antipsychotic Medications

• Aripiprazole
• Aripiprazole lauroxil
• Asenapine
• Brexpiprazole
• Cariprazine
• Chlorpromazine
• Clozapine
• Fluphenazine
• Haloperidol
• Iloperidone
• Loxapine
• Lurasidone
• Molindone
• Olanzapine
• Paliperidone
• Perphenazine
• Pimozide
• Quetiapine
• Risperidone
• Thioridazine
• Thiothixene
• Trifluoperazine
• Ziprasidone

Antipsychotic Combination Medications

• Amitriptyline-Perphenazine
• Fluoxetine-olanzapine