COA - Care for Older Adults

Product Lines:
Advantage MD, Dual Eligible Special Needs Plans (D-SNP).

Eligible Population:
Members 66 years of age and older as of December 31 of the measurement year.

Description:
The percentage of adults 66 years and older who had each of the following during the measurement year:

  • Medication review.  Provider type must be a prescribing practitioner or clinical pharmacist:
  • Functional status assessment.*
  • Pain assessment.*

NOTE:  Above can be documented through Admin Data or Medical record review:

  • *The Functional Status Assessment and Pain Assessment indicators do not require a specific setting. Therefore, services rendered during a telephone visit, e-visit or virtual check-in meet criteria

Continuous Enrollment:

  • The measurement year.

Best Practice and Measure Tips

Medication review:

Either of the following meets criteria:

  • Both of the following during the same visit with the appropriate provider:  
    • At least one medication review (Medication Review Value Set).
    • The presence of a medication list in the medical record (Medication List Value Set). or
    • Transitional care management services during the measurement year.
  • A medication list, signed and dated during the measurement year meets criteria:  The practitioner’s signature is considered evidence that the medications were reviewed. 
  • Review and List of the member’s medications in the medical record: May include medication names only or may include medication names, dosages and frequency, over-the-counter (OTC) medications and herbal or supplemental therapies. 
  • A medication review performed without the member present meets criteria.

Functional status assessment
A complete functional status assessment must include one of the following:

  • Notation that Activities of Daily Living (ADL) were assessed or
  • Notation that at least five of the following were assessed:
    • Bathing, dressing, eating, transferring [e.g., getting in and out of chairs], using toilet, walking.
  • Notation that Instrumental Activities of Daily Living (IADL) were assessed or
  • Notation that at least four of the following were assessed:
    • Shopping for groceries, driving or using public transportation, using the telephone, cooking or meal preparation, housework, home repair, laundry, taking medications, handling finances. •    
  • Documentation in the medical record must include evidence of a complete functional status assessment and the date when it was performed.
  • A functional status assessment limited to an acute or single condition, event or body system (e.g., lower back, leg) does not meet criteria for a comprehensive functional status assessment.
  • The components of the functional status assessment numerator may take place during separate visits within the measurement year.
  • Do not include comprehensive functional status assessments performed in an acute inpatient setting.
  • A set of structured questions that elicit member information may be helpful.   May include person-reported outcome measures, screening or assessment tools or standardized questionnaires. 
  • Result of assessment using a standardized functional status assessment tool, not limited to:
    • SF-36®.
    • Assessment of Living Skills and Resources (ALSAR).
    • Barthel ADL Index Physical Self-Maintenance (ADLS) Scale.
    • Bayer ADL (B-ADL) Scale.
    • Barthel Index.
    • Edmonton Frail Scale.
    • Extended ADL (EADL) Scale.
    • Groningen Frailty Index.
    • Independent Living Scale (ILS).
    • Katz Index of Independence in ADL.
    • Kenny Self-Care Evaluation.
    • Klein-Bell ADL Scale.
    • Kohlman Evaluation of Living Skills (KELS).
    • Lawton & Brody’s IADL scales.
    • Patient Reported Outcome Measurement Information System (PROMIS) Global or Physical Function Scales.

Pain Assessment:

Documentation in the medical record must include evidence of a pain assessment and the date when it was performed.

  • A medication review performed without the member present meets criteria.

Notations for a pain assessment must include one of the following:

  • Documentation that the patient was assessed for pain (which may include positive or negative findings for pain)
  • Result of assessment using a standardized pain assessment tool, not limited to:
    • Numeric rating scales (verbal or written).
    • Face, Legs, Activity, Cry Consolability (FLACC) scale.
    • Verbal descriptor scales (5–7 Word Scales, Present Pain Inventory).
    • Pain Thermometer.
    • Pictorial Pain Scales (Faces Pain Scale, Wong-Baker Pain Scale).
    • Visual analogue scale.
    • Brief Pain Inventory.
    • Chronic Pain Grade.
    • PROMIS Pain Intensity Scale.
    • Pain Assessment in Advanced Dementia (PAINAD) Scale.

Not Acceptable for Pain Assessment: 

  • Do not include pain assessments performed in an acute inpatient setting.
  • Notation alone of a pain management plan does not meet criteria.
  • Notation alone of a pain treatment plan does not meet criteria.
  • Notation alone of screening for chest pain or documentation alone of chest pain does not meet criteria.

Measure Exclusions

Required Exclusion: 

  • Members in hospice or using hospice services anytime during the measurement year.
  • Exclude services provided in an acute inpatient setting.
  • Members who died any time during the measurement year.

Measure Codes

  • Medication review:  
    • CPT: 90863, 99483, 99605, 99606  
    • CPT II: 1160F
  • Medication List:
    • CPT II: 1159F
    • HCPCS: G8427
  • Transitional Care Management Services 
    • CPT: 99495, 99496
  • Functional status assessment    
    • CPT: 99483
    • CPT II: 1170F
    • HCPCS: G0438, G0439
  • Pain assessment
    • CPT II: 1125F, 1126F