Claims data/encounter Diabetes Care for People with Serious 2607 data Mental Illness: Hemoglobin A1c (HbA1c) Poor Control (>9.0%) Claims data/encounter Metabolic Monitoring for Children and No data Adolescents on Antipsychotics Claims data/encounter Cardiovascular health screening for 1927 data people with schizophrenia or bipolar disorder who are prescribed antipsychotic medications Claims data/encounter Cardiovascular health monitoring for 1933 data people with cardiovascular disease and schizophrenia Claims data/encounter Adherence to Mood Stabilizers for 1880 data Individuals with Bipolar I Disorder Claims data/encounter Adherence to Antipsychotic Medications No data for Individuals with Schizophrenia (see Medicaid Adult Core Set) Claims data/encounter Follow-Up After Hospitalization for 0576 data Mental Illness, ages 21+ (adult) (see Medicaid Adult Core Set) Claims data/encounter Follow-Up After Hospitalization for 0576 data Mental Illness, ages 6 to 21 (child/adolescent) (see Medicaid Child Core Set) Claims data/encounter Follow-up care for children prescribed 0108 data ADHD medication (see Medicaid Child Core Set) Claims data/encounter Antidepressant Medication 0105 data Management (see Medicaid Adult Core Set) Table 3. Quality Bonus Payment Medicaid Adult and Core Set Measures For the state to make QBP, the CCBHC must demonstrate that it has achieved all of the required quality measures shown in Table 3. The state can make QBP using the additional measures provided in this guidance, but only after the certified clinic has met performance goals for the required set of measures. States may propose quality measures for QBP; however, CMS approval is required. The QBP measures included in this guidance are derived primarily from the Medicaid adult and child core set measures. In applying to participate in this demonstration the state must demonstrate how it plans to implement QBP if it plans to make such payments. QBP Required Included Measure Measure Eligible QBP in Table 1 Steward2 Measures Measures or 2 above Follow-Up After Hospitalization FUH-AD for Mental Illness (adult age NCQA/HEDIS Yes Yes Yes groups) Follow-Up After Hospitalization FUH-CH for Mental Illness NCQA/HEDIS Yes Yes Yes (child/adolescents)
Claims data/encounter data Diabetes Care for People with Serious Mental Illness: Hemoglobin A1c (HbA1c) Poor Control (>9.0%) 2607 Claims data/encounter data Metabolic Monitoring for Children and Adolescents on Antipsychotics No Claims data/encounter data Cardiovascular health screening for people with schizophrenia or bipolar disorder who are prescribed antipsychotic medications 1927 Claims data/encounter data Cardiovascular health monitoring for people with cardiovascular disease and schizophrenia 1933 Claims data/encounter data Adherence to Mood Stabilizers for Individuals with Bipolar I Disorder 1880 Claims data/encounter data Adherence to Antipsychotic Medications for Individuals with Schizophrenia (see Medicaid Adult Core Set) No Claims data/encounter data Follow-Up After Hospitalization for Mental Illness, ages 21+ (adult) (see Medicaid Adult Core Set) 0576 Claims data/encounter data Follow-Up After Hospitalization for Mental Illness, ages 6 to 21 (child/adolescent) (see Medicaid Child Core Set) 0576 Claims data/encounter data Follow-up care for children prescribed ADHD medication (see Medicaid Child Core Set) 0108 Claims data/encounter data Antidepressant Medication Management (see Medicaid Adult Core Set) 0105 Table 3. Quality Bonus Payment Medicaid Adult and Core Set Measures For the state to make QBP, the CCBHC must demonstrate that it has achieved all of the required quality measures shown in Table 3. The state can make QBP using the additional measures provided in this guidance, but only after the certified clinic has met performance goals for the required set of measures. States may propose quality measures for QBP; however, CMS approval is required. The QBP measures included in this guidance are derived primarily from the Medicaid adult and child core set measures. In applying to participate in this demonstration the state must demonstrate how it plans to implement QBP if it plans to make such payments. Measure Measure Steward2 QBP Eligible Measures Required QBP Measures Included in Table 1 or 2 above FUH-AD Follow-Up After Hospitalization for Mental Illness (adult age groups) NCQA/HEDIS Yes Yes Yes FUH-CH Follow-Up After Hospitalization for Mental Illness (child/adolescents) NCQA/HEDIS Yes Yes Yes
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