potential. Higher than recommended doses increase the risk of side effects. All Diagnoses 28. Follow-up after emergency % of members 18 years of age Numerator: Those members in the A substantial proportion of young Medicaid Claims & Encounter B room visit or younger with an emergency denominator who received a Medicaid beneficiaries who present Data room visit for mental health or outpatient mental health visit to EDs with deliberate self-harm are Eligibility Files (All diagnoses) substance abuse disorder and/or within 30 days of discharge from the discharged to the community and do Professional File deliberate self-harm who ED not receive emergency mental received a follow-up outpatient health assessments or follow-up mental health within 30 days of Denominator: The number of outpatient mental health care. For discharge from the ED members 18 years of age or younger example, a recent national study who were continuously enrolled found that only 43% of youths during the measurement period and received outpatient care following diagnosed with a mental health or and ED visit for mental health. substance abuse disorder and discharged from the emergency room See Appendix C for CPT codes 29. Follow-up after % of patients hospitalized for Numerator: Those members in the In the United States, inpatient Medicaid Claims & Encounter C hospitalization 30 Days treatment of depressive denominator who had an ambulatory services account for about 33% Files disorder, seen by a mental or other specified type of outpatient ($3.9 billion) of the total mental Inpatient Files (All diagnoses) health provider within 30 days of follow-up within 30 days after health expenditures for children and Eligibility Files discharge discharge from the hospital adolescents; across age groups Professional Files adolescents are the highest users of Denominator: The number of inpatient services. Lack of timely members < 18 who were follow-up care is associated with continuously enrolled and who increased risk for suicide/suicidal received inpatient treatment for a behavior, readmission, and relapse. mental health disorder during the measurement period See Appendix C for CPT codes 30. Treatment engagement % of members of members 18 Numerator: Those members from the Many patients discontinue treatment Medicaid Claims & Encounter C years of age or younger who denominator who had a mental health prematurely, resulting in failure to
potential. Higher than recommended doses increase the risk of side effects. All Diagnoses 28. Follow-up after emergency room visit (All diagnoses) % of members 18 years of age or younger with an emergency room visit for mental health or substance abuse disorder and/or deliberate self-harm who received a follow-up outpatient mental health within 30 days of discharge from the ED Numerator: Those members in the denominator who received a outpatient mental health visit within 30 days of discharge from the ED Denominator: The number of members 18 years of age or younger who were continuously enrolled during the measurement period and diagnosed with a mental health or substance abuse disorder and discharged from the emergency room See Appendix C for CPT codes A substantial proportion of young Medicaid beneficiaries who present to EDs with deliberate self-harm are discharged to the community and do not receive emergency mental health assessments or follow-up outpatient mental health care. For example, a recent national study found that only 43% of youths received outpatient care following and ED visit for mental health. Medicaid Claims & Encounter Data Eligibility Files Professional File B 29. Follow-up after hospitalization 30 Days (All diagnoses) % of patients hospitalized for treatment of depressive disorder, seen by a mental health provider within 30 days of discharge Numerator: Those members in the denominator who had an ambulatory or other specified type of outpatient follow-up within 30 days after discharge from the hospital Denominator: The number of members < 18 who were continuously enrolled and who received inpatient treatment for a mental health disorder during the measurement period See Appendix C for CPT codes In the United States, inpatient services account for about 33% ($3.9 billion) of the total mental health expenditures for children and adolescents; across age groups adolescents are the highest users of inpatient services. Lack of timely follow-up care is associated with increased risk for suicide/suicidal behavior, readmission, and relapse. Medicaid Claims & Encounter Files Inpatient Files Eligibility Files Professional Files C 30. Treatment engagement % of members of members 18 years of age or younger who Numerator: Those members from the denominator who had a mental health Many patients discontinue treatment prematurely, resulting in failure to Medicaid Claims & Encounter C
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