Description: The percentage of discharges for members 6 years of age and older who were hospitalized for treatment of selected mental illness diagnoses and who had an outpatient visit, an intensive outpatient encounter or partial hospitalization with a mental health practitioner. Two rates are reported:

The percentage of discharges for which the member received follow-up within 30 days of discharge.

The percentage of discharges for which the member received follow-up within 7 days of discharge.


Denominator: 


Product lines
Commercial, Medicaid, Medicare (report each product line separately).
Ages
6 years and older as of the date of discharge.
Continuous enrollment
Date of discharge through 30 days after discharge.
Allowable gap
No gaps in enrollment.
Anchor date
None.
Benefits
Medical and mental health (inpatient and outpatient).
Event/ diagnosis
An acute inpatient discharge with a principal diagnosis of mental illness (Mental Illness Value Set) on or between January 1 and December 1 of the measurement year. To identify acute inpatient discharges:
Identify all acute and nonacute inpatient stays (Inpatient Stay Value Set).
Exclude nonacute inpatient stays (Nonacute Inpatient Stay Value Set).
Identify the discharge date for the stay.
The denominator for this measure is based on discharges, not on members. If members have more than one discharge, include all discharges on or between January 1 and December 1 of the measurement year.

Acute readmission or direct transfer

If the discharge is followed by readmission or direct transfer to an acute inpatient care setting for a principal mental health diagnosis (Mental Health Diagnosis Value Set) within the 30-day follow-up period, count only the last discharge. Exclude both the initial discharge and the readmission/direct transfer discharge if the last discharge occurs after December 1 of the measurement year.


 

To identify readmissions to an acute inpatient care setting:
Identify all acute and nonacute inpatient stays (Inpatient Stay Value Set).
Exclude nonacute inpatient stays (Nonacute Inpatient Stay Value Set).
Identify the admission date for the stay.
Organizations must identify “transfers” using their own methods and then confirm the acute inpatient care setting using the steps above.

Exclusions

Exclude discharges followed by readmission or direct transfer to a nonacute inpatient care setting within the 30-day follow-up period, regardless of principal diagnosis for the readmission. To identify readmissions to a nonacute inpatient care setting:
Identify all acute and nonacute inpatient stays (Inpatient Stay Value Set).
Confirm the stay was for nonacute care based on the presence of a nonacute code (Nonacute Inpatient Stay Value Set) on the claim.
Identify the admission date for the stay.
Exclude discharges followed by readmission or direct transfer to an acute inpatient care setting within the 30-day follow-up period if the principal diagnosis was for non-mental health (any principal diagnosis code other than those included in the Mental Health Diagnosis Value Set). To identify readmissions to an acute inpatient care setting:
Identify all acute and nonacute inpatient stays (Inpatient Stay Value Set).
Exclude nonacute inpatient stays (Nonacute Inpatient Stay Value Set).
Identify the admission date for the stay.
Organizations must identify “transfers” using their own methods and then confirm the acute inpatient care setting using the steps above.
These discharges are excluded from the measure because rehospitalization or transfer may prevent an outpatient follow-up visit from taking place.


Numerator:

30-Day
Follow-Up

An outpatient visit, intensive outpatient visit or partial hospitalization with a mental health practitioner within 30 days after discharge. Include outpatient visits, intensive outpatient visits or partial hospitalizations that occur on the date of discharge.

7-Day
Follow-Up

An outpatient visit, intensive outpatient visit or partial hospitalization with a mental health practitioner within 7 days after discharge. Include outpatient visits, intensive outpatient visits or partial hospitalizations that occur on the date of discharge.
For both indicators, any of the following meet criteria for a follow-up visit:
A visit (FUH Stand Alone Visits Value Set) with a mental health practitioner.
A visit (FUH Visits Group 1 Value Set and FUH POS Group 1 Value Set) with a mental health practitioner.
 
A visit (FUH Visits Group 2 Value Set and FUH POS Group 2 Value Set) with a mental health practitioner.
A visit in a behavioral healthcare setting (FUH RevCodes Group 1 Value Set).
A visit in a nonbehavioral healthcare setting (FUH RevCodes Group 2 Value Set) with a mental health practitioner.
A visit in a nonbehavioral healthcare setting (FUH RevCodes Group 2 Value Set) with a diagnosis of mental illness (Mental Illness Value Set).
Transitional care management services (TCM 7 Day Value Set), where the date of service on the claim is 29 days after the eligible population event/diagnosis date of discharge.
The following meets criteria for only the 30-Day Follow-Up indicator:
Transitional care management services (TCM 14 Day Value Set), where the date of service on the claim is 29 days after the event/diagnosis date of discharge.
Note: Transitional care management is a 30-day period that begins on the date of discharge and continues for the next 29 days. The date of service on the claim is 29 days after discharge and not the date of the face-to-face visit.