HEDIS Standards of Care
The Health Plan appreciates all the quality care that is given to our members by the entire network of Behavioral Health Providers. The Plan encourages our providers to continue to provide quality care and to do so within the timely guidelines of the HEDIS standards.
The Health Plan participates in gathering of information on a yearly basis to measure the performance of our network. The standard that The Plan utilizes is called The Healthcare Effectiveness Data and Information Set (HEDIS). HEDIS is one of the most widely used set of health care performance measures in the United States.
The measures look at the effectiveness of care relating to Antidepressant medication administration, Follow up care of children receiving ADHD medication and Follow-Up care after Hospitalization for Mental Illness. Also, access and availability of care following an initial evaluation or visit for alcohol or other drug dependence treatment is evaluated.
The following are the HEDIS standards for care in these situations:
Anti-depressant Medication Management (AMM)- HEDIS measures the percentage of members 18 years of age and older who were diagnosed with a new episode of major depression, treated with antidepressant medication, and who remained on the medication.
- Two rates are reported: First, The Effective Acute Phase which is the percentage of newly diagnosed and treated members who remain on medication for at least 84 days (12 weeks). Second, The Effective Continuation Phase which is the percentage of newly diagnosed and treated members who remain on medication for at least 180 days (6 months).
Follow-Up Care for Children Prescribed ADHD Medication
- This standard of care who are 6 to 12 years of age.
- Children who are receiving a new ADHD medication should have a follow-up visit to the prescribing doctor within 30 days of beginning the medication.
- After the initial follow-up visit, the child should have two subsequent follow-up visits during the next nine (9) months.
Follow-Up After Hospitalization for Mental Illness
- Members who are discharged from an inpatient stay should be seen by a behavioral health provider within seven (7) days of discharge.
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment
- Members who have started treatment through an AOD admission, outpatient visit, intensive outpatient encounter or partial hospitalization should be sent within 14 days of that encounter. (Initiation Visit)
- Members should further have at least two more additional services within 30 days of initiation visit. Services must relate to the AOD diagnosis.