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Follow-Up Care for Children Prescribed ADHD Medication (ADD)

What is the ADD – HEDIS® Measure?

Based on current NCQA HEDIS® recommendations for best practices, children who are newly prescribed attention-deficit hyperactivity disorder (ADHD) medications should have at least three follow-up care visits within a 10-month period. The first visit should be completed within 30 days from when the first ADHD medication was dispensed. The two rates reported for this measure are: Initiation Phase (IP) and Continuation and Maintenance (C&M) Phase.

The following will meet HEDIS® compliance:

  • Initiation phase
    • Members 6 – 12 years of age as of the Index Prescription Start Date (IPSD) with a prescription dispensed for ADHD medication who had:
      • One follow-up visit with a practitioner with prescribing authority within 30 days from the date the prescription was filled or IPSD
  • Continuation and maintenance phase
    • Members 6 – 12 years of age as of the IPSD with a prescription dispensed for ADHD medication who had:
      • Remained on the medication for at least 210 days
      • Had at least two follow-up visits with any practitioner within 270 days (9 months) after the IP ended

NCQA HEDIS® Population Definition for This Measure:

Population: Members who are age 6 as of March 1 of the year prior to the measurement year; and 12 years of age as of the last calendar day of February of the measurement year

Line of Business: Commercial, Medicaid

Best Practices

  • Discuss with patients the importance of taking medication as prescribed and remaining on the medication
  • Educate patients on possible side effects and the length of time it will take for the medication to have the desired effect
  • Schedule at least three follow-up appointments within a 10-month period (e.g., 2-week, 6-week, 3- or 6-month appointments) before the patient leaves the office. First visit must be completed within 30 days of IPSD
  • Send appointment reminders to ensure the patient returns
  • Develop tracking method for patients who were prescribed or restarted ADHD medication
  • Require staff to follow up with patients who miss or cancel their appointment
  • When available, use gap lists to help manage total population
  • Consider telemedicine appointments if in-person visits are not available
  • Consider the parent’s work schedule as a barrier to the visit, and offer extended evening or weekend hours

ADHD Medications

  • Clonidine
  • Guanfacine
  • Dextroamphetamine
  • Dexmethylphenidate
  • Lisdexamfetamine
  • Methamphetamine
  • Methylphenidate
  • Atomoxetine

To learn more about your practice’s current HEDIS performance, 2022 HEDIS Value sets for this or other measures, or for assistance in compliance with the HEDIS guidelines, please email BH_HEDISTeam@HorizonBlue.com or visit https://www.horizonblue.com/providers/resources/guidelines/hedis-measurement-year-my-2022-provider-tips-optimizing-hedis-results

Reference: Follow-Up Care for Children Prescribed ADHD Medication, NCQA HEDIS 2022 Tech Specifications