SSD Measure Tip Sheet

Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications 1

Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications (SSD)

SUMMARY OF CHANGES TO HEDIS 2019

 Clarified that schizoaffective disorder is included in the measure in the description and step 1 of the event/diagnosis.

 Incorporated telehealth into the measure specification.

 Restructured the codes and value sets for identifying members with schizophrenia or bipolar disorder (step 1). Refer to the Value Set Directory for a detailed summary of changes.

 Added “Psychotherapeutic combinations” medications to SSD Antipsychotic Medications List and removed the Antipsychotic Combination Medications List.

 Renamed Antipsychotic Medications List to SSD Antipsychotic Medications List.

 Removed “Pimozide” from the prescriptions of miscellaneous antipsychotic agents in the SSD Antipsychotic Medications List.

 Removed “Fluoxetine-olanzapine” from the prescriptions of psychotherapeutic combinations in the SSD Antipsychotic Medications List.

 Removed “Lower 95% confidence interval” and “Upper 95% confidence interval” data elements from the Data Elements for Reporting tables.

Description

The percentage of members 18–64 years of age with schizophrenia, schizoaffective disorder or bipolar disorder, who were dispensed an antipsychotic medication and had a diabetes screening test during the measurement year.

Eligible Population

Note: Members in hospice are excluded from the eligible population. Refer to General Guideline 17: Members in Hospice.

Product lines Medicaid.

Ages 18–64 years as of December 31 of the measurement year.

Continuous enrollment

The measurement year.

Allowable gap No more than one gap in enrollment of up to 45 days during the measurement year. To determine continuous enrollment for a Medicaid beneficiary for whom enrollment is verified monthly, the member may not have more than a 1-month gap in coverage (i.e., a member whose coverage lapses for 2 months [60 days] is not considered continuously enrolled).

Anchor date December 31 of the measurement year.

Benefits Medical and pharmacy.

Event/ diagnosis

Follow the steps below to identify the eligible population.

Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications 2

Step 1 Identify members with schizophrenia or bipolar disorder as those who met at least one of the following criteria during the measurement year.

 At least one acute inpatient encounter, with any diagnosis of schizophrenia, schizoaffective disorder or bipolar disorder. Any of the following code combinations meet criteria:

– BH Stand Alone Acute Inpatient Value Set with (Schizophrenia Value Set; Bipolar Disorder Value Set; Other Bipolar Disorder Value Set).

– Visit Setting Unspecified Value Set with Acute Inpatient POS Value Set with Schizophrenia Value Set; Bipolar Disorder Value Set; Other Bipolar Disorder Value Set.

 At least two of the following, on different dates of service, with or without a telehealth modifier (Telehealth Modifier Value Set) where both encounters have any diagnosis of schizophrenia or schizoaffective disorder (Schizophrenia Value Set) or both encounters have any diagnosis of bipolar disorder (Bipolar Disorder Value Set; Other Bipolar Disorder Value Set).

– An outpatient visit (Visit Setting Unspecified Value Set) with Outpatient POS Value Set.

– An outpatient visit (BH Outpatient Value Set).

– An intensive outpatient encounter or partial hospitalization (Visit Setting Unspecified Value Set with Partial Hospitalization POS Value Set).

– An intensive outpatient encounter or partial hospitalization (Partial Hospitalization/Intensive Outpatient Value Set).

– A community mental health center visit (Visit Setting Unspecified Value Set with Community Mental Health Center POS Value Set).

– Electroconvulsive therapy (Electroconvulsive Therapy Value Set).

– An observation visit (Observation Value Set).

– An ED visit (ED Value Set).

– An ED visit (Visit Setting Unspecified Value Set with ED POS Value Set).

– A nonacute inpatient encounter (BH Stand Alone Nonacute Inpatient Value Set).

– A nonacute inpatient encounter (Visit Setting Unspecified Value Set with Nonacute Inpatient POS Value Set).

– A telehealth visit (Visit Setting Unspecified Value Set with Telehealth POS Value Set).

Step 2: Required

exclusions

Exclude members who met any of the following criteria:

 Members with diabetes. There are two ways to identify members with diabetes: by claim/encounter data and by pharmacy data. The organization must use both methods to identify members with diabetes, but a member need only be identified by one method to be excluded from the measure. Members may be identified as having diabetes during the measurement year or the year prior to the measurement year. – Claim/encounter data. Members who met at any of the following criteria

during the measurement year or the year prior to the measurement year (count services that occur over both years).

Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications 3

 At least one acute inpatient encounter (Acute Inpatient Value Set) with a diagnosis of diabetes (Diabetes Value Set) without (Telehealth Modifier Value Set; Telehealth POS Value Set).

 At least two outpatient visits (Outpatient Value Set), observation visits (Observation Value Set), ED visits (ED Value Set) or nonacute inpatient encounters (Nonacute Inpatient Value Set) on different dates of service, with a diagnosis of diabetes (Diabetes Value Set). Visit type need not be the same for the two encounters.

Only include nonacute inpatient encounters (Nonacute Inpatient Value Set) without telehealth (Telehealth Modifier Value Set; Telehealth POS Value Set).

Only one of the two visits may be a telehealth visit, a telephone visit or an online assessment. Identify telehealth visits by the presence of a telehealth modifier (Telehealth Modifier Value Set) or the presence of a telehealth POS code (Telehealth POS Value Set) associated with the outpatient visit. Use the code combinations below to identify telephone visits and online assessments: – A telephone visit (Telephone Visits Value Set) with any diagnosis of

diabetes (Diabetes Value Set). – An online assessment (Online Assessments Value Set) with any

diagnosis of diabetes (Diabetes Value Set).

– Pharmacy data. Members who were dispensed insulin or oral hypoglycemics/ antihyperglycemics during the measurement year or year prior to the measurement year on an ambulatory basis (Diabetes Medications List).