Follow-Up After High- Intensity Care for Substance Use Disorder (FUI)

HEDIS Measure

Follow-Up After High- Intensity Care for Substance Use Disorder (FUI)

Line of business: Commercial Medicaid Medicare

Data Collection Method: Administrative (Claims)

Measure Description

The percentage of acute inpatient hospitalizations, residential treatment or detoxification visits for a diagnosis of substance use disorder among members 13 years of age and older that result in a follow-up visit or service for substance use disorder. Two rates are reported:

• The percentage of visits or discharges for which the member received follow-up for substance use disorder within the 30 days after the visit or discharge.
• The percentage of visits or discharges for which the member received follow-up for substance use disorder within the 7 days after the visit or discharge.

Numerator Compliance

30-Day Follow-Up - A follow-up visit or event with any practitioner for a principal diagnosis of substance use disorder within the 30 days after an episode for substance use disorder. Do not include visits that occur on the date of the denominator episode.

7-Day Follow-Up - A follow-up visit or event with any practitioner for a principal diagnosis of substance use disorder within the 7 days after an episode for substance use disorder. Do not include visits that occur on the date of the denominator episode.

For both indicators, any of the following meet criteria for a follow-up visit:

• An acute or non-acute inpatient admission or residential behavioral health stay with a principal diagnosis of substance use disorder on the discharge claim.
• Outpatient, intensive outpatient encounter, observation visit, partial hospitalization, non-residential substance abuse treatment facility, or community mental health center visit with a principal diagnosis of substance use disorder
• Telehealth visit, or substance use disorder service with a principal diagnosis of substance use disorder
• Opioid treatment service that bills monthly or weekly or residential behavioral health treatment with a principal diagnosis of substance use disorder
• Telephone, e-visit or virtual check-in with a principal diagnosis of substance use disorder
• Pharmacotherapy dispensing event or medication treatment event

NOTE: Follow-up does not include detoxification. Exclude all detoxification events when identifying follow-up care for numerator compliance.

Best Practices

• Discuss the importance of timely, recommended follow-up visits
• Use the same diagnosis for substance use at each follow-up
• Coordinate care between behavioral health and primary care physicians
• Share progress notes and updates
• Include the diagnosis for substance use
• Reach out to patients who cancel appointment and assist them with rescheduling as soon as possible
• Consider telemedicine visit when in-person visits are not available
• Use the same diagnosis for AOD abuse or dependence at each follow up (a non-mental illness diagnosis code will not fulfill this measure)
• Schedule follow-up appointments as soon as possible, particularly those patients recently discharged from the ED
• Train patients and staff on the “Teach Back Method” to ensure patients and caregivers review and understand discharge instructions and the next steps in their care for follow-up
• Encourage the patient to bring their discharge paperwork to their first appointment
• Educate the patient about the importance of follow-up and adherence to treatment recommendations
• Outreach patients who cancel appointment and assist them with rescheduling as soon as possible
• Set flags if available in EHR or develop tracking method for patients due or past due for follow-up after discharge visits and require staff to follow-up with patients that miss or cancel their appointment

Quality Value Set Directory Coding Tips

Per NCQA HEDIS Specifications there are additional codes - For additional codes, please email BH_HEDISTeam@HorizonBlue.com

Alcohol Abuse and Dependence

AOD Medication Treatment

BH Outpatient

Community Mental Health Center POS

Inpatient Stay

Non-residential Substance Abuse Treatment Facility POS

Observation

Online Assessments

OUD Monthly Office Based Treatment

OUD Weekly Drug Treatment Service

OUD Weekly Non Drug Service

Outpatient POS

Partial Hospitalization or Intensive Outpatient

Partial Hospitalization POS

Residential Behavioral Health Treatment

Substance Use Disorder Services

Telehealth POS

Telephone Visits

Visit Setting Unspecified