Alcohol and Drug Misuse: Screening, Brief Intervention and ... - Oregon

CCO Incentive Measure Specification Changes

Between 2020 and 2021

This document summarizes changes between the 2020 and 2021 specifications for the CCO incentive measures. Specifications are posted online .

Please contact us at metrics.questions@dhsoha.state.or.us with any questions.

Alcohol and Drug Misuse: Screening, Brief Intervention and Referral to

Treatment (SBIRT)

? For the Rate 1 denominator, SBIRT uses the same eligible encounters as CMS2v10, depression screening and follow-up. The CMS2v10 denominator criteria have changed as follows: o New data element was added to allow for Physical Therapy Evaluation as an eligible encounter, per specialty society request. o Value set (2.16.840.1.113883.3.600.1916) was renamed to Encounter to Screen for Depression to align with best practices, based on expert review and/or public feedback.

? For the dementia or mental degenerations exclusions (used in CMS149v8), new codes were added to the value set.

? For the Patient Reason exception, the value set has been replaced to remain consistent with the exception used in CMS2v10.

? For the Medical Reason exception, the value set has been replaced to remain consistent with the exception used in CMS2v10.

Value Set Name and OID

Status

Value set (2.16.840.1.113883.3.600.1916)

Renamed to Encounter to Screen for Depression to align with best practices, based on expert review and/or public feedback.

Value set Encounter to Screen for Depression (2.16.840.1.113883.3.600.1916)

Added 2 CPT codes (96156, 96158) and deleted 2 CPT codes (96150, 96151) based on terminology update. Deleted 1 SNOMED CT code (32537008) based on terminology update.

Value set Physical Therapy Evaluation (2.16.840.1.113883.3.526.3.1022)

Added Physical Therapy Evaluation based on expert review and/or public feedback.

Value set Dementia & Mental Degenerations (2.16.840.1.113883.3.526.3.1005)

Added 46 SNOMED CT codes.

SNOMED CT value set Patient Reason refused (2.16.840.1.113883.3.600.791)

Replaced with grouping value set Patient Declined (2.16.840.1.113883.3.526.3.1582) to align with best practices, based on expert review and/or public feedback.

Updated January 27, 2021

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SNOMED CT value set Medical or Other reason not done (2.16.840.1.113883.3.600.1.1502)

Replaced with grouping value set Medical Reason (2.16.840.1.113883.3.526.3.1007) for harmonization purposes, based on expert review and/or public feedback.

Assessments for Children in DHS Custody

? OHA no longer cites HEDIS Mental Health Diagnosis Value Set for the ICD-10 codes to qualify new patient E&M visits (CPT 99201 ? 99205) for both physical and mental health assessments. OHA will start to review appropriate mental health, abuse, and neglect codes qualifying for the scenario. For MY2020/2021, the included codes remain the same.

Child and Adolescent Well-Care Visits

? HEDIS MY2020/2021 created this new measure which is a combination that replaces the former: o Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life (W34) and o Adolescent Well-Care Visits (AWC) measures. o Additional age range 7-11 is added so the new measure now covers the entire age range 3-21.

? Removed the numerator exclusion for telehealth. OHA decided in May 2020 to deviate from this HEDIS 2020 exclusion and continues to count telehealth like previous years due to the COVID-19 pandemic emergency. This reversal of telehealth exclusion in HEDIS MY2020/2021 specifications means OHA's method is back in alignment with HEDIS.

? Removed the hybrid data collection method, as well as the restriction that only commercial plans can use administrative-only method.

? Updated the Well-Care Value Set for HCPCS, ICD10 and SNOMED codes. ? OHA clarifies inpatient and ED claims are not used for identifying well-care visits.

Childhood Immunization Status

? HEDIS MY2020/2021 added a requirement that LAIV (influenza) vaccination must occur on the child's second birthday. This does not affect OHA since the Combo 2 rate does not include influenza.

? HEDIS MY2020/2021 updated CPT codes DTaP Vaccine Procedure Value Set and Haemophilus Influenzae Type B (HiB) Vaccine Procedure Value Set. This does not affect OHA since only ALERT data with CVX codes are used.

Cigarette Smoking Prevalence

? For use of CMS 138v9 to identify the Rate 1 denominator, added clarification that these smoking prevalence specifications borrow the value sets for qualifying visits, but do not include the CMS138v9 requirement on number if visits. In other words, a CCO member is in the Rate 1 denominator based on any qualifying visit; this measure does not require two or more office visits.

Updated January 27, 2021

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? For CMS138v9, the following changes have been made in value sets for encounter types:

Value Set Name and OID

Status

Value set Physical Therapy Evaluation (2.16.840.1.113883.3.526.3.1022) Value set Health & Behavioral Assessment Individual (2.16.840.1.113883.3.526.3.1020)

Value set Health and Behavioral Assessment - Initial (2.16.840.1.113883.3.526.3.1245)

Value set Health and Behavioral Assessment, Reassessment (2.16.840.1.113883.3.526.3.1529)

Added Physical Therapy Evaluation based on expert review and/or public feedback.

Replaced with direct reference code CPT code (96156) to align with best practices for replacing single code value sets with direct reference codes.

Replaced with direct reference code CPT code (96158) to align with best practices for replacing single code value sets with direct reference codes.

Replaced with direct reference code CPT code (96156) to align with best practices for replacing single code value sets with direct reference codes.

Depression Screening

See Technical Release Notes for a complete list of changes: . Changes include:

? Removed suicide risk assessment and additional evaluation or assessment for depression as appropriate follow-up options to meet the numerator based on subject matter expert input.

? Revised denominator exclusions language based upon subject matter experts' feedback to reflect that any patient with a current or historical diagnosis of bipolar disorder or depression should be excluded from the measure. o Guidance section of the measure now says: "Patients who have ever been diagnosed with depression or bipolar disorder will be excluded from the measure."

? Revised numerator logic to allow providers to choose the age-appropriate tool to screen a patient who is 17 years old at the start of the measurement period for depression. This means patients seen when they are 17 years old of age can be screened using an adolescent depression screening tool, or patients seen after they turn 18 years of age during the measurement period can be screened using an adult depression screening tool.

? Added new data element to allow for Physical Therapy Evaluation as an eligible encounter, per specialty society request.

? Revised CQL definition construction to reduce the overall complexity of the measure logic without changing the intent and/or application of data element. These revisions were intended to make the definition logic less complex, easier to understand, and more meaningful.

? Revised measure timings to improve alignment with the intent of the measure requirements.

Value Set Name and OID

Status

Value set (2.16.840.1.113883.3.600.1916)

Renamed to Encounter to Screen for Depression to align with best practices, based on expert review and/or public feedback.

Updated January 27, 2021

Page 3 of 9

Value set Encounter to Screen for Depression (2.16.840.1.113883.3.600.1916)

SNOMED CT value set Follow up for depression adolescent (2.16.840.1.113883.3.600.467)

SNOMED CT value set Follow up for depression adult (2.16.840.1.113883.3.600.468)

RxNorm value set Depression medications adolescent (2.16.840.1.113883.3.600.469)

Value set Adolescent Depression Medications (2.16.840.1.113883.3.526.3.1567): RxNorm value set Depression medications - adult (2.16.840.1.113883.3.600.470)

Value set Adult Depression Medications (2.16.840.1.113883.3.526.3.1566) SNOMED CT value set Referral for Depression Adolescent (2.16.840.1.113883.3.600.537)

Value set Referral for Adolescent Depression (2.16.840.1.113883.3.526.3.1570)

SNOMED CT value set Referral for Depression Adult (2.16.840.1.113883.3.600.538)

Value set Referral for Adult Depression (2.16.840.1.113883.3.526.3.1571)

Value set (2.16.840.1.113883.3.600.145

SNOMED CT value set Medical or Other Reason Not Done (2.16.840.1.113883.3.600.1.1502)

Value set Additional evaluation for depression adolescent (2.16.840.1.113883.3.600.1542) Value set Additional evaluation for depression adult (2.16.840.1.113883.3.600.1545) Value set Suicide Risk Assessment (2.16.840.1.113883.3.600.559)

Added 2 CPT codes (96156, 96158) and deleted 2 CPT codes (96150, 96151) based on terminology update. Deleted 1 SNOMED CT code (32537008) based on terminology update.

Replaced with grouping value set Follow Up for Adolescent Depression (2.16.840.1.113883.3.526.3.1569) to align with best practices, based on expert review and/or public feedback.

Replaced with grouping value set Follow Up for Adult Depression (2.16.840.1.113883.3.526.3.1568) to align with best practices, based on expert review and/or public feedback.

Replaced with grouping value set Adolescent Depression Medications (2.16.840.1.113883.3.526.3.1567) to align with best practices, based on expert review and/or public feedback.

Deleted 3 RxNorm codes (199990, 248097, 248098) based on terminology update; codes are no longer prescribable.

Replaced with grouping value set Adult Depression Medications (2.16.840.1.113883.3.526.3.1566) to align with best practices, based on expert review and/or public feedback.

Deleted 3 RxNorm codes (857291, 857296, 857315) based on terminology update; codes are no longer prescribable.

Replaced with grouping value set Referral for Adolescent Depression (2.16.840.1.113883.3.526.3.1570) to align with best practices, based on expert review and/or public feedback.

Deleted 4 SNOMED CT codes (305922005, 401174001, 429387009, 61801003) that do not align with data element intent.

Replaced with grouping value set Referral for Adult Depression (2.16.840.1.113883.3.526.3.1571) to align with best practices, based on expert review and/or public feedback.

Deleted 5 SNOMED CT codes (103696004, 14129001, 401174001, 429387009, 61801003) that do not align with data element intent.

Renamed to Depression Diagnosis to align with best practices, based on expert review and/or public feedback.

Replaced with grouping value set Medical Reason (2.16.840.1.113883.3.526.3.1007) for harmonization purposes, based on expert review and/or public feedback.

Removed Additional evaluation for depression - adolescent based on expert review and/or public feedback.

Removed Additional evaluation for depression - adult based on expert review and/or public feedback.

Removed Suicide Risk Assessment based on expert review and/or public feedback.

Updated January 27, 2021

Page 4 of 9

SNOMED CT value set Negative Depression Screening (2.16.840.1.113883.3.600.2451)

SNOMED CT value set Positive Depression Screening (2.16.840.1.113883.3.600.2450)

Value set Physical Therapy Evaluation (2.16.840.1.113883.3.526.3.1022) SNOMED CT value set Patient Reason refused (2.16.840.1.113883.3.600.791)

Replaced with grouping value set Negative Depression Screening (2.16.840.1.113883.3.526.3.1564) to align with best practices, based on expert review and/or public feedback.

Replaced with grouping value set Positive Depression Screening (2.16.840.1.113883.3.526.3.1565) to align with best practices, based on expert review and/or public feedback.

Added Physical Therapy Evaluation based on expert review and/or public feedback.

Replaced with grouping value set Patient Declined (2.16.840.1.113883.3.526.3.1582) to align with best practices, based on expert review and/or public feedback.

Diabetes: HbA1c Poor Control

See Technical Release Notes for complete list of changes: . Changes include:

? Updated denominator exclusion logic for frailty and clarified that the long-term illness exclusion should be for 90 'consecutive' days to reduce ambiguity.

Value Set name and OID

Value set Diabetes (2.16.840.1.113883.3.464.1003.103.12.1001) Value set Frailty Device (2.16.840.1.113883.3.464.1003.118.12.1300)

Value set Frailty Symptom (2.16.840.1.113883.3.464.1003.113.12.1075) Value set Nursing Facility Visit (2.16.840.1.113883.3.464.1003.101.12.1012)

Value set Acute Inpatient (2.16.840.1.113883.3.464.1003.101.12.1083)

Status

Deleted 3 SNOMED CT codes (314772004, 421164006, 314894004) based on terminology update.

Removed extensional value set Frailty Device (2.16.840.1.113883.3.464.1003.118.11.1114) with HCPCS codes from the grouping and added Frailty Device SNOMED (2.16.840.1.113883.3.464.1003.118.11.1220) with SNOMED CT codes to the grouping to align with recommended terminology.

Deleted 4 SNOMED CT codes (267031002, 272060000, 272062008, 314109004) based on terminology update.

Added 3 CPT codes (99315, 99316, 99318) based on updated evidence in published guidelines, published literature, or from published specialty medical society or group recommendations, to capture additional nursing facility visit encounter types.

Deleted 1 SNOMED CT code (2876009) based on terminology update.

Updated January 27, 2021

Page 5 of 9

Disparity Measure: Emergency Department Utilization for Individuals Experiencing Mental Illness

? HEDIS MY2020/2021 added 38 CPT codes and removed 19 CPT codes for the ED Procedure Code Value Set. Also added 21 ICD10 diagnosis codes for the Mental and Behavioral Disorders Value Set.

Immunization Status for Adolescents

? None.

Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment

? Revised the Intake Period to end on November 14 of the measurement year. ? Clarified the Episode Date when detoxification occurs during an acute inpatient stay. ? Updated the step 3 instructions for ED and observation visits that result in an inpatient stay, to

make them consistent with instructions in the Definitions section. ? Added value sets for opioid treatment services that are billed weekly or monthly to the

denominator and numerators: OUD Monthly Office Based Treatment Visits Value Set, OUD Weekly Drug Treatment Service Value Set, OUD Weekly Non Drug Service Value Set. ? Updated the continuous enrollment period. ? HEDIS updated codes in MY2020/2021 Value Sets: Alcohol Abuse and Dependence Value Set, AOD Abuse and Dependence Value Set, Detoxification Value Set, IET Stand Alone Visits Value Set, IET POS Group 1 Value Set, Online Assessments Value Set, Opioid Abuse and Dependence Value Set, Other Drug Abuse and Dependence Value Set.

Meaningful Language Access to Culturally Responsive Health Care Services

? This is a new measure for 2021, although compared to the draft version approved by Metrics and Scoring Committee in July, 2020, the final specifications are updated in December 2020: o Clarified CCOs are responsible for reporting the measure Component 2 denominator visits with required stratifications, but also introduced a new method using OHG and additional cross-walking and de-duplication methods for OHA to validate the CCOreported denominator visits. Additional detail added in Appendix 4. (Note, OHA no longer uses HEDIS value sets for this measure). o Clarified the incentive measure rate which uses `the total visits from members with interpreter needs' as the denominator, instead of only the visits when interpreter services were provided

Updated January 27, 2021

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Members Receiving Preventive Dental or Oral Health Services

? Per Metrics and Scoring Committee decision on November 20, 2020 and Health Plan Quality Metrics Committee approval on January 26, 2021, the CCO incentive measure is expanded to allow all provider types (dental or non-dental), and the CPT code 99188 (fluoride varnish by nondental providers) is added.

? The revised specifications also follow the DQA method to report three separate rates which allows OHA to continue monitoring services from different provider types, as well as for other OHA programs to choose different areas for incentivizing in the future: o Rate 1: Preventive Dental Services, o Rate 2: Preventive Oral Health Services, o Rate 3: Preventive Dental or Oral Health Services (incentivized for the CCO program starting 2021).

? This new Preventive Dental or Oral Services measure is now detached from the Any Dental Services Utilization measure (which contains other components including Diagnostic and Treatment Services).

Oral Evaluation for Adults with Diabetes

? OHA follows HEDIS MY2020/2021 Comprehensive Diabetes Care (CDC) specification changes in denominator exclusion: o Added telephone visits, e-visits and virtual check-ins to advanced illness exclusion o Added palliative care as a required exclusion

? OHA follows HEDIS MY2020/2021 CDC measure and exclude members age 66 and above enrolled in an Institutional SNP (I-SNP), or living long-term in an institution.

? OHA follows the latest HEDIS MY2020/2021 Comprehensive Diabetes Care (CDC) specifications for the section identifying members with diabetes, which is structured slightly different from DQA's specifications but the logic remains the same. DQA intends to follow HEDIS MY2020/2021 diabetes logic for its next specifications update cycle.

? HEDIS MY2020/2021 Diabetes Exclusions Value Set added ICD10-diagnosis E28.2.

Prenatal & Postpartum Care

? Revised the definition of last enrollment segment.

? Clarified that visits that occur prior to the enrollment start date (during the pregnancy) meet criteria.

? Added telephone visits (Telephone Visits Value Set) e-visits and virtual check-ins (Online Assessments Value Set) to the Timeliness of Prenatal Care rate (administrative specification) and clarified in the Notes that services provided via telephone, e-visit or virtual check-in are eligible for use in reporting both prenatal and postpartum rates.

? Updated the Hybrid specification to indicate that sample size reduction is allowed using only the current year's administrative rate for MY 2020; for MY 2021, organizations may reduce the sample size using the current year's administrative rate or the prior year's audited, product linespecific rate. OHA maintains full sample size of 411 cases per CCO.

Updated January 27, 2021

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? Added examples of "pregnancy diagnosis" in the Hybrid specification of the Timeliness of Prenatal Care indicator.

? OHA clarifies only CCO-paid claims are included in the CCO sample frame.

Incentive Measure Telehealth Eligibility

2020/2021 incentive measures

Alcohol or other substance misuse screening (SBIRT)

Assessments for children in DHS custody

Telehealth-eligible

Denominator

Numerator

Yes, qualifying denominator visits can Yes

be telehealth

N/A (denominator is based only on age, Yes, the measure does not foster care placement and enrollment) restrict the place of service for

the qualifying numerator codes

Cigarette smoking prevalence Child and Adolescent WellCare Visits (age 3-6)

Yes, qualifying denominator visits can be telehealth

N/A (denominator is based only on age and enrollment)

Yes

Yes, well-care visits can be telehealth

Childhood immunization status - Combo 2 Comprehensive diabetes care: HbA1c poor control

Depression screening and follow-up plan Disparity measure: Emergency department utilization among members with mental illness Equity measure: Meaningful language access to culturally responsive health care services

Immunizations for adolescents - Combo 2 Initiation and engagement of alcohol and other drug abuse or dependence treatment

N/A (denominator is based only on age and enrollment) Yes, qualifying denominator visits can be telehealth

Yes, qualifying denominator visits can be telehealth Yes, qualifying denominator visits with MH diagnosis can be telehealth

Yes, all visits from members with interpreter needs are required to be reported in the denominator, regardless of place of service

N/A (denominator is based only on age and enrollment) Yes, qualifying denominator visits with AOD diagnosis can be telehealth

No

Yes, but if a patient uses a selfadministered home test to collect a specimen, the specimen must be sent to a lab or provider's office for analysis. support/browse/CQM4336 Yes

No, numerator ED visits are inperson

Yes, telehealth visits with remote interpreter services can qualify; in-person visits can also utilize remote interpreter services No

Yes, telehealth included for qualifying treatment visits

Updated January 27, 2021

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