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Physical and Mental Health Integration: Quality Measures

The Medicaid Innovation Accelerator Program’s (IAP) Physical and Mental Health Integration area worked with states to support integrated care approaches that have been shown to improve health outcomes for individuals with behavioral health conditions. Effective integrated care can also enhance patient engagement and activation, which has been shown to be associated with increased treatment adherence, improved patient satisfaction, better quality of life, and increased mental and physical health.

The Centers for Medicare & Medicaid Services (CMS) has contracted with Mathematica Policy Research and its partners, Brandeis University and the National Committee for Quality Assurance, to develop two measures for IAP:

  1. Follow-up care for adult Medicaid beneficiaries who are newly prescribed an antipsychotic medication.
  2. All-cause emergency department utilization rate for Medicaid beneficiaries who may benefit from integrated physical and behavioral health care.

Follow-up care for adult Medicaid beneficiaries who are newly prescribed an antipsychotic medication (NQF 3313): Percentage of new antipsychotic prescriptions for Medicaid beneficiaries age 18 years and older who have completed a follow-up visit with a provider with prescribing authority within four weeks (28 days) of prescription of an antipsychotic medication.

All-cause emergency department utilization rate for Medicaid beneficiaries who may benefit from integrated physical and behavioral health care: All-cause emergency department (ED) utilization rate for non-dual Medicaid beneficiaries age 18 and older who meet any of four population eligibility criteria:

  • Beneficiaries with co-occurring physical health and mental health conditions
  • Beneficiaries with a co-occurring physical health condition and a substance use disorder (SUD)
  • Beneficiaries with a co-occurring mental health condition and a SUD
  • Beneficiaries with serious mental illness
  • Technical Specifications and Resource Manual (PDF, 267.54 KB)
  • Value Set (XLSX, 8.17 MB)

Measure Dissemination Webinar

Webinar on New Quality Measures for Medicaid Beneficiaries with Integrated Care Needs (PDF, 812.54 KB)