Follow-Up After Hospitalization for Mental Illness: Age 21 & Older (30-Day Follow-Up)

About This Measure

This measure reports state performance on the percentage of discharges among adults age 21 and older who were hospitalized for treatment of selected mental illness diagnoses and who had an outpatient visit, an intensive outpatient encounter, or partial hospitalization with a mental health provider within 30 days of discharge. Higher rates are better.

The data presented below are taken from the Adult Core Set for Federal Fiscal Year (FFY) 2016. Reporting is currently voluntary and reporting methods can vary by state. For example, some states have access to different data on populations covered under fee-for-service as compared to populations covered under managed care. This variation in data availability can impact measure performance. Readers should review the detailed measure notes located after the graph to better understand states’ reported rates.

Follow-up care after hospitalization for mental illness helps improve health outcomes and prevent readmissions in the days after discharge from inpatient mental health treatment. Recommended post-discharge treatment includes a visit with an outpatient mental health provider within 30 days of discharge and, ideally, within 7 days of discharge. For state performance on post-discharge treatment within seven days, see Follow-Up After Hospitalization for Mental Illness: Age 21 and Older (7-Day Follow-Up).

The red, dashed line represents the median, or middle of all values reported.

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Stem plot with a median of 60% and the states and values:

State Percent
Alabama 85%
Arkansas 56%
California 66%
Colorado 44%
Connecticut 58%
Dist. Of Col. 43%
Delaware 71%
Georgia 55%
Hawaii 49%
Iowa 68%
Illinois 43%
Kentucky 57%
Louisiana 45%
Massachusetts 81%
Minnesota 63%
Missouri 50%
Mississippi 46%
North Carolina 46%
Nebraska 76%
New Jersey 47%
New Mexico 61%
Nevada 67%
New York 56%
Ohio 66%
Oklahoma 37%
Oregon 88%
Pennsylvania 62%
Rhode Island 75%
South Carolina 54%
Tennessee 71%
Texas 48%
Utah 73%
Virginia 62%
Vermont 76%
Washington 78%
West Virginia 51%

Source: Mathematica analysis of MACPro reports for the Adult Core Set FFY 2016 reporting cycle; see 2016 Child and Adult Health Care Quality Measures.

Notes:

The following states did not report data to CMS for this measure: AK, AZ, FL, ID, IN, KS, MD, ME, MI, MT, ND, NH, SD, WI, and WY.

Measure Specific Tables (MSTs) available on Medicaid.gov provide important context for understanding state performance on each measure. MSTs include information about variation in included populations, methods, and data sources used to calculate the measure, as well as deviations from Core Set measure specifications.

Unless otherwise specified:

  • States used Adult Core Set specifications, based on HEDIS 2016 specifications.
  • The measurement period for this measure was January 1, 2015 to December 31, 2015. IA reported data for January 2015 to December 2016; CO reported data for July 2015 to June 2016.
  • Rates displayed reflect state reporting for Medicaid enrollees ages 21 to 64. CT and TX reported results for age 21 and older. DC, HI, KY, MS, NJ, NM, NV, RI, TN, UT, and VA reported results for age 6 and older.

The Adult Core Set specifications include guidance for calculating this measure using the administrative method. Unless otherwise specified, the administrative data source is the state’s Medicaid Management Information System (MMIS) and/or data submitted by managed care plans, including behavioral health plans.

Denominators are assumed to be the measure-eligible population for states using the administrative method. Some states reported exclusions from the denominator, as noted in the state-specific comments below.

State-Specific Comments:

AL: Rates include FFS and PCCM populations who are eligible for full Medicaid benefits. Rates exclude Medicare-Medicaid Dual Eligibles. State attributes rate increases from FFY 2015 to improvements in data sharing with the state Department of Mental Health and correction of coding for the re-admission exclusion.

AR: Rates include PCCM population, representing 99 percent of the population. Rates exclude Medicare-Medicaid Dual Eligibles. To identify visits for the numerator, the state used codes that were tailored to mental health care in the state. In addition, the following provider specialties were considered mental health practitioners: Psychiatry, Geriatric Psychiatry, Psychologist, Clinical Psychologist, Addiction Medicine, Licensed Clinical Social Worker, Neuropsychiatry, and Rehabilitation Agency.

CA: Rates include FFS and managed care populations (26 MCOs). Rates exclude Medicare-Medicaid Dual Eligibles. Some taxonomies from mental health that were not in the state's MMIS were captured from a specialty table. Rates are provisional due to changes in the Medicaid program and data systems during this period.

CO: Rates include behavioral health organization population (5 BHOs), representing 97 percent of the population. Denominator excludes individuals in foster care. Individuals who are readmitted or transferred to the Department of Youth Corrections, Department of Human Services, or similar organizations are included in the denominator but cannot be included in the numerator. Numerators exclude transitional care management follow-up visits. Rates were calculated by the state's EQRO.

CT: Rates include FFS population age 21 and older. Rates exclude Medicare-Medicaid Dual Eligibles.

DE: Rates include managed care population (2 MCOs), representing 85 percent of the population. Rates exclude FFS population, representing 15 percent of the population.

DC: Rates include managed care population (4 MCOs) age 6 and older, representing 77 percent of the population. Rates exclude FFS population, representing 23 percent of the population. The District reported that rate increases from FFY 2015 may be the result of the District requesting that MCOs develop interventions related to these services and implementing a Health Home program for persons with a serious mental illness.

GA: Rates include FFS and managed care populations (4 MCOs). Rates exclude Medicare-Medicaid Dual Eligibles and Planning for Healthy Babies (P4HB) demonstration members per CMS Special Terms and Conditions.

HI: Rates include managed care population (6 MCOs) age 6 and older. Rates were calculated by the state's EQRO.

IL: Rates include FFS, PCCM, and managed care populations (13 MCOs). Rates exclude Medicare-Medicaid Dual Eligibles. State converts Place of Service (POS) codes using a standard conversion to the state's POS codes with specific exceptions to meet the measure specifications. Rates include paid and rejected claims, but exclude pending claims because they are adjudicated in sufficient time to not impact measurement. Rates were audited by the state's EQRO.

IA: Rates include FFS, PCCM, and managed care populations (1 MCO). Rates exclude Medicare-Medicaid Dual Eligibles. Primary diagnosis of mental health diagnosis or mental illness was required for the numerator because provider type was not well-populated in the state's data. Rates include ICD-9 codes that were used in claims after October 1, 2015.

KY: Rates include managed care population (5 MCOs) age 6 and older, representing 81 percent of the population. Rates exclude FFS population, representing 19 percent of the population. Rates were calculated by the state's EQRO and data analytics contractor.

LA: Rates include FFS and managed care populations (5 MCOs). Rates exclude Medicare-Medicaid Dual Eligibles.

MA: Rates include PCCM and managed care populations (6 MCOs), representing 66 percent of the population. Rates exclude FFS population (representing 34 percent of the population), but most FFS beneficiaries would not be eligible for the measure, including beneficiaries who have other insurance (commercial or Medicare), reside in a long-term care institution, or receive limited or temporary Medicaid benefits.

MN: Rates include FFS and managed care populations (8 MCOs). Rates include paid claims only.

MS: Rates include managed care population (2 MCOs) age 6 and older, representing 68 percent of the population. Rates exclude FFS population (representing 32 percent of the population) as well as Medicare-Medicaid Dual Eligibles.

MO: Rates include populations with FFS, managed care (3 MCOs), or both FFS and managed care coverage during the year. Rates exclude Medicare-Medicaid Dual Eligibles.

NE: Rates include FFS and managed care populations (1 MCO).

NV: Rates include managed care population (2 MCOs) age 6 and older. Rates exclude FFS population, representing 33 percent of Medicaid adults and 25 percent of Medicaid children, as well as Medicare-Medicaid Dual Eligibles. Rates were calculated by the state's EQRO.

NJ: Rates include managed care population age 6 and older who receive services from the state's Division of Developmental Disabilities (DDD) or are in Managed Long Term Services and Supports (MLTSS). Rates exclude FFS population (representing 12 percent of the population), Medicare-Medicaid Dual Eligibles, and managed care enrollees who did not receive services from DDD or participate in MLTSS.

NM: Rates include managed care population (4 MCOs) age 6 and older, representing 92 percent of the population. Rates exclude FFS population (representing 8 percent of the population) as well as Medicare-Medicaid Dual Eligibles.

NY: Rates include FFS and managed care populations (51 MCOs). Rates exclude Medicare-Medicaid Dual Eligibles.

NC: Rates include FFS and PCCM populations. Rates exclude Medicare-Medicaid Dual Eligibles.

OH: Rates include FFS and managed care populations (5 MCOs). Rates exclude Medicare-Medicaid Dual Eligibles.

OK: Rates include FFS and PCCM populations. Rates exclude home- and community-based services waiver enrollees, representing 9 percent of the adult Medicaid population. State used a continuous enrollment criterion of any number of allowable gaps up to 45 days in either the measurement year or the year prior.

OR: Rates include managed care population (16 CCOs), representing 77 percent of the population. Rates exclude FFS population, representing 23 percent of the population. Rates include additional procedure codes for follow-up visits (90846, H0006, H2021, T1016). Denominator excludes discharges followed by direct transfer to adult mental health residential services. State attributes performance improvement from previous year to coordinated care efforts by the CCOs in the state.

PA: Rates include enrollees in behavioral health plans (5 MCOs). Data were submitted by MCOs and compiled by the state's EQRO.

RI: Rates include managed care population (2 MCOs) age 6 and older, representing more than 90 percent of the population. Rates exclude FFS population (less than 10 percent of the population) as well as Medicare-Medicaid Dual Eligibles.

SC: Rates include FFS and managed care populations (6 MCOs). Rates exclude Medicare-Medicaid Dual Eligibles.

TN: Rates include managed care population (4 MCOs) age 6 and older. Rates exclude Medicare-Medicaid Dual Eligibles. Rates were calculated by the state's EQRO.

TX: Rates include FFS and managed care populations (25 MCOs) age 21 and older. Rates exclude Medicare-Medicaid Dual Eligibles. Rates were calculated by the state's EQRO.

UT: Rates include managed care population (11 MCOs) age 6 and older. Rates exclude FFS population, representing 26 percent of Medicaid adults and 14 percent of Medicaid children. Data source is audited HEDIS data submitted by the MCOs to the state.

VT: Rates include FFS population. Administrative data sources are MMIS and encounter data from the state Department of Mental Health Monthly Service Report (MSR) database. State developed a crosswalk between the HEDIS technical specifications and the MSR database to create "HEDIS-like" rates that more accurately capture the follow-up visits by beneficiaries. The methodology was reviewed by the state's EQRO.

VA: Rates include managed care population (6 MCOs) age 6 and older, representing 36 percent of the Medicaid population. Rates exclude FFS population (representing 22 percent of the population) as well as Medicaid beneficiaries eligible only for limited benefits, Program of All-Inclusive Care for the Elderly (PACE) enrollees, and Medicare-Medicaid Dual-Eligibles (42 percent of the Medicaid population). State obtained rates from the Quality Compass and denominator is not available.

WA: Rates include FFS and managed care population (5 MCOs). Rates exclude Medicare-Medicaid Dual Eligibles.

WV: Rates include FFS and managed care (4 MCOs) populations. State did not apply exclusions in calculating the measure. Rates include paid claims only. Rates include patients who were of appropriate age at any time during the measurement year. State attributes rate increases to more accurate data collection and to a Medicaid quality improvement project. Rates were calculated by the state's EQRO and data analytics contractor.