Use of Multiple Concurrent Antipsychotics in Children & Adolescents: Ages 1-17

About This Measure

This measure reports state performance on the percentage of children and adolescents ages 1 to 17 who were treated with antipsychotic medications and who were prescribed two or more concurrent antipsychotic medications for at least 90 consecutive days during the measurement year. Lower rates are better.

The data presented below are taken from the Child 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.

Concurrent use of multiple, antipsychotic medications in children and adolescents has increased over time. Concerns about use of these medications in children have grown due to questions about appropriate use, medication management, and side effects.

This measure addresses concerns about the appropriateness and safety of prescribing multiple antipsychotic medications concurrently for at least 90 days. CMS publicly reported states’ performance on this measure for the first time for FFY 2016.

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

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Stem plot with a median of 3% and the states and values:

State Percent
Alabama* 4%
Arkansas 1%
California 4%
Colorado 6%
Connecticut 3%
Dist. Of Col. 1%
Delaware 3%
Florida* 2%
Georgia 3%
Iowa* 3%
Kansas 5%
Louisiana 2%
Massachusetts 2%
Maine 2%
Minnesota 0%
North Carolina* 5%
Nebraska 6%
New Hampshire* 3%
New Mexico 5%
Nevada* 1%
New York 3%
Oklahoma 14%
Pennsylvania* 2%
Rhode Island 2%
South Carolina 2%
Tennessee* 3%
Texas* 2%
Utah* 6%
Virginia 3%
Vermont 4%
West Virginia** 39%
Wyoming* 6%

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

Notes:

* Indicates that the rate is for the state's Medicaid population only.

** Indicates that the rate is for the state's CHIP population only.

States with no asterisk indicates a rate for the state’s combined Medicaid and CHIP populations.

The following states did not report data to CMS for this measure: AK, AZ, HI, ID, IL, IN, KY, MD, MI, MO, MS, MT, ND, NJ, OH, OR, SD, WA, and WI.

MN reported a value of 0.3% for this measure.

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 Child Core Set specifications, based on Agency for Healthcare Research and Quality - CMS Children's Health Insurance Program Reauthorization Act National Collaborative for Innovation in Quality Measurement 2016 specifications.

The measurement period for this measure was January 1, 2015 to October 1, 2015. MN, NM, and WY (CHIP) reported data for calendar year 2015.

The Child 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 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: Medicaid rate includes Medicaid FFS and PCCM populations. Denominator excludes children enrolled in separate CHIP.

AR: Rate includes FFS and PCCM populations.

CA: Rate includes FFS and managed care populations (26 MCOs). Rate is provisional due to changes in the Medicaid program and data systems during this period.

CO: Rate includes FFS, PCCM, and managed care populations (7 MCOs). Rate was calculated by the state's EQRO.

CT: Rate includes FFS population.

DE: Rate includes managed care population (2 MCOs), representing 94 percent of the population. Rate excludes FFS population, representing 6 percent of the population.

DC: Rate includes managed care population (4 MCOs), representing 96 percent of the population. Rate excludes FFS population, representing 4 percent of the population.

FL: Rate includes managed care population (17 MCOs), representing 92 percent of the population. Rate excludes FFS and PCCM populations, representing less than 10 percent of the population.

GA: Rate includes FFS and managed care populations (4 MCOs).

IA: Medicaid rate includes FFS, PCCM, and managed care populations (1 MCO). Rate includes paid claims only.

KS: Rate includes managed care population (3 MCOs). Rate was calculated by MCOs and compiled by EQRO and state staff.

LA: Rate includes FFS and managed care populations (5 MCOs).

ME: Rate includes FFS population.

MA: Rate includes PCCM and managed care populations (5 MCOs). Rate excludes FFS population (representing 20 percent of the population), but the majority of these children would not have been measure-eligible, including children who have other primary insurance, children with limited Medicaid benefits, children in premium assistance programs, new enrollees who have not yet enrolled in an MCO, and children in state custody.

MN: Rate includes FFS and managed care populations (8 MCOs). Rate includes paid claims only.

NE: Rate includes FFS and managed care populations (1 MCO).

NV: Medicaid rate includes managed care population (2 MCOs), representing 75 percent of the population. Rate excludes FFS population, representing 25 percent of the population. Rate was calculated by the state's EQRO.

NH: Rate includes managed care population (2 MCOs), representing 90 percent of the population. Rate excludes FFS population, representing 10 percent of the population.

NM: Rate includes managed care population (3 MCOs), representing 75 percent of the population. Rate excludes FFS population (representing 8 percent of the population) as well as enrollees from one MCO that did not report the measure for FFY 2016 (representing 17 percent of the population).

NY: Rate includes managed care population (19 MCOs), representing 89 percent of the Medicaid population and all CHIP children. Rate excludes FFS population, representing 11 percent of the Medicaid population.

NC: Rate includes FFS and PCCM populations.

OK: Rate includes FFS and PCCM populations. Rate excludes enrollees in home- and community-based services waivers, representing less than 1 percent of the 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.

PA: Rate includes the Medicaid managed care population (9 MCOs). Data were submitted by MCOs and compiled by the state's EQRO.

RI: Rate includes managed care population (2 MCOs), representing 98 percent of the population. Rate excludes FFS population, representing less than 2 percent of the population.

SC: Rate includes FFS and managed care populations (6 MCOs).

TN: Medicaid rate includes Medicaid managed care population (4 MCOs). Rate was calculated by the state's EQRO.

TX: Medicaid rate includes FFS and managed care populations (25 MCOs). Rate was calculated by the state's EQRO.

UT: Medicaid rate includes managed care population (4 MCOs), representing 86 percent of the population. Rate excludes FFS population, representing 14 percent of the population. Data source is audited HEDIS data for each MCO.

VT: Rate includes FFS population. Rate was calculated by the state's EQRO and data analytics contractor.

VA: Rate includes managed care population (6 MCOs), representing 94 percent of the population. Rate excludes FFS population, representing 6 percent of the population. State obtained rates reported by the MCOs to Quality Compass and denominator is not available.

WV: Rate includes the CHIP FFS population. State implemented a new pre-authorization system for all antipsychotic prescriptions during calendar year 2016 and therefore anticipates performance improvement in future reporting years. Rate was calculated by the state's data analytics contractor.

WY: Medicaid rate includes FFS population.