Behavioral Health
Behavioral Health Resources
Below are documents you will find helpful when working with on ADHD and depression issues with patients.
- ADHD and Depression Toolkit Introduction Letter (PDF)
- Behavioral Health & Wellness Brochure (PDF)
- Talking to Friends & Family Brochure (PDF)
- Suicide Prevention Brochure (PDF)
ADHD
Depression
BH News
The Measurement Year (MY) 2025 changes to the behavioral health measures include:
- Antidepressant Medication Management (Retired)
- Follow-Up Care for Children Prescribed ADHD Medication
- Follow-Up After Hospitalization for Mental Illness
- Follow-Up After Emergency Department Visit for Mental Illness
- Social Need Screening and Intervention
Antidepressant Medication Management (AMM)
Commercial, Medicaid, Medicare, and Marketplace Ages 18+
- The AMM measure has been fully retired, reflecting NCQA's shift towards other aspects of mental health.
Follow-Up Care for Children Prescribed ADHD Medication (ADD-E)
Medicaid Ages 6-12
The percentage of children newly prescribed attention-deficit/hyperactivity disorder (ADHD) medication who had at least three follow-up care visits within a 300-day (10-month) period, one of which was within 30 days of when the first ADHD medication was dispensed. Two rates are reported.
- Initiation Phase. The percentage of members 6–12 years of age with a prescription dispensed for ADHD medication, who had one follow-up visit with a practitioner with prescribing authority during the 30-day Initiation Phase.
- Continuation and Maintenance (C&M) Phase. The percentage of members 6–12 years of age with a prescription dispensed for ADHD medication, who remained on the medication for at least 210 days and who, in addition to the visit in the Initiation Phase, had at least two follow-up visits with a practitioner within 270 days (9 months) after the Initiation Phase ended.
Key Changes to ADD-E:
- Added ADHD medications: dexmethylphenidate-serdexmethylphenidate and viloxazine (potential to increase the denominator).
- Clarified the age criteria (members 6 years of age as of the start of the intake period to 12 years of age as of the end of the intake period)
Follow-Up After Hospitalization for Mental Illness (FUH)
Commercial, Medicaid, Medicare, and Marketplace Ages 6+
The percentage of discharges received between January 1 - December 1, for members 6 years of age and older who were hospitalized for a principal diagnosis of mental illness, or any diagnosis of intentional self-harm and had a mental health follow up service. Two rates are reported:
- The percentage of discharges for which the member received follow-up within 30 days after discharge.
- The percentage of discharges for which the member received follow-up within 7 days after discharge.
Key Changes to FUH:
- Modified the denominator criteria to allow intentional self-harm diagnoses to take any position on the acute inpatient discharge claim (potential to increase the denominator).
- Added new diagnoses including phobia, anxiety, intentional self-harm X-chapter codes, and the R45.851 suicidal ideation code to the denominator in the event/diagnosis (potential to increase the denominator).
- Added more provider type visits (i.e., PCP) with any diagnosis of a mental health disorder to meet the mental health follow-up numerator (potential to increase the numerator).
- Added peer support and residential treatment services to the numerator (potential to increase the numerator).
Follow-Up After Emergency Department Visit for Mental Illness (FUM)
Commercial, Medicaid, Medicare Ages 6+
The percentage of emergency department (ED) visits between January 1 – December 1, for members 6 years of age and older with a principal diagnosis of mental illness, or any diagnosis of intentional self-harm, and had a mental health follow-up service. Two rates are reported:
- The percentage of ED visits for which the member received follow-up within 30 days of the ED visit (31 total days).
- The percentage of ED visits for which the member received follow-up within 7 days of the ED visit (8 total days).
Key Changes to FUM:
- Modified the denominator criteria to allow intentional self-harm diagnoses to take any position on the claim (potential to increase the denominator).
- Added new diagnoses including phobia, anxiety, intentional self-harm X-chapter codes, and the R45.851 suicidal ideation code to the denominator in the event/diagnosis (potential to increase the denominator).
- Modified the numerator criteria to allow a mental health diagnosis to take any position on the claim (potential to increase the numerator).
- Added peer support and residential treatment services to the numerator (potential to increase the numerator).
- Added visits in a behavioral healthcare setting and psychiatric collaborative care management services to the numerator(potential to increase the numerator).
- Deleted the mental health diagnosis requirement for partial hospitalization/ intensive outpatient visits, community mental health center visits and electroconvulsive therapy (potential to increase the numerator).
Social Need Screening and Intervention (SNS-E)
Commercial, Medicaid, Medicare, and Marketplace
The percentage of members who were screened, using prespecified instruments, at least once during the measurement period for unmet food, housing, and transportation needs, and received a corresponding intervention if they screened positive.
- Food Screening. The percentage of members who were screened for food insecurity.
- Food Intervention. The percentage of members who received a corresponding intervention within 1 month of screening positive for food insecurity.
- Housing Screening. The percentage of members who were screened for housing instability, homelessness, or housing inadequacy.
- Housing Intervention. The percentage of members who received a corresponding intervention within 1 month of screening positive for housing instability, homelessness, or housing inadequacy.
- Transportation Screening. The percentage of members who were screened for transportation insecurity.
- Transportation Intervention. The percentage of members who received a corresponding intervention within 1 month of screening positive for transportation insecurity.
Key Changes to SNS-E:
- Updated the description of the intervention categories to include any of the following categories: adjustment, assistance, coordination, counseling, education, evaluation of eligibility, evaluation/assessment, provision, or referral (potential to increase the numerator).
The Measurement Year (MY) 2025 changes to the behavioral health follow-up measures include updates to the Follow-Up After Hospitalization for Mental Illness and Follow-Up After Emergency Department Visit for Mental Illness to expand criteria for diagnoses considered and types of mental health follow-up care that qualify. Efforts have been made to align the follow-up measures, allowing for a more consistent approach to evaluating follow-up care across different care settings.
Follow-Up After Hospitalization for Mental Illness (FUH)
Commercial, Medicaid, Medicare, and Marketplace Ages 6+
The percentage of discharges received between January 1 - December 1, for members 6 years of age and older who were hospitalized for a principal diagnosis of mental illness, or any diagnosis of intentional self-harm and had a mental health follow up service. Two rates are reported:
- The percentage of discharges for which the member received follow-up within 30 days after discharge.
- The percentage of discharges for which the member received follow-up within 7 days after discharge.
Key Changes to FUH:
- Modified the denominator criteria to allow intentional self-harm diagnoses to take any position on the acute inpatient discharge claim (potential to increase the denominator).
- Added new diagnoses including phobia, anxiety, intentional self-harm X-chapter codes, and the R45.851 suicidal ideation code to the denominator in the event/diagnosis (potential to increase the denominator).
- Added more provider type visits (i.e., PCP) with any diagnosis of a mental health disorder to meet the mental health follow-up numerator (potential to increase the numerator).
- Added peer support and residential treatment services to the numerator (potential to increase the numerator).
Follow-Up After Emergency Department Visit for Mental Illness (FUM)
Commercial, Medicaid, Medicare Ages 6+
The percentage of emergency department (ED) visits between January 1 – December 1, for members 6 years of age and older with a principal diagnosis of mental illness, or any diagnosis of intentional self-harm, and had a mental health follow-up service. Two rates are reported:
- The percentage of ED visits for which the member received follow-up within 30 days of the ED visit (31 total days).
- The percentage of ED visits for which the member received follow-up within 7 days of the ED visit (8 total days).
Key Changes to FUM:
- Modified the denominator criteria to allow intentional self-harm diagnoses to take any position on the claim (potential to increase the denominator).
- Added new diagnoses including phobia, anxiety, intentional self-harm X-chapter codes, and the R45.851 suicidal ideation code to the denominator in the event/diagnosis (potential to increase the denominator).
- Modified the numerator criteria to allow a mental health diagnosis to take any position on the claim (potential to increase the numerator).
- Added peer support and residential treatment services to the numerator (potential to increase the numerator).
- Added visits in a behavioral healthcare setting and psychiatric collaborative care management services to the numerator(potential to increase the numerator).
- Deleted the mental health diagnosis requirement for partial hospitalization/ intensive outpatient visits, community mental health center visits and electroconvulsive therapy (potential to increase the numerator).
Follow-Up After Emergency Department Visit for Substance Use (FUA)- No Key Changes
Commercial, Medicaid, Medicare Ages 13+
The percentage of emergency department (ED) visits between January 1 - December 1, among members aged 13 years and older with a principal diagnosis of substance use disorder (SUD), or any diagnosis of drug overdose, for which there was follow-up. Two rates are reported:
- The percentage of ED visits for which the member received follow-up within 30 days of the ED visit (31 total days).
- The percentage of ED visits for which the member received follow-up within 7 days of the ED visit (8 total days).
Follow-Up After High-Intensity Care for Substance Use Disorder (FUI)- No Key Changes
Commercial, Medicaid, Medicare Ages 13+
The percentage of acute inpatient hospitalizations, residential treatment, or withdrawal management visits for a diagnosis of substance use disorder between January 1 – December 1, 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.
Tips for Providers:
- Offer in-person, virtual, telehealth and phone visits when applicable.
- Include the patient and caregivers in decision making.
- Schedule follow-up appointments to meet the 7- and 30-day requirements.
- Address social drivers of health, determinants, health equity, and quality care.
- Coordinate care between physical and behavioral health providers to address any comorbidity.
- Offer psychoeducation, various treatment, medication assistance and recovery options.
- Provide timely submission of claims and code related diagnosis and visits correctly.
The Ohio Department of Mental Health and Addiction Services will be releasing a public facing registry of recovery homes in early November. Starting January 1, only homes on this registry may receive referrals from mental health and addiction services providers. Providers should check this registry and ensure that any homes that they regularly refer individuals to are listed on the registry. If they are not, those individuals need to take the needed steps to ensure that they are on the registry by January 1, 2025. Only homes that are appropriately accredited may be on the registry. The two entities that are providing the accreditation are Ohio Recovery Housing which offers a certification and Oxford House which charters recovery homes. For more information or questions contact Ohio Recovery Housing at 614-453-5133 or info@ohiorecoveryhousing.org.
We need providers to bill with the POS 53 to have it count for our HEDIS rates.
FUH= A community mental health center visit with POS code 53 with a principal diagnosis of a mental health disorder.
FUM= A community mental health center visit with POS code 53 with a principal diagnosis of a mental health disorder.
FUA= A community mental health center visit with POS code 53 with any diagnosis of SUD.
Archived News
Prior Authorization Update: Effective immediately, we are no longer requiring a prior authorization for Assertive Community Treatment (ACT) Services CPT code H0040 for the initial 12 months. After 12 months, providers will submit a prior authorization for a medical necessity review.
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Updated Medicaid Behavioral Health Provider Manual Issued For January 1, 2023
ODM has published an updated version of the Medicaid Behavioral Health Provider Manual including several changes that will become effective January 1, 2023. Version 1.25 of the BH provider manual contains the following updates:
- Revised Medicaid payment rates for the administration of the Child and Adolescent Needs Survey (CANS). (This change aligns with recent updates to OhioRISE provider guidance.)
- Clarification that Mobile Response Stabilization Service (MRSS) may not be billed for time spent administering the CANS assessment. (This change aligns with recent updates to OhioRISE provider guidance)
- Discontinuation of prolonged services codes (99354 and 99355) for psychotherapy services beginning January 1, 2023, and after. This follows the new CPT/HCPCS guidance from the American Medical Association (AMA) beginning January 1, 2023.
- Discontinuation of CPT code 99343, Evaluation & Management Home Visit, presenting problems moderate to high severity, typically 45 minutes. This change also follows guidance of the AMA.
- Codes added for several provider administered pharmaceuticals on Table 2-9
Questions regarding the Medicaid Behavioral Health Provider Manual may be submitted to the ODM Behavioral Health Policy mailbox, BH-Enroll@medicaid.ohio.gov.
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