The National Committee for Quality Assurance (NCQA) has implemented key changes to the HEDIS Follow-Up After Hospitalization for Mental Illness (FUH) measure. These updates expand Provider and service eligibility, making it easier to meet the measure and support timely follow-up care.
Key Updates:
- Follow-up visits can now be completed by any qualified Provider, including Primary Care Providers (PCPs), if the claim includes a mental health diagnosis and the Provider is licensed to bill the appropriate codes.
- The numerator criteria have been expanded to include any diagnosis of a mental health disorder during the follow-up visit. This provides more flexibility in documenting and coding follow-up care that meets the measure.
- Qualifying diagnoses added for the denominator:
- Phobia, anxiety, and additional intentional self-harm diagnoses to the denominator in the event/diagnosis have been added.
- Intentional self-harm diagnoses now count regardless of their position on the hospital discharge claim.
- Additional services count toward the measure (nominator):
- Peer support and residential treatment services now qualify as valid follow-up services.
These updates apply to discharges on or after January 1, 2025, and are intended to reduce hospital readmissions and improve continuity of care.
Community First Health Plans Behavioral Health Inpatient Transition Navigators are educating Members on this change and may refer them to PCPs post-BH IP discharge if access to BH Provider is delayed outside of the 7 days of discharge.
Providers are encouraged to share this information with their staff. If you have any questions about this notice, please email Provider Relations at ProviderRelations@cfhp.com or call 210-358-6030. You can also contact your Provider Relations Representative directly.
To access all Provider alerts:
- Log into the Community First Provider Portal
- Go to CommunityFirstHealthPlans.com/Provider-News
- Sign up for the Community First Provider eNewsletter
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