Rural Health Clinics and Federally Qualified Health Centers May Meet Quality Measure

December 7, 2021

Starting Jan. 1, 2022, Rural Health Clinics (RHC) and Federally Qualified Health Centers (FQHC) may meet the requirements for the quality measure Follow-up After Hospitalization for Mental Illness (FUH). We track FUH as part of monitoring the quality of our members’ care.

Meeting the Measure
For RHCs and FQHCs, Psychiatric Collaborative Care Model (CoCM) service may satisfy the measure. Psychiatric CoCM must meet all of the following criteria:

  • Sixty minutes or more of clinical staff time for psychiatric CoCM services directed by an RHC or FQHC practitioner (physician, nurse practitioner, physician’s assistant or certified nurse-midwife), and
  • Include services furnished by a behavioral health care manager and consultation with a psychiatric consultant, per calendar month.

This guidance is for RHCs and FQHCs only. It applies to measurement year 2022.

Why FUH Matters
FUH is a Healthcare Effectiveness Data and Information Set (HEDIS®) measure Learn more about third-party links from the National Committee for Quality Assurance (NCQA). It requires a timely outpatient follow-up visit with a qualified mental health provider, including telehealth visits, or in certain outpatient settings. Timely follow-up care is important for members’ health and well-being after hospitalization for mental illness, according to NCQA Learn more about third-party links.

For FUH we capture the percentage of discharges for members ages 6 and older who were hospitalized for the treatment of selected mental illness or intentional self-harm and who had a follow-up visit with a mental health provider. The follow-up visit must be on a different date than the discharge date. Two percentages are measured and reported:

  • Discharges for which members had a follow-up visit within 30 days after discharge
  • Discharges for which members had a follow-up visit within seven days after discharge

If the first follow-up visit is within seven days after discharge, then both rates are counted for this measure.

Questions? Email BHQualityImprovement@bcbstx.com or contact your Provider Network Representative.

The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material, is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.

HEDIS is a registered trademark of NCQA. Use of this resource is subject to NCQA’s copyright, found here. The NCQA HEDIS measure specification has been adjusted pursuant to NCQA’s Rules for Allowable Adjustments of HEDIS. The adjusted measure specification may be used only for quality improvement purposes.