2024 MIPS Measure #502: Improvement or Maintenance of Functioning for Individuals with a Mental and/or Substance Use Disorder

Quality ID 502
High Priority Measure Yes
Specifications Registry
Measure Type Outcome
Specialty Clinical Social Work Family Medicine Internal Medicine Mental/Behavioral Health Physical Therapy/Occupational Therapy

Measure Description

The percentage of patients aged 18 and older with a mental and/or substance use disorder who demonstrated improvement or maintenance of functioning based on results from the 12-item World Health Organization Disability Assessment Schedule (WHODAS 2.0) or Sheehan Disability Scale (SDS) 30 to 180 days after an index assessment.

 

Instructions

This measure is to be submitted a minimum of once per performance period for patients with mental and substance use disorder who are seen during the performance period. This measure is intended to reflect the quality of services provided for patients aged 18 and older with a mental and/or substance use disorder and an encounter with an index assessment completed using the 12-item WHODAS 2.0 or Sheehan Disability Scale (SDS) during the denominator identification period. This measure may be submitted by Merit-based Incentive Payment System (MIPS) eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.

NOTE: Patient encounters for this measure conducted via telehealth (including but not limited to encounters coded with GQ, GT, 95, POS 02, POS 10) are allowable.

Measure Submission Type:

Measure data may be submitted by individual MIPS eligible clinicians, groups, or third-party intermediaries. The listed denominator criteria are used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions as allowed by the measure. The quality data codes listed do not need to be submitted by MIPS eligible clinicians, groups, or third-party intermediaries that utilize this modality for submissions; however, these codes may be submitted for those third-party intermediaries that utilize Medicare Part B claims data. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.

 

Denominator

Patients aged 18 years and older with a mental and/or substance use disorder and an encounter with an index assessment completed using the 12-item WHODAS 2.0 or Sheehan Disability Scale (SDS) during the denominator identification period

Definitions:

Denominator identification period – Period in which patients had an encounter with an index assessment using the WHODAS 2.0 or SDS. The “denominator identification period” is defined by a 12-month window starting 6 months prior to the measurement year through the first 6 months of the measurement year (July 1 of the previous year through June 30 of the current year).

Index assessment – The outpatient encounter where the patient first completed the WHODAS 2.0 or SDS is counted as the “index assessment”. If there are multiple assessments during the denominator identification period, the first assessment completed is counted as the “index assessment”.

WHODAS 2.0 – “WHODAS 2.0” assesses change-over-time in functioning for all individuals with mental health and/or substance use disorders. The domains covered in the tool are communication and understanding, mobility, self-care, social functioning, life activities (work and home), and participation in society. Response options include: (0) None, (1) Mild, (2) Moderate, (3) Severe, and (4) Extreme or Cannot Do. A 12-item and 36- item version of the WHODAS 2.0 are available. Summed scores on the 12-item and 36-item “WHODAS 2.0” are converted to a summary scale from 0 to 100 (where 0 = no disability; 100 = full disability). There is no recommended cutoff score. A higher score on the “WHODAS 2.0” equates to a lower level of functioning (Ustun et al., 2010). Available at: https://www.who.int/standards/classifications/international-classification-offunctioning-disability-and-health/who-disability-assessment-schedule.

Sheehan Disability Scale (SDS) – SDS assesses change-over-time in functioning for individuals with mental health and/or substance use disorders. The domains covered in the tool are work/school, social life/leisure activities, and family life/home responsibilities. Response options include: (0) Not at all, (1-3) Mildly, (4-6) Moderately, (7-9) Markedly, and (10) Extremely, regarding how current symptoms have disrupted activities in each of the domains covered by the assessment. The 3 items are summed into a single dimensional measure of global functioning from 0 to 30 (where 0 = unimpaired and 30 = highly impaired). There is no recommended cutoff score. A higher score on the SDS equates to a lower level of functioning (Sheehan et al., 2008). Available at: https://eprovide.mapi-trust.org/instruments/sheehan-disability-scale.

DENOMINATOR NOTE: *Signifies that this CPT Category I code is a non-covered service under the Medicare Part B Physician Fee Schedule (PFS). These non-covered services should be counted in the denominator population for MIPS CQMs.

Denominator Criteria (Eligible Cases):

Patients aged 18 years and older as of the date of the index encounter

AND

Diagnosis for any mental, behavioral, or substance use disorder (ICD-10-CM): F10.10, F10.11, F10.120, F10.121, F10.129, F10.130, F10.131, F10.132, F10.139, F10.14, F10.150, F10.151, F10.159, F10.180, F10.181, F10.182, F10.188, F10.19, F10.20, F10.21, F10.220, F10.221, F10.229, F10.230, F10.231, F10.232, F10.239, F10.24, F10.250, F10.251, F10.259, F10.26, F10.27, F10.280, F10.281, F10.282, F10.288, F10.29, F10.90, F10.91, F10.920, F10.921, F10.929, F10.930, F10.931, F10.932, F10.939, F10.94, F10.950, F10.951, F10.959, F10.96, F10.97, F10.980, F10.981, F10.982, F10.988, F10.99, F11.10, F11.11, F11.120, F11.121, F11.122, F11.129, F11.13, F11.14, F11.150, F11.151, F11.159, F11.181, F11.182, F11.188, F11.19, F11.20, F11.21, F11.220, F11.221, F11.222, F11.229, F11.23, F11.24, F11.250, F11.251, F11.259, F11.281, F11.282, F11.288, F11.29, F11.90, F11.91, F11.920, F11.921, F11.922, F11.929, F11.93, F11.94, F11.950, F11.951, F11.959, F11.981, F11.982, F11.988, F11.99, F12.10, F12.11, F12.120, F12.121, F12.122, F12.129, F12.13, F12.150, F12.151, F12.159, F12.180, F12.188, F12.19, F12.20, F12.21, F12.220, F12.221, F12.222, F12.229, F12.23, F12.250, F12.251, F12.259, F12.280, F12.288, F12.29, F12.90, F12.91, F12.920, F12.921, F12.922, F12.929, F12.93, F12.950, F12.951, F12.959, F12.980, F12.988, F12.99, F13.10, F13.11, F13.120, F13.121, F13.129, F13.130, F13.131, F13.132, F13.139, F13.14, F13.150, F13.151, F13.159, F13.180, F13.181, F13.182, F13.188, F13.19, F13.20, F13.21, F13.220, F13.221, F13.229, F13.230, F13.231, F13.232, F13.239, F13.24, F13.250, F13.251, F13.259, F13.26, F13.27, F13.280, F13.281, F13.282, F13.288, F13.29, F13.90, F13.91, F13.920, F13.921, F13.929, F13.930, F13.931, F13.932, F13.939, F13.94, F13.950, F13.951, F13.959, F13.96, F13.97, F13.980, F13.981, F13.982, F13.988, F13.99, F14.10, F14.11, F14.120, F14.121, F14.122, F14.129, F14.13, F14.14, F14.150, F14.151, F14.159, F14.180, F14.181, F14.182, F14.188, F14.19, F14.20, F14.21, F14.220, F14.221, F14.222, F14.229, F14.23, F14.24, F14.250, F14.251, F14.259, F14.280, F14.281, F14.282, F14.288, F14.29, F14.90, F14.91, F14.920, F14.921, F14.922, F14.929, F14.93, F14.94, F14.950, F14.951, F14.959, F14.980, F14.981, F14.982, F14.988, F14.99, F15.10, F15.11, F15.120, F15.121, F15.122, F15.129, F15.13, F15.14, F15.150, F15.151, F15.159, F15.180, F15.181, F15.182, F15.188, F15.19, F15.20, F15.21, F15.220, F15.221, F15.222, F15.229, F15.23, F15.24, F15.250, F15.251, F15.259, F15.280, F15.281, F15.282, F15.288, F15.29, F15.90, F15.91, F15.920, F15.921, F15.922, F15.929, F15.93, F15.94, F15.950, F15.951, F15.959, F15.980, F15.981, F15.982, F15.988, F15.99, F16.10, F16.11, F16.120, F16.121, F16.122, F16.129, F16.14, F16.150, F16.151, F16.159, F16.180, F16.183, F16.188, F16.19, F16.20, F16.21, F16.220, F16.221, F16.229, F16.24, F16.250, F16.251, F16.259, F16.280, F16.283, F16.288, F16.29, F16.90, F16.91, F16.920, F16.921, F16.929, F16.94, F16.950, F16.951, F16.959, F16.980, F16.983, F16.988, F16.99, F17.200, F17.201, F17.203, F17.208, F17.209, F17.210, F17.211, F17.213, F17.218, F17.219, F17.220, F17.221, F17.223, F17.228, F17.229, F17.290, F17.291, F17.293, F17.298, F17.299, F18.10, F18.11, F18.120, F18.121, F18.129, F18.14, F18.150, F18.151, F18.159, F18.17, F18.180, F18.188, F18.19, F18.20, F18.21, F18.220, F18.221, F18.229, F18.24, F18.250, F18.251, F18.259, F18.27, F18.280, F18.288, F18.29, F18.90, F18.91, F18.920, F18.921, F18.929, F18.94, F18.950, F18.951, F18.959, F18.97, F18.980, F18.988, F18.99, F19.10, F19.11, F19.120, F19.121, F19.122, F19.129, F19.130, F19.131, F19.132, F19.139, F19.14, F19.150, F19.151, F19.159, F19.16, F19.17, F19.180, F19.181, F19.182, F19.188, F19.19, F19.20, F19.21, F19.220, F19.221, F19.222, F19.229, F19.230, F19.231, F19.232, F19.239, F19.24, F19.250, F19.251, F19.259, F19.26, F19.27, F19.280, F19.281, F19.282, F19.288, F19.29, F19.90, F19.91, F19.920, F19.921, F19.922, F19.929, F19.930, F19.931, F19.932, F19.939, F19.94, F19.950, F19.951, F19.959, F19.96, F19.97, F19.980, F19.981, F19.982, F19.988, F19.99, F20.0, F20.1, F20.2, F20.3, F20.5, F20.81, F20.89, F20.9, F21, F22, F23, F24, F25.0, F25.1, F25.8, F25.9, F28, F29, F30.10, F30.11, F30.12, F30.13, F30.2, F30.3, F30.4, F30.8, F30.9, F31.0, F31.10, F31.11, F31.12, F31.13, F31.2, F31.30, F31.31, F31.32, F31.4, F31.5, F31.60, F31.61, F31.62, F31.63, F31.64, F31.70, F31.71, F31.72, F31.73, F31.74, F31.75, F31.76, F31.77, F31.78, F31.81, F31.89, F31.9, F32.0, F32.1, F32.2, F32.3, F32.4, F32.5, F32.81, F32.89, F32.9, F32.A, F33.0, F33.1, F33.2, F33.3, F33.40, F33.41, F33.42, F33.8, F33.9, F34.0, F34.1, F34.81, F34.89, F34.9, F39, F40.00, F40.01, F40.02, F40.10, F40.11, F40.210, F40.218, F40.220, F40.228, F40.230, F40.231, F40.232, F40.233, F40.240, F40.241, F40.242, F40.243, F40.248, F40.290, F40.291, F40.298, F40.8, F40.9, F41.0, F41.1, F41.3, F41.8, F41.9, F42.2, F42.3, F42.4, F42.8, F42.9, F43.0, F43.10, F43.11, F43.12, F43.20, F43.21, F43.22, F43.23, F43.24, F43.25, F43.29, F43.81, F43.89, F43.9, F44.0, F44.1, F44.2, F44.4, F44.5, F44.6, F44.7, F44.81, F44.89, F44.9, F45.0, F45.1, F45.20, F45.21, F45.22, F45.29, F45.41, F45.42, F45.8, F45.9, F48.1, F48.2, F48.8, F48.9, F50.00, F50.01, F50.02, F50.2, F50.81, F50.82, F50.89, F50.9, F51.01, F51.02, F51.03, F51.04, F51.05, F51.09, F51.11, F51.12, F51.13, F51.19, F51.3, F51.4, F51.5, F51.8, F51.9, F52.0, F52.1, F52.21, F52.22, F52.31, F52.32, F52.4, F52.5, F52.6, F52.8, F52.9, F53.0, F53.1, F54, F55.0, F55.1, F55.2, F55.3, F55.4, F55.8, F59, F60.0, F60.1, F60.2, F60.3, F60.4, F60.5, F60.6, F60.7, F60.81, F60.89, F60.9, F63.0, F63.1, F63.2, F63.3, F63.81, F63.89, F63.9, F64.0, F64.1, F64.2, F64.8, F64.9, F65.0, F65.1, F65.2, F65.3, F65.4, F65.50, F65.51, F65.52, F65.81, F65.89, F65.9, F66, F68.10, F68.11, F68.12, F68.13, F68.8, F68.A, F69, F90.0, F90.1, F90.2, F90.8, F90.9, F91.0, F91.1, F91.2, F91.3, F91.8, F91.9, F93.0, F93.8, F93.9, F94.0, F94.1, F94.2, F94.8, F94.9, F95.0, F95.1, F95.2, F95.8, F95.9, F98.0, F98.1, F98.21, F98.29, F98.3, F98.4, F98.5, F98.8, F98.9, F99

AND

Patient encounter during the denominator identification period (CPT): 90791, 90792, 90832, 90834, 90837, 90839, 90845, 90847, 90849, 90853, 90865, 90875*, 90876*, 90880, 90901, 90912, 96112, 96116, 96125, 96127, 96130, 96132, 96136, 96138, 96146, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99242*, 99243*, 99244*, 99245*, 99401*, 99402*, 99403*, 99404*, 99406, 99407, 99408*, 99409*, 99421, 99422, 99423, 99441, 99442, 99443

AND

Index assessment completed using the 12-item WHODAS 2.0 or SDS during the denominator identification period: M1340

AND NOT

DENOMINATOR EXCLUSIONS:

Patient situations, at any point during the denominator identification period, where the patient's functional capacity or motivation (or lack thereof) to improve may impact the accuracy of results of validated tools, such as delirium, dementia, intellectual disabilities, and pervasive and specific development disorders (ICD-10-CM): F01.50, F01.511, F01.518, F01.52, F01.53, F01.54, F01.A0, F01.A11, F01.A18, F01.A2, F01.A3, F01.A4, F01.B0, F01.B11, F01.B18, F01.B2, F01.B3, F01.B4, F01.C0, F01.C11, F01.C18, F01.C2, F01.C3, F01.C4, F02.80, F02.811, F02.818, F02.82, F02.83, F02.84, F02.A0, F02.A11, F02.A18, F02.A2, F02.A3, F02.A4, F02.B0, F02.B11, F02.B18, F02.B2, F02.B3, F02.B4, F02.C0, F02.C11, F02.C18, F02.C2, F02.C3, F02.C4, F03.90, F03.911, F03.918, F03.92, F03.93, F03.94, F03.A0, F03.A11, F03.A18, F03.A2, F03.A3, F03.A4, F03.B0, F03.B11, F03.B18, F03.B2, F03.B3, F03.B4, F03.C0, F03.C11, F03.C18, F03.C2, F03.C3, F03.C4, F04, F05, F06.0, F06.1, F06.2, F06.30, F06.31, F06.32, F06.33, F06.34, F06.4, F06.70, F06.71, F06.8, F07.0, F07.81, F07.89, F07.9, F09, F70, F71, F72, F73, F78.A1, F78.A9, F79, F80.0, F80.1, F80.2, F80.4, F80.81, F80.82, F80.89, F80.9, F81.0, F81.2, F81.81, F81.89, F81.9, F82, F84.0, F84.2, F84.3, F84.5, F84.8, F84.9, F88, F89

OR

Patients who died during the performance period: M1342

 

Numerator

Patients who demonstrated improvement or maintenance of functioning, as demonstrated by results of follow-up assessment using the 12-item WHODAS 2.0 or Sheehan Disability Scale 30 to 180 days after the index assessment during the performance period

Definitions:

Follow-up Assessment – The “follow-up assessment” is the 12-item WHODAS 2.0 or Sheehan Disability Scale (SDS) assessment completed at an encounter 30 to 180 days after the encounter with the index assessment, within the 14-month performance period. If there are multiple assessments completed within the follow-up time window (i.e., a 150-day window, beginning 30 days after the index assessment), the assessment that will be counted as the follow-up is the last assessment completed during the window.

Improvement or Maintenance – “Improvement” is defined as any positive improvement in score at the followup assessment compared to the index assessment. “Maintenance” is defined as no change in score at the follow-up assessment compared to the index assessment.

Performance Period – A 17-month period starting 5 months prior to the performance year through the end of the performance year.

Numerator Options:

Performance Met: Patients who had follow-up assessment 30 to 180 days after the index assessment who demonstrated positive improvement or maintenance of functioning scores during the performance period (M1339)

OR

Performance Not Met: Patients who had follow-up assessment 30 to 180 days after the index assessment who did not demonstrate positive improvement or maintenance of functioning scores during the performance period (M1338)

OR

Performance Not Met: Patients who did not have a follow-up assessment or did not have an assessment within 30 to 180 days after the index assessment during the performance period (M1341)

 

Rational

Mental and substance use disorders are among the 25 leading causes of years lived with disability and contribute significantly to the global burden of disease (Mokdad et al., 2018). Specifically, 19% of U.S. adults (46.6 million individuals aged 18 and older) have a mental illness and 7.6% (18.7 million individuals aged 18 and older) have a substance use disorder (McCance-Katz, 2019). Mental and substance use disorders often co-occur, with about 8.5 million adults aged 18 and older in the U.S. having both conditions (McCance-Katz, 2019). Individuals with mental and/or substance use disorders are more likely to report severe impairment in functioning compared to those with chronic medical conditions (Kostanjsek, 2011). In fact, the level and pattern of functional impairment is described as the best indicator of service needs, treatment outcomes, and quality care, with greater level of functional impairment being a risk factor for poor prognosis for both mental and substance use disorders as well other medical conditions (Kilbourne et al., 2018). Improvement or maintaining functioning is strongly predictive of a positive outcome. Improvement or maintaining functioning is strongly predictive of a positive outcome (Kilbourne et al., 2018).

 

Clinical Recommendation Statements

WHO Disability Assessment Scale 2.0 (WHODAS 2.0) (Ustun et al., 2010) assesses change-over-time in functioning for all individuals with mental health and/or substance use disorders. The domains covered in the tool are communication and understanding, mobility, self-care, social functioning, life activities (work and home), and participation in society. Response options include: (0) None, (1) Mild, (2) Moderate, (3) Severe, and (4) Extreme or Cannot Do. A 12-item and 36-item version of the WHODAS 2.0 are available. Summed scores on the 12-item and 36-item WHODAS 2.0 are converted to a summary scale from 0 to 100 (where 0 = no disability; 100 = full disability). There is no recommended cutoff score. A higher score on the WHODAS 2.0 equates to a lower level of functioning. Available at: https://www.who.int/standards/classifications/international-classification-of-functioning-disability-and-health/whodisability-assessment-schedule.

Sheehan Disability Scale (SDS) (Sheehan et al., 2008) assesses change-over-time in functioning for individuals with mental health and/or substance use disorders. The domains covered in the tool are work/school, social life/leisure activities, and family life/home responsibilities. Response options include: (0) Not at all, (1-3) Mildly, (4-6) Moderately, (7-9) Markedly, and (10) Extremely, regarding how current symptoms have disrupted activities in each of the domains covered by the assessment. The 3 items are summed into a single dimensional measure of global functioning from 0 to 30 (where 0 = unimpaired and 30 = highly impaired). There is no recommended cutoff score. A higher score on the SDS equates to a lower level of functioning. Available at: https://harmresearch.org/about-us/david-v-sheehan-mdmba/sheehan-scales-and-structured-diagnostic-interviews/sheehan-disability-scale-sds.

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