• This is a Healthcare Effectiveness & Data Information Set (HEDIS®) adjusted administrative measure and only includes Medicaid Primary beneficiaries.
• The annual reported rate captures activity during the stated measurement year (MY).
• The DVHA Data Unit includes mental health services reported to the Department of Mental Health via the MSR & excludes residential mental health and substance abuse services.

The Healthcare Effectiveness Data and Information Set (HEDIS®) is a registered trademark of NCQA.

This measure looks at continuity of care for mental illness. It measures the percentage of Medicaid beneficiaries 6 years of age and older who were hospitalized for selected mental disorders and who were seen on an outpatient basis by a mental health provider within 7 days or within 30 days after their discharge from the hospital. The Child Core Set asks states to report the rate for the subset of members 6-20 years of age (shown above).  The specifications for this measure are consistent with guidelines of the National Institute of Mental Health and the Centers for Mental Health Services.

It is important to provide regular follow-up therapy to patients after they have been hospitalized for mental illness. An outpatient visit with a mental health practitioner after discharge is recommended to make sure that the patient’s transition to the home or work environment is supported and that gains made during hospitalization are not lost. It also helps health care providers detect early post-hospitalization reactions or medication problems and provide continuing care.

Last updated:  January 2024

• Medicaid beneficiaries and families
• Mental health practitioners
• Hospitals
• Department of Mental Health
• Department of Children and Families
• Department of Aging and Independent Living
• Vermont Department of Health

• Schedule follow-up appointments when a patient is discharged, as part of the treatment or case management plan.
• Educate patients and practitioners about the importance of timely follow-up visits.
• Consider reminder systems or “re-schedule” notices that are delivered to patients.
• Develop outreach systems or assign case managers to encourage recently discharged patients to keep follow-up appointments or reschedule missed appointments.