Provider Alert! Follow-Up Care for Children Prescribed ADHD Medication (ADD, ADD-E)

Date: December 7, 2023

Attention: All Providers

Call to Action:

Texas Children Health Plan (TCHP) would like to remind providers to continue to take measures to ensure that your patients with an Attention Deficit Hyperactivity Disorder (ADHD) diagnosis are receiving excellent care. ADHD is one of the most common behavioral health disorders in children (National Committee for Quality Assurance, 2023; Visser et al., 2014). To ensure that medication is prescribed and managed correctly, it is important that prescribing providers carefully monitor their pediatric patients who take a medication for ADHD management.

Why it Matters:

When managed appropriately, medication for ADHD can control symptoms of hyperactivity, impulsiveness, and inability to sustain concentration. To ensure that medication is prescribed and managed correctly, it is important that children be monitored by a pediatrician or child psychiatrist with prescribing authority (National Committee for Quality Assurance, 2023).

Partnership for Quality Care:

TCHP encourages providers to partner with us in emphasizing the importance of care and ongoing monitoring of members with an ADHD diagnosis.

How providers can facilitate follow-up care for children prescribed ADHD medications:

• Establish an ADHD patient appointment reminder process for your office.
• Explain to parents or caregivers the medication options and possible side effects. Collaborate to ensure agreement to a treatment plan.
• Discuss additional therapy options, such as behavioral, family, and psychotherapy. Include resources for therapy groups, social skills training, and/or parenting skills training.
• Promote continuity of care between physicians, other providers, and schools to ensure medication and plan of care adherence.
• Use telehealth and telephone visits, where appropriate, when in-person services are not possible or telephone services are preferred by the patient and/or family and caregivers.

Consider the following when prescribing a new ADHD medication for patients:

• Initiation Phase: Children between 6 and 12 years of age who are diagnosed with ADHD will require a follow-up visit with a practitioner with prescribing authority within 30 days of their first prescription of ADHD medication (National Committee for Quality Assurance, 2023).
• Continuation and Maintenance Phase: Children between 6 and 12 years of age who have a prescription for ADHD medication and remain on the medication for at least 210 days require at least two follow-up visits with a practitioner in the nine (9) months after the Initiation Phase (National Committee for Quality Assurance, 2023).
• Timing of scheduled visits is key. Visits should occur on a frequency that coincides with the patient’s prescription quantity supply. This cadence will allow the provider to evaluate medication effectiveness and adverse effects, along with monitoring the patient’s progress.
• An example for scheduling effectively and timely includes scheduling a 30-day, 60-day and 180-day follow-up visit from the initial visit before the member leaves your office.
• If your patient experiences a hospitalization for mental illness, please note that you will also need to adhere to the Follow-Up After Hospitalization for Mental Illness (FUH) HEDIS measure requirements. This requirement identifies the need for both a 7 day and 30 day follow-up after discharge to ensure patient safety, medication adherence, and prevention of readmission.

Applicable ADHD Medications:

Description	Prescription
CNS Stimulants	Dexmethylphenidate Dextroamphetamine Lisdexamfetamine Methylphenidate Methamphetamine
Alpha-2 receptor agonists	Clonidine Guanfacine
Miscellaneous ADHD medications	Atomoxetine

Next step for Providers: Providers are encouraged to share this communication with their staff. 

Resources:

• HEDIS toolkit on Follow-up Care for Children Prescribed ADHD Medication
• HEDIS toolkit on Follow-Up After Hospitalization for Mental Illness
• Appointment Availability Standards Reminder

References

National Committee for Quality Assurance. (2023). Follow-up care for children prescribed ADHD medication (ADD, ADD-E). https://www.ncqa.org/hedis/measures/follow-up-care-for-children-prescribed-adhd-medication/

Visser, S. N., M. L. Danielson, R. H. Bitsko, J. R. Holbrook, M. D. Kogan, R. M. Ghandour, … & Blumberg, S. J. (2014). Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit/hyperactivity disorder: United States, 2003—2011. Journal of the American Academy of Child & Adolescent Psychiatry, 53(1), 34–46.

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.

For access to all Provider Alerts,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.