Quality

Resources

• The BH HEDIS® 2025 At-A-Glance Provider Toolkit - This provider focused intervention offers CABH and Health Plan clinical/UM teams, along with health plan network practitioners/providers with the HEDIS® behavioral health measure specifications, treatment recommendations, diagnostic codes, and service codes applicable to each of the measures.  The goal is to improve the quality of behavioral health treatment among at-risk member populations in coordination with improved HEDIS® behavioral health measure outcomes.
• SAMHSA Guidance on Strategies to Promote Best Practice in Antipsychotic Prescribers for Children & Adolescents
• Assess, Educate, and Treat Patients with Depression
• Mental Health Tools for Pediatrics (Free Access)
• Psychiatric Collaborative Care Mode Provider Bulletin

Behavioral Health HEDIS Training for Medicaid Providers

Purpose: This course equips healthcare professionals with the skills to identify and address behavioral health needs through validated screening tools and evidence-based interventions.

Target Audience: Medical and Behavioral health Providers, including licensed and unlicensed health care professionals and office staff.

• Clinical Excellence in Mental Health: Enhancing Care Quality and Engagement Across Primary and Behavioral Health (PDF)

Reducing the Risk of Opioid Overuse and Misuse

Drug overdoses impact families, communities, workplaces, and the economy. Together, we can bring awareness, resources, and expertise to better coordinate efforts to prevent opioid overdoses and deaths. Treating opioid use disorder with medications for opioid use disorder (MOUD) increases the chance of recovery success, patients may also benefit from counseling and psychosocial support.¹

• HEDIS® 2025 Behavioral Health Measure Toolkit (PDF)

Provider Tips

• Use the state Prescription Drug Monitoring Program (PDMP) database prior to initiating opioid therapy and periodically, ranging from every prescription to every 3 months.
• Involve patient in decisions to initiate or continue opioid use, only prescribe opioids when medically necessary, in the lowest effective dose, for the shortest duration necessary.
• Follow established guidelines regarding co-prescribing of Naloxone to patients at risk of overdose. 
• Educate patients on opioid safety and risk associated with long-term and use of multiple opioids from different providers. 
• Inform patients with an OUD of the risks and benefits of pharmacotherapy treatment.
• Discuss with patient nonopioid and nonpharmacologic alternative therapies for pain management; NSAIDs, physical therapy, acupuncture, massage therapy, and corticosteroids when clinically appropriate. 
• Encourage coordination of care between physical and behavioral health providers, including transitions in care. 
• Offer mutual help like peer recovery support, harm reduction, 12-step fellowships (AA, NA, etc.)
• Educate patients and caregivers about local naloxone access and good Samaritan laws.
• Provide timely submission of claims with correct medication name, dosage, frequency, and days covered.

Measures

• Risk of Continued Opioid Use (COU)
• Use of Opioids at High Dosage (HDO)
• Pharmacotherapy for Opioid Use Disorder (POD)
• Use of Opioids from Multiple Providers (UOP)

Additional Support

• National Institute of Drug Abuse www.drugabuse.gov
• SAMHSA Find Help & Treatment 1-800-662-4357,  www.samhsa.gov 
• The American Society of Addiction Medicine www.asam.org
• Providers Clinical Support System (PCSS) www.pcssnow.org

Sources:

^{1 Treatment of Opioid Use Disorder. (Retrieved 5/31/2024). www.cdc.gov/overdose-prevention/treatment/opioid-use-disorder.html}