Follow-Up After Hospitalization for Mental Illness (FUH) & Follow Up After High-Intensity Care for Substance Use Disorder (FUI)
| Date: | November 1, 2023 |
| To: | Health Plan of San Joaquin (HPSJ) Contracted Hospitals, Emergency Rooms, and Other Network Providers |
| Type: | Educational/Informational |
| Subject: | Follow-Up After Hospitalization for Mental Illness (FUH) & Follow Up After High-Intensity Care for Substance Use Disorder (FUI) |
| Business: | Medi-Cal Managed Care |
Healthcare Effectiveness Data and informational Set (HEDIS) for Measurement Year 2023
Follow-up After Hospitalization for Mental illness (FUH):
Patients ages 6 and older who were hospitalized for treatment of selected mental illness or intentional self-harm diagnosis should receive follow up care follow-up care with a mental health provider within 7 – 30 days of discharge. Can include same day follow up.
Qualifying Visits for follow up care when the principal diagnosis of the visit is behavioral health include:
- Outpatient or telehealth visit with a mental health provider
- Intensive out-patient visit or partial hospitalization
- A community mental health center visit
- An observation visit with a mental health provider.
- Transitional care management services with a mental health provider
- A visit in a behavioral healthcare setting
- Psychiatric collaborative care management
Follow-Up After High-Intensity Care for Substance Use Disorder (FUI):
Patients 13 years of age and older who had an acute inpatient hospitalizations, residential treatment, or withdrawal management visits for a diagnosis of substance use disorder (SUD) that result in a follow-up visit or service for SUD within 7-30 days post-discharge.
Qualifying Visits for follow up care include:
A principal diagnosis of SUD and
- An inpatient admission or residential behavioral health stay
- An outpatient visit
- An intensive outpatient encounter or partial hospitalization
- A non-residential substance abuse treatment facility visit
- A community mental health center visit
- A telehealth visit
- A substance use disorder service
- An opioid treatment service that bills monthly or weekly
- An observation visit
- Residential behavioral health treatment
- A pharmacotherapy dispensing even
If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan of San Joaquin and our services is always available on our website https://www.hpsj.com/