Category: Medicaid

Children and adolescents may be prescribed antipsychotic medications by psychiatrists, neurologists, pediatricians or providers in other specialties for various mental health diagnoses ranging from mood disorders to autism. Some commonly prescribed antipsychotics include: risperidone, aripiprazole, quetiapine, lurasidone, haloperidol, olanzapine and chlorpromazine. The National Committee for Quality Assurance (NCQA) has developed three quality HEDIS® measures related to the prescribing of antipsychotics to children and adolescents.

Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics (APP): 

  • This measures the percentage of children and adolescents ages 1 to 17 years old who are prescribed an antipsychotic medication during the measurement year and have documentation of psychosocial care provided as first-line treatment.
  • Empire BlueCross BlueShield HealthPlus (Empire) conducts outreach to the parents and guardians of those dependent members. The case manager inquires if the member has received therapeutic services in the 30 days since being prescribed this new antipsychotic medication. If the member isn’t connected to therapeutic services, the case manager will assist the parent or guardian with referrals for outpatient behavioral health services.
  • Providers are encouraged to address psychosocial care and link members to therapeutic services. If the prescriber is also providing these services, the provider is encouraged to send a claim with CPT code [XXXX].

Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM):

  • Children and adolescents taking antipsychotic medication are recommended to have at least [annual] health screenings and blood tests that include a cholesterol test (LDL) and a glucose test or HbA1c.
  • The behavioral health case manager from Empire reaches out to a member’s parents/guardians by phone and mail to provide education on the importance and purpose of having these regular health screenings. The case manager also offers assistance to parents in scheduling these health screenings.
  • Prescribers are encouraged to monitor HbA1c and LDL at least once a year.

Use of Multiple Concurrent Antipsychotics in Children and Adolescents (APC): 

  • This measures the percentage of children and adolescents 1 to 17 years of age who are on two or more concurrent antipsychotic medications for at least 90 consecutive days during the measurement year.
  • These individuals should be assessed and monitored closely by a psychiatric professional such as a psychiatric nurse practitioner or psychiatrist.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).


NYE-NU-0156-19 July 2019

Featured In:
September 2019 Empire Provider News