Regulatory and Accreditation Programs

The percentage of emergency department (ED) visits for members 6 years of age and older with a principal diagnosis of mental illness or intentional self-harm, who had a follow-up visit for mental illness. Two rates are reported:
- The percentage of ED visits for which the member received follow-up within 30 days of the ED visit (31 total days).
- The percentage of ED visits for which the member received follow-up within 7 days of the ED visit (8 total days).

Change in rasch derived values of mobility function from admission to discharge among adults aged 18 and older receiving inpatient medical rehabilitation at a post acute care facility who were discharged alive. The timeframe for the measure is 12 months. The measure includes the following 4 mobility items:1. Transfer Bed/Chair/Wheelchair, 2. Transfer Toilet, 3. Locomotion, 4. Stairs.

Change in rasch derived values of motor function from admission to discharge among adult inpatient rehabilitation facility patients aged 18 years and older who were discharged alive. The timeframe for the measure is 12 months. The measure includes the following 12 FIM® items:Feeding, Grooming, Dressing Upper Body, Dressing Lower Body, Toileting, Bowel, Expression, Memory, Transfer Bed/Chair/Wheelchair, Transfer Toilet, Locomotion and Stairs.

Change in rasch derived values of self-care function from admission to discharge among adults receiving inpatient medical rehabilitation and discharged alive. The timeframe for the measure is 12 months. The measure includes the following 8 items: Feeding, Grooming, Dressing Upper Body, Dressing Lower Body, Toileting, Bowel, Expression, and Memory.

This composite measure assesses the percentage of hospitalizations for adults aged 18 years and older at the start of the inpatient encounter during the measurement period with a length of stay equal to or greater than 24 hours who received optimal malnutrition care during the current inpatient hospitalization where care performed was appropriate to the patient's level of malnutrition risk and severity.

The proportion of patients, age greater than and equal to 1 year, admitted to a hospital-based inpatient psychiatric setting who are screened within the first three days of hospitalization for all of the following: risk of violence to self or others, substance use, psychological trauma history and patient strengths.

The total number of hours that all patients admitted to a hospital-based inpatient psychiatric setting were maintained in physical restraint.

The total number of hours that all patients admitted to a hospital-based inpatient psychiatric setting were held in seclusion.

The proportion of patients discharged from a hospital-based inpatient psychiatric setting on two or more antipsychotic medications.

The proportion of patients, age greater than and equal to 1 year, discharged from a hospital-based inpatient psychiatric setting on two or more antipsychotic medications with appropriate justification.