2024 MIPS Measure #498: Connection to Community Service Provider

2024 COLLECTION TYPE:

MIPS Clinical Quality Measures (CQMS)

‌MEASURE TYPE: Process – High Priority

Description

‌Percent of patients 18 years or older who screen positive for one or more of the following health-related social needs (HRSNs): food insecurity, housing instability, transportation needs, utility help needs, or interpersonal safety; and had contact with a Community Service Provider (CSP) for at least one of their HRSNs within 60 days after screening.

‌Instructions

This measure is to be submitted a minimum of once per performance period for patients seen during the performance period. This measure is intended to reflect the quality of services provided for patients who are screened for HRSNs. This measure may be submitted by Merit-based Incentive Payment System (MIPS) eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.

NOTE: Include only patients that have been seen during the denominator identification period of November 1st of the previous performance period through October 31st of the current performance period. This will allow the evaluation of at least 60 days after the denominator eligible encounter within the performance period.

NOTE: Patient encounters for this measure conducted via telehealth (including but not limited to encounters coded with GQ, GT, 95, POS 02, POS 10) are allowable.

‌Measure Submission Type

Measure data may be submitted by individual MIPS eligible clinicians, groups, or third-party intermediaries. The listed denominator criteria are used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions as allowed by the measure. The quality data codes listed do not need to be submitted by MIPS eligible clinicians, groups, or third-party intermediaries that utilize this modality for submissions; however, these codes may be submitted for those third-party intermediaries that utilize Medicare Part B claims data. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.

‌Denominator

Patients aged 18 years or older who screened positive for at least one of the five HRSN domains (food insecurity, housing instability, transportation needs, utility help needs, or interpersonal safety) during the measurement period

Definitions:

Community Service Provider (CSP) – Defined as any independent, for-profit, non-profit, state, territorial, or local agency capable of addressing core or supplemental health-related social needs. The clinician’s own organization may be considered a CSP for the purposes of the measure (e.g., a clinic with an in-house food pantry or co-located housing resources).

Denominator Identification Period – The period in which eligible patients can have a denominator eligible encounter. The “denominator identification period” occurs from November 1st of the previous performance period thru October 31st of the current performance period. This will allow for a full 12-month period for denominator eligibility determination.

DENOMINATOR NOTE: *Signifies that this CPT Category I code is a non-covered service under the Medicare Part B Physician Fee Schedule (PFS). These non-covered services should be counted in the denominator population for MIPS CQMs.

Denominator Criteria (Eligible Cases):

Patients aged 18 years or older

AND

Patient encounter during the denominator identification period (CPT or HCPCS): 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350, 99385*, 99386*, 99387*, 99395*, 99396*, 99397*, 99421, 99422, 99423, 99441, 99442, 99443, G0402, G0438, G0439

AND

Patients who screened positive for at least 1 of the 5 HRSNs: M1320

AND NOT

Denominator Exclusions:

Patients who are counseled on connection with a CSP and explicitly opt out: M1317

Numerator

Patients who had contact with a CSP for at least one of their HRSNs within 60 days after screening

Definition:

Contact – For the purpose of reporting this measure, defined as engagement with CSP for the purpose of addressing at least one HRSN, either as reported by patient or acknowledged from CSP.

NUMERATOR NOTE: Electronic health record and non-electronic clinical data, as well as patient reported data and electronic data received from CSP may be used to determine whether contact was made with a CSP.

Numerator Options:

Performance Met: Patients who had documented contact with a CSP for at least one of their screened positive HRSNs within 60 days after screening (M1319)

OR

Performance Not Met: Patients who did not have documented contact with a CSP for at least one of their screened positive HRSNs within 60 days after screening OR documentation that there was no contact with a CSP (M1318)