ADHD is a very common childhood neurobehavioral disorder. It is usually �rst diagnosed in childhood and can last into adulthood. Children with ADHD may:

• Have trouble paying attention• Have trouble controlling impulsive behaviors• Be overly active• Daydream frequently

• Seem to not listen• Act or speak without thinking• Squirm, �dget or be unable to stay seated

Attention-Deficit/Hyperactivity Disorder (ADHD)

Medical records may be faxed to: 313.202.0006

There are three different types of ADHD:

Treatment and Measuring Evidence-Based Care:In most cases, ADHD is best treated with a combination of medication and behavioral therapy. Meridian monitors provider performance in the initial and continuation phase of ADHD treatment.

Patients ages 6–12 years should have at least one follow-up visit with a practitioner with prescribing authority within 30 days of receiving a prescription for an ADHD medication.

In addition to the 30-day follow-up visit after receiving an ADHD prescription, patients ages 6-12 should have at least two additional follow-up visits with a practitioner within ten months of �rst receiving the prescription.

Predominantly Hyperactive-impulsive Type: The person �dgets, cannot sit still for long and talks a lot. They also feel restless and may impulsively interrupt others a lot, grab things from people or speak at inappropriate times. It is hard for the person to wait their turn or listen to directions. A person with impulsiveness may have more accidents and injuries than others

Combined Type: Symptoms of the above two types are equally present in the person

ADHD Medications*:

• Amphetamine- dextroamphetamine • Dexmethylphenidate• Dextroamphetamine• Lisdexamfetamine• Methamphetamine• Methylphenidate

• Clonidine• Guanfacine

• Atomoxetine

*Not covered by MeridianRx. These medications are typically considered carve outs and regulated by the state of MI. Genetic tests for ADHD require a prior authorization.

Alpha-2 receptor agonists:

Misc. ADHD Medications:

CNS Stimulants:

Initiation Phase

Continuation and Maintenance (C&M) Phase

EDPS34 MI (R 20180523) www.mhplan.com

Predominantly Inattentive Type: It is hard for the person to organize or �nish a task, pay attention to details, or follow instructions or conversations. The person is easily distracted or forgets details of daily routines

At least 1 follow-up visit 2+ follow-up visits

TOTAL: 3+ follow-up visits within 10 months of prescribing an ADHD medication

monthsdays

ADHD MedicationPrescription written

2 3 4 5 6 7 8 9 1030

Please refer to the HEDIS Criteria Guidelines on https://corp.mhplan.com/en/provider/michigan/meridianhealthplan/bene�ts-resources/tools-resources/documents-forms/for further clari�cation on billing requirements.

M

ERIDIAN

PA S S P O R T

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888.437.0606

If you have questions, please call Meridian's Quality Improvement department at:

Codes to Identify Follow-Up Visitsw:

Stand Alone Visits CPT96150-96154, 98960-98962, 99078, 99201-99205, 99211-99215, 99217-99220, 99241-99245,99341-99345,99347-99350, 99381-99384, 99391-99394, 99401-99404, 99411, 99412, 99510

HCPCSG0155, G0176, G0177, G0409-G0411, G0463, H0002, H0004, H0031, H0034-H0037, H0039, H0040, H2000, H2001, H2011-H2020, S0201, S9480, S9484, S9485, T1015

UB Revenue0510, 0513, 0515-0517, 0519-0523, 0526-0529, 0900, 0902-0905, 0907, 0911-0917, 0919, 0982, 0983

wCodes listed are speci�c to subject matter of this �yer. While Meridian encourages you to use these codes in association with the subject matter of this �yer, Meridian recognizes that the circumstances around the services provided may not always directly support/match the codes. It is crucial that the medical record documentation describes the services rendered in order to support the medical necessity and use of these codes.

EDPS34 MI (R 20180523) www.mhplan.com

Overview of the ADHD Care Process

Family(parents, guardian, other frequent caregivers):• Chief concerns• History of symptoms (e.g. age of onset and course over time)• Family history• Past medical history• Psychosocial history• Review of systems• Validated ADHD instrument• Evaluation of coexisting conditions• Report of function, both strengths and weaknesses

School(and important community informants):• Concerns• Validated ADHD instrument• Evaluation of coexisting conditions• Report on how well patients function in academic, work and social interactions• Academic records (e.g., report cards, standardized testing, psychoeducational evaluations)• Administrative reports (e.g., disciplinary actions)

Child/Adolescent(as appropriate for child’s age and developmental status):• Interview, including concerns regarding behavior, family relationships, peers, school• For adolescents: validated self-report instrument of ADHD and coexisting conditions• Report of child’s self-identi�ed impression of function, both strengths and weaknesses• Clinician’s observations of child’s behavior• Physical and neurologic examination

Perform Diagnostic Evaluation for ADHD and Evaluate or Screen for Other/Coexisting Conditions:

DSM-V diagnosis of ADHD? Coexisting conditions?

ESTABLISH MANAGEMENT TEAM

Identify child as CYSHCN*

Action

Start

Decision

Continued Care

Legend:

Do symptoms improve?

Follow-up for chronic care management at least two times per year for ADHD issues

Collaborate with family,school and child to identify target goals

Establish team including coordination plan

Coexisting disorders preclude primary care management?

Follow-up and establish co-management plan

Exit this guideline evaluate or refer, as appropriate;Identify the child as CYSHCN*, if appropriate

Other condition?

Apparently typical or developmental variation?

Provide education addressing concern (e.g., expectations for attention as a functionof age); enhanced surveillance

Inattention and/or hyperactivity/impulsivity problems not rising to DSM-V diagnosis; provide education of family and child re: concerns(e.g., triggers for inattention or hyperactivity) and behaviormanagement strategies or school-based strategies; enhanced surveillance

Reevaluate to con�rm diagnosis and/or provide education to improve adherence;reconsider treatment plan including: changing of the medication or dose, adding a medication approved for adjuvant therapy and/or changing behavioral therapy

Assess impact on treatment plan; further evaluation/referral as needed

Provide education of family and child re: concerns(e.g., triggers for inattention or hyperactivity) and behaviormanagement strategies or school-based strategies

BEGIN TREATMENT

Option: Medication(ADHD only and past medical or familyhistory of cardiovascular disease considered)• Initiate treatment• Titrate to maximum bene�t, minimum adverse e�ects• Monitor target outcomes

Option: Behavior management(developmental variation, problem or ADHD)• Identify service or approach• Monitor target outcomes

Option: Collaborate with school to enhance supports and services (developmental variation, problem or ADHD)• Identify changes• Monitor target outcomes

Yes Yes

Yes

Yes

Yes

No

No

No

No

No

Yes

No

Source: American Academy of Pediatrics (AAP)*CYSHCN = Children & Youth with Special Healthcare Needs

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Patients identi�ed with signs or symptoms suggesting ADHD. Symptoms can come from parents’ direct concerns or the mental health screen recommended by the Task Force on Mental Health (TFOMH)