MedicaidDocumentationMedium impact
[Indiana] HEDIS® Measure Reminder- Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics (APP)
CareSource·IN · Pediatrics, Psychiatry, General Practice·Quality Measures
Effective date
Oct 1, 2025
We identified it
May 9, 2026
Summary
CareSource is reminding Indiana Medicaid providers about HEDIS quality measure requirements for children and adolescents prescribed antipsychotics. Providers must document and ensure that psychosocial care (behavioral health therapy) is delivered as first-line treatment before or within 30 days after antipsychotic initiation for eligible patients ages 1-17. This is a measurement and performance monitoring requirement, not a billing code change, but affects documentation and care coordination practices.
Action Required
Effective immediately (notice date October 1, 2025): (1) Clinical providers must document psychosocial care initiation within 90 days prior to or 30 days after new antipsychotic prescriptions for pediatric patients ages 1-17 without indication for antipsychotics (e.g., ADD, behavioral disorders—excluding schizophrenia, bipolar, autism, developmental disorders). (2) Billing/clinical staff must verify continuous Medicaid enrollment for 120 days pre-prescription through 30 days post-prescription before submitting claims. (3) Update EMR templates and encounter forms to prompt providers to document psychosocial care referrals and baseline metabolic monitoring. (4) Establish internal tracking to monitor APP measure compliance and identify patients requiring referral to CareSource Care Management (1-844-607-2829) or Nurse Advice Line (1-844-206-5947). (5) Educate parents/guardians on side effects and community resources. Failure to document and provide psychosocial care may negatively impact HEDIS quality scores and CareSource performance ratings.