CMS-10398 #59 Monitoring Workbook

Generic Clearance for Medicaid and CHIP State Plan, Waiver, and Program Submissions (CMS-10398)

10 - 1115-SMI-Monitoring-Workbook_013020 (version 2).xlsm

GenIC # 59 (New) - Medicaid Section 1115 Severe Mental Illness and Children with Serious Emotional Disturbance Demonstrations

OMB: 0938-1148

Document [xlsx]
Download: xlsx | pdf

Overview

PRA Disclosure Statement
Protocol-Planned metrics
Protocol-SMI & SED definitions
Report-Metrics reporting
Report-Data & reporting issues
Instructions - Avail assessment
Definitions - Avail assessment
Availability Asesssment

Sheet 1: PRA Disclosure Statement
PRA Disclosure Statement This information is being collected to assist the Centers for Medicare & Medicaid Services in program monitoring of Medicaid Section 1115 Severe Mental Illness and Severe Emotional Disturbance Demonstrations. This mandatory information collection (42 CFR § 431.428) will be used to support more efficient, timely and accurate review of states’ monitoring report submissions of Medicaid Section 1115 Severe Mental Illness and Severe Emotional Disturbance Demonstrations, and also support consistency in monitoring and evaluation, increase in reporting accuracy, and reduction in timeframes required for monitoring and evaluation. Under the Privacy Act of 1974 any personally identifying information obtained will be kept private to the extent of the law.
End of worksheet
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-1148 (CMS-10398 #59). The time required to complete this information collection is estimated to average 29 hours per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.

Sheet 2: Protocol-Planned metrics

Medicaid Section 1115 SMI/SED Demonstration Protocol - Planned metrics




















State [Enter State Name]



















Demonstration Name [Enter Demonstration Name]



















Demonstration Year (DY) [Enter Demonstration Year] (Format: DY1, DY2, DY3, etc.)



















Calendar Dates for DY [Enter Calendar Dates for Demonstration Year] (Format: MM/DD/YYYY - MM/DD/YYYY)



















Reporting Period [Enter Reporting Period] (Format: Q1, Q2, Q3, Q4)



















Calendar Dates for Reporting Period [Enter Calendar Dates for Reporting Period (Format: MM/DD/YYYY - MM/DD/YYYY)



















Submitted on [Enter Date] (Format: MM/DD/YYYY)











































Standard information on CMS-provided metrics






Baseline, annual goals, and demonstration target Alignment with CMS-provided technical specifications Initial reporting date
# Metric name Metric description Milestone or reporting topic Metric type Reporting category Data source Measurement period Reporting frequency Reporting priority State will report (Y/N) Baseline Reporting Period (MM/DD/YYYY--MM/DD/YYYY) Annual goal Overall demonstration target Attest that planned reporting matches the CMS-provided specification (Y/N) Explanation of any deviations from the CMS-provided specifications (different data source, definition, codes, target population, etc.) Dates covered by first measurement period for metric (MM/DD/YYYY - MM/DD/YYYY) Name of first report in which the metric will be submitted (Format: DY1 Q3 report) Submission date of first report in which the metric will be reported (MM/DD/YYYY) State plans to phase in reporting (Y/N) Explanation of any plans to phase in reporting over time
1 SUD Screening of Beneficiaries Admitted to Psychiatric Hospitals or Residential Treatment Settings (SUB-2) Two rates will be reported for this measure:
1. SUB-2: Patients who screened positive for unhealthy alcohol use who received or refused a brief intervention during the hospital stay.
2. SUB-2a: Patients who received the brief intervention during the hospital stay.		 Milestone 1 Established quality measure Annual metrics that are an established quality measure Medical record review or claims Year Annually Recommended











2 Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics (APP-CH) Percentage of children and adolescents ages 1 to 17 who had a new prescription for an antipsychotic medication and had documentation of psychosocial care as first-line treatment. Milestone 1 Established quality measure Annual metrics that are an established quality measure Claims Year Annually Required











3 All-Cause Emergency Department Utilization Rate for Medicaid Beneficiaries who may Benefit From Integrated Physical and Behavioral Health Care (PMH-20) Number of all-cause ED visits per 1,000 beneficiary months among adult Medicaid beneficiaries age 18 and older who meet the eligibility criteria of beneficiaries with SMI. Milestone 2 Established quality measure Annual metrics that are an established quality measure Claims Year Annually Required











4 30-Day All-Cause Unplanned Readmission Following Psychiatric Hospitalization in an Inpatient Psychiatric Facility (IPF) The rate of unplanned, 30-day, readmission rate for demonstration beneficiaries with a primary discharge diagnosis of a psychiatric disorder or dementia/Alzheimer’s disease. The measurement period used to identify cases in the measure population is 12 months from January 1 through December 31. Milestone 2 Established quality measure Annual metrics that are an established quality measure Claims Year Annually Required











5 Medication Reconciliation Upon Admission Percentage of patients for whom a designated prior to admission (PTA) medication list was generated by referencing one or more external sources of PTA medications and for which all PTA medications have a documented reconciliation action by the end of Day 2 of the hospitalization. Milestone 2 Established quality measure Annual metrics that are an established quality measure Electronic/paper medical records Year Annually Recommended











6 Medication Continuation Following Inpatient Psychiatric Discharge This measure assesses whether psychiatric patients admitted to an inpatient psychiatric facility (IPF) for major depressive disorder (MDD), schizophrenia, or bipolar disorder filled a prescription for evidence-based medication within 2 days prior to discharge and 30 days post-discharge. Milestone 2 Established quality measure Annual metrics that are an established quality measure Claims Year Annually Required











7 Follow-up After Hospitalization for Mental Illness: Ages 6-17 (FUH-CH) Percentage of discharges for children ages 6 to 17 who were hospitalized for treatment of selected mental illness or intentional self-harm diagnoses and who had a follow-up visit with a mental health practitioner. Two rates are reported:
• Percentage of discharges for which the child received follow-up within 30 days after discharge
• Percentage of discharges for which the child received follow-up within 7 days after discharge		 Milestone 2 Established quality measure Annual metrics that are an established quality measure Claims Year Annually Required











8 Follow-up After Hospitalization for Mental Illness: Age 18 and older (FUH-AD) Percentage of discharges for beneficiaries age 18 years and older who were hospitalized for treatment of selected mental illness diagnoses or intentional self-harm and who had a follow-up visit with a mental health practitioner. Two rates are reported:
• Percentage of discharges for which the beneficiary received follow-up within 30 days after discharge
• Percentage of discharges for which the beneficiary received follow-up within 7 days after discharge		 Milestone 2 Established quality measure Annual metrics that are an established quality measure Claims Year Annually Required











9 Follow-up After Emergency Department Visit for Alcohol and Other Drug Abuse (FUA-AD) Percentage of emergency department (ED) visits for beneficiaries age 18 and older with a principal diagnosis of alcohol or other drug (AOD) abuse dependence who had a follow-up visit for AOD abuse or dependence. Two rates are reported:
• Percentage of ED visits for AOD abuse or dependence for which the beneficiary received follow-up within 30 days of the ED visit
• Percentage of ED visits for AOD abuse or dependence for which the beneficiary received follow-up within 7 days of the ED visit		 Milestone 2 Established quality measure Annual metrics that are an established quality measure Claims Year Annually Required











10 Follow-Up After Emergency Department Visit for Mental Illness (FUM-AD) Percentage of emergency department (ED) visits for beneficiaries age 18 and older with a principal diagnosis of mental illness or intentional self-harm and who had a follow-up visit for mental illness. Two rates are reported:
• Percentage of ED visits for mental illness for which the beneficiary received follow-up within 30 days of the ED visit
• Percentage of ED visits for mental illness for which the beneficiary received follow-up within 7 days of the ED visit		 Milestone 2 Established quality measure Annual metrics that are an established quality measure Claims Year Annually Required











11 Suicide or Overdose Death Within 7 and 30 Days of Discharge From an Inpatient Facility or Residential Treatment for Mental Health Among Beneficiaries With SMI or SED (count) Number of suicide or overdose deaths among Medicaid beneficiaries with SMI or SED within 7 and 30 days of discharge from an inpatient facility or residential stay for mental health. Milestone 2 CMS-constructed Other annual metrics State data on cause of death Year Annually Recommended











12 Suicide or Overdose Death Within 7 and 30 Days of Discharge From an Inpatient Facility or Residential Treatment for Mental Health Among Beneficiaries With SMI or SED (rate) Rate of suicide or overdose deaths among Medicaid beneficiaries with SMI or SED within 7 and 30 days of discharge from an inpatient facility or residential stay for mental health. Milestone 2 CMS-constructed Other annual metrics State data on cause of death Year Annually Recommended











13 Mental Health Services Utilization - Inpatient Number of beneficiaries in the demonstration or with SMI/SED who use inpatient services related to mental health during the measurement period. Milestone 3 CMS-constructed Other monthly and quarterly metrics Claims Month Quarterly Required











14 Mental Health Services Utilization - Intensive Outpatient and Partial Hospitalization Number of beneficiaries in the demonstration or with SMI/SED who used intensive outpatient and/or partial hospitalization services related to mental health during the measurement period. Milestone 3 CMS-constructed Other monthly and quarterly metrics Claims Month Quarterly Required











15 Mental Health Services Utilization - Outpatient Number of beneficiaries in the demonstration or with SMI/SED who used outpatient services related to mental health during the measurement period. Milestone 3 CMS-constructed Other monthly and quarterly metrics Claims Month Quarterly Required











16 Mental Health Services Utilization - ED Number of beneficiaries in the demonstration or with SMI/SED who use emergency department services for mental health during the measurement period. Milestone 3 CMS-constructed Other monthly and quarterly metrics Claims Month Quarterly Required











17 Mental Health Services Utilization - Telehealth Number of beneficiaries in the demonstration or with SMI/SED who used telehealth services related to mental health during the measurement period. Milestone 3 CMS-constructed Other monthly and quarterly metrics Claims Month Quarterly Required











18 Mental Health Services Utilization - Any Services Number of beneficiaries in the demonstration or with SMI/SED who used any services related to mental health during the measurement period. Milestone 3 CMS-constructed Other monthly and quarterly metrics Claims Month Quarterly Required











19a Average Length of Stay in IMDs Average length of stay (ALOS) for beneficiaries with SMI discharged from an inpatient or residential stay in an IMD. Three rates are reported:
• ALOS for all IMDs and populations
• ALOS among short-term stays (less than or equal to 60 days)
• ALOS among long-term stays (greater than 60 days)		 Milestone 3 CMS-constructed Other annual metrics Claims
State-specific IMD database		 Year Annually Required











19b Average Length of Stay in IMDs (IMDs receiving FFP only) Average length of stay (ALOS) for beneficiaries with SMI discharged from an inpatient or residential stay in an IMD receiving federal financial participation (FFP). Three rates are reported:
• ALOS for all IMDs and populations
• ALOS among short-term stays (less than or equal to 60 days)
• ALOS among long-term stays (greater than 60 days)		 Milestone 3 CMS-constructed Other annual metrics Claims
State-specific IMD database		 Year Annually Required











20 Beneficiaries With SMI/SED Treated in an IMD for Mental Health Number of beneficiaries with SMI/SED who have a claim for inpatient or residential treatment for mental health in an IMD during the reporting year. Milestone 3 CMS-constructed Other annual metrics Claims Year Annually Required











21 Count of Beneficiaries With SMI/SED (monthly) Count the number of unique beneficiaries (de-duplicated total) enrolled in the measurement period who have qualifying facility, or provider claims have sufficient qualifying facility, or provider claims to qualify as having SMI/SED-related treatment during the measurement period and/or in the 11 months before the measurement period. Milestone 4 CMS-constructed Other monthly and quarterly metrics Claims Month Quarterly Required











22 Count of Beneficiaries With SMI/SED (annually) Number of beneficiaries in the demonstration (with a diagnosis and service history indicating SMI/SED) during the measurement period and/or in the 11 months before the measurement period. Milestone 4 CMS-constructed Other annual metrics Claims Year Annually Required











23 Diabetes Care for Patients with Serious Mental Illness: Hemoglobin A1c (HbA1c) Poor Control (>9.0%) (HPCMI-AD) Percentage of beneficiaries ages 18 to 75 with a serious mental illness and diabetes (type 1 and type 2) whose most recent Hemoglobin A1c (HbA1c) level during the measurement year is >9.0%. Milestone 4 Established quality measure Annual metrics that are an established quality measure Claims
Medical records		 Year Annually Required











24 Screening for Depression and Follow-Up Plan: Age 18 and Older (CDF-AD) Percentage of beneficiaries age 18 and older screened for depression on the date of the encounter using an age appropriate standardized depression screening tool, AND if positive, a follow-up plan is documented on the date of the positive screen. Milestone 4 Established quality measure Annual metrics that are an established quality measure Claims
Medical records		 Year Annually Recommended











25 Screening for Depression and Follow-Up Plan: Ages 12–17 (CDF-CH) Percentage of beneficiaries ages 12 to 17 screened for depression on the date of the encounter using an age appropriate standardized depression screening tool, AND if positive, a follow-up plan is documented on the date of the positive screen. Milestone 4 Established quality measure Annual metrics that are an established quality measure Claims
Electronic medical records		 Year Annually Recommended











26 Access to Preventive/Ambulatory Health Services for Medicaid Beneficiaries With SMI The percentage of Medicaid beneficiaries with SMI who had an ambulatory or preventive care visit during the measurement period. Milestone 4 Established quality measure Annual metrics that are an established quality measure Claims Year Annually Required











27 Tobacco Use Screening and Follow-up for People with SMI or Alcohol or Other Drug Dependence The percentage of patients 18 years and older with a serious mental illness or alcohol or other drug dependence who received a screening for tobacco use and follow-up for those identified as a current tobacco user. Two rates are reported:
• Percentage of adults with SMI who received a screening for tobacco use and follow-up for those identified as a current tobacco user
• Percentage of adults with AOD who received a screening for tobacco use and follow-up for those identified as a current tobacco user		 Milestone 4 Established quality measure Annual metrics that are an established quality measure Claims Year Annually Recommended











28 Alcohol Screening and Follow-up for People with SMI The percentage of patients 18 years and older with a serious mental illness, who were screened for unhealthy alcohol use and received brief counseling or other follow-up care if identified as an unhealthy alcohol user. Milestone 4 Established quality measure Annual metrics that are an established quality measure Claims Year Annually Recommended











29 Metabolic Monitoring for Children and Adolescents on Antipsychotics The percentage of children and adolescents 1-17 years of age with ongoing antipsychotic medication use who had metabolic testing during the year. Milestone 4 Established quality measure Annual metrics that are an established quality measure Claims Year Annually Required











30 Follow-Up Care for Adult Medicaid Beneficiaries Who are Newly Prescribed an Antipsychotic Medication Percentage of new antipsychotic prescriptions for Medicaid beneficiaries age 18 years and older who have completed a follow-up visit with a provider with prescribing authority within four weeks (28 days) of prescription of an antipsychotic medication. Milestone 4 Established quality measure Annual metrics that are an established quality measure Claims Year Annually Required











31 Use of Multiple Concurrent Antipsychotics in Children and Adolescents (APC-CH) Percentage of children and adolescents ages 1 to 17 who were treated with antipsychotic medications and who were on two or more concurrent antipsychotic medications for at least 90 consecutive days during the measurement year. Milestone 4 Established quality measure Annual metrics that are an established quality measure Claims Year Annually Required











32 Total Costs Associated With Mental Health Services Among Beneficiaries With SMI/SED - Not Inpatient or Residential Total Medicaid costs for non-inpatient or residential services for mental health, among beneficiaries in the demonstration or with SMI/SED during the measurement period. Other SMI/SED metrics CMS-constructed Other annual metrics Claims Year Annually Required











33 Total Costs Associated With Mental Health Services Among Beneficiaries With SMI/SED - Inpatient or Residential Total Medicaid costs for inpatient or residential services for mental health among beneficiaries with SMI/SED during the measurement period. Other SMI/SED metrics CMS-constructed Other annual metrics Claims Year Annually Required











34 Per Capita Costs Associated With Mental Health Services Among Beneficiaries With SMI/SED - Not Inpatient or Residential Per capita costs for non-inpatient, non-residential services for mental health, among beneficiaries with SMI/SED during the measurement period. Other SMI/SED metrics CMS-constructed Other annual metrics Claims Year Annually Required











35 Per Capita Costs Associated With Mental Health Services Among Beneficiaries With SMI/SED - Inpatient or Residential Per capita costs for not inpatient or residential services for mental health, among beneficiaries with SMI/SED during the measurement period. Other SMI/SED metrics CMS-constructed Other annual metrics Claims Year Annually Required











36 Grievances Related to Services for SMI/SED Number of grievances filed during the measurement period that are related to services for SMI/SED. Other SMI/SED metrics CMS-constructed Grievances and appeals Administrative records Quarter Quarterly Required











37 Appeals Related to Services for SMI/SED Number of appeals filed during the measurement period that are related to services for SMI/SED. Other SMI/SED metrics CMS-constructed Grievances and appeals Administrative records Quarter Quarterly Required











38 Critical Incidents Related to Services for SMI/SED Number of critical incidents filed during the measurement period that are related to services for SMI/SED. Other SMI/SED metrics CMS-constructed Grievances and appeals Administrative records Quarter Quarterly Required











39 Total Costs Associated With Treatment for Mental Health in an IMD Among Beneficiaries With SMI/SED Total Medicaid costs for beneficiaries with SMI/SED who had claims for inpatient or residential treatment for mental health in an IMD during the reporting year. Other SMI/SED metrics CMS-constructed Other annual metrics Claims Year Annually Required











40 Per Capita Costs Associated With Treatment for Mental Health in an IMD Among Beneficiaries With SMI/SED Per capita Medicaid costs for beneficiaries with SMI/SED who had claims for inpatient or residential treatment for mental health in an IMD during the reporting year. Other SMI/SED metrics CMS-constructed Other annual metrics Claims Year Annually Required











Q1 [Insert selected metric(s) for health IT question 1]
Health IT State-identified



Required











Q2 [Insert selected metric(s) for health IT question 2]
Health IT State-identified



Required











Q3 [Insert selected metric(s) for health IT question 3]
Health IT State-identified



Required

































End of workbook




















Sheet 3: Protocol-SMI & SED definitions
Medicaid Section 1115 SMI/SED Demonstration Protocol - SMI & SED definitions

State [Enter State Name]
Demonstration Name [Enter Demonstration Name]
Demonstration Year (DY) [Enter Demonstration Year] (Format: DY1, DY2, DY3, etc.)
Calendar Dates for DY [Enter Calendar Dates for Demonstration Year] (Format: MM/DD/YYYY - MM/DD/YYYY)
Reporting Period [Enter Reporting Period] (Format: Q1, Q2, Q3, Q4)
Calendar Dates for Reporting Period [Enter Calendar Dates for Reporting Period (Format: MM/DD/YYYY - MM/DD/YYYY)
Submitted on [Enter Date] (Format: MM/DD/YYYY)



Narrative description of the SMI/SED demonstration population
EXAMPLEa
Adults age 18 or older with serious mental illness or children under the age of 18 with a serious emotional disturbance living within the state.
. Serious Mental Illness (SMI) Serious Emotional Disturbance (SED)
Narrative description of how the state defines the population for purposes of monitoring (including included ages, diagnosis groups and associated service use requirements) EXAMPLEa
*At least one acute inpatient claim/encounter with any diagnosis of schizophrenia, bipolar I disorder, or major depression, OR
*At least two visits in an outpatient, intensive outpatient (IOP), partial hospitalization (PH), emergency department (ED), or nonacute inpatient setting, on different dates of service, with any diagnosis of schizophrenia, OR
*At least two visits in an outpatient, IOP, PH, ED, or nonacute inpatient setting on different dates of service with a diagnosis of bipolar I disorder. 		See SMI example for format and required information
Codes used to identify populationb

States may use ICD-10 diagnosis codes or state-specific treatment, diagnosis, or other types of codes to identify the population. When applicable, states should supplement ICD-10 codes with state-specific codes.		 EXAMPLEa
*Schizophrenia: F20.0-F20.5, F20.81, F20.89
*Major depression: F32.0 - F32.4, F33.0 - F33.3
*Bipolar I disorder: F30.10-F30.13, F30.2 - F30.9		 See SMI example for format and required information
Procedure (e.g., CPT, HCPCS) or revenue codes used to identify/define service requirementsb

If the state is not using procedure or revenue codes, the state should include the data source(s) (e.g., state-specific codes) used to identify/define service requirements.		 EXAMPLEa
*Outpatient: 98960-98962, 99211-99215, G0155, G0176, G0177, G0409, 0510, 0513, 0515-0517		 See SMI example for format and required information
aThe examples are based on a definition of SMI from the National Committee for Quality Assurance (NCQA). The examples provided are intended to be illustrative only. The example codes provided are not comprehensive.

bStates may choose to include codes as separate tabs in this workbook.

End of workbook

  

Sheet 4: Report-Metrics reporting

Medicaid Section 1115 SED/SMI Demonstration Report - Metrics reporting



























































State [Enter State Name]


























































Demonstration Name [Enter Demonstration Name]


























































Demonstration Year (DY) [Enter Demonstration Year] (Format: DY1, DY2, DY3, etc.)


























































Calendar Dates for DY [Enter Calendar Dates for Demonstration Year] (Format: MM/DD/YYYY - MM/DD/YYYY)


























































Reporting Period [Enter Reporting Period] (Format: Q1, Q2, Q3, Q4)


























































Calendar Dates for Reporting Period [Enter Calendar Dates for Reporting Period (Format: MM/DD/YYYY - MM/DD/YYYY)


























































Submitted on [Enter Date] (Format: MM/DD/YYYY)






















































































































Serious Mental Illness/Serious Emotional Disturbance (SMI/SED) Metricsa








































































Demonstration Modeled Standardized definition of SMI State-specific definition of SMI Children (Age <16) Transition-age youth (Age 16-24) Adults (Age 25-64) Older adults (Age 65+) Dual-eligible (Medicare-Medicaid eligible) Medicaid only Eligible for Medicaid on the basis of disability Not eligible for Medicaid on the basis of disability Criminally involved Not criminally involved Co-occurring SUD Co-occurring physical conditions
# Metric name Metric description Milestone or reporting topic Metric type Reporting category Data source Technical specification manual version Attest that reporting matches CMS-provided specification (Y/N)b Describe any deviations from CMS-provided specifications Reporting issue (Y/N)
(further describe in data and reporting issues tab)		 Measurement period (month, quarter, yearc) Dates covered by measurement period (MM/DD/YYYY-MM/DD/YYYY) Denominator Numerator or count Rate/Percentaged Denominator Numerator or count Rate/Percentaged Denominator Numerator or count Rate/Percentaged Denominator Numerator or count Rate/Percentaged Denominator Numerator or count Rate/Percentaged Denominator Numerator or count Rate/Percentaged Denominator Numerator or count Rate/Percentaged Denominator Numerator or count Rate/Percentaged Denominator Numerator or count Rate/Percentaged Denominator Numerator or count Rate/Percentaged Denominator Numerator or count Rate/Percentaged Denominator Numerator or count Rate/Percentaged Denominator Numerator or count Rate/Percentaged Denominator Numerator or count Rate/Percentaged Denominator Numerator or count Rate/Percentaged Denominator Numerator or count Rate/Percentaged

SMI & SED definitions


























































1 SUD Screening of Beneficiaries Admitted to Psychiatric Hospitals or Residential Treatment Settings (SUB-2)
SUB-2: Patients who screened positive for unhealthy alcohol use who received or refused a brief intervention during the hospital stay.

 Milestone 1 Established quality measure Annual metrics that are an established quality measure Medical record review or claims



Year


#DIV/0!

#DIV/0!









































SUB-2a: Patients who received the brief intervention during the hospital stay.



Year


#DIV/0!

#DIV/0!









































2 Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics (APP-CH) Percentage of children and adolescents ages 1 to 17 who had a new prescription for an antipsychotic medication and had documentation of psychosocial care as first-line treatment. Milestone 1 Established quality measure Annual metrics that are an established quality measure Claims



Year


#DIV/0!

#DIV/0!









































3 All-Cause Emergency Department Utilization Rate for Medicaid Beneficiaries who may Benefit From Integrated Physical and Behavioral Health Care (PMH-20) Number of all-cause ED visits per 1,000 beneficiary months among adult Medicaid beneficiaries age 18 and older who meet the eligibility criteria of beneficiaries with SMI. Milestone 2 Established quality measure Annual metrics that are an established quality measure Claims



Year
















































4 30-Day All-Cause Unplanned Readmission Following Psychiatric Hospitalization in an Inpatient Psychiatric Facility (IPF) The rate of unplanned, 30-day, readmission rate for demonstration beneficiaries with a primary discharge diagnosis of a psychiatric disorder or dementia/Alzheimer’s disease. The measurement period used to identify cases in the measure population is 12 months from January 1 through December 31. Milestone 2 Established quality measure Annual metrics that are an established quality measure Claims



Year


#DIV/0!

#DIV/0!









































5 Medication Reconciliation Upon Admission Percentage of patients for whom a designated prior to admission (PTA) medication list was generated by referencing one or more external sources of PTA medications and for which all PTA medications have a documented reconciliation action by the end of Day 2 of the hospitalization. Milestone 2 Established quality measure Annual metrics that are an established quality measure Electronic/paper medical records



Year


#DIV/0!

#DIV/0!









































6 Medication Continuation Following Inpatient Psychiatric Discharge This measure assesses whether psychiatric patients admitted to an inpatient psychiatric facility (IPF) for major depressive disorder (MDD), schizophrenia, or bipolar disorder filled a prescription for evidence-based medication within 2 days prior to discharge and 30 days post-discharge. Milestone 2 Established quality measure Annual metrics that are an established quality measure Claims



Year


#DIV/0!

#DIV/0!









































7 Follow-up After Hospitalization for Mental Illness: Ages 6-17 (FUH-CH) Percentage of discharges for children ages 6 to 17 who were hospitalized for treatment of selected mental illness or intentional self-harm diagnoses and who had a follow-up visit with a mental health practitioner. Two rates are reported:
Milestone 2 Established quality measure Annual metrics that are an established quality measure






















































Percentage of discharges for which the child received follow-up within 30 days after discharge. Claims



Year


#DIV/0!

#DIV/0!









































Percentage of discharges for which the child received follow-up within 7 days after discharge. Claims



Year


#DIV/0!

#DIV/0!









































8 Follow-up After Hospitalization for Mental Illness: Age 18 and Older (FUH-AD) Percentage of discharges for beneficiaries age 18 years and older who were hospitalized for treatment of selected mental illness diagnoses or intentional self-harm and who had a follow-up visit with a mental health practitioner. Two rates are reported:
 Milestone 2 Established quality measure Annual metrics that are an established quality measure






















































Percentage of discharges for which the beneficiary received follow-up within 30 days after discharge. Claims



Year


#DIV/0!

#DIV/0!









































Percentage of discharges for which the beneficiary received follow-up within 7 days after discharge. Claims



Year


#DIV/0!

#DIV/0!









































9 Follow-up After Emergency Department Visit for Alcohol and Other Drug Abuse (FUA-AD) Percentage of emergency department (ED) visits for beneficiaries age 18 and older with a principal diagnosis of alcohol or other drug (AOD) abuse dependence who had a follow-up visit for AOD abuse or dependence. Two rates are reported: Milestone 2 Established quality measure Annual metrics that are an established quality measure






















































Percentage of ED visits for AOD abuse or dependence for which the beneficiary received follow-up within 30 days of the ED visit. Claims



Year


#DIV/0!

#DIV/0!









































Percentage of ED visits for AOD abuse or dependence for which the beneficiary received follow-up within 7 days of the ED visit. Claims



Year


#DIV/0!

#DIV/0!









































10 Follow-Up After Emergency Department Visit for Mental Illness (FUM-AD) Percentage of emergency department (ED) visits for beneficiaries age 18 and older with a principal diagnosis of mental illness or intentional self-harm and who had a follow-up visit for mental illness. Two rates are reported:

Milestone 2 Established quality measure Annual metrics that are an established quality measure






















































Percentage of ED visits for mental illness for which the beneficiary received follow-up within 30 days of the ED visit. Claims



Year


#DIV/0!

#DIV/0!









































Percentage of ED visits for mental illness for which the beneficiary received follow-up within 7 days of the ED visit. Claims



Year


#DIV/0!

#DIV/0!









































11 Suicide or Overdose Death Within 7 and 30 Days of Discharge From an Inpatient Facility or Residential Treatment for Mental Health Among Beneficiaries With SMI or SED (count) Number of suicide or overdose deaths among Medicaid beneficiaries with SMI or SED within 7 and 30 days of discharge from an inpatient facility or residential stay for mental health. Milestone 2 CMS-constructed Other annual metrics






















































7 days of discharge from an inpatient facility or residential stay for mental health. State data on cause of death



Year
















































30 days of discharge from an inpatient facility or residential stay for mental health. State data on cause of death



Year
















































12 Suicide or Overdose Death Within 7 and 30 Days of Discharge From an Inpatient Facility or Residential Treatment for Mental Health Among Beneficiaries With SMI or SED (rate) Rate of suicide or overdose deaths among Medicaid beneficiaries with SMI or SED within 7 and 30 days of discharge from an inpatient facility or residential stay for mental health. Milestone 2 CMS-constructed Other annual metrics






















































7 days of discharge from an inpatient facility or residential stay for mental health. State data on cause of death



Year


#DIV/0!

#DIV/0!







#DIV/0!

#DIV/0!

#DIV/0!

#DIV/0!























30 days of discharge from an inpatient facility or residential stay for mental health. State data on cause of death



Year


#DIV/0!

#DIV/0!







#DIV/0!

#DIV/0!

#DIV/0!

#DIV/0!























13 Mental Health Services Utilization - Inpatient Number of beneficiaries in the demonstration or with SMI/SED who use inpatient services related to mental health during the measurement period. Milestone 3 CMS-constructed Other monthly and quarterly metrics Claims



Month 1
















































Month 2
















































Month 3
















































14 Mental Health Services Utilization - Intensive Outpatient and Partial Hospitalization Number of beneficiaries in the demonstration or with SMI/SED who used intensive outpatient and/or partial hospitalization services related to mental health during the measurement period. Milestone 3 CMS-constructed Other monthly and quarterly metrics Claims



Month 1
















































Month 2
















































Month 3
















































15 Mental Health Services Utilization - Outpatient Number of beneficiaries in the demonstration or with SMI/SED who used outpatient services related to mental health during the measurement period. Milestone 3 CMS-constructed Other monthly and quarterly metrics Claims



Month 1
















































Month 2
















































Month 3
















































16 Mental Health Services Utilization - ED Number of beneficiaries in the demonstration or with SMI/SED who use emergency department services for mental health during the measurement period. Milestone 3 CMS-constructed Other monthly and quarterly metrics Claims



Month 1
















































Month 2
















































Month 3
















































17 Mental Health Services Utilization - Telehealth Number of beneficiaries in the demonstration or with SMI/SED who used telehealth services related to mental health during the measurement period. Milestone 3 CMS-constructed Other monthly and quarterly metrics Claims



Month 1
















































Month 2
















































Month 3
















































18 Mental Health Services Utilization - Any Services Number of beneficiaries in the demonstration or with SMI/SED who used any services related to mental health during the measurement period. Milestone 3 CMS-constructed Other monthly and quarterly metrics Claims



Month 1
















































Month 2
















































Month 3
















































19a Average Length of Stay in IMDs Average length of stay (ALOS) for beneficiaries with SMI discharged from an inpatient or residential stay in an IMD. Three rates are reported: Milestone 3 CMS-constructed Other annual metrics






















































ALOS for all IMDs and populations Claims
State-specific IMD database



Year


#DIV/0!

#DIV/0!









































ALOS among short-term stays (less than or equal to 60 days) Claims
State-specific IMD database



Year


#DIV/0!

#DIV/0!









































ALOS among long-term stays (greater than 60 days) Claims
State-specific IMD database



Year


#DIV/0!

#DIV/0!









































19b Average Length of Stay in IMDs (IMDs receiving FFP only) Average length of stay (ALOS) for beneficiaries with SMI discharged from an inpatient or residential stay in an IMD receiving federal financial participation (FFP). Three rates are reported: Milestone 3 CMS-constructed Other annual metrics






















































ALOS for all IMDs and populations Claims
State-specific IMD database



Year


#DIV/0!

#DIV/0!









































ALOS among short-term stays (less than or equal to 60 days) Claims
State-specific IMD database



Year


#DIV/0!

#DIV/0!









































ALOS among long-term stays (greater than 60 days) Claims
State-specific IMD database



Year


#DIV/0!

#DIV/0!









































20 Beneficiaries With SMI/SED Treated in an IMD for Mental Health Number of beneficiaries with SMI/SED who have a claim for inpatient or residential treatment for mental health in an IMD during the reporting year. Milestone 3 CMS-constructed Other annual metrics Claims



Year
















































21 Count of Beneficiaries With SMI/SED (monthly) Count the number of unique beneficiaries (de-duplicated total) enrolled in the measurement period who have qualifying facility, or provider claims have sufficient qualifying facility, or provider claims to qualify as having SMI/SED-related treatment during the measurement period and/or in the 11 months before the measurement period. Milestone 4 CMS-constructed Other monthly and quarterly metrics Claims



Month 1
















































Month 2
















































Month 3
















































22 Count of Beneficiaries With SMI/SED (annually) Number of beneficiaries in the demonstration (with a diagnosis and service history indicating SMI/SED) during the measurement period and/or in the 11 months before the measurement period. Milestone 4 CMS-constructed Other annual metrics Claims



Year
















































23 Diabetes Care for Patients with Serious Mental Illness: Hemoglobin A1c (HbA1c) Poor Control (>9.0%) (HPCMI-AD) Percentage of beneficiaries ages 18 to 75 with a serious mental illness and diabetes (type 1 and type 2) whose most recent Hemoglobin A1c (HbA1c) level during the measurement year is >9.0%. Milestone 4 Established quality measure Annual metrics that are an established quality measure Claims
Medical records



Year


#DIV/0!

#DIV/0!









































24 Screening for Depression and Follow-Up Plan: Age 18 and Older (CDF-AD) Percentage of beneficiaries age 18 and older screened for depression on the date of the encounter using an age appropriate standardized depression screening tool, AND if positive, a follow-up plan is documented on the date of the positive screen. Milestone 4 Established quality measure Annual metrics that are an established quality measure Claims
Medical records



Year


#DIV/0!

#DIV/0!









































25 Screening for Depression and Follow-Up Plan: Ages 12–17 (CDF-CH) Percentage of beneficiaries ages 12 to 17 screened for depression on the date of the encounter using an age appropriate standardized depression screening tool, AND if positive, a follow-up plan is documented on the date of the positive screen. Milestone 4 Established quality measure Annual metrics that are an established quality measure Claims
Electronic medical records



Year


#DIV/0!

#DIV/0!









































26 Access to Preventive/Ambulatory Health Services for Medicaid Beneficiaries With SMI The percentage of Medicaid beneficiaries with SMI who had an ambulatory or preventive care visit during the measurement period. Milestone 4 Established quality measure Annual metrics that are an established quality measure Claims



Year


#DIV/0!

#DIV/0!









































27 Tobacco Use Screening and Follow-up for People with Serious Mental Illness or Alcohol or Other Drug Dependence The percentage of patients 18 years and older with a serious mental illness or alcohol or other drug dependence who received a screening for tobacco use and follow-up for those identified as a current tobacco user. Two rates are reported: Milestone 4 Established quality measure Annual metrics that are an established quality measure






















































Percentage of adults with SMI who received a screening for tobacco use and follow-up for those identified as a current tobacco user Claims



Year


#DIV/0!

#DIV/0!









































Percentage of adults with AOD who received a screening for tobacco use and follow-up for those identified as a current tobacco user Claims



Year


#DIV/0!

#DIV/0!









































28 Alcohol Screening and Follow-up for People with Serious Mental Illness The percentage of patients 18 years and older with a serious mental illness, who were screened for unhealthy alcohol use and received brief counseling or other follow-up care if identified as an unhealthy alcohol user. Milestone 4 Established quality measure Annual metrics that are an established quality measure Claims



Year


#DIV/0!

#DIV/0!









































29 Metabolic Monitoring for Children and Adolescents on Antipsychotics The percentage of children and adolescents 1-17 years of age with ongoing antipsychotic medication use who had metabolic testing during the year. Milestone 4 Established quality measure Annual metrics that are an established quality measure Claims



Year


#DIV/0!

#DIV/0!









































30 Follow-Up Care for Adult Medicaid Beneficiaries Who are Newly Prescribed an Antipsychotic Medication Percentage of new antipsychotic prescriptions for Medicaid beneficiaries age 18 years and older who have completed a follow-up visit with a provider with prescribing authority within four weeks (28 days) of prescription of an antipsychotic medication. Milestone 4 Established quality measure Annual metrics that are an established quality measure Claims



Year


#DIV/0!

#DIV/0!









































31 Use of Multiple Concurrent Antipsychotics in Children and Adolescents (APC-CH) Percentage of children and adolescents ages 1 to 17 who were treated with antipsychotic medications and who were on two or more concurrent antipsychotic medications for at least 90 consecutive days during the measurement year. Milestone 4 Established quality measure Annual metrics that are an established quality measure Claims



Year


#DIV/0!

#DIV/0!









































32 Total Costs Associated With Mental Health Services Among Beneficiaries With SMI/SED - Not Inpatient or Residential Total Medicaid costs for non-inpatient or residential services for mental health, among beneficiaries in the demonstration or with SMI/SED during the measurement period. Other SMI/SED metrics CMS-constructed Other annual metrics Claims



Year
















































33 Total Costs Associated With Mental Health Services Among Beneficiaries With SMI/SED - Inpatient or Residential Total Medicaid costs for inpatient or residential services for mental health among beneficiaries with SMI/SED during the measurement period. Other SMI/SED metrics CMS-constructed Other annual metrics Claims



Year
















































34 Per Capita Costs Associated With Mental Health Services Among Beneficiaries With SMI/SED - Not Inpatient or Residential Per capita costs for non-inpatient, non-residential services for mental health, among beneficiaries with SMI/SED during the measurement period. Other SMI/SED metrics CMS-constructed Other annual metrics Claims



Year
















































35 Per Capita Costs Associated With Mental Health Services Among Beneficiaries With SMI/SED - Inpatient or Residential Per capita costs for not inpatient or residential services for mental health, among beneficiaries with SMI/SED during the measurement period. Other SMI/SED metrics CMS-constructed Other annual metrics Claims



Year
















































36 Grievances Related to Services for SMI/SED Number of grievances filed during the measurement period that are related to services for SMI/SED. Other SMI/SED metrics CMS-constructed Grievances and appeals Administrative records



Quarter
















































37 Appeals Related to Services for SMI/SED Number of appeals filed during the measurement period that are related to services for SMI/SED. Other SMI/SED metrics CMS-constructed Grievances and appeals Administrative records



Quarter
















































38 Critical Incidents Related to Services for SMI/SED Number of critical incidents filed during the measurement period that are related to services for SMI/SED. Other SMI/SED metrics CMS-constructed Grievances and appeals Administrative records



Quarter
















































39 Total Costs Associated With Treatment for Mental Health in an IMD Among Beneficiaries With SMI/SED Total Medicaid costs for beneficiaries with SMI/SED who had claims for inpatient or residential treatment for mental health in an IMD during the reporting year. Other SMI/SED metrics CMS-constructed Other annual metrics Claims



Year
















































40 Per Capita Costs Associated With Treatment for Mental Health in an IMD Among Beneficiaries With SMI/SED Per capita Medicaid costs for beneficiaries with SMI/SED who had claims for inpatient or residential treatment for mental health in an IMD during the reporting year. Other SMI/SED metrics CMS-constructed Other annual metrics Claims



Year
















































Q1 Insert selected metric(s) related to key health IT question 1
Health IT
State-identified






















































Q2 Insert selected metric(s) related to key health IT question 2
Health IT
State-identified






















































Q3 Insert selected metric(s) related to key health IT question 3
Health IT
State-identified



















































































































Note: Licensee and states must prominently display the following notice on any display of Measure rates:
The MPT, FUH-CH, FUH-AD, FUA-AD, FUM-AD, AAP, APM, and APC measures (metrics #13, 14, 15, 16, 17, 18, 7, 8, 9, 10, 26, 29, 31) are Healthcare Effectiveness Data and Information Set (“HEDIS®”) measures that are owned and copyrighted by the National Committee for Quality Assurance (“NCQA”). NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications.

The measure specification methodology used by CMS is different from NCQA’s methodology. NCQA has not validated the adjusted measure specifications but has granted CMS permission to adjust. Calculated measure results, based on the adjusted HEDIS specifications, may be called only “Uncertified, Unaudited HEDIS rates.”

Certain non-NCQA measures in the CMS 1115 Serious Mental Illness/Serious Emotional Disturbance Demonstration contain HEDIS Value Sets (VS) developed by and included with the permission of the NCQA. Proprietary coding is contained in the VS. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. NCQA disclaims all liability for use or accuracy of the VS with the non-NCQA measures and any coding contained in the VS.
























































a States should create a new metrics report for each reporting quarter.



























































b For state-identified metrics or the SMI & SED definitions states should attest that it is reporting as specified in its monitoring protocol.



























































c Report metrics that are one annual value for a demonstration year only in the report specified in the reporting schedule.



























































d If applicable. See CMS-provided technical specifications.



























































e Enter any new models that will be reported after column BI; create new columns as needed.



























































End of workbook




























































Checks:



























































Numerator in #11 is equal to the numerator in #12.



























































Numerator in #32 is equal to the numerator in #34



























































Numerator in #33 is equal to the numerator in #35



























































Denominator in #34 and #35 is equal to #21 and #22.



























































Numerator in #40 is equal to #39.


























































Sheet 5: Report-Data & reporting issues
Medicaid Section 1115 SMI/SED Demonstration Report - Data & reporting issues





State [Enter State Name]




Demonstration Name [Enter Demonstration Name]




Demonstration Year (DY) [Enter Demonstration Year] (Format: DY1, DY2, DY3, etc.)




Calendar Dates for DY [Enter Calendar Dates for Demonstration Year] (Format: MM/DD/YYYY - MM/DD/YYYY)




Reporting Period [Enter Reporting Period] (Format: Q1, Q2, Q3, Q4)




Calendar Dates for Reporting Period [Enter Calendar Dates for Reporting Period (Format: MM/DD/YYYY - MM/DD/YYYY)




Submitted on [Enter Date] (Format: MM/DD/YYYY)


















Milestone or reporting topic Metric(s) impacted Summary of issue Date and report in which issue was first reported Estimated number of impacted beneficiaries Known or suspected cause(s) of issue (if applicable) Remediation plan and timeline for resolution (if applicable)/status update if issue previously reporteda
Milestone 1 [Add rows as needed]


































aThe state should also use this column to provide updates on any data or reporting issues described in previous reports. When applicable, the state should note when issues are resolved. If an issue was noted as resolved in the previous report, it should not be reported in the current report.





End of workbook





Sheet 6: Instructions - Avail assessment
Instructions for Completing the Assessment of the Availability of Mental Health Services ("Availability Assessment" tab)
Before you begin: The state will submit multiple availability assessments. The state will submit an initial assessment at the time of application and annual assessments thereafter.
The state should select a consistent month in each year to populate the information in the availability assessment (e.g. provide initial information based on counts covering August 2019, and update the information based on counts covering August 2020, August 2021, August 2022, and August 2023).
Enter the state name, data entry date(s), and time period reflected in the availability assessment in cells C1-3.
To add rows for additional geographic designations, click the "Add row" button.
Column Instructions
B In column B, enter each geographic designation starting in cell B8. Add rows as needed to capture all geographic designations. Geographic designation means a state-defined geographic unit for reporting data, such as county, region, or catchment area. The state should consider how it divides its mental health system into smaller units or catchment areas to select geographic designations that will yield meaningful, actionable information.
C In column C, starting in cell C8, please select whether geographic designation entered in the corresponding cell in column B could be considered urban or rural. If the geographic designation should be categorized as something other than urban or rural, select "Other-please explain" and record an explanation in the notes box in column D. Urban is defined as a Metropolitan Statistical Area or a Metropolitan division (in the case where a Metropolitan Statistical Area is divided into Metropolitan Divisions), as defined by the Executive Office of Management and Budget (42 CFR § 412.64(b)) Rural is defined as any area outside an urban area as defined in 42 CFR § 412.64(b).
D In column D, beginning in cell D8, please use this space to explain the state's response if the state selects 'Other-please explain' in column C.
E In column E, starting in cell E8, enter the total number of adult Medicaid beneficiaries ages 18-20 in each geographic designation at the selected point in time. Medicaid beneficiary means a person who has been determined to be eligible to receive Medicaid services as defined at 42 CFR §400.200. Note: this age category is separate in order to avoid double counting beneficiaries in the residential treatment category and to facilitate the calculation of certain ratios in the assessment. See the note in the following cell for additional explanation
F In column F, starting in cell F8, enter the number of adult Medicaid beneficiaries ages 18-20 with SMI in each geographic designation at the selected point in time. As defined on page 1 of the State Medicaid Directors Letter, serious mental illness means persons age 18 and over who currently, or at any time during the past year, have had a diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet diagnostic criteria, that has resulted in functional impairment which substantially interferes with or limits one or more major life activities.

Note: in the State Medicaid Directors letter (SMDL #18-011), SMI is defined to include individuals age 18 years and older, and SED includes children younger than 18. However, the residential treatment section of the availability assessment requests data on PRTFs, and the federal definition for PRTFs includes facilities that serve individuals under the age of 21. In order to avoid double counting beneficiaries in the residential treatment category, the assessment requests data on beneficiaries age 0-17, 18-20, and 21 and older separately.
G In column G, starting in cell G8, enter the total number of adult Medicaid beneficiaries age 21 and older in each geographic designation at the selected point in time.
H In column H, starting in cell H8, enter the number of adult Medicaid beneficiaries age 21 and older with SMI in each geographic designation at the selected point in time.

Note: in the SMDL, SMI is defined to include individuals age 18 years and older, and SED includes children younger than 18. However, the residential treatment section of the availability assessment requests data on PRTFs, and the federal definition for PRTFs includes facilities that serve individuals under the age of 21. In order to avoid double counting beneficiaries in the residential treatment category, the assessment requests data on beneficiaries age 0-17, 18-20, and 21 and older separately.
I In column I, starting in cell I8, the availability assessment will automatically calculate the percent of adult Medicaid beneficiaries who have SMI in each geographic designation. The state should not input any values into this column or modify the formulas in this column.
J In column J, starting in cell J8, enter the total number of Medicaid beneficiaries under the age of 18 in each geographic designation at the selected point in time.
K In column K, starting in cell K8, enter the number of beneficiaries under the age of 18 with SED in each geographic designation at the selected point in time. As defined on page 2 of the SMDL, individuals with SED are those from birth up to age 18 who currently, or at any time during the past year, have had a diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet diagnostic criteria that resulted in functional impairment which substantially interferes with or limits the child’s role or functioning in family, school, or community activities. Functional impairment” is defined as difficulties that substantially interfere with or limit a child or adolescent from achieving or maintaining one or more developmentally-appropriate social, behavioral, cognitive, communicative, or adaptive skills.
L In column L starting in cell L8, the availability assessment will automatically calculate the percent of beneficiaries under the age of 18 who have SED in each geographic designation. The state should not input any values into this column or modify the formulas in this column.
M In column M, starting in cell M8, the availability assessment will automatically calculate the number of Medicaid beneficiaries (total) in each geographic designation.
N In column N, starting in cell N8, the availability assessment will automatically calculate the percent with Medicaid beneficiaries with SMI or SED (total) in each geographic designation.
O In column O, starting in cell O8, the availability assessment will automatically calculate the percent with SMI or SED (total) in each geographic designation.
P In column P, beginning in cell P8, please use this space to provide notes about or qualifications to beneficiary data. For example, use this cell to explain data limitations or missing data.
Q In column Q, starting in cell Q8, enter the number of psychiatrists or other practitioners who are authorized to prescribe in each geographic designation. A psychiatrist is any psychiatrist licensed to practice in the state under state licensure laws. Other prescribers authorized to prescribe means the number of mental health practitioners other than psychiatrists who are authorized to prescribe as defined by state licensure laws.
R In column R, starting in cell R8, enter the number of Medicaid-enrolled psychiatrists or other practitioners who are authorized to prescribe in each geographic designation. Medicaid-enrolled means any provider enrolled in Medicaid to obtain Medicaid billing privileges, as defined in 42 CFR §455.410.
S In column S, starting in cell S8, enter the number of Medicaid-enrolled psychiatrists or other practitioners who are authorized to prescribe and are accepting new Medicaid patients in each geographic designation. Accepting new Medicaid patients means any provider enrolled in Medicaid to obtain Medicaid billing privileges who will treat new Medicaid-enrolled patients.
T-V In columns T-V, starting in cell T8, the availability assessment will automatically calculate the ratios in each geographic designation. The state should not input any values into these columns or modify the formulas in these columns.
W In column W, beginning in cell W8, please use this space to provide notes about or qualifications to category data. For example, use this cell to explain data limitations or missing data.
X In column X, starting in cell X8, enter the number of other practitioners certified or licensed to independently treat mental illness in each geographic designation. Other types of practitioners certified or licensed to independently treat mental illness means non-psychiatrist mental health providers who are certified or licensed to independently treat mental illness as defined by state licensure laws. This may include, but is not limited to, licensed psychologists, clinical social workers, and professional counselors.
Y In column Y, starting in cell Y8, enter the number of Medicaid-enrolled other types of practitioners certified and licensed to independently treat mental illness in each geographic designation.
Z In column Z, starting in cell Z8, enter the number of Medicaid-enrolled other types of practitioners certified and licensed to independently treat mental illness accepting new Medicaid patients in each geographic designation.
AA-AC In columns AA-AC, starting in cell AA8, the availability assessment will automatically calculate the ratios in each geographic designation. The state should not input any values into these columns or modify the formulas in these columns.
AD In column AD, beginning in cell AD8, please use this space to provide notes about or qualifications to category data. For example, use this cell to explain data limitations or missing data.
AE In column AE, starting in cell AE8, enter the number of community mental health centers (CMHCs) in each geographic designation. A community mental health center is an entity that provides outpatient mental health services, 24 hour emergency care services, day treatment, screenings, and consultation and educational services, as defined at 42 CFR §410.2.
AF In column AF, starting in cell AF8, enter the number of Medicaid-enrolled CMHCs in each geographic designation.
AG In column AG, starting in cell AG8, enter the number of Medicaid-enrolled CMHCs accepting new Medicaid patients in each geographic designation.
AH-AJ In columns AH-AJ, starting in cell AH8, the availability assessment will automatically calculate the ratios in each geographic designation. The state should not input any values into these columns or modify the formulas in these columns.
AK In column AK, beginning in cell AK8, please use this space to provide notes about or qualifications to category data. For example, use this cell to explain data limitations or missing data.
AL In column AL, starting in cell AL8, enter the number of intensive outpatient/partial hospitalization providers in each geographic designation. Partial hospitalization or intensive outpatient services means a distinct and organized intensive ambulatory treatment program that offers less than 24-hour daily care other than in an individual's home or in an inpatient or residential setting.
AM In column AM, starting in cell AM8, enter the number of Medicaid-enrolled intensive outpatient/partial hospitalization providers in each geographic designation.
AN In column AN, starting in cell AN8, enter the number of Medicaid-enrolled intensive outpatient/partial hospitalization providers accepting new Medicaid patients in each geographic designation.
AO-AQ In column AO-AQ, starting in cell AO8, the availability assessment will automatically calculate the ratios in each geographic designation. The state should not input any values into these columns or modify the formulas in these columns.
AR In column AR, beginning in cell AR8, please use this space to provide notes about or qualifications to category data. For example, use this cell to explain data limitations or missing data.
AS In column AS, starting in cell AS8, enter the number of residential mental health treatment facilities (adult) in each geographic designation. A residential mental health treatment facilities (adult) is a facility not licensed as a psychiatric hospital, whose primary purpose is to provide individually planned programs of mental health treatment services in a residential care setting for adults as defined for SAMHSA's N-MHSS. Please exclude residential SUD treatment facilities.
AT In column AT, starting in cell AT8, enter the number of Medicaid-enrolled residential mental health treatment facilities (adult) in each geographic designation.
AU In column AU, starting in cell AU8, enter the number of Medicaid-enrolled residential mental health treatment facilities (adult) accepting new Medicaid patients in each geographic designation.
AV-AX In column AV-AX, starting in cell AV8, the availability assessment will automatically calculate the ratios in each geographic designation. The state should not input any values into these columns or modify the formulas in these columns.
AY In column AY, starting in cell AY8, enter the total number of residential mental health treatment facility beds (adult) in each geographic designation.
AZ In column AZ, starting in cell AZ8, enter the total number of Medicaid-enrolled residential mental health treatment beds (adult) in each geographic designation.
BA In column BA, starting in cell BA8, enter the total number of Medicaid-enrolled residential mental health treatment beds available to adult Medicaid patients in each geographic designation. Available to Medicaid adult Medicaid patients means any facility or bed available to serve Medicaid patients over the age of 18.
BB-BD In column BB-BD, starting in cell BB8, the availability assessment will automatically calculate the ratios in each geographic designation. The state should not input any values into these columns or modify the formulas in these columns.
BE In column BE, beginning in cell BE8, please use this space to provide notes about or qualifications to category data. For example, use this cell to explain data limitations or missing data.
BF In column BF, starting in cell BF8, enter the number of psychiatric residential treatment facilities (PRTF) in each geographic designation. A PRTF is a non-hospital facility with a provider agreement with a state Medicaid agency to provide the inpatient psychiatric services to individuals under age 21 benefit (psych under 21 benefit). The facility must be accredited by the Joint Commission, the Council on Accreditation of Services for Families and Children, the Commission on Accreditation of Rehabilitation Facilities, or any other accrediting organization with comparable standards recognized by the State. PRTFs must also meet the requirements at 42 CFR §441.151 - §441.182, and 42 CFR §483.350 – §483.376.
BG In column BG, starting in cell BG8, enter the number of Medicaid-enrolled PRTFs in each geographic designation.
BH In column BH, starting in cell BH8, enter the number of Medicaid-enrolled PRTFs accepting new Medicaid patients in each geographic designation.
BI-BK In column BI-BK, starting in cell BI8, the availability assessment will automatically calculate the ratios in each geographic designation. The state should not input any values into these columns or modify the formulas in these columns.
BL In column BL, starting in cell BL8, enter the total number of PRTF beds in each geographic designation.
BM In column BM, starting in cell BM8, enter the number of Medicaid-enrolled PRTF beds in each geographic designation.
BN In column BN, starting in cell BN8, enter the number of Medicaid-enrolled PRTF beds available to Medicaid patients in each geographic designation. Available to Medicaid patients means any facility or bed available to serve Medicaid patients.
BO-BQ In column BO-BQ, starting in cell BO8, the availability assessment will automatically calculate the ratios in each geographic designation. The state should not input any values into these columns or modify the formulas in these columns.
BR In column BR, beginning in cell BR8, please use this space to provide notes about or qualifications to category data. For example, use this cell to explain data limitations or missing data.
BS In column BS, starting in cell BS8, enter the number of psychiatric hospitals in each geographic designation. A psychiatric hospital is an institution which provides diagnosis and treatment of mentally ill persons, as defined at 42 USC §1395x.
BT In column BT, starting in cell BT8, enter the number of psychiatric hospitals available to Medicaid patients in each geographic designation.
BU-BV In column BU-BV, starting in cell BU8, the availability assessment will automatically calculate the ratios in each geographic designation. The state should not input any values into these columns or modify the formulas in these columns.
BW In column BW, beginning in cell BW8, please use this space to provide notes about or qualifications to category data. For example, use this cell to explain data limitations or missing data.
BX In column BX, starting in cell BX8, enter the number of psychiatric units in acute care hospitals in each geographic designation. A psychiatric unit is a separate inpatient psychiatric unit of a general hospital that provides inpatient mental health services and has specifically allocated staff and space (beds) for the treatment of persons with mental illness, as defined for SAMHSA's N-MHSS.
BY In column BY, starting in cell BY8, enter the number of psychiatric units in critical access hospitals (CAHs) in each geographic designation. A critical access hospital is a small facility that provides 24-hour emergency care, outpatient services, as well as inpatient services to people in rural areas, as defined in 42 CFR §485.606.
BZ In column BZ, starting in cell BZ8, enter the number of Medicaid-enrolled psychiatric units in acute care hospitals in each geographic designation.
CA In column CA, starting in cell CA8, enter the number of Medicaid-enrolled psychiatric units in CAHs in each geographic designation.
CB In column CB, starting in cell CB8, enter the number of Medicaid-enrolled psychiatric units in acute care hospitals accepting new Medicaid patients in each geographic designation.
CC In column CC starting in cell CC8, enter the number of Medicaid-enrolled psychiatric units in CAHs accepting new Medicaid patients in each geographic designation.
CD-CI In column CD-CI, starting in cell CD8, the availability assessment will automatically calculate the ratios in each geographic designation. The state should not input any values into these columns or modify the formulas in these columns.
CJ In column CJ, beginning in cell CJ8, please use this space to provide notes about or qualifications to category data. For example, use this cell to explain data limitations or missing data.
CK In column CK, starting in cell CK8, enter the number of licensed psychiatric hospital beds (psychiatric hospital + psychiatric units) in each geographic designation. Please enter the number of licensed psychiatric hospital beds as defined by state licensure requirements.
CL In column CL, starting in cell CL8, enter the number of licensed psychiatric hospital beds (psychiatric hospital + psychiatric units) available to Medicaid patients in each geographic designation.
CM-CN In column CM-CN, starting in cell CM8, the availability assessment will automatically calculate the ratios in each geographic designation. The state should not input any values into these columns or modify the formulas in these columns.
CO In column CO, beginning in cell CO8, please use this space to provide notes about or qualifications to category data. For example, use this cell to explain data limitations or missing data.
CP In column CP, starting in cell CP8, enter the number of residential mental health treatment facilities (adult) that qualify as an institution for mental diseases (IMDs) in each geographic designation. An IMD is a hospital, nursing facility, or other institution of more than 16 beds that is primarily engaged in providing diagnosis, treatment or care of persons with mental diseases, including medical attention, nursing care and related services per section 1905(i) of the Social Security Act. See also 42 CFR §435.1010 and section 4390 of the State Medicaid Manual.
CQ In column CQ, starting in cell CQ8, enter the number of Medicaid-enrolled residential mental health treatment facilities (adult) that qualify as IMDs in each geographic designation.
CR In column CR, starting in cell CR8, enter the number of Medicaid-enrolled residential mental health treatment facilities (adult) that qualify as IMDs accepting Medicaid patients in each geographic designation.
CS-CU In column CS-CU, starting in cell CS8, the availability assessment will automatically calculate the ratios in each geographic designation. The state should not input any values into these columns or modify the formulas in these columns.
CV In column CV, starting in cell CV8, enter the number of psychiatric hospitals that qualify as IMDs in each geographic designation.
CW In column CW, starting in cell CW8, the availability assessment will automatically calculate the ratios in each geographic designation. The state should not input any values into these columns or modify the formulas in these columns.
CX In column CX, beginning in cell CX8, please use this space to provide notes about or qualifications to category data. For example, use this cell to explain data limitations or missing data.
CY In column CY, starting in cell CY8, enter the number of crisis call centers in each geographic designation. Please enter the number of crisis call centers as defined by the state.
CZ In column CZ, starting in cell CZ8, enter the number of mobile crisis units in each geographic designation. A mobile crisis unit is a team that intervenes during mental health crises, as defined by the state.
DA In column DA, starting in cell DA8, enter the number of crisis observation/ assessment centers in each geographic designation. Please enter the number of observation or assessment centers as defined by the state.
DB In column DB, starting in cell DB8, enter the number of crisis stabilization units in each geographic designation. Crisis stabilization units offer medically monitored short-term crisis stabilization services, as defined by the state.
DC In column DC, starting in cell DC8, enter the number of coordinated community crisis response teams in each geographic designation. Coordinated community crisis response means a community-based program or entity that manages crisis response across various community entities or programs, as defined by the state.
DD-DH In column DD-DH, starting in cell DD8, the availability assessment will automatically calculate the ratios in each geographic designation. The state should not input any values into these columns or modify the formulas in these columns.
DI In column DI, beginning in cell DI8, please use this space to provide notes about or qualifications to category data. For example, use this cell to explain data limitations or missing data.
DJ In column DJ, starting in cell DJ8, enter the number FQHCs that offer behavioral health services in each geographic designation. Federally qualified health center (FQHC) means an entity that has entered into an agreement with CMS to meet Medicare program requirements under 42 CFR §405.2434 and 42 CFR §405.2401.
DK In column DK, starting in cell DK8,the availability assessment will automatically calculate the ratios in each geographic designation. The state should not input any values into these columns or modify the formulas in these columns.
DL In column DL, beginning in cell DL8, please use this space to provide notes about or qualifications to category data.
DM Beginning in column DM, add additional counts and ratios for provider and setting types that the state considers important to its mental health system. The state should not modify any of the previous columns.
End of worksheet











Sheet 7: Definitions - Avail assessment
Definitions of terms used in the Availability Assessment
Term Definition
Accepting new Medicaid patients Accepting new Medicaid patients means any provider enrolled in Medicaid to obtain Medicaid billing privileges who will treat new Medicaid-enrolled patients.
Available to Medicaid patients Available to Medicaid patients means any facility or bed available to serve Medicaid patients.
Adult An adult is a person age 18 and over [SMDL].
Community mental health center (CMHC) A community mental health center (CMHC) is an entity that provides outpatient mental health services, 24 hour emergency care services, day treatment, screenings, and consultation and educational services, as defined at 42 CFR §410.2.
Coordinated community crisis response Coordinated community crisis response means a community-based program or entity that manages crisis response across various community entities or programs, as defined by the state.
Crisis call center Crisis call centers are defined by the state.
Crisis stabilization unit Crisis stabilization units offer medically monitored short-term crisis stabilization services, as defined by the state.
Critical access hospital A critical access hospital is a small facility that provides 24-hour emergency care, outpatient services, as well as inpatient services to people in rural areas, as defined in 42 CFR §485.606.
Federally qualified health center Federally qualified health center (FQHC) means an entity that has entered into an agreement with CMS to meet Medicare program requirements under 42 CFR §405.2434 and 42 CFR §405.2401
Geographic designation Geographic designation means a state-defined geographic unit for reporting data, such as county, region, or catchment area.
Institution for mental diseases (IMD) An institution for mental diseases is a hospital, nursing facility, or other institution of more than 16 beds that is primarily engaged in providing diagnosis, treatment or care of persons with mental diseases, including medical attention, nursing care and related services per section 1905(i) of the Social Security Act. See also 42 CFR §435.1010 and section 4390 of the State Medicaid Manual.
Intensive outpatient services or partial hospitalization Intensive outpatient services or partial hospitalization means a distinct and organized intensive ambulatory treatment program that offers less than 24-hour daily care other than in an individual's home or in an inpatient or residential setting.
Licensed psychiatric hospital bed Licensed psychiatric hospital bedsare defined by state licensure requirements.
Medicaid beneficiary Medicaid beneficiary means a person who has been determined to be eligible to receive Medicaid services as defined at 42 CFR §400.200.
Medicaid-enrolled Medicaid-enrolled means any provider enrolled in Medicaid to obtain Medicaid billing privileges, as defined in 42 CFR §455.410.
Mobile crisis unit A mobile crisis unit is a team that intervenes during mental health crises, as defined by the state.
Mental health practitioners other than psychiatrists who are authorized to prescribe Mental health practitioners other than psychiatrists who are authorized to prescribe are defined by state licensure laws.
Mental health practitioners other than psychiatrists who are certified or licensed by the state to independently treat mental illness. Mental health practitioners other than psychiatrists who are certified or licensed to treat mental illness are non-psychiatrist mental health providers who are certified or licensed to independently treat mental illness as defined by state licensure laws. This may include, but is not limited to, licensed psychologists, clinical social workers, and professional counselors .
Observation or assessment centers Observation or assessment centers are defined by the state.
Psychiatric hospital A psychiatric hospital is an institution which provides diagnosis and treatment of mentally ill person, as defined at 42 USC §1395x.
Psychiatric residential treatment facility (PRTF) A psychiatric residential treatment facility is a non-hospital facility with a provider agreement with a state Medicaid agency to provide the inpatient psychiatric services to individuals under age 21 benefit (psych under 21 benefit). The facility must be accredited by the Joint Commission, the Council on Accreditation of Services for Families and Children, the Commission on Accreditation of Rehabilitation Facilities, or any other accrediting organization with comparable standards recognized by the State. PRTFs must also meet the requirements at 42 CFR §441.151 - §441.182, and 42 CFR §483.350 – §483.376.
Psychiatric unit A psychiatric unit is a separate inpatient psychiatric unit of a general hospital that provides inpatient mental health services and has specifically allocated staff and space (beds) for the treatment of persons with mental illness, as defined for SAMHSA's National Mental Health Services Survey (N-MHSS).
Psychiatrist A psychiatrist is any psychiatrist licensed to practice in the state under state licensure laws
Residential mental health treatment facilities (adult) A residential mental health treatment facilities (adult) is a facility not licensed as a psychiatric hospital, whose primary purpose is to provide individually planned programs of mental health treatment services in a residential care setting for adults as defined for SAMHSA's N-MHSS. Please exclude residential SUD treatment facilities.
Rural Rural means any area outside an urban area as defined in 42 CFR § 412.64(b)
Serious emotional disturbance Persons withserious emotional disturbance means individuals from birth up to age 18 who currently, or at any time during the past year, have had a diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet diagnostic criteria that resulted in functional impairment which substantially interferes with or limits the child’s role or functioning in family, school, or community activities. Functional impairment” is defined as difficulties that substantially interfere with or limit a child or adolescent from achieving or maintaining one or more developmentally-appropriate social, behavioral, cognitive, communicative, or adaptive skills [SMDL].
Serious mental illness Persons with serious mental illness means individuals, age 18 and over, who currently, or at any time during the past year, have had a diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet diagnostic criteria, that has resulted in functional impairment which substantially interferes with or limits one or more major life activities. [SMDL]

Note: in the SMDL, SMI is defined to include individuals age 18 years and older, and SED includes children younger than 18. However, the residential treatment section of the availability assessment requests data on PRTFs, and the federal definition for PRTFs includes facilities that serve individuals under the age of 21. In order to avoid double counting beneficiaries in the residential treatment category, the assessment requests data on beneficiaries age 0-17, 18-20, and 21 and older separately.
Urban Urban means a Metropolitan Statistical Area or a Metropolitan division (in the case where a Metropolitan Statistical Area is divided into Metropolitan Divisions), as defined by the Executive Office of Management and Budget (42 CFR § 412.64(b)).
End of worksheet

Sheet 8: Availability Asesssment

State Name





































































































































Date of Assessment




































































































































Time Period Reflected in Assessment














































































































































































































































































Geographic Designation

Beneficiaries Providers Community Mental Health Centers Intensive Outpatient or Partial Hospitalization Providers Residential Mental Health Treatment Facilities Inpatient Institutions for Mental Diseases Crisis Stabilization Services Federally Qualified Health Centers



























Adult Children Total
Psychiatrists or Other Practitioners Who Are Authorized to Prescribe Other Practitioners Certified and Licensed to Independently Treat Mental Illness













Residential Mental Health Treatment Facilities (Adult) Psychiatric Residential Treatment Facilities Psychiatric Hospitals Psychiatric Units Psychiatric Beds Residential Treatment Facilities That Qualify As IMDs Psychiatric Hospitals That Qualify As IMDs





































Geographic designation Is this geographic designation primarily urban or rural? Geographic Designation Notes Number of adult Medicaid beneficiaries (18 - 20) Number of adult Medicaid beneficiaries with SMI
(18 - 20)		 Number of adult Medicaid beneficiaries (21+) Number of adult Medicaid beneficiaries with SMI (21+) Percent with SMI (Adult) Number of Medicaid beneficiaries (0 - 17) Number of Medicaid beneficiaries with SED
(0 - 17)		 Percent with SED (0-17) Number of Medicaid beneficiaries (Total) Number of Medicaid beneficiaries with SMI or SED (Total) Percent with SMI or SED (Total) Beneficiary Category Notes Number of Psychiatrists or Other Practitioners Who Are Authorized to Prescribe Number of Medicaid-Enrolled Psychiatrists or Other Practitioners Who Are Authorized to Prescribe Number of Medicaid-Enrolled Psychiatrists or Other Practitioners Who Are Authorized to Prescribe Accepting New Medicaid Patients Ratio of Medicaid beneficiaries with SMI/SED to Medicaid-Enrolled Psychiatrists or Other Prescribers Ratio of Total Psychiatrists or Other Prescribers to Medicaid-Enrolled Psychiatrists or Other Prescribers Ratio of Medicaid-Enrolled Psychiatrists or Other Prescribers to Medicaid-Enrolled Psychiatrists or Other Prescribers Accepting New Medicaid Patients Psychiatrists or Other Practitioners Who Are Authorized to Prescribe Category Notes Number of Other Practitioners Certified or Licensed to Independently Treat Mental Illness Number of Medicaid-Enrolled Other Practitioners Certified or Licensed to Independently Treat Mental Illness Number of Medicaid-Enrolled Other Practitioners Certified or Licensed to Independently Treat Mental Illness Accepting New Medicaid Patients Ratio of Medicaid Beneficiaries with SMI/SED to Medicaid-Enrolled Other Practitioners Certified or Licensed to Independently Treat Mental Illness Ratio of Other Practitioners Certified or Licensed to Independently Treat Mental Illness to Medicaid-Enrolled Other Practitioners Certified or Licensed to Independently Treat Mental Illness Ratio of Medicaid-Enrolled Other Practitioners Certified and Licensed to Independently Treat Mental Illness to Medicaid-Enrolled Other Practitioners Certified and Licensed to Independently Treat Mental Illness Accepting New Patients Other Practitioner Category Notes Number of CMHCs Number of Medicaid- Enrolled CMHCs Number of Medicaid-Enrolled CMHCs Accepting New Medicaid Patients Ratio of Medicaid Beneficiaries with SMI/SED to Medicaid- Enrolled CMHCs Ratio of Total CMHCs to Medicaid- Enrolled CMHCs Ratio of Medicaid-Enrolled CMHCs to Medicaid-Enrolled CMHCs Accepting New Patients CMHC Category Notes Number of Intensive Outpatient/ Partial Hospitalization Providers Number of Medicaid-Enrolled Intensive Outpatient/ Partial Hospitalization Providers Number of Medicaid-Enrolled Intensive Outpatient/Partial Hospitalization Providers Accepting New Medicaid Patients Ratio of Medicaid Beneficiaries with SMI/SED to Medicaid- Enrolled Intensive Outpatient/ Partial Hospitalization Providers Ratio of Total Partial Hospitalization/ Day Treatment Providers to Medicaid-Enrolled Intensive Outpatient/ Partial Hospitalization Providers Ratio of Medicaid-Enrolled Partial Hospitalization/ Day Treatment Providers to Medicaid- Enrolled Intensive Outpatient/ Partial Hospitalization Providers Accepting New Medicaid Patients Intensive Outpatient/ Partial Hospitalization Category Notes Number of Residential Mental Health Treatment Facilities (Adult) Number of Medicaid- Enrolled Residential Mental Health Treatment Facilities (Adult) Number of Medicaid-Enrolled Residential Mental Health Treatment Facilities Accepting New Medicaid Patients (Adult) Ratio of Medicaid Beneficiaries with SMI (Adult) to Medicaid- Enrolled Residential Mental Health Treatment Facilities (Adult) Ratio of Total Residential Mental Health Treatment Facilities (Adult) to Medicaid-Enrolled Residential Mental Health Treatment Facilities (Adult) Ratio of Medicaid-Enrolled Residential Mental Health Treatment Facilities (Adult) to Medicaid- Enrolled Residential Mental Health Treatment Facilities (Adult) Accepting New Patients Total Number of Residential Mental Health Treatment Facility Beds (Adult) Total Number of Medicaid- Enrolled Residential Mental Health Treatment Beds (Adult) Total Number of Medicaid-Enrolled Residential Mental Health Treatment Beds Available to Adult Medicaid Patients Ratio of Medicaid Beneficiaries with SMI (Adult) to Medicaid-Enrolled Residential Mental Health Treatment Beds Ratio of Total Residential Mental Health Treatment Beds to Medicaid-Enrolled Residential Mental Health Treatment Beds Ratio of Medicaid-Enrolled Residential Mental Health Treatment Beds to Medicaid- Enrolled Residential Mental Health Treatment Beds Available to Medicaid Patients Residential Mental Health Treatment Facility Category Notes (Adult) Number of Psychiatric Residential Treatment Facilities (PRTF) Number of Medicaid- Enrolled PRTFs Number of Medicaid-Enrolled PRTFs Accepting New Medicaid Patients Ratio of Medicaid Beneficiaries with SED to Medicaid-Enrolled PTRFs Ratio of Total PTRFs to Medicaid- Enrolled PRTFs Ratio of Medicaid-Enrolled PRTFs to Medicaid-Enrolled PRTFs Accepting New Medicaid Patients Total Number of PRTF Beds Number of Medicaid-Enrolled PRTF Beds Number of Medicaid-Enrolled PRTF Beds Available to Medicaid Patients Ratio of Medicaid Beneficiaries with SED to Medicaid-Enrolled PRTF Beds Available to Medicaid Patients Ratio of Total Number of PRTF Beds to Medicaid- Enrolled PRTF Beds Ratio of Medicaid- Enrolled PRTF Beds to Medicaid- Enrolled PRTFs Available to Medicaid Patients Psychiatric Residential Treatment Facility (Under 21) Category Notes Number of Psychiatric Hospitals Psychiatric Hospitals Available to Medicaid Patients Ratio of Medicaid Beneficiaries with SMI/SED to Psychiatric Hospitals Available to Medicaid Patients Ratio of Psychiatric Hospitals to Psychiatric Hospitals Available to Medicaid Patients Psychiatric Hospital Category Notes Number of Psychiatric Units in Acute Care Hospitals Number of Psychiatric Units in Critical Access Hospitals (CAHs) Number of Medicaid- Enrolled Psychiatric Units in Acute Care Hospitals Number of Medicaid-Enrolled Psychiatric Units in CAHs Number of Medicaid-Enrolled Psychiatric Units in Acute Care Hospitals Accepting New Medicaid Patients Number of Medicaid-Enrolled Psychiatric Units in CAHs Accepting New Medicaid Patients Ratio of Medicaid Beneficiaries with SMI/SED to Medicaid-Enrolled Psychiatric Units in Acute Care Hospitals Ratio of Medicaid Beneficiaries with SMI/SED to Medicaid-Enrolled Psychiatric Units in CAHs Ratio of Psychiatric Units in Acute Care Hospitals to Medicaid-Enrolled Psychiatric Units in Acute Care Hospitals Ratio of Psychiatric Units in CAHs to Medicaid-Enrolled Psychiatric Units in CAHs Ratio of Medicaid-Enrolled Psychiatric Units in Acute Care Hospitals to Medicaid-Enrolled Psychiatric Units in Acute Care Hospitals Accepting New Medicaid Patients Ratio of Medicaid-Enrolled Psychiatric Units in CAHs to Medicaid-Enrolled Psychiatric Units in CAHs Accepting New Medicaid Patients Psychiatric Unit Category Notes Number of Licensed Psychiatric Hospital Beds (Psychiatric Hospital + Psychiatric Units) Number of Licensed Psychiatric Hospital Beds (Psychiatric Hospital + Psychiatric Units) Available to Medicaid Patients Ratio of Medicaid Beneficiaries with SMI/SED to Licensed Psychiatric Hospital Beds Available to Medicaid Patients Ratio of Licensed Psychiatric Hospital Beds to Licensed Psychiatric Hospital Beds Available to Medicaid Patients Psychiatric Beds Category Notes Number of Residential Mental Health Treatment Facilities (Adult) that Qualify as IMDs Number of Medicaid- Enrolled Residential Mental Health Treatment Facilities (Adult) that Qualify as IMDs Number of Medicaid- Enrolled Residential Mental Health Treatment Facilities (Adult) that Qualify as IMDs Accepting Medicaid Patients Ratio of Medicaid Beneficiaries with SMI (Adult) to Medicaid- Enrolled Residential Mental Health Treatment Facilities that Qualify as IMDs Ratio of Total Residential Mental Health Treatment Facilities (Adult) that Qualify as IMDs to Medicaid-Enrolled Residential Mental Health Treatment Facilities (Adult) that Qualify as IMDs Ratio of Medicaid-Enrolled Residential Mental Health Treatment Facilities (Adult) that Qualify as IMDs to Medicaid- Enrolled Residential Mental Health Treatment Facilities (Adult) that Qualify as IMDs Accepting New Medicaid Patients Number of Psychiatric Hospitals that Qualify as IMDs Ratio of Medicaid Beneficiaries with SMI/SED to Psychiatric Hospitals that Qualify as IMDs Facilities That Qualify As IMDs Category Notes Number of Crisis Call Centers Number of Mobile Crisis Units Number of Crisis Observation/ Assessment Centers Number of Crisis Stabilization Units Number of Coordinated Community Crisis Response Teams Ratio of Medicaid Beneficiaries with SMI/SED to Crisis Call Centers Ratio of Medicaid Beneficiaries with SMI/SED to Mobile Crisis Units Ratio of Medicaid Beneficiaries with SMI/SED to Crisis Observation/ Assessment Centers Ratio of Medicaid Beneficiaries with SMI/SED to Crisis Stabilization Units Ratio of Medicaid Beneficiaries with SMI/SED to Coordinated Community Crisis Response Teams Crisis Stabilization Services Category Notes Number FQHCs that Offer Behavioral Health Services Ratio of Medicaid Beneficiaries with SMI/SED to FQHCs that Offer Behavioral Health Services FQHC Category Notes























1.






-

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Total

0 0 0 0 - 0 0 - 0 0 -
0 0 0 - - -
0 0 0 - - -
0 0 0 - - -
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0 0 0 - - - 0 0 0 - - -
0 0 0 - - - 0 0 0 - - -
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0 0 0 0 0 0 - - - - - -
0 0 - -
0 0 0 - - - 0 -
0 0 0 0 0 - - - - -
0 -



































































































































































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