Frequently Asked Questions

P-SCIP Sickle Cell Anemia Measure Specifications

For detailed information about the measure specifications, please see TCD | Antibiotics | Hydroxyurea 

What is sickle cell disease (SCD) and how does it differ from sickle cell anemia (SCA)?

SCD is a group of inherited red blood cell disorders that affects about 100,000 people in the United States. Red blood cells contain hemoglobin, a protein that carries oxygen. Healthy red blood cells are round, and they move through small blood vessels easily to carry oxygen to all parts of the body.

In someone who has SCD, the hemoglobin is abnormal, which causes the red blood cells to become hard and sticky and look like a C-shaped farm tool called a sickle. The sickle cells die earlier than normal red blood cells, which causes a constant shortage of red blood cells. Also, when they travel through small blood vessels, sickle cells can get stuck and clog the blood flow. This can cause pain crises and other serious complications such as infection, acute chest syndrome, and stroke.  (Ref: About Sickle Cell Disease | Sickle Cell Disease (SCD) | CDC)

SCA is a specific subtype and more severe form of sickle cell disease. The P-SCIP measures specifically focus on children with SCA.

What are the three P-SCIP SCA Measures?

1. Transcranial Doppler ultrasonography screening among children ages 2 to 16 years with SCA (For more information on TCDs, click here.)

2. Appropriate antibiotic prophylaxis among children ages 3 months to 5 years with SCA (For more information on antibiotics, click here.)

3. Use of hydroxyurea among children ages 1 to 18 years with SCA (For more information on hydroxyurea, click here.)

What is the patient population (denominator) for the three P-SCIP SCA Measures?

All three measures identify the denominator, children with SCA, in the same way. The only difference among measure denominators is the age of children during the measurement year.

The table below provides the ICD-10-CM codes for identifying children with SCA. 

Do children with S Beta+ Thalassemia require annual TCD screenings and hydroxyurea?

Children with S Beta+ Thalassemia sickle cell disease are not included in measure denominators. (See qualifying ICD-10-CM codes above).

What is the measurement year for the three P-SCIP SCA measures?

Specifically for P-SCIP, the measurement year for the three SCA measures is July 1 - June 30 of each year. This aligns with annual health plan reporting to MDHHS.

Do children need to have an outpatient visit to be included in the specifications?

Yes. The language from the specifications reads “Children with sickle cell anemia are identified as those with at least one outpatient visit with a sickle cell anemia-related or D571 ICD-10-CM diagnosis code within the measurement year (July 1 through June 30).”

In other words, children with sickle cell anemia (SCA) are identified as those with at least one outpatient visit. This outpatient visit must be correlated with a SCA-related ICD-10 code, including D571.

Are there denominator exclusions for the three P-SCIP SCA measures?

There are no exclusions to the P-SCIP SCA measures.

If a health plan believes that a pediatric member should be excluded from a measure due to a special clinical consideration, the health plan can proceed with the “Exemption for Clinical Consideration” process.

Exemption for Clinical Considerations

Health plans have requested to have a process to remove members from their denominators when a preventive service (TCD, antibiotics or hydroxyurea) may not be appropriate for the member due to a special clinical reason. The process for requesting the removal of a member from a measure denominator is outlined below. Requests may be made in conjunction with the narrative report sent annually to MDHHS. Requests must be submitted to MDHHS by September 30, 2025, for exemptions to be included for the reporting period.

What is the process for submitting Exemptions for Clinical Considerations?

The process is outlined below:

  1. Health plans planning to submit a “Request for Exemption for Clinical Consideration” for any member(s) should first verify in CC360, as per MDHHS guidance, whether the members for whom exemptions are requested are currently included in the CC360 denominator.

  2. If members ARE included in CC360 denominator, health plans complete the “Request for Exemption for Clinical Consideration” table in narrative report for these members.

  3. If members ARE NOT included in CC360 denominator, health plans do not request exemption for these members, as this is not necessary.

  4. Health plans submits their narrative report template with the “Request for Exemption for Clinical Consideration” to MDHHS by September 30, 2025.

  5. MDHHS sends “Request for Exemption for Clinical Consideration” information to the UM team for review.

  6. The UM team provides feedback to MDHHS regarding validity of requests for exemptions.

  7. MDHHS verifies feedback and requests that Optum remove approved members from health-plan denominators.

  8. Optum removes approved members from the denominator for the annual performance bonus (07/01/24 – 06/30/25 measurement year). These members will also be removed from the three subsequent quarterly data pulls. This process will be repeated annually.

• Please note, members who are excluded from the quality measures will still be visible in CC360 member level detail to support data reconciliation. The CC360 extract detail will indicate that they have been excluded from the quality measure rate.

  9. MDHHS delivers final template scoring to health plans.

If a patient has received MRIs of the brain, may they be excluded from the TCD measure denominator?

Patients who receive MRIs of the brain are generally not excluded from the TCD measure denominator. Per the P-SCIP consulting hematologist, children will get an MRI/MRA if there is an abnormal TCD. Even if a child receives an MRI, they should still have a TCD during the measurement year.

There are rare cases where due to anatomy, TCD results are consistently unreliable, in which case an MRI/MRA could be substituted for the annual TCD, and therefore, excluded from the measure. This special clinical situation will need to be confirmed and documented by a hematologist to be considered for exclusion from the measure.

Extended Fills for Hydroxyurea and Antibiotics

What is the maximum days supply that can be dispensed for a single prescription of antibiotics and hydroxyurea?

Due to efforts by our pharmacy workgroup, a 90-day supply of antibiotics and a 102-day supply of hydroxyurea now may be prescribed and dispensed for children with sickle cell anemia.

What should a provider write on the prescription for an extended fill?

Per members of the pharmacy workgroup, a provider may use the following sig:

• “Dispense entire 3-month (or 102-day) supply"

• “Chronic treatment for Sickle Cell Disease” 

• "Do not reconstitute at the pharmacy, please instruct the patient/caregiver on the reconstitution volume and stability so they may reconstitute at home as needed" (For antibiotics only)

How may hematologists or pharmacist support family education regarding reconstitution?

The pharmacy workgroup has suggested the following process for providers and pharmacists:

1. Prescribing hematologist: Write the extended fill prescription based on the sig “dispense entire 3-month/102-day supply" and "do not reconstitute, patient/caregiver has been instructed to reconstitute as needed."

2. Prescribing hematologist: Empower the patient/family to ask for counseling to support the request for an extended fill.

3. Dispensing pharmacist: Counsel family and demonstrate the reconstitution process.

• If the pharmacy declines the extended fill – the pt/family or provider should reach out to the health plan or our team so that we can identify an accommodating pharmacy.

4. Providers/pharmacists may suggest that patients or families may contact their health plan case manager with questions or for additional education and counseling.