Clinic-Collected-Required Measures:

Screening for Depression & Follow-up Plan (CDF-AD and CDF-CH) 

Depression Remission at Six Months (DEP-REM-6)

Peggy O’Brien and Shweta Palakkode

Substance Abuse and Mental Health Services Administration

U.S. Department of Health and Human Services

November 1, 2023

2:30-4:00 PM ET
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Logistics

This webinar is being recorded and closed captioning is 

provided. The recording will be available about a week 

after the presentation and will be posted on the 

SAMHSA CCBHC website for later reference.

Please mute your lines (Thank you!).

We will have time for discussion and questions at the 

end. In the meantime, please feel free to put 

questions in the chat. We will address them at the end 

as well.
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Intended audience for this webinar

1. Prospective and existing CCBHC Section 223 

Demonstration state staff and CCBHCs

2. Independent state CCBHC initiative personnel

3. CCBHC-Expansion (CCBHC-PDI and -IA) grant 

clinics and SAMHSA GPOs
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Overview of Today’s Clinic-Collected Required Measures
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Screening for Depression 

& Follow-up Plan (CDFAD and CDF-CH)

Who? 

Clients not 

diagnosed 

with 

depression
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Poll #1

1. Our clinic is prepared to screen for depression 

and plan for treatment [select one response]

a) Yes

b) Yes AND deliver services

c) No

d) Partly

e) I do not know
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CDF-AD Measure: Description and Source

The CDF-AD measure calculates the percentage of 

clients ages 18 and older screened for depression 

on the date of the encounter or 14 days prior to 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 eligible encounter. 

 Source: Based on CMS Medicaid Adult Core Set Measure (2023), 

stewarded by CMS

CMS: Centers for Medicare & Medicaid Services 
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CDF-CH Measure: Description and Source

The CDF-CH measure calculates the percentage of 

clients ages 12 to 17 years screened for depression 

on the date of the encounter or 14 days prior to 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 eligible encounter. 

 Source: Based on CMS Medicaid Child Core Set Measure (2023), 

stewarded by CMS

CMS: Centers for Medicare & Medicaid Services 
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CDF-AD & CDF-CH Measures: Importance and Uses

 Importance:

 Among U.S. adolescents in 2021, 20.1 percent had a past year Major Depressive 

Episode (MDE) and, of those, 59 percent received no treatment for depression 

(SAMHSA, 2022).

 Among adults in 2021, 8.3 percent had a past year MDE, with higher rates among 

those ages 18 to 49 years of age. Overall, 39 percent of adults with past year MDE 

did not receive treatment, with rates of nontreatment higher among those ages 18 

to 25 years (SAMHSA, 2022).

 Use for Quality Improvement: 

 Implement evidence-based screening for depression

 Determine client needs

 Develop plan for follow-up services

 Use for evaluation of the CCBHC model

 Potential use for PPS
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CDF-AD & CDF-CH Measures: Data Source and Measurement Period

Data source: Administrative data or electronic 

health records

Measurement Period (aka, the time period 

that data must cover): The Measurement Year 

(example: Jan. 1, 2025-Dec. 31, 2025)

aka: also known as
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CDF-AD & CDF-CH Measures: Calculation of Denominators

 Denominator is all clients in the Eligible Population:

All clients receiving at least one CCBHC service (identified 

by one of the Current Procedural Terminology [CPT®] 

encounter codes in the specifications) during the 

Measurement Year

For CDF-AD: Age 18 years or older on date of service

For CDF-CH: Age 12-17 years on date of service

Excluding those with existing diagnosis of depression or 

bipolar disorder

 Stratification: payer, race, ethnicity

Bold indicates data need.
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CDF-AD & CDF-CH Measures: Calculation of Numerators

 Numerator is all clients in the appropriate 

Denominator (AD or CH):

 Screened for depression on the date of the encounter or 14 days prior to 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 eligible 

encounter

Exception: If the client does not meet the numerator criteria but meets the following 

exception criteria, they should be removed from the measure denominator:

– Client reason: Client refuses to participate.

– Medical reason: Client is in an urgent or emergent situation where time is of the 

essence and to delay treatment would jeopardize client’s health status, OR situations 

where client’s cognitive, functional, or motivational limitations may impact the 

accuracy of results of screening. 

However, if the client meets the numerator criteria, the client would be included in the 

measure denominator. 

Bold indicates data need.
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CDF-CH Measure: Practice Example

Denominator

Number of people receiving CCBHC 

service in Measurement Year (MY)

2,500

Of those, service was one of the 

appropriate encounter codes

2,250

Of those, ages 12-17 at date of 

service

500

Of those, already diagnosed with 

depression or bipolar disorder

225

Denominator 275 -

15=260

Numerator

Number in Denominator 275 -

15=26

0

Screened during encounter (or 

up to 14 days before), no 

depression

125

Screened during encounter (or 

up to 14 days before), yes 

depression and follow-up plan

100

Screened during encounter (or 

up to 14 days before), yes 

depression and NO follow-up 

plan

35

Not screened for depression 

during encounter 

15- 15

Numerator 225

BUT, Exceptions!

Not screened, 

because:

15

Refused 4

Urgent 9

Other medical 

excuse

2

Total 

Exceptions

15

Screened 

despite medical 

excuse (Keep in 

D and N)

3

CDF-CH rate = 225/260 = .87 (87%)
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CDF-AD & CDF-CH Examples of Standardized Depression Screening Tools

A normalized and validated depression screening tool developed for the population in 

which it is being utilized. Examples of depression screening tools include but are not 

limited to: 

• Adult Screening Tools (age 18 and older) 

– Patient Health Questionnaire (PHQ-9), Beck Depression Inventory (BDI or BDI-II), Center for 

Epidemiologic Studies Depression Scale (CES-D), Depression Scale (DEPS), Duke Anxiety- Depression 

Scale (DADS), Geriatric Depression Scale (GDS), Cornell Scale for Depression in Dementia (CSDD), 

PRIME MD-PHQ2, Hamilton Rating Scale for Depression (HAM-D), Quick Inventory of Depressive 

Symptomatology Self-Report (QID-SR), Computerized Adaptive Testing Depression Inventory (CAT- DI), and Computerized Adaptive Diagnostic Screener (CAD-MDD). 

• Adolescent Screening Tools (12–17 years) – Patient Health Questionnaire for Adolescents (PHQ-A), Beck Depression Inventory-Primary Care 

Version (BDI-PC), Mood Feeling Questionnaire (MFQ), Center for Epidemiologic Studies Depression 

Scale (CES-D), Patient Health Questionnaire (PHQ-9), Pediatric Symptom Checklist (PSC-17), and 

PRIME MD-PHQ2

• Perinatal Screening Tools 

– Edinburgh Postnatal Depression Scale, Postpartum Depression Screening Scale, Patient Health 

Questionnaire 9 (PHQ-9), Beck Depression Inventory, Beck Depression Inventory–II, Center for 

Epidemiologic Studies Depression Scale, and Zung Self-rating Depression Scale. 
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CDF-AD & CDF-CH Follow-up Planning

• Documented follow-up for a positive depression screening must include one or 

more of the following: 

– Referral to a provider for additional evaluation and assessment to formulate a follow-up plan for a 

positive depression screen. 

– Pharmacological interventions. 

– Other interventions or follow-up for the diagnosis or treatment of depression. 

• Examples of a follow-up plan include but are not limited to: – Referral to a provider or program for further evaluation for depression; for example, referral to a 

psychiatrist, psychologist, social worker, mental health counselor, or other mental health service such 

as family or group therapy, support group, depression management program, or other service for 

treatment of depression. 

– Other interventions designed to treat depression such as behavioral health evaluation, 

psychotherapy, pharmacological interventions, or additional treatment options. 

• The documented follow-up plan must be related to positive depression screening; 

for example: “Client referred for psychiatric evaluation due to positive depression 

screening.” 
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CDF-AD & CDF-CH Measures: To Do in 2024

Needed for the CDF Measures:

1. Identify standardized Depression screening tool(s) you will use, considering requirements 

of the DEP-REM-6 measure as well

2. Determine where, when, and how in the clinic workflow screening and follow-up planning 

will be implemented and documented

3. Prepare documentation systems needed to capture whether screening and follow-up 

planning have or have not occurred, as well as results of screening

4. Train staff, as needed, regarding screening, follow-up planning, and documentation

Also Important:

1. The depression screening must be reviewed and addressed by the provider on the date of 

the encounter. Positive pre-screening results indicating a client is at high risk for self-harm 

should receive more urgent intervention as determined by the provider practice, including 

but not limited to, suicide risk assessment and appropriate clinical response.
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Depression Remission at 

Six Months (DEP-REM-6)
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Poll #2

1. Our clinic is prepared to conduct client follow-up

for depression six months after a new diagnosis 

of depression [select one response]:

a) Yes, only if they are still in treatment after six months

b) Yes, even if they are no longer receiving our services

c) No

d) Partly

e) I do not know
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DEP-REM-6: Description and Source

The DEP-REM-6 measure calculates the 

percentage of clients (12 years of age or older) 

with Major Depression or Dysthymia who reach 

Remission Six Months (+/- 60 days) after an 

Index Event Date. 

 Source: Based on CMS MIPS CQMS #370 (2023), stewarded by 

MN Community Measurement (CBE #0710), modified for 

Depression Remission at Six Months (CBE #0711)

CMS: Centers for Medicare & Medicaid Services 
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DEP-REM-6 Measure: Importance and Uses

 Importance: “Patients with depression, an isolating condition, are less 

capable of reaching out, keeping appointments, and maintaining a connection 

with their provider compared to patients with other conditions. Maintaining 

proactive contact (in person, phone or other mode) is key to recovery and 

improved outcomes” (MN Community Measurement, 2018).

 Use for Quality Improvement: 

 Implement medium-term follow-up for clients diagnosed with depression

 Understand effectiveness of treatment over time

 Reconnect as needed with clients out of treatment to determine if 

additional treatment is needed

 Use for evaluation of the CCBHC model

 Potential use for PPS
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DEP-REM-6 Measure: Data Source and Measurement Period

 Data source: Medical records (e.g., electronic health 

records)

 Measurement Period (aka, the time period that data 

must cover): The Measurement Period for the 

denominator is the Measurement Year (example: Jan. 

1, 2025-Dec. 31, 2025) and for the numerator begins 

four months after the beginning of the Measurement 

Year and extends eight (8) months past the end of the 

Measurement Year (example: May 1, 2025-August 31, 

2026).

aka: also known as
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DEP-REM-6 Visual of Measurement Year, Measurement Periods, & 

Index Event Dates (Figure 1 in Technical Specification)

IED: Index Event Date; MY: Measurement Year; MP: Measurement Period; R: Six Month Remission 

may be measured, depending on date, 4-8 months after IED (6 months (+/- 60 days)). 
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DEP-REM-6 Measure: Calculation of Denominator

 Denominator is all clients in the Eligible Population:

 All clients receiving at least one CCBHC service (identified by one of the 

Current Procedural Terminology [CPT®] encounter codes in the specifications) 

during the Measurement Year

 Age 12 years or older on the Index Event Date

 Who have an active diagnosis of Major Depression or Dysthymia

 Who have an Index Event Date PHQ-9 or PHQ-9M score greater than nine (9) 

documented during the Measurement Year

 Excluding those who meet specified criteria for: Bipolar Disorder, Personality 

Disorder, Schizophrenia or Psychotic Disorder, or Pervasive Developmental 

Disorder, or died before the end of their numerator Measurement Period, or 

received hospice or palliative care

 Stratification: age, payer, race, ethnicity

Bold indicates data need.

Note: Index Event Date is the date on which the first instance of PHQ-9 or PHQ-9M > nine AND diagnosis of 

Depression or Dysthymia occurs during the Measurement Year.

Note: Diagnosis AND PHQ score must be documented on the same date or up to seven days before the 

Index Event.
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DEP-REM-6 Measure: Calculation of Numerator

Numerator is all clients in the denominator:

 Who achieved Remission at Six Months as demonstrated by a 

PHQ-9 or PHQ-9M score of less than five (5)

 Remission at Six Months is defined as a Six Month (+/- 60 days) PHQ-9 or PHQ-9M 

score of less than five (5)

 Documentation needed for the numerator includes:

 Performance Met (Remission achieved during the allowable Numerator 

Measurement Period), OR

 Performance Not Met:

 Six Month score not less than five (5), OR

 Not assessed during the allowed time period

Bold indicates data need.
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Visual of DEP-REM-6 Specification (Figure 2 in Technical Specification)

MP: Measurement Period; MY: Measurement Year. 

a The Numerator MP is the total potential time for which data must be available to compute the numerator. The reporter 

does not have 20 months to meet remission for Clients. Rather, this MP is for the entire group of Clients in the 

denominator, with the individual’s remission measured depending on when the Index Event occurred in the 12 month MY. 
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DEP-REM-6: Practice Example

Denominator

Number of people receiving CCBHC 

service in Measurement Year (MY)

2,500

Of those, service was one of the 

appropriate encounter codes

2,300

Of those, 12 or older at date of service 2,100

Dx of MDD or Dysthymia AND

PHQ-9 > nine (9) documented same date 

(or up to seven days before) as the service

1,850

Of those, excluded as already diagnosed 

with bipolar disorder, etc

-400

Denominator (1,850 – 400) 1,450

Numerator

Number in Denominator 1,450

Screened six months (+/- 60 days) and 

score < five 

700

Screened six months (+/- 60 days) and 

score five or more

425

Not screened six months (+/- 60 days) 325

Numerator 700

DEP-REM-6 rate = 700/1,450 = .48 (or 48%)
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Screening Requirements for DEP-REM-6

• Patient Health Questionnaire – 9 item version 

(PHQ-9), available at PHQ Screeners

OR

• Patient Health Questionnaire – 9 Modified for 

Teens and Adolescents (PHQ-9M), available at
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DEP-REM-6 Measure: To Do in 2024

Needed for the DEP-REM-6 Measure:

1. Prepare to use the PHQ-9 (or 9M) for follow-up (and earlier as appropriate)

2. Determine how follow-up to obtain these six-month outcomes will be 

implemented and documented

3. Prepare documentation systems needed to capture follow-up screening, as well 

as results of screening

4. Train staff, as needed, regarding follow-up screening and documentation

Also Important:

1. Positive follow-up screening results indicating a client is at high risk for self-harm 

should receive more urgent intervention as determined by the provider practice, 

including but not limited to, suicide risk assessment and appropriate clinical 

response.
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Upcoming Quality Measure Webinars

Upcoming Quality 

Measure Webinars
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Schedule of Clinic-Collected Measure-Specific Webinars 

Friday, October 27, 2023

‒ Clinic-Collected-Required Measures: I-SERV, SDOH, ASC

Wednesday, November 1, 2023 (TODAY)

‒ Clinic-Collected-Required Measures: CDF-AD & CH, DEP-REM-6

Thursday, November 9, 2023 

‒ Clinic-Collected-Optional Measures: TSC, SRA-A & C, CBP, WCC
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Subsequent Technical Assistance

November or December 2023, Office Hours for Clinic-Collected 

Measures

January 18, 2024, State-Collected-Required Measures Part 1

February 15, 2024, State-Collected-Required Part 2 and Optional 

Measures

Late February or March 2024, Reporting Template and Commonly 

Asked Quality Measure Questions

March 2024, Office Hours for State-Collected Measures
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Questions and Discussion
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Poll #3

In the last 90 minutes, I have learned (please 

select the best option):

A. A lot of useful new information

B. Some useful new information

C. Very little new information

D. Not sure

E. Other (please add comments to the chat 

box)
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References

• MN Community Measurement, 2018: MN Community 

Measurement (2018). Depression Care in Minnesota. Available at 

MNCM Depression Report 2018

• SAMHSA, 2022: Substance Abuse and Mental Health Services 

Administration. (2022). Key substance use and mental health 

indicators in the United States: Results from the 2021 National 

Survey on Drug Use and Health (HHS Publication No. PEP22-07-01-

005, NSDUH Series H-57). Center for Behavioral Health Statistics 

and Quality, Substance Abuse and Mental Health Services 

Administration. Available at 2021 NSDUH Annual National Report
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Thank You

SAMHSA’s mission is to lead public health and service delivery 

efforts that promote mental health, prevent substance misuse, 

and provide treatments and supports to foster recovery while 

ensuring equitable access and better outcomes.

Direct Quality Measure Questions to: 

CCBHCMeasuresSubmission@samhsa.hhs.gov

www.samhsa.gov

1-877-SAMHSA-7 (1-877-726-4727) ● 1-800-487-4889 (TDD)