Closing the Gap: Why 7 Day Behavioral Health Follow Up Matters More Than Ever

Date: 02/26/26

Timely follow-up after a behavioral health hospitalization or emergency department (ED) visit is a critical step in supporting member safety, continuity of care, and long-term recovery. This year, our priority focus is improving 7‑day follow‑up rates for key HEDIS® measures:

• Follow-Up After Hospitalization for Mental Illness (FUH)
• Follow-Up After Emergency Department Visit for Mental Illness (FUM)
• Follow-Up After Emergency Department Visit for Substance Use (FUA)

Early connection to outpatient care plays a vital role in stabilizing members, reducing avoidable readmissions, and strengthening transitions from acute to ongoing treatment.

Why the 7‑Day Follow‑Up Is So Important

The first week after discharge or an ED visit is a particularly vulnerable time for individuals experiencing behavioral health needs. Evidence consistently shows that earlier follow-up leads to better outcomes.

A 7‑day follow-up visit helps to:

• Reduce the risk of relapse, self-harm, and repeat ED visits
• Support medication review and adherence
• Identify and address barriers early, such as transportation, social needs, or appointment access
• Reinforce care coordination between inpatient, ED, and outpatient providers

By prioritizing follow-up within 7 days, providers help ensure members don’t fall through the cracks during this critical transition period.

Helping Members Find Care Faster

Access to timely outpatient care can be one of the biggest challenges following a behavioral health hospitalization or ED visit. To support faster scheduling, our Find a Provider tool is available on our website and can help quickly connect individuals to nearby PCPs, behavioral health providers and specialists in.

Encouraging staff and care teams to use this tool can help reduce delays and improve 7‑day follow-up turnaround times, especially when members need rapid access to outpatient services.

Eligible Provider Types for Gap Closure

Multiple provider types across behavioral health, substance use treatment, and primary care settings can support and close FUH, FUM, and FUA HEDIS measures, giving Medicaid members flexible access to timely follow‑up care through outpatient, intensive outpatient, partial hospitalization, and telehealth services.

HEDIS Measure	Measure Name	Provider Types That Can Close the Care Gap
FUH	Follow‑Up After Hospitalization for Mental Illness	• Psychiatrist (MD/DO) • Psychologist (PhD/PsyD) • Licensed Clinical Social Worker (LCSW) • Licensed Professional Counselor (LPC/LMHC) • Licensed Marriage & Family Therapist (LMFT) • Psychiatric Nurse Practitioner (PMHNP) • Psychiatric Clinical Nurse Specialist • Primary Care Provider (MD/DO/NP/PA) when visit includes a mental health diagnosis
FUM	Follow‑Up After Emergency Department Visit for Mental Illness	• Psychiatrist (MD/DO) • Psychologist (PhD/PsyD) • LCSW, LPC/LMHC, LMFT • Psychiatric Nurse Practitioner / CNS • Primary Care Provider (MD/DO/NP/PA) with a mental health diagnosis documented
FUA	Follow‑Up After Emergency Department Visit for Substance Use	• Substance Use Disorder (SUD) treatment provider • Psychiatrist • Psychologist

Practical Tips for Closure

1. Schedule follow‑up before discharge (hospital or ED)
2. Use telehealth when access is limited
3. Ensure diagnosis codes match the index event
4. Submit claims timely and accurately

Improving 7‑day follow-up rates for FUH, FUM, and FUA is more than a quality metric - it’s a shared commitment to member well-being. Timely follow-up supports stabilization, strengthens continuity of care, and helps members stay engaged on their path to recovery.