HEDIS FUH/FUM Compliance Tracking — Integration

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Overview

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Quick Reference

• Data contract: cl_hedis_fuh_fum_summary view — aggregates FUH/FUM numerator/denominator counts by organization_id and measurement_year
• Flag tables: cl_aftercare_plans (6 new boolean columns; inherit existing RLS)
• Consumers: CL-15 (rates/export UI), CL-35 (care gap input)
• Producers: Application-level hooks on cl_aftercare_plans save and cl_follow_up_contacts save
• Permission gates: cl.hedis-tracking.view, cl.hedis-tracking.export

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Data Contract: cl_hedis_fuh_fum_summary View

CREATE OR REPLACE VIEW cl_hedis_fuh_fum_summary
WITH (security_invoker = true)
AS
SELECT
  organization_id,
  date_trunc('year', plan_date)   AS measurement_year,
  COUNT(*) FILTER (WHERE hedis_fuh_denominator)          AS fuh_denominator,
  COUNT(*) FILTER (WHERE hedis_fuh_7day_numerator)       AS fuh_7day_numerator,
  COUNT(*) FILTER (WHERE hedis_fuh_30day_numerator)      AS fuh_30day_numerator,
  COUNT(*) FILTER (WHERE hedis_fum_denominator)          AS fum_denominator,
  COUNT(*) FILTER (WHERE hedis_fum_7day_numerator)       AS fum_7day_numerator,
  COUNT(*) FILTER (WHERE hedis_fum_30day_numerator)      AS fum_30day_numerator
FROM cl_aftercare_plans
GROUP BY organization_id, date_trunc('year', plan_date);

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Integration: CL-15 (Quality Measures Dashboard)

• Pattern: Intra-core query via Supabase client hook
• Consumer hook: useHedisFuhFumSummary(organizationId, measurementYear) — queries cl_hedis_fuh_fum_summary view
• Permission gate: cl.hedis-tracking.view (rates panel), cl.hedis-tracking.export (export)
• UI: Rates panel in CL-15 with measurement year selector; FUH 7-day/30-day rate and FUM 7-day/30-day rate displayed as percentages; CSV export
• Status: 📋 Planned

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Integration: CL-35 (Population Health — Care Gap)

• Pattern: Intra-core query via Supabase client hook
• Consumer hook: useHedisCareGaps(organizationId, measurementYear) — queries cl_hedis_fuh_fum_summary view; identifies patients with open denominator events (numerator not yet met)
• Permission gate: cl.hedis-tracking.view
• Status: 📋 Planned

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Integration: PM Encounters

• Pattern: Platform Integration Layer — @/platform/scheduling (useEncounterContext) and @/platform/types (EncounterContext)
• Data accessed: encounter_type (FUH proxy: residential_daily; FUM proxy: crisis — see spec for full mapping), principal_diagnosis_code, visit_date
• No direct cross-core import: All PM encounter data accessed via platform types
• Status: 📋 Planned

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Integration: PF-70 (Medical Terminology)

• Pattern: Direct PF query (intra-platform)
• Query: SELECT code FROM pf_icd10_codes WHERE metadata_tags @> '["hedis_fuh_qualifying"]'; similarly for hedis_fum_qualifying
• Usage: Denominator flag logic evaluates principal diagnosis against PF-70 code lists at discharge/encounter save time
• No hardcoded code lists — always query PF-70 at runtime
• Status: 📋 Planned
• Pre-Phase 1 verification: The metadata tags hedis_fuh_qualifying and hedis_fum_qualifying are not currently seeded in PF-70 (no existing spec or seed/migration contains them). Pre-Phase 1 checklist item: Seed PF-70 with NCQA MY 2025 ICD-10-CM lists tagged hedis_fuh_qualifying and hedis_fum_qualifying via a migration or seed file before denominator logic that queries pf_icd10_codes WHERE metadata_tags @> '["hedis_fuh_qualifying"]' or @> '["hedis_fum_qualifying"]' is released. See spec Pre-Phase 1 checklist.

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Flag-Setting Logic (Application Layer)

// Pseudocode — implement in service function
// encounterType uses actual pm_encounters.encounter_type values; FUH proxy = 'residential_daily', FUM proxy = 'crisis'
async function evaluateHedisDenominator(
  aftercarePlanId: string,
  encounterType: 'residential_daily' | 'crisis' | 'outpatient' | 'iop' | 'php' | 'group' | 'telehealth' | 'evaluation',
  principalDiagnosisCode: string,
  patientDob: Date,
  indexDate: Date
): Promise<{ fuhDenominator: boolean; fumDenominator: boolean }>

// Pseudocode
async function evaluateHedisNumerator(
  aftercarePlanId: string,
  followUpDate: Date,
  indexDate: Date,
  contactModality: 'in_person' | 'telehealth' | 'telephone' | string,
  measureType: 'fuh' | 'fum'
): Promise<{ met7Day: boolean; met30Day: boolean }>

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Security Notes

• All new columns on cl_aftercare_plans inherit existing RLS — no new policies needed
• View uses security_invoker = true — caller’s RLS applies
• 42 CFR Part 2: If the HEDIS export exposes SUD diagnosis-based flags to payers/AHCCCS, a patient authorization or QSOA is required before the export endpoint is enabled. Gate this in the export permission check.

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References

• Spec
• Parent CL-29 Integration
• CROSS_CORE_INTEGRATIONS.md
• REGULATORY_COMPLIANCE_TRACKER.md — NCQA HEDIS FUH/FUM entry