> ## Documentation Index
> Fetch the complete documentation index at: https://docs.encoreos.io/llms.txt
> Use this file to discover all available pages before exploring further.

# HEDIS FUH/FUM Compliance Tracking — Integration

> Feature ID: CL-29-EN-65 Parent: CL-29 Discharge & Aftercare Planning — CL-29-discharge-aftercare-planning-INTEGRATION.md Status: 📋 Specification Spec Referenc…

**Feature ID:** CL-29-EN-65\
**Parent:** CL-29 Discharge & Aftercare Planning — [CL-29-discharge-aftercare-planning-INTEGRATION.md](./discharge-aftercare-planning-integration.md)\
**Status:** 📋 Specification\
**Spec Reference:** [CL-29-EN-65-hedis-fuh-fum-tracking.md](../../../specs/cl/specs/CL-29-EN-65-hedis-fuh-fum-tracking.md)\
**Last Updated:** 2026-03-03

***

## Overview

Extends `cl_aftercare_plans` with 6 HEDIS FUH/FUM boolean flag columns. Exposes a `cl_hedis_fuh_fum_summary` view consumed by CL-15 (Quality Measures Dashboard) and CL-35 (Population Health) for measure performance reporting and care gap calculation. Flag-setting logic runs application-side at discharge save and follow-up contact save. No new cross-core dependencies beyond what CL-29 already uses; PM encounter type accessed via `@/platform/scheduling` and `@/platform/types`.

***

## 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`

***

## Data Contract: `cl_hedis_fuh_fum_summary` View

```sql theme={null}
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);
```

**Security:** `security_invoker = true` — RLS on `cl_aftercare_plans` applies to the caller's identity. Consumers must pass a valid authenticated session; hooks must include `organization_id` filter.

**Columns:**

| Column                | Type        | Description                                                                   |
| --------------------- | ----------- | ----------------------------------------------------------------------------- |
| `organization_id`     | UUID        | Tenant identifier                                                             |
| `measurement_year`    | TIMESTAMPTZ | Truncated to year (Jan 1 of measurement year)                                 |
| `fuh_denominator`     | BIGINT      | Count of qualifying inpatient discharge events (FUH index events)             |
| `fuh_7day_numerator`  | BIGINT      | Count with qualifying follow-up within 7 days (different date from discharge) |
| `fuh_30day_numerator` | BIGINT      | Count with qualifying follow-up within 30 days                                |
| `fum_denominator`     | BIGINT      | Count of qualifying ED visit events (FUM index events)                        |
| `fum_7day_numerator`  | BIGINT      | Count with qualifying follow-up within 7 days (same date allowed)             |
| `fum_30day_numerator` | BIGINT      | Count with qualifying follow-up within 30 days                                |

***

## 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

***

## 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

***

## 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

***

## 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.

***

## Flag-Setting Logic (Application Layer)

**Denominator evaluation** (called at `cl_aftercare_plans` save):

```typescript theme={null}
// 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 }>
```

**Numerator evaluation** (called at `cl_follow_up_contacts` save):

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

***

## 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.

***

## References

* [Spec](../../../specs/cl/specs/CL-29-EN-65-hedis-fuh-fum-tracking.md)
* [Parent CL-29 Integration](./discharge-aftercare-planning-integration.md)
* [CROSS\_CORE\_INTEGRATIONS.md](./CROSS_CORE_INTEGRATIONS.md)
* [REGULATORY\_COMPLIANCE\_TRACKER.md](../../compliance/REGULATORY_COMPLIANCE_TRACKER.md) — NCQA HEDIS FUH/FUM entry