Initiation and Engagement of Alcohol and Other Drug Dependence Treatment

Measure Information	2021 Performance Period
CMS eCQM ID	CMS137v9
NQF Number	Not Applicable
MIPS Quality ID	305
Description	Percentage of patients 13 years of age and older with a new episode of alcohol or other drug abuse or (AOD) dependence who received the following. Two rates are reported. a. Percentage of patients who initiated treatment including either an intervention or medication for the treatment of AOD abuse or dependence within 14 days of the diagnosis b. Percentage of patients who engaged in ongoing treatment including two additional interventions or a medication for the treatment of AOD abuse or dependence within 34 days of the initiation visit. For patients who initiated treatment with a medication, at least one of the two engagement events must be a treatment intervention.
Initial Population	Patients age 13 years of age and older who were diagnosed with a new episode of alcohol, opioid, or other drug abuse or dependency during a visit between January 1 and November 14 of the measurement period
Numerator	Numerator 1: Initiation of treatment includes either an intervention or medication for the treatment of AOD abuse or dependence within 14 days of the diagnosis. Numerator 2: Engagement in ongoing treatment includes two additional interventions or a medication for the treatment of AOD abuse or dependence within 34 days of the initiation visit. For patients who initiated treatment with a medication, at least one of the two engagement events must be a treatment intervention (i.e., engagement for these members cannot be satisfied with medication treatment alone).
Numerator Exclusions	Not Applicable
Denominator	Equals Initial Population
Denominator Exclusions	Exclude patients with a previous active diagnosis of alcohol, opioid or other drug abuse or dependence in the 60 days prior to the first episode of alcohol or drug dependence. Exclude patients whose hospice care overlaps the measurement period.
Denominator Exceptions	None
Steward	National Committee for Quality Assurance
Measure Scoring	Proportion measure
Measure Type	Process measure
Improvement Notation	Higher score indicates better quality
Guidance	The new episode of alcohol and other drug dependence should be the first episode of the measurement period that is not preceded in the 60 days prior by another episode of alcohol or other drug dependence. This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center for more information on the QDM.
Telehealth Eligible	Yes
Next Version	CMS137v10
Previous Version	No Version Available

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Measure Information	2021 Performance Period	2022 Performance Period	2023 Performance Period	2024 Performance Period
Title	Initiation and Engagement of Alcohol and Other Drug Dependence Treatment	Initiation and Engagement of Alcohol and Other Drug Dependence Treatment	Initiation and Engagement of Substance Use Disorder Treatment	Initiation and Engagement of Substance Use Disorder Treatment
CMS eCQM ID	CMS137v9	CMS137v10	CMS137v11	CMS137v12
NQF Number	Not Applicable	Not Applicable	Not Applicable	Not Applicable
Description	Percentage of patients 13 years of age and older with a new episode of alcohol or other drug abuse or (AOD) dependence who received the following. Two rates are reported. a. Percentage of patients who initiated treatment including either an intervention or medication for the treatment of AOD abuse or dependence within 14 days of the diagnosis b. Percentage of patients who engaged in ongoing treatment including two additional interventions or a medication for the treatment of AOD abuse or dependence within 34 days of the initiation visit. For patients who initiated treatment with a medication, at least one of the two engagement events must be a treatment intervention.	Percentage of patients 13 years of age and older with a new episode of alcohol or other drug abuse or (AOD) dependence who received the following. Two rates are reported. a. Percentage of patients who initiated treatment including either an intervention or medication for the treatment of AOD abuse or dependence within 14 days of the diagnosis b. Percentage of patients who engaged in ongoing treatment including two additional interventions or a medication for the treatment of AOD abuse or dependence within 34 days of the initiation visit. For patients who initiated treatment with a medication, at least one of the two engagement events must be a treatment intervention.	Percentage of patients 13 years of age and older with a new substance use disorder (SUD) episode who received the following (Two rates are reported): a. Percentage of patients who initiated treatment, including either an intervention or medication for the treatment of SUD, within 14 days of the new SUD episode. b. Percentage of patients who engaged in ongoing treatment, including two additional interventions or short-term medications, or one long-term medication for the treatment of SUD, within 34 days of the initiation.	Percentage of patients 13 years of age and older with a new substance use disorder (SUD) episode who received the following (Two rates are reported): a. Percentage of patients who initiated treatment, including either an intervention or medication for the treatment of SUD, within 14 days of the new SUD episode. b. Percentage of patients who engaged in ongoing treatment, including two additional interventions or short-term medications, or one long-term medication for the treatment of SUD, within 34 days of the initiation.
Initial Population	Patients age 13 years of age and older who were diagnosed with a new episode of alcohol, opioid, or other drug abuse or dependency during a visit between January 1 and November 14 of the measurement period	Patients age 13 years of age and older who were diagnosed with a new episode of alcohol, opioid, or other drug abuse or dependency during a visit between January 1 and November 14 of the measurement period	Patients age 13 years of age and older as of the start of the measurement period who were diagnosed with a new SUD episode during a visit between January 1 and November 14 of the measurement period	Patients 13 years of age and older as of the start of the measurement period who were diagnosed with a new SUD episode during a visit between January 1 and November 14 of the measurement period
Denominator	Equals Initial Population	Equals Initial Population	Equals Initial Population	Equals Initial Population
Denominator Exclusions	Exclude patients with a previous active diagnosis of alcohol, opioid or other drug abuse or dependence in the 60 days prior to the first episode of alcohol or drug dependence. Exclude patients whose hospice care overlaps the measurement period.	Exclude patients with a negative diagnosis history, defined as an encounter or medication treatment for a diagnosis of alcohol, opioid or other drug abuse or dependence in the 60 days prior to the first episode of alcohol or drug dependence. Exclude patients who are in hospice care for any part of the measurement period.	Exclude patients who are in hospice care for any part of the measurement period	Exclude patients who are in hospice care for any part of the measurement period
Numerator	Numerator 1: Initiation of treatment includes either an intervention or medication for the treatment of AOD abuse or dependence within 14 days of the diagnosis. Numerator 2: Engagement in ongoing treatment includes two additional interventions or a medication for the treatment of AOD abuse or dependence within 34 days of the initiation visit. For patients who initiated treatment with a medication, at least one of the two engagement events must be a treatment intervention (i.e., engagement for these members cannot be satisfied with medication treatment alone).	Numerator 1: Initiation of treatment includes either an intervention or medication for the treatment of AOD abuse or dependence within 14 days of the diagnosis. Numerator 2: Engagement in ongoing treatment within 34 days of initiation includes: 1. Patients that initiated treatment with a psychosocial visit, and whose engagement criteria was fulfilled by a dispensed medication. 2. Patients that initiated treatment with a psychosocial visit, and whose engagement criteria was fulfilled by two further psychosocial visits. 3. Patients that initiated treatment with a dispensed medication, and whose engagement criteria was fulfilled by both a further medication dispense and a psychosocial visit. 4. Patients that initiated treatment with a dispensed medication, and whose engagement criteria was fulfilled by two psychosocial visits.	Numerator 1: Initiation of treatment includes either an intervention or medication for the treatment of SUD within 14 days of the new SUD episode Numerator 2: Engagement in ongoing SUD treatment within 34 days of initiation includes: 1. A long-acting SUD medication on the day after the initiation through 34 days after the initiation of treatment 2. One of the following options on the day after the initiation of treatment through 34 days after the initiation of treatment: a) two engagement visits, b) two engagement medication treatment events, c) one engagement visit and one engagement medication treatment event	Numerator 1: Initiation of treatment includes either an intervention or medication for the treatment of SUD within 14 days of the new SUD episode Numerator 2: Engagement in ongoing SUD treatment within 34 days of initiation includes: 1. A long-acting SUD medication on the day after the initiation through 34 days after the initiation of treatment 2. One of the following options on the day after the initiation of treatment through 34 days after the initiation of treatment: a) two engagement visits, b) two engagement medication treatment events, c) one engagement visit and one engagement medication treatment event
Numerator Exclusions	Not Applicable	Not Applicable	Not Applicable	Not Applicable
Denominator Exceptions	None	None	None	None
Measure Steward	National Committee for Quality Assurance	National Committee for Quality Assurance	National Committee for Quality Assurance	National Committee for Quality Assurance
Measure Scoring	Proportion measure	Proportion measure	Proportion measure	Proportion measure
Measure Type	Process measure	Process measure	Process measure	Process measure
Improvement Notation	Higher score indicates better quality	Higher score indicates better quality	Higher score indicates better quality	Higher score indicates better quality
Guidance	The new episode of alcohol and other drug dependence should be the first episode of the measurement period that is not preceded in the 60 days prior by another episode of alcohol or other drug dependence. This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center for more information on the QDM.	The new episode of alcohol and other drug dependence should be the first episode of the measurement period that is not preceded in the 60 days prior by another episode of alcohol or other drug dependence. This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center for more information on the QDM.	This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.	This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.
MIPS Quality ID	305	305	305	305
Telehealth Eligible	Yes	Yes	Yes	Yes
Next Version	CMS137v10	CMS137v11	CMS137v12	No Version Available
Previous Version	No Version Available	CMS137v9	CMS137v10	CMS137v11

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Data Element Repository

Data Elements contained within CMS137v9

Value Sets

Value Sets to be used with CMS137v9

Release Notes

CMS137v9-TRN.xlsx

Header

Updated eCQM Version Number.

Measure Section: eCQM Version Number

Source of Change: Standards Update
Updated copyright.

Measure Section: Copyright

Source of Change: Annual Update
Updated the rationale to remove outdated references and content and to update references.

Measure Section: Rationale

Source of Change: Measure Lead
Updated the clinical recommendations statement to remove outdated references and update with the most recent clinical recommendations.

Measure Section: Clinical Recommendation Statement

Source of Change: Measure Lead
Updated references.

Measure Section: Reference

Source of Change: Standards Update
Updated the definition to change the intake period from November 13 to November 14 to ensure all services can occur before the measurement period ends.

Measure Section: Definition

Source of Change: Measure Lead
Added text to identify the Quality Data Model (QDM) version used in the measure specification.

Measure Section: Guidance

Source of Change: Standards Update
Added text to indicate whether the measure is patient-based or episode-based.

Measure Section: Guidance

Source of Change: Standards Update
Added 'Exclude' in the first line of the denominator exclusions statement to be consistent with wording of other exclusions.

Measure Section: Denominator Exceptions

Source of Change: Measure Lead

Logic

Changed 'start of 'Measurement Period') in Interval[13,17]' to 'end of 'Measurement Period') in Interval[13, 17]' to capture patients age 17 at the end of the measurement period and align with measure intent.

Measure Section: Denominator

Source of Change: Measure Lead
Changed the period within which the 'Initial Dependence Diagnosis' must occur to ensure all services can occur before the measurement period ends.

Measure Section: Numerator

Source of Change: Measure Lead
Revised aliases to better differentiate medication treatment from intervention treatment to align with style conventions.

Measure Section: Numerator

Source of Change: Measure Lead
Added 'day of' timing to the Dependence Treatment Intervention Initiated logic definition for added clarity.

Measure Section: Definitions

Source of Change: Measure Lead
Revised aliases to better differentiate medication treatment from intervention treatment to align with style conventions.

Measure Section: Definitions

Source of Change: Measure Lead
Updated the definition to change the intake period from November 13 to November 14 to ensure all services can occur before the measurement period ends.

Measure Section: Definitions

Source of Change: Measure Lead
Updated the names of Clinical Quality Language (CQL) definitions, functions, and/or aliases for clarification and to align with the CQL Style Guide.

Measure Section: Definitions

Source of Change: Standards Update
Updated timing logic for the follow-up assessment to use 'in Interval' to simplify logic and promote harmonization between measures.

Measure Section: Definitions

Source of Change: Measure Lead
Updated CQL definitions, functions, and/or aliases for clarification and to align with the CQL Style Guide.

Measure Section: Functions

Source of Change: Standards Update
CQL Library version update: Updated version number of the Hospice Library (Hospice-2.2.000).

Measure Section: Multiple Sections

Source of Change: Measure Lead
Updated CQL expression to conform with the HL7 Standard: Clinical Quality Language Specification, Release 1 STU 4 (CQL 1.4).

Measure Section: Multiple Sections

Source of Change: Standards Update
Updated version number of the Measure Authoring Tool (MAT) Global Common Functions Library (MATGlobalCommonFunctions-5.0.000). Updated definitions and functions in the MAT Global Common Functions Library to align with standards changes, CQL Style Guide, and to include one new function related to calculating length of hospital stays with observation stays.

Measure Section: Multiple Sections

Source of Change: Standards Update

Value Set

The VSAC is the source of truth for the value set content, please visit the VSAC for downloads of current value sets.

Value set Opiate Antagonists (2.16.840.1.113883.3.464.1003.198.12.1132): Deleted 10 ICD-10-PCS codes (HZ90ZZZ, HZ91ZZZ, HZ92ZZZ, HZ93ZZZ, HZ94ZZZ, HZ95ZZZ, HZ96ZZZ, HZ97ZZZ, HZ98ZZZ, HZ99ZZZ). Added 29 RxNorm codes. Removed ICD-10-PCS codes from the grouping value set and replaced them with RxNorm codes, as that is the recommended terminology.

Measure Section: Terminology

Source of Change: Measure Lead
Value set Telehealth Services (2.16.840.1.113883.3.464.1003.101.12.1031): Deleted 2 CPT codes (98969, 99444) based on terminology update.

Measure Section: Terminology

Source of Change: Annual Update