Back to top
Top
U.S. flag

An official website of the United States government

Dot gov

Official websites use .gov
A .gov website belongs to an official government organization in the United States.

Https

Secure .gov websites use HTTPS
A lock ( ) or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.

Initiation and Engagement of Alcohol and Other Drug Dependence Treatment

Compare Versions of: "Initiation and Engagement of Alcohol and Other Drug Dependence Treatment"

The Compare function compares two years of the measure specifications found in the header of the measure's HTML. It does not include a comparison of any information in the body of the HTML, e.g., population criteria, Clinical Quality Language, or value sets.

Strikethrough text highlighted in red indicates information changed from the previous version. Text highlighted in green indicates information updated in the new eCQM version.

Compare version to

Measure Information 2022 Performance Period 2023 Performance Period 2024 Performance Period
Title 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 CMS137v10 CMS137v11 CMS137v12
CBE ID Not Applicable Not Applicable Not Applicable
MIPS Quality ID 305 305 305
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.

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.

Definition *See CMS137v10.html *See CMS137v11.html

The new SUD episode is the first encounter during the Intake Period with a diagnosis of SUD with no encounter or medication treatment for a diagnosis of SUD in the 60 days prior.

The initiation of treatment is the first SUD treatment within 14 days of a new SUD episode.

Treatment includes inpatient SUD admissions, outpatient visits, intensive outpatient encounters or partial hospitalizations, and medications for the treatment of SUD.

The Intake Period: January 1-November 14 of the measurement year. The Intake Period is used to capture new SUD episodes. The November 14 cut-off date ensures that all services can occur before the measurement period ends.

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 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

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 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

Denominator

Equals Initial Population

Equals Initial Population

Equals Initial Population

Denominator Exclusions

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

Denominator Exceptions

None

None

None

Measure Steward National Committee for Quality Assurance National Committee for Quality Assurance National Committee for Quality Assurance
Measure Scoring Proportion measure Proportion measure Proportion measure
Measure Type Process measure Process measure Process measure
Improvement Notation

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.

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.

Telehealth Eligible Yes Yes Yes
Rationale *See CMS137v10.html *See CMS137v11.html

There are more deaths, illnesses and disabilities from substance abuse than from any other preventable health condition. In 2018, 20.3 million individuals in the U.S. age 12 or older (approximately 8 percent of the population) were classified as having an SUD within the past year (Substance Abuse and Mental Health Services Administration [SAMHSA], 2019). Despite the high prevalence of SUD in the U.S., fewer than 20 percent of individuals with SUD receive any substance use treatment and only 12 percent receive treatment in a specialty SUD program (SAMHSA, 2019).

Stratification *See CMS137v10.html *See CMS137v11.html

Report a total score, and each of the following strata:

Stratum 1: Patients age 13-17 at the start of the measurement period

Stratum 2: Patients age 18-64 at the start of the measurement period

Stratum 3: Patients age 65 and older at the start of the measurement period

Risk Adjustment *See CMS137v10.html *See CMS137v11.html

None

Clinical Recommendation Statement *See CMS137v10.html *See CMS137v11.html

American Society of Addiction Medicine (2020)

- All Food and Drug Administration approved medications for the treatment of opioid use disorder should be available to all patients. Clinicians should consider the patient’s preferences, past treatment history, current state of illness, and treatment setting when deciding between the use of methadone, buprenorphine, and naltrexone.

- There is no recommended time limit for pharmacological treatment

- Patients’ psychosocial needs should be assessed, and patients should be offered or referred to psychosocial treatment based on their individual needs. However, a patient’s decision to decline psychosocial treatment or the absence of available psychosocial treatment should not preclude or delay pharmacotherapy, with appropriate medication management. Motivational interviewing or enhancement can be used to encourage patients to engage in psychosocial treatment services appropriate for addressing individual needs.

American Psychiatric Association (2018)

- Patients with alcohol use disorder should have a documented comprehensive and person-centered treatment plan that includes evidence-based nonpharmacological and pharmacological treatments. [1C]

- Naltrexone or acamprosate should be offered to patients with moderate to severe alcohol use disorder who have a goal of reducing alcohol consumption or achieving abstinence, prefer pharmacotherapy or have not responded to nonpharmacological treatments alone, and have no contraindications to the use of these medications. [1B]

- Disulfiram should be offered to patients with moderate to severe alcohol use disorder who have a goal of achieving abstinence, prefer disulfiram or are intolerant to or have not responded to naltrexone and acamprosate, are capable of understanding the risks of alcohol consumption while taking disulfiram, and have no contraindications to the use of this medication. [2C]

- Topiramate or gabapentin should be offered to patients with moderate to severe alcohol use disorder who have a goal of reducing alcohol consumption or achieving abstinence, prefer topiramate or gabapentin or are intolerant to or have not responded to naltrexone and acamprosate, and have no contraindications to the use of these medications. [2C]

American Psychiatric Association (2006)

- Because many substance use disorders are chronic, patients usually require long-term treatment, although the intensity and specific components of treatment may vary over time [I rating].

- It is important to intensify the monitoring for substance use during periods when the patient is at a high risk of relapsing, including during the early stages of treatment, times of transition to less intensive levels of care, and the first year after active treatment has ceased [I rating].

- Outpatient treatment of substance use disorders is appropriate for patients whose clinical condition or environmental circumstances do not require a more intensive level of care [I rating]. As in other treatment settings, a comprehensive approach is optimal, using, where indicated, a variety of psychotherapeutic and pharmacological interventions along with behavioral monitoring [I rating ].

- Disulfiram is also recommended for patients with alcohol dependence [II rating].

- Naltrexone, injectable naltrexone, acamprosate, a y-aminobutyric acid (GABA) are recommended for patients with alcohol dependence [I rating]. Disulfiram is also recommended for patients with alcohol dependence [II rating].

- Methadone and buprenorphine are recommended for patients with opioid dependence [I rating].

- Naltrexone is an alternative strategy [I rating].

American Society of Addiction Medicine (2015)

- Methadone and buprenorphine are recommended for opioid use disorder treatment and withdrawal management.

- Naltrexone (oral; extended-release injectable) is recommended for relapse prevention.

Michigan Quality Improvement Consortium (2017)

- Patients with substance use disorder or risky substance use: Patient Education and Brief Intervention by PCP or Trained Staff (e.g. RN, MSW)

- If diagnosed with substance use disorder or risky substance use, initiate an intervention within 14 days.

- Frequent follow-up is helpful to support behavior change; preferably 2 visits within 30 days.

- Refer to a substance abuse health specialist, an addiction physician specialist, or a physician experienced in pharmacologic management of addiction.

Department of Veterans Affairs/Department of Defense (2015)

- Offer referral to specialty SUD care for addiction treatment if based on willingness to engage. [B]

- For patients with moderate-severe alcohol use disorder, we recommend: Acamprosate, Disulfiram, Naltrexone- oral or extended release, or Topiramate. [A]

- Medications should be offered in combined with addiction-focused counseling. offering one or more of the following interventions considering patient preference and provider training/competence: Behavioral Couples Therapy for alcohol use disorder, Cognitive Behavioral Therapy for substance use disorders, Community Reinforcement Approach, Motivational Enhancement Therapy, 12-Step Facilitation. [A]

- For patients with opioid use disorder we recommend buprenorphine/naloxone or methadone in an Opioid Treatment Program. For patients for whom agonist treatment is contraindicated, unacceptable, unavailable, or discontinued, we recommend extended-release injectable naltrexone. [A]

- For patients initiated in an intensive phase of outpatient or residential treatment, recommend ongoing systematic relapse prevention efforts or recovery support, individualized on the basis of treatment response. [A]

Next Version No Version Available
Previous Version No Version Available
Specifications
Attachment Size
CMS137v10.html 98.69 KB
CMS137v10.zip 95.66 KB
CMS137v10-TRN.xlsx 19.84 KB
eCQM Jira Issue Tracker

Header

  • Updated the eCQM version number.

    Measure Section: eCQM Version Number

    Source of Change: Annual Update

  • Updated copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Updated the rationale to align with current evidence.

    Measure Section: Rationale

    Source of Change: Measure Lead

  • Updated the clinical recommendation statement to align with current clinical recommendations.

    Measure Section: Clinical Recommendation Statement

    Source of Change: Measure Lead

  • Updated references.

    Measure Section: Reference

    Source of Change: Annual Update

  • Replaced 'overlaps' or 'overlapping' in the denominator exclusions with plain language to clarify the measure intent.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

  • Revised the denominator exclusions description to align with the measure intent of identifying patients who had a previous and recent history of treatment for substance abuse.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

  • Restructured the numerator 2 description to improve its clarity.

    Measure Section: Numerator

    Source of Change: Measure Lead

Logic

  • Added online assessments and telephone visits as appropriate encounters based on the increased use of telehealth services.

    Measure Section: Initial Population

    Source of Change: Measure Lead

  • Revised the denominator exclusions logic to align with the measure intent of identifying patients who had a previous and recent history of treatment for substance abuse.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

  • Restructured the numerator 2 logic to improve its clarity.

    Measure Section: Numerator

    Source of Change: Measure Lead

  • Revised the numerator timing logic to align with the measure intent.

    Measure Section: Numerator

    Source of Change: Measure Lead

  • ​Revised the age calculations for stratifications to calculate age based on the beginning of the measurement period to align with the age criterion within the initial population.

    Measure Section: Stratification

    Source of Change: Measure Lead

  • ​Revised the definition names to clearly indicate the distinct options for treatment initiation to satisfy measure criteria.

    Measure Section: Definitions

    Source of Change: Measure Lead

  • Updated the alias for First Dependence Diagnosis During Measurement Period for clarity and simplification.

    Measure Section: Multiple Sections

    Source of Change: Annual Update

  • Updated the Psychosocial Visit and Qualifying Encounters definitions to add online assessment encounters to account for the increase in telehealth services.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Updated the timing attribute associated with orders of medications to align with QDM guidance.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated the version number of the Measure Authoring Tool (MAT) Global Common Functions Library (MATGlobalCommonFunctions-6.2.000). Updated the 'Inpatient Encounter' definition to include a 'day of' timing clarification. Added the following timing functions: Normalize Interval, Has Start, Has End, Latest, Latest Of, Earliest, and Earliest Of. Please see individual measure details for application of specific timing functions.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Added new NormalizeInterval function to timing attributes to decrease implementation burden due to variable use of timing attributes for select QDM data types. The NormalizeInterval function was applied, where applicable, for the following data elements: Assessment, Performed; Device, Applied; Diagnostic Study, Performed; Intervention, Performed; Laboratory Test, Performed; Medication, Administered; Medication, Dispensed; Physical Exam, Performed; Procedure, Performed; Substance, Administered.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated Hospice CQL Library to version 3.0.000.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

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 Detoxification Visit (2.16.840.1.113883.3.464.1003.101.12.1059): Added 1 SNOMED CT code (827094004) based on updated evidence in published guidelines, published literature, or from published specialty medical society or group recommendations.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Alcohol and Drug Dependence Treatment (2.16.840.1.113883.3.464.1003.106.12.1005): Added 2 SNOMED CT codes (792901003, 792902005) based on terminology update. Added 16 HCPCS codes based on updated evidence in published guidelines, published literature, or from published specialty medical society or group recommendations.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Alcohol and Drug Dependence (2.16.840.1.113883.3.464.1003.106.12.1001): Added 77 SNOMED CT codes based on evidence in published guidelines, published literature, or from published specialty medical society or group recommendations or terminology update. Deleted 160 SNOMED CT codes based on evidence in published guidelines, published literature, or from published specialty medical society or group recommendations. Added 16 ICD-10-CM codes based on evidence in published guidelines, published literature, or from published specialty medical society or group recommendations.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Opiate Antagonists (2.16.840.1.113883.3.464.1003.198.12.1132): Added 4 RxNorm codes (1551468, 197623, 197624, 835726) based on terminology update. Deleted 5 RxNorm codes (2058257, 1483774, 1483780, 246474, 250426) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Replaced value set Telehealth Services (2.16.840.1.113883.3.464.1003.101.12.1031) with value set Online Assessment (2.16.840.1.113883.3.464.1003.101.12.1089) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added value set Telephone Visits (2.16.840.1.113883.3.464.1003.101.12.1080) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

Last Updated: Feb 13, 2024