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Initiation and Engagement of Alcohol and Other Drug Dependence Treatment

Measure Information 2022 Performance Period
CMS eCQM ID CMS137v10
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 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 Exclusions

Not Applicable

Denominator

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.

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
Previous Version

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Filter Measure By
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

Release Notes

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: Apr 24, 2023