Initiation and Engagement of Substance Use Disorder Treatment

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Measure Information	2023 Performance Period	2024 Performance Period	2025 Performance Period
Title	Initiation and Engagement of Substance Use Disorder Treatment	Initiation and Engagement of Substance Use Disorder Treatment	Initiation and Engagement of Substance Use Disorder Treatment
CMS eCQM ID	CMS137v11	CMS137v12	CMS137v13
CBE ID*	Not Applicable	Not Applicable	Not Applicable
MIPS Quality ID	305	305	305
Measure Steward	National Committee for Quality Assurance	National Committee for Quality Assurance	National Committee for Quality Assurance
Description	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. Show more > 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. Show less	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. Show more > 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. Show less	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 medication treatment events for SUD, or one long-acting medication event for the treatment of SUD, within 34 days of the initiation. Show more > 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 medication treatment events for SUD, or one long-acting medication event for the treatment of SUD, within 34 days of the initiation. Show less
Measure Scoring	Proportion measure	Proportion measure	Proportion measure
Measure Type	Process	Process	Process
Stratification	*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 ... Show more > 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 Show less	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 ... Show more > 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 Show less
Risk Adjustment	*See CMS137v11.html	None	None
Rationale	*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). Show more > 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). Show less	There are more deaths, illnesses and disabilities from substance abuse than from any other preventable health condition. In 2021, 46.3 million individuals in the U.S. age 12 or older (16.5 percent of the population) met the diagnosis criteria for having an SUD within the past year... (Substance Abuse and Mental Health Services Administration [SAMHSA], 2022). Despite the high prevalence of SUD in the U.S., 94 percent of individuals aged 12 or older with an SUD did not receive any treatment (SAMHSA, 2022). Show more > There are more deaths, illnesses and disabilities from substance abuse than from any other preventable health condition. In 2021, 46.3 million individuals in the U.S. age 12 or older (16.5 percent of the population) met the diagnosis criteria for having an SUD within the past year (Substance Abuse and Mental Health Services Administration [SAMHSA], 2022). Despite the high prevalence of SUD in the U.S., 94 percent of individuals aged 12 or older with an SUD did not receive any treatment (SAMHSA, 2022). Show less
Clinical Recommendation Statement	*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] Show more > 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] Show less	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 (2021) - Patients with substance use disorder or risky substance use: Patient Education and Brief Intervention by a Primary Care Physician (PCP) or Trained Staff (e.g., Registered Nurse [RN], Master of Social Work [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 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] Show more > 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 (2021) - Patients with substance use disorder or risky substance use: Patient Education and Brief Intervention by a Primary Care Physician (PCP) or Trained Staff (e.g., Registered Nurse [RN], Master of Social Work [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 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] Show less
Improvement Notation	Higher score indicates better quality	Higher score indicates better quality	Higher score indicates better quality
Definition	*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. Show more > 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. Show less	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. Show more > 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. Show less
Guidance	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.	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.
Initial Population	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	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
Denominator Exclusions	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 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 Show more > 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 Show less	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 Show more > 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 Show less	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. Show more > 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. Show less
Numerator Exclusions	Not Applicable	Not Applicable	Not Applicable
Denominator Exceptions	None	None	None
Telehealth Eligible	Yes	Yes	Yes
Next Version	CMS137v12	CMS137v13	No Version Available
Previous Version	No Version Available	CMS137v11	CMS137v12

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CMS137v11-TRN.xlsx

Header

Updated copyright.
Measure Section: Copyright
Source of Change: Annual Update
Revised age stratifications from 'age 13-17 and 18 or older' to 'age 13-17, 18-64 and 65 or older' to increase measure utility and actionability.
Measure Section: Stratification
Source of Change: Measure Lead
Updated the definition for 'initiation treatment' to clarify the timing requirement.
Measure Section: Definition
Source of Change: Measure Lead
Updated the definition of 'treatment' to include medications to reflect the measure logic and intent.
Measure Section: Definition
Source of Change: Measure Lead
Updated version number of the Quality Data Model (QDM) used in the measure specification to v5.6.
Measure Section: Guidance
Source of Change: Standards/Technical Update
Added age anchor specification to the initial population description to clarify measure requirements.
Measure Section: Initial Population
Source of Change: Measure Lead
Updated grammar and punctuation to improve readability.
Measure Section: Multiple Sections
Source of Change: Measure Lead
Updated narrative specification to replace references to 'substance abuse and dependence' with 'substance use disorder' (SUD) to align with current Diagnostic and Statistical Manual of Mental Disorders (DSM) terminology.
Measure Section: Multiple Sections
Source of Change: Measure Lead
Updated numerator 2 language to allow one long-acting medication event to meet the full engagement criteria to align with the measure intent.
Measure Section: Multiple Sections
Source of Change: Measure Lead
Moved 'negative treatment history' criteria currently captured as denominator exclusions to initial population by redefining a 'new SUD episode' to align with the measure intent.
Measure Section: Multiple Sections
Source of Change: Measure Lead
Updated the definition for a new episode of substance use disorder to align with the measure intent, and relocated the definition from 'Guidance' to 'Definition' section.
Measure Section: Multiple Sections
Source of Change: Measure Lead
Revised language related to the second numerator option to no longer require pharmacotherapy be accompanied by at least one psychosocial treatment for the treatment of substance use disorder per current clinical practice guidelines.
Measure Section: Multiple Sections
Source of Change: Measure Lead

Logic

Updated the timing precision in the definitions from datetime to date by adding 'day of', 'date from', and/or function 'ToDateInterval' to align with the measure intent.
Measure Section: Definitions
Source of Change: Measure Lead
Updated logic to align with the intent of allowing initiation treatment to start the same day as the new episode or during the 13 days after.
Measure Section: Definitions
Source of Change: Measure Lead
Modified logic from 'diagnosis with encounter' to 'encounter with diagnosis' to align with measure intent.
Measure Section: Definitions
Source of Change: Measure Lead
Added QDM datatypes 'Encounter, Performed' and 'Assessment, Performed' and associated logic to the Hospice.'Has Hospice Services' definition to provide additional approaches for identifying patients receiving hospice services.
Measure Section: Definitions
Source of Change: Measure Lead
Removed 'Encounter, Performed' of ED visits and medically managed withdrawals from list of qualifying treatment history events to align with the measure intent.
Measure Section: Definitions
Source of Change: Measure Lead
Added 'Min' operators to the treatment engagement definitions to require the first treatment initiation event to be used in the instances of multiple qualifying initiation events to align with the measure intent.
Measure Section: Definitions
Source of Change: Measure Lead
Updated the version of the Quality Data Model (QDM) to 5.6 and Clinical Quality Language (CQL) to 1.5.
Measure Section: Multiple Sections
Source of Change: Standards/Technical Update
Updated the version number of the Measure Authoring Tool (MAT) Global Common Functions Library to v7.0.000.
Measure Section: Multiple Sections
Source of Change: Standards/Technical Update
Updated the version number of the Hospice Library to v4.0.000.
Measure Section: Multiple Sections
Source of Change: Measure Lead
Updated the names of CQL definitions, functions, and/or aliases for clarification and to align with the CQL Style Guide.
Measure Section: Multiple Sections
Source of Change: Standards/Technical Update
Moved 'negative treatment history' criteria currently captured as denominator exclusions to initial population to align with the measure intent.
Measure Section: Multiple Sections
Source of Change: Measure Lead
Revised age stratifications from 'age 13-17 and 18 or older' to 'age 13-17, 18-64 and 65 or older' to increase measure utility and actionability.
Measure Section: Multiple Sections
Source of Change: Measure Lead
Separated medication value sets into long-acting medications and short-acting medications; added new medication administration value sets and QDM datatype Procedure, Performed to identify qualifying medication administration events for treatment history, initiation and engagement; and updated numerator 2 logic to allow one long-acting medication or medication administration event to meet the full engagement criteria to align with the measure intent.
Measure Section: Multiple Sections
Source of Change: Measure Lead
Replaced the Global.CalendarAgeInYearsAt function with the native CQL function AgeInYearsAt to take advantage of existing CQL features and increase human readability. As a result of this change, the LOINC code 21112-8 is no longer required and has been removed from the Terminology section of the human readable specification.
Measure Section: Multiple Sections
Source of Change: Measure Lead
Replaced references to 'substance abuse and dependence' with 'substance use disorder' (SUD) to align with current DSM terminology.
Measure Section: Multiple Sections
Source of Change: Measure Lead
Revised numerator 2 to no longer require pharmacotherapy be accompanied by at least one psychosocial treatment for the treatment of substance use disorder per current clinical practice guidelines.
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.

Removed direct reference code LOINC code (21112-8) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Removed value set Opiate Antagonists (2.16.840.1.113883.3.464.1003.198.12.1132) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added value set Substance Use Disorder Long Acting Medication (2.16.840.1.113883.3.464.1003.1149) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added value set Substance Use Disorder Long Acting Medication Administration (2.16.840.1.113883.3.464.1003.1156) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added value set Hospice Encounter (2.16.840.1.113883.3.464.1003.1003) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Added value set Substance Use Disorder Short Acting Medication Administration (2.16.840.1.113883.3.464.1003.1157) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Value set (2.16.840.1.113883.3.464.1003.106.12.1001): Renamed to Substance Use Disorder based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Value set (2.16.840.1.113883.3.464.1003.101.12.1004): Renamed to Initial Hospital Inpatient Visit based on recommended value set naming conventions.
Measure Section: Terminology
Source of Change: Annual Update
Value set (2.16.840.1.113883.3.464.1003.106.12.1005): Renamed to Substance Use Disorder Treatment based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Value set Substance Use Disorder (2.16.840.1.113883.3.464.1003.106.12.1001): Added 8 SNOMED CT codes (12398281000119105, 16236661000119100, 361150008, 1142050005, 191877009, 231475006, 703846009, 703847000) based on review by technical experts, SMEs, and/or public feedback. Deleted 14 SNOMED CT codes based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Value set (2.16.840.1.113883.3.464.1003.101.12.1002): Renamed to Initial Hospital Observation Care based on recommended value set naming conventions.
Measure Section: Terminology
Source of Change: Annual Update
Replaced value set Hospice Care Ambulatory (2.16.840.1.113762.1.4.1108.15) with value set Hospice Care Ambulatory (2.16.840.1.113883.3.526.3.1584) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code LOINC code (45755-6) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Added value set Substance Use Disorder Short Acting Medication (2.16.840.1.113883.3.464.1003.1150) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
Added direct reference code SNOMED CT code (373066001) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead