Initiation and Engagement of Substance Use Disorder Treatment

Measure Information	2023 Performance Period
CMS eCQM ID	CMS137v11
NQF Number	Not Applicable
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.
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
Denominator	Equals Initial Population
Denominator Exclusions	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
Numerator Exclusions	Not Applicable
Denominator Exceptions	None
Measure Steward	National Committee for Quality Assurance
Quality Domain	Effective Clinical Care
Measure Scoring	Proportion measure
Measure Type	Process measure
Improvement Notation	Higher score indicates better quality
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.
MIPS Quality ID	305
Meaningful Measure	Prevention and Treatment of Opioid and Substance Use Disorders
Telehealth Eligible	Yes
Next Version	No Version Available
Previous Version	CMS137v10

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Measure Information	2021 Performance Period	2022 Performance Period	2023 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
CMS eCQM ID	CMS137v9	CMS137v10	CMS137v11
NQF Number	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.
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
Denominator	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
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 Exclusions	Not Applicable	Not Applicable	Not Applicable
Denominator Exceptions	None	None	None
Measure Steward	National Committee for Quality Assurance	National Committee for Quality Assurance	National Committee for Quality Assurance
Quality Domain	Effective Clinical Care	Effective Clinical Care	Effective Clinical Care
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.	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.
MIPS Quality ID	305	305	305
Meaningful Measure	Prevention and Treatment of Opioid and Substance Use Disorders	Prevention and Treatment of Opioid and Substance Use Disorders	Prevention and Treatment of Opioid and Substance Use Disorders
Telehealth Eligible	Yes	Yes	Yes
Next Version	CMS137v10	CMS137v11	No Version Available
Previous Version	No Version Available	CMS137v9	CMS137v10

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Data Element Repository

Data Elements contained within CMS137v11

Value Sets

Value Sets to be used with CMS137v11

Release Notes

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