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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

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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 (https://ecqi.healthit.gov/qdm) 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

Release Notes

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

Last Updated: Aug 29, 2022