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Initiation and Engagement of Alcohol and Other Drug Dependence Treatment

General eCQM Information

CMS Measure ID CMS137v10
NQF Number Not Applicable
Measure 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
Denominator Statement

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.

Numerator Statement

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 Exceptions

None

Measure Steward National Committee for Quality Assurance
Domain Effective Clinical Care
Measure Scoring Proportion
Measure Type Process
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 (https://ecqi.healthit.gov/qdm) for more information on the QDM.

Quality ID 305
Meaningful Measure Prevention and Treatment of Opioid and Substance Use Disorders
Telehealth Eligible Yes
Previous Version

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: Jul 08, 2021