Initiation and Engagement of Alcohol and Other Drug Dependence Treatment

Last updated: May 3, 2018

CMS Measure ID: CMS137v6
Version: 6
NQF Number: 0004
Measure Description:

Percentage of patients 13 years of age and older with a new episode of alcohol and other drug (AOD) dependence who received the following. Two rates are reported.

a. Percentage of patients who initiated treatment within 14 days of the diagnosis.

b. Percentage of patients who initiated treatment and who had two or more additional services with an AOD diagnosis within 30 days of the initiation visit.

Initial Patient Population:

Patients age 13 years of age and older who were diagnosed with a new episode of alcohol or drug dependency during a visit in the first 11 months of the measurement period

Denominator Statement:

Equals Initial Population

Denominator Exclusions:

Patients with a previous active diagnosis of alcohol or drug dependence in the 60 days prior to the first episode of alcohol or drug dependence.

Exclude patients who were in hospice care during the measurement year.

Numerator Statement:

Numerator 1: Patients who initiated treatment within 14 days of the diagnosis

Numerator 2: Patients who initiated treatment and who had two or more additional services with an AOD diagnosis within 30 days of the initiation visit

Numerator Exclusions:

Not Applicable

Denominator Exceptions:

None

Measure Steward: National Committee for Quality Assurance
Domain: Effective Clinical Care
Next Version:
Previous Version:
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.

Notes: Value Set content updated Sept 2017, TRNs updated Oct 2017

Specifications

Release Notes

Header

  • ​Incremented eMeasure Version number.

    Measure Section: eMeasure Version number

    Source of Change: Measure Lead

  • ​Updated Copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • ​Updated Disclaimer.

    Measure Section: Disclaimer

    Source of Change: Measure Lead

  • Added language to the Definition section stating that the diagnosis must occur between January 1 and November 15 of the measurement year to ensure all services occur before the end of the measurement year.

    Measure Section: Definition

    Source of Change: JIRA (CQM-2246)

  • ​Updated the exclusion statement in the header to exclude patients in hospice care from the Denominator. Measures that focus on screenings and procedures may not be appropriate or a priority for those who are at end of life (ie, on hospice).

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

Logic

  • Added a new line of logic for $FirstAlcoholDrugDependenceDx that restricts the diagnosis to occur between January 1 and November 15 to ensure all services occur before the end of the measurement period.

    Measure Section: Initial Population

    Source of Change: JIRA (CQM-2246)

  • Updated the logic for the $FirstAlcoholDrugDependenceDx variable by tying the 'FIRST' function to the diagnosis rather than the measurement period, which better meets the intent of the measure.

    Measure Section: Initial Population

    Source of Change: Measure Lead

  • Added new lines of logic to the Denominator Exclusions for all NCQA-stewarded measures (except CMS82) to ensure patients in hospice care are excluded from the Denominator.

    Measure Section: Denominator Exclusions

    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 Alcohol and Drug Dependence (2.16.840.1.113883.3.464.1003.106.12.1001): Added 18 SNOMEDCT codes and deleted 40 SNOMEDCT codes. Deleted 76 ICD9CM codes. Deleted 131 ICD10CM codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Alcohol and Drug Dependence Treatment (2.16.840.1.113883.3.464.1003.106.12.1005): Added 2 SNOMEDCT codes (20093000, 707166002).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Encounter Inpatient (2.16.840.1.113883.3.666.5.307): Added Encounter Inpatient.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Hospice care ambulatory (2.16.840.1.113762.1.4.1108.15): Added Hospice care ambulatory.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Discharged to Health Care Facility for Hospice Care (2.16.840.1.113883.3.117.1.7.1.207): Added Discharged to Health Care Facility for Hospice Care.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Discharged to Home for Hospice Care (2.16.840.1.113883.3.117.1.7.1.209): Added Discharged to Home for Hospice Care.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Alcohol and Drug Dependence Treatment (2.16.840.1.113883.3.464.1003.106.12.1005): Added 4 SNOMEDCT codes (720174008, 720175009, 720176005, 720177001).

    Measure Section: QDM Data Elements

    Source of Change: 2018 Addendum

External Resources