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Initiation and Engagement of Alcohol and Other Drug Dependence Treatment

Last updated: May 9, 2019

CMS Measure ID: CMS137v8
Version: 8
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 Populationinfo-icon

Denominator Exclusions:

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.

Numerator Statement:

Numeratorinfo-icon 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 Exclusions:

Not Applicable

Denominator Exceptions:

None

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

Quality ID: 305
Meaningful Measure: Prevention and Treatment of Opioid and Substance Use Disorders

Specifications

Release Notes

Header

  • Updated eCQMinfo-icon version number.

    Measure Section: eCQM Version number

    Source of Change: Measure Lead

  • Updated NQFinfo-icon number to 'Not Applicable.'

    Measure Section: NQF Number

    Source of Change: Standards Update

  • Updated endorsed by field to 'None.'

    Measure Section: Endorsed By

    Source of Change: Standards Update

  • Updated description statement to indicate Numeratorinfo-icon 2 time period for follow-up changed from 30 days to 34 days to accommodate injectable medications and align with HEDIS parent measure.

    Measure Section: Description

    Source of Change: Measure Lead

  • Updated description statement with addition to Numerator statement Pharmacotherapy (Patients who initiated treatment with a medication need two or more engagement events where only one can be a medication treatment event) to align with current guidelines and HEDIS parent measure.

    Measure Section: Description

    Source of Change: Measure Lead

  • Updated copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Updated rationale.

    Measure Section: Rationale

    Source of Change: Measure Lead

  • Updated clinical recommendation statement.

    Measure Section: Clinical Recommendation Statement

    Source of Change: Measure Lead

  • Updated references to align with American Psychological Association (APA) style.

    Measure Section: Reference

    Source of Change: Measure Lead

  • Updated references.

    Measure Section: Reference

    Source of Change: Measure Lead

  • Updated definition statement to between January 1 to November 14 (intake period) of the measurement period to align with the parent measure.

    Measure Section: Definition

    Source of Change: Measure Lead

  • Updated initial populationinfo-icon statement visit time to between January 1 to November 14 (intake period) of the measurement period to align with the parent measure.

    Measure Section: Initial Population

    Source of Change: Measure Lead

  • Updated numerator statement with addition of Pharmacotherapy (Patients who initiated treatment with a medication need two or more engagement events where only one can be a medication treatment event) to align with current guidelines and HEDIS parent measure.

    Measure Section: Numerator

    Source of Change: Measure Lead

  • Updated numerator statement with addition to Numerator 2 time period for follow-up from 30 days to 34 days to accommodate injectable medications and align with HEDIS parent measure.

    Measure Section: Numerator

    Source of Change: Measure Lead

  • Updated parenthetical citations to align with American Psychological Association (APA) style.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

Logic

  • Added telehealth services to the 'Qualifying Encounters' define statement.

    Measure Section: Initial Population

    Source of Change: Measure Lead

  • Revised the 'First Dependence Diagnosis' to constrain the intake period to between January 1 and November 14 (starts 47 days or more before end of measurement period) to align with HEDIS parent measure.

    Measure Section: Initial Population

    Source of Change: Measure Lead

  • Added telehealth services as an option for dependence intervention to particular define statements included in the numerator.

    Measure Section: Numerator

    Source of Change: Measure Lead

  • Added pharmacotherapy as an option for dependence treatment in the numerator to align with current guidelines.

    Measure Section: Numerator

    Source of Change: Measure Lead

  • Changed the Quality Data Model (QDM)info-icon category for the Alcohol and Drug Dependence Treatment value setinfo-icon (2.16.840.1.113883.3.464.1003.106.12.1005) from 'Encounter' to 'Intervention' to align with QDM standards.

    Measure Section: Numerator

    Source of Change: Measure Lead

  • Increased the time period for follow-up from 30 days to 34 days for all define statements included in the numerator.

    Measure Section: Numerator

    Source of Change: Measure Lead

  • Updated the names of Clinical Quality Language (CQL)info-icon definitions, functions, and/or aliases for clarification and to align with CQL Style Guideinfo-icon.

    Measure Section: Definitions and Functions

    Source of Change: Standards Update

  • Updated Clinical Quality Language (CQL) expression to conform with the HL7info-icon Standard: Clinical Quality Language Specificationinfo-icon, Release 1 STUinfo-icon 3 (CQL 1.3).

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated definitions and functions in the Measure Authoring Tool (MATinfo-icon) Global Common Functions Library to align with standards changes, Clinical Quality Language (CQL) Style Guide, and to include two new functions related to calculating hospital stays.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated version number of the Hospice Library (Hospice-2.0.000).

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Updated version number of the Measure Authoring Tool (MAT) Global Common Functions Library (MATGlobalCommonFunctions-4.0.000).

    Measure Section: Multiple Sections

    Source of Change: Standards Update

Value Set

The VSACinfo-icon is the source of truth for the value set content, please visit the VSAC for downloads of current value setsinfo-icon.

  • Value set Psych Visit - Psychotherapy (2.16.840.1.113883.3.526.3.1496): Added SNOMED CT extensional value set (2.16.840.1.113883.3.526.2.1777) including 13 codes.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Alcohol and Drug Dependence (2.16.840.1.113883.3.464.1003.106.12.1001): Added 84 SNOMED CT codes and deleted 12 SNOMED CT codes. Added 1 ICD-10-CM code (F12.23).

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Opiate Antagonists (2.16.840.1.113883.3.464.1003.198.12.1132): Added Opiate Antagonists.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Telehealth Services (2.16.840.1.113883.3.464.1003.101.12.1031): Added Telehealth Services.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Direct reference code for Birth date (LOINC Code (21112-8)) now displayed in Human Readable.

    Measure Section: Terminology

    Source of Change: Annual Update

  • ​Removed code systeminfo-icon versions from direct reference codes. Please refer to Appendix A of the Electronic Clinical Quality Measureinfo-icon Logic and Implementation Guidance document for a list of code system versions used in the eCQM specificationsinfo-icon for 2020 reporting/performance.

    Measure Section: Terminology

    Source of Change: Standards Update

  • Standardized purpose statement language in value sets across eCQMsinfo-icon. Value set purpose statements are visible in the Value Set Authority Center (VSAC) as well as the downloadable eCQM value set files.

    Measure Section: Terminology

    Source of Change: Measure Lead

External Resources