Brief Description of Measure:

​CMS137: Initiation and Engagement of Alcohol and Other Drug Dependence Treatment:
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.

+Description of Issue:
+

​​The term "abuse or dependence" in reference to substance use is stigmatizing, inferring willful misbehavior. To support the use of neutral, science-based terminology and align with current Diagnostic and Statistical Manual of Mental Disorders (DSM-5) terminology/framing, NCQA proposes to update all references of the term "abuse and dependence" to read "substance use disorder (SUD)".

Example terms to be replaced by "SUD" or "SUD episode" include:
-alcohol or other drug abuse or (AOD) dependence
-AOD abuse or dependence
-alcohol or other drug dependence
-diagnosis of alcohol or other drug dependence
-AOD
-episodes of alcohol or drug dependence
-episode of alcohol, opioid, or other drug abuse or dependency

++

 
Proposed Solution:

​//Header: eCQM Title
//Before
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment
//After
Initiation and Engagement of Substance Use Disorder Treatment
 
//Header: Description
//Before
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.
//After 
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 a medication for the treatment of SUD, 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.
 
//Header: Definition
//Before
...first visit for alcohol or other drug dependence treatment within 14 days after a diagnosis of alcohol or other drug dependence.
//After
...first visit for SUD treatment within 14 days after a new SUD episode.
 
//Before
Treatment includes inpatient AOD admissions...
//After
Treatment includes inpatient SUD admissions...
 
//Before
The Intake Period: ...capture new episodes of Alcohol or Drug Dependence.
//After
The Intake Period: ...capture new SUD episodes.
 
//Header: Guidance
//Before
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.
//After
The SUD Episode date is the date of service for an encounter during the Intake period with a diagnosis of SUD.
 
//Header: Initial Population
//Before
...diagnosed with a new episode of alcohol, opioid, or other drug abuse or dependency...
//After
...diagnosed with a new SUD episode...
 
//Header: Numerator
//Before
Numerator 1: ...for the treatment of AOD abuse or dependence within 14 days of the diagnosis.
//After
Numerator 1: ...for the treatment of SUD within 14 days of the new SUD episode.
 
//Before
Numerator 2: Engagement in ongoing treatment...
//After
Numerator 2: Engagement in ongoing SUD treatment...
 
//CQL LIBRARY NAME
//Before
InitiationandEngagementofAlcoholandOtherDrugDependenceTreatment
//After
InitiationandEngagementofSubstanceUseDisorderTreatment
 
//LOGIC
//Before
define "First Dependence Diagnosis During Measurement Period"
//After
define "First SUD Episode During Measurement Period"
//Note: the alias to be used is "FirstSUDEpisode"
 
//Before
define "Initial Population"
...and "First Dependence Diagnosis During Measurement Period"...
//After
define "Initial Population"
...and "First SUD Episode During Measurement Period"...
 
//Before
define "History of Dependence Diagnosis or Treatment":
..."First Dependence Diagnosis During Measurement Period" FirstDiagnosis
...FirstDiagnosis.relevantDatetime, FirstDiagnosis.relevantPeriod...
//After
define "History of SUD Episode":
..."First SUD Episode During Measurement Period" FirstSUDEpisode
...FirstSUDEpisode.relevantDatetime, FirstSUDEpisode.relevantPeriod...
 
//Before
define "Treatment Initiation With Medication Order"
...with "First Dependence Diagnosis During Measurement Period" FirstDiagnosed
...FirstDiagnosed.relevantDatetime, FirstDiagnosed.relevantPeriod...
//After
define "Treatment Initiation With Medication Order"
...with "First SUD Episode During Measurement Period" FirstSUDEpisode
...FirstSUDEpisode.relevantDatetime, FirstSUDEpisode.relevantPeriod...
 
//Before
define "Treatment Initiation with Non Medication Order"
...with "First Dependence Diagnosis During Measurement Period" FirstDiagnosed
...FirstDiagnosed.relevantDatetime, FirstDiagnosed.relevantPeriod...
//After
define "Treatment Initiation With Non Medication Order"
...with "First SUD Episode During Measurement Period" FirstSUDEpisode
...FirstSUDEpisode.relevantDatetime, FirstSUDEpisode.relevantPeriod...

Rationale for Change:

​The goal of this proposed change is to promote the use of neutral, science-based terminology in the measure. This change will also align the measure with the current DSM terminology.