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:

Two event types (ED visits and medically managed withdrawal events) were removed from the "negative lookback rules" included in the HEDIS MY2022 Initiation and Engagement of Substance Use Disorder Treatment (IET) measure, which this eCQM is based upon. These types of events were removed as both ED visits and  medically managed withdrawal, alone, are not suggestive of ongoing or planned treatment for individuals with substance use disorder (SUD). Therefore, these two event types should not signal that an individual is already engaged in comprehensive care. These revisions were supported by stakeholders in an expert panel.
 
To align with stakeholder and expert panel recommendations, as well as the parent HEDIS measure, NCQA proposes to remove ED visits and medically managed withdrawals from the negative lookback rules in the eCQM's denominator exclusions criteria, as these revisions are applicable to clinician level reporting and align with the measure intent. 

Proposed Solution:

​//Logic - "History of Dependence Diagnosis or Treatment"
//Before
...union ( ( "Qualifying Encounters" QualifyingEncounter
        where ( exists QualifyingEncounter.diagnoses Diagnosis
            where Diagnosis.code in "Alcohol and Drug Dependence"
        ) )
    
//After
...union ( ( ("Qualifying Encounters"
except "Emergency Department or Detoxification Visit") QualifyingEncounter
        where ( exists QualifyingEncounter.diagnoses Diagnosis
            where Diagnosis.code in "Alcohol and Drug Dependence"
        ) )
 
Add the following definition:
define "Emergency Department or Detoxification Visit":
  ["Encounter, Performed": "Emergency Department Visit"]
      union ["Encounter, Performed": "Detoxification Visit"]

Rationale for Change:

NCQA proposes to remove ED visits and medically managed withdrawals from the negative lookback rules to promote alignment with the measure intent and be responsive to stakeholder feedback.