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:

​NCQA revised the numerator rules for the HEDIS MY2022 Initiation and Engagement of Substance Use Disorder Treatment (IET) measure to no longer require that pharmacotherapy for both alcohol and opioid use disorder be accompanied by at least one psychosocial encounter for the treatment of substance use disorder (SUD). This revision was supported by NCQA expert panels and is aligned with current clinical practice guidelines.
 
Because this eCQM is based upon the IET HEDIS measure noted above, NCQA proposes to remove the requirement that psychosocial treatment accompany pharmacotherapy in CMS137, as this revision is aligned with current clinical practice guidelines and stakeholder feedback.

Proposed Solution:

​//Note: the measure will now allow full engagement criteria to be met if an individual received a long-acting medication for the treatment of SUD. The measure also separates out drug medications by long-acting and short-acting. This issue is documented separately in another CRP issue.

//Header: Description
//Before
...For patients who initiated treatment with a medication, at least one of the two engagement events must be a treatment intervention.

//After
(removed)

//Header: Numerator
//Before
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.

//After
Numerator 2: Engagement in ongoing SUD treatment within 34 days of initiation includes:
1. A long-acting SUD medication on the day after the initiation encounter through 34 days after the initiation encounter.
2. At least two of the following (any combination) on the day after the initiation encounter through 34 days after the initiation encounter: 1) engagement visit, 2) engagement medication treatment event.

//Logic
//Before

define "Numerator 2":
  exists ( "Treatment Initiation with Non Medication Intervention" NonMedicationInitiation
      with "Treatment with Single Medication Order During Measurement Period" MedicationContinuation
        such that MedicationContinuation.authorDatetime 34 days or less after start of Global."NormalizeInterval" ( NonMedicationInitiation.relevantDatetime, NonMedicationInitiation.relevantPeriod )
  )
    or "Has Dependence Treatment Intervention Continued"
    or ( exists "Treatment Initiation With Medication Order" InitiatedTreatment
        where ( exists "Continuation of Treatment Event Following Medication Initiation" )
          and ( exists "Treatment with Single Medication Order During Measurement Period" MedicationContinuation
              where MedicationContinuation.authorDatetime 34 days or less after InitiatedTreatment.authorDatetime
          )
    )
    or "Has Treatment Initiation With Medication and Continuation of Treatment with Encounters"

define "Continuation of Treatment Event Following Medication Initiation":
"Psychosocial Visit" ContinuedTreatment
  with "Treatment Initiation With Medication Order" TreatmentEvent
    such that Global."NormalizeInterval" ( ContinuedTreatment.relevantDatetime, ContinuedTreatment.relevantPeriod ) starts 34 days or less after TreatmentEvent.authorDatetime

define "Has Dependence Treatment Intervention Continued":
Count("Psychosocial Visit" ContinuedTreatment
    with "Treatment Initiation with Non Medication Intervention" InitiatedTreatment
      such that start of Global."NormalizeInterval"(ContinuedTreatment.relevantDatetime, ContinuedTreatment.relevantPeriod)34 days or less after start of Global."NormalizeInterval"(InitiatedTreatment.relevantDatetime, InitiatedTreatment.relevantPeriod)
)>= 2

define "Has Treatment Initiation With Medication and Continuation of Treatment with Encounters":
Count("Psychosocial Visit" ContinuedTreatment
    with("Treatment Initiation With Medication Order")InitiatedTreatment
      such that Global."NormalizeInterval"(ContinuedTreatment.relevantDatetime, ContinuedTreatment.relevantPeriod)starts 34 days or less after InitiatedTreatment.authorDatetime
)>= 2

define "Treatment with Single Medication Order During Measurement Period":
["Medication, Order": "Opiate Antagonists"] MedicationOrderOpiate
  where MedicationOrderOpiate.authorDatetime during "Measurement Period"

//After

define "Numerator 2":
  exists ...
    or "Treatment Engagement With Short Acting Medication or Non Medication Intervention"

define "Short Acting Medication or Non Medication Intervention":
  ( ( "Psychosocial Visit"
      union ["Intervention, Performed": "Substance Use Disorder Short Acting Medication Administration"] ) ShortActingTreatment
      return "Medication, Order" { authorDatetime: start of Global."NormalizeInterval" ( ShortActingTreatment.relevantDatetime, ShortActingTreatment.relevantPeriod ) }
  )
    union ["Medication, Order": "Substance Use Disorder Short Acting Medication"]

define "Treatment Engagement With Short Acting Medication or Non Medication Intervention":
  Count("Short Acting Medication or Non Medication Intervention" ContinuedTreatment
      with (  "Treatment Initiation With Medication Order"
    union "Treatment Initiation with Non Medication Intervention") InitiatedTreatment
        such that date from ContinuedTreatment.authorDatetime 34 days or less after date from InitiatedTreatment.authorDatetime
  )>= 2

//The following definitions are removed:
"Continuation of Treatment Event Following Medication Initiation"...
"Has Dependence Treatment Intervention Continued"...
"Has Treatment Initiation With Medication and Continuation of Treatment with Encounters"...
"Treatment with Single Medication Order During Measurement Period"...

Rationale for Change:

NCQA proposes to remove the requirement that psychosocial treatment accompany pharmacotherapy to align the measure with current clinical practice guidelines and address stakeholder feedback.