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 HEDIS MY2022 Initiation and Engagement of Substance Use Disorder (SUD) Treatment (IET) measure removes individuals with SUD diagnosis history from the eligible population; whereas, CMS137 accounts for individuals with SUD diagnosis history through the Denominator Exclusions criteria. 
 
NCQA proposes to update CMS137 to align with the approach used in the HEDIS measure version to further align the measure with the measure intent and more accurately reflect the appropriate patient population for evaluation by this measure.

Proposed Solution:

​//Header: Guidance - Remove the following statement:
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.
 
//Before
//Header: 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
 
//After
//Header: 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, and who had a negative diagnosis history, defined as an encounter or medication treatment for a diagnosis of SUD in the 60 days prior to the first SUD episode.
 
//Header: Denominator Exclusions - Remove the following statement:
Exclude patients with a negative diagnosis history, defined as an encounter or medication treatment for a diagnosis of alcohol, opioid or other drug abuse or dependence in the 60 days prior to the first episode of alcohol or drug dependence.
 
//Logic
//Before
define "Initial Population":
   exists ["Patient Characteristic Birthdate": "Birth date"] BirthDate
     where Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 13
       and "First Dependence Diagnosis During Measurement Period" is not null
 
define "Denominator Exclusions":
   Hospice."Has Hospice"
     or exists "History of Dependence Diagnosis or Treatment"
 
//After
define "Initial Population":
   exists ["Patient Characteristic Birthdate": "Birth date"] BirthDate
     where Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 13
       and "First Dependence Diagnosis During Measurement Period" is not null
       and not exists "History of Dependence Diagnosis or Treatment"
 
define "Denominator Exclusions":
   Hospice."Has Hospice"

Rationale for Change:

Updating the measure to adopt the approach specified by the HEDIS MY2022 IET measure to remove individuals with an SUD diagnosis history from the initial population meets the eCQM measure intent.