Overview of Substance Use Disorder Measures in the 2021 ...

1 TECHNICAL ASSISTANCE RESOURCE. May 2021. Overview of Substance Use Disorder Measures in the 2021 Adult and Health Home Core Sets Introduction Table 1. SUD Measures Included in the 2021 Adult and Health Home Core Sets Improving outcomes for Medicaid beneficiaries with Substance use disorders (SUDs) is a top priority for the Health Centers for Medicare & Medicaid Services (CMS). The NQF# Measure Name Adult Home opioid epidemic in particular continues to highlight the 0004 Initiation and Engagement of need for both preventing inappropriate prescribing and Alcohol and Other Drug Abuse or . providing access to high quality treatment. Dependence Treatment (IET-AD /.)

2 IET-HH). In keeping with these objectives, the Adult and Health 2940 Use of Opioids at High Dosage in Home Core Sets include several Measures that focus on Persons Without Cancer (OHD-AD) . SUD. This technical assistance resource provides an 3389 Concurrent Use of Opioids and Overview of the SUD Measures in the 2021 Adult and Benzodiazepines (COB-AD) . Health Home Core Sets. 3400 Use of Pharmacotherapy for The 2021 Adult Core Set includes five SUD Measures Opioid Use Disorder (OUD-AD / . and the 2021 Health Home Core Set includes three SUD OUD-HH). Measures (see Table 1). These Measures are also 3488 Follow-Up After Emergency included in the Behavioral Health Core Set that CMS Department Visit for Alcohol and.

3 Has identified to improve behavioral health in Medicaid Other Drug Abuse or Dependence and CHIP. 1 Successful reporting of these Measures will (FUA-AD / FUA-HH). help CMS and states to continue their quality * As terisks denote the m easur e is i ncl uded in that v ersion of the m anual. improvement efforts across the continuum of care for SUDs and to monitor progress in combatting the opioid SUD Treatment Measures in the Adult and crisis. Health Home Core Sets The 2021 Adult and Health Home Core Sets include three Measures of treatment for Substance use Disorder , including opioid use Disorder and alcohol and other drug abuse or dependence (AOD) (see Table 2).

4 1. The list of 2021 Core Set of Behavioral Health Measures for Medicaid and CHIP is available at care/ This technical assistance resource is a product of the Technical Assistance and Analytic Support for the Medicaid and CHIP Quality Measurement and Improvement Program, sponsored by the Center for Medicaid and CHIP Services. The technical assistance team is led by Mathematica, in collaboration with the National Committee for Quality Assurance, Center for Health Care Strategies, AcademyHealth, and Aurrera Health Group. 1. Table 2. Overview of SUD Treatment Measures in the 2021 Adult and Health Home Core Sets . IET-AD / IET-HH FUA-AD / FUA-HH OUD-AD / OUD-HH.

5 Measure National Committee for Quality National Committee for Quality Centers for Medicare & Medicaid steward Assurance Assurance Services Description Percentage of beneficiaries age 18 and Percentage of emergency department Percentage of Medicaid beneficiaries older1 with a new episode of AOD abuse (ED) visits for beneficiaries age 18 and ages 18 to 64 with an opioid use or dependence who received: older2 with a principal diagnosis of Disorder (OUD) who filled a Initiation of AOD treatment within 14 AOD abuse or dependence who had a prescription for or were administered days of diagnosis follow-up visit with a corresponding or dispensed an FDA-approved Engagement of AOD treatment, principal diagnosis for AOD abuse or medication for the Disorder during defined as engaged in ongoing AOD dependence.

6 The measurement year. treatment within 34 days of initiation Two rates are reported: This measure includes a total rate as visit A follow-up visit within 30 days of well as four separate rates Each rate is stratified by the following the ED visit representing the following four types AOD diagnosis cohorts: A follow-up visit within 7 days of the of Food and Drug Administration Alcohol abuse or dependence ED visit (FDA)-approved drug products: Opioid abuse or dependence Buprenorphine Other drug abuse or dependence Oral naltrexone Total AOD abuse or dependence Long-acting, injectable naltrexone Methadone Index The earliest date of service for an eligible None None Episode encounter between January 1 and Start Date November 14 with a diagnosis of AOD.

7 (IESD) abuse or dependence Numerator Beneficiaries who received AOD Number of ED visits for beneficiaries Beneficiaries with evidence of at treatment: with a principal diagnosis of AOD least one prescription filled or who Within 14 days of the IESD (Initiation abuse or dependence who had a were administered or dispensed a of AOD treatment) follow-up visit with any practitioner FDA-approved medication for OUD. Within 34 days of the initiation event with a principal diagnosis of AOD during the measurement year (Engagement of AOD treatment) abuse or dependence: where: Within 30 days of the ED visit The beneficiary had an opioid Within 7 days of the ED visit treatment service that bills monthly or a visit that included medication administration (Note: This criterion is only applicable for beneficiaries with an IESD for a diagnosis of opioid abuse or dependence), OR.

8 The initiation of AOD treatment event was a medication treatment event, and the beneficiary received two or more engagement events, only one of which was a medication treatment event, OR. The initiation of AOD treatment event was not a medication treatment event, and the beneficiary received at least one engagement medication treatment event or at least two engagement visits Denominator Beneficiaries with a new episode of AOD ED visits with a primary diagnosis of Beneficiaries who had at least one abuse or dependence. AOD abuse or dependence. encounter with a diagnosis of opioid For this measure, a new' episode abuse, dependence, or remission requires a lookback period of 60 days (primary or other) at any time during where no SUD treatment took place.

9 The measurement year. Exclusions Beneficiaries who use hospice services Beneficiaries who use hospice None during the measurement year services during the measurement year Data source Administrative or electronic health record Administrative Administrative The IET-HH measure is reported for Health Home enrollees age 13 and older. 1. The FUA-HH measure is reported for Health Home enrollees age 13 and older. 2. 2. Initiation and Engagement of Alcohol and Other Drug includes two rates: (1) follow-up within 30 days of the Abuse or Dependence Treatment (IET-AD / IET-HH) ED visit, and (2) follow-up within 7 days of the ED visit. The Initiation and Engagement of Alcohol and Other For the 2021 Adult and Health Home Core Sets, the Drug Abuse or Dependence Treatment (IET-AD / IET- measure steward revised the FUA-AD and FUA-HH.)

10 HH) measure examines the percentage of beneficiaries technical specifications by adding value sets for OUD. with a new episode of AOD abuse or dependence who treatment services that are billed weekly or monthly to received treatment. This measure includes two rates: one the numerator to identify a follow-up visit. for the initiation of timely AOD treatment and one for the continuation (engagement) of AOD treatment. Use of Pharmacotherapy for Opioid Use Disorder (OUD-AD / OUD-HH). In addition to the total initiation and engagement rates, the measure is stratified by three diagnosis cohorts: The Use of Pharmacotherapy for Opioid Use Disorder . (1) alcohol abuse or dependence, (2) opioid abuse or (OUD-AD / OUD-HH) measure examines the use of dependence, and (3) other drug abuse or dependence.