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CMS137v14: Initiation and Engagement of Substance Use Disorder Treatment

*Telehealth Eligible

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 medication treatment events for SUD, or one long-acting medication event for the treatment of SUD, within 34 days of the initiation.

Numerator

  • Numerator A: Initiation of treatment includes either an intervention or medication for the treatment of SUD within 14 days of the new SUD episode

    • Clinical Decision Support: Complete the following Clinical Decision Support Rules within 14 days of the diagnosis onset date:
      • "Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse in Adults"

    • Text in Chart: In the Physical Exam, Plan or Assessment text box contains any of the following phrases:

      • Drug addiction education initial

      • Drug Addiction counseling

      • Alcoholism counseling

      • Alcohol rehabilitation

      • Substance abuse counseling

      • Substance abuse prevention education

    • Orders: A referral ordered through the orders screen, containing the phrase “rehab” in the order.
    • Medication: A medication for the treatment of AOD abuse or dependence is prescribed within 14 days of the diagnosis onset date.
  • Numerator B : Engagement in ongoing SUD treatment within 34 days in initiation includes:
    • Medications: A long-acting SUD medication on the day after in initiation though 34 days after the initiation of treatment

      AND

    • One of the following options on the day after the initiation of treatment through 34 days after the initiation of treatment:

      • two engagement visits

      • two engagement medication treatment events

      • one engagement visit and one engagement mediation treatment event

    • CDS Rule: Complete the following Clinical Decision Support Rules within 34 days of the diagnosis onset date:
      • "Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse in Adults"

    • Text in Chart: The Physical Exam, Plan or Assessment text box contains any of the following phrases:

      • Drug addiction education

      • Drug Addiction counseling

      • Alcoholism counseling

      • Alcohol rehabilitation

      • Substance abuse counseling

      • Substance abuse prevention education

    • Orders: A referral ordered through the orders screen, containing the phrase “rehab” in the order.

    Denominator

    A patient will qualify for this measure by meeting all of the following criteria:
    • Patients 18-75 years of age by the end of the measurement period
    • At least one visit during the measurement period.
      • Visits must have the appropriate office visit CPT code entered into Amazing Charts (ex: 99213, 99214, etc)
    • An active diagnosis of Substance Abuse Disorder,

    Denominator Exclusions

    • Exclude patients whose hospice or palliative care overlaps the measurement period:
      • Identified in the patient's Alerts and Directives, located in the demographic screen or the Summary Sheet, in the name, text or comments saved with that alert/directive. The Alert/Directive should include either of the following phrases:
        • palliative
        • hospice