CMS 137 - Initiation and Engagement of Alcohol and Other Drug Dependence Treatment

Covered by this topic

Overview

CMS137v8 (2020)

CMS137v9 (2021)

CMS137v10 (2022)

Identifiers

CMS eCQM ID	NQF eCQM ID	NQF	MIPS Quality ID
CMS137v10	–	–	305

*MIE only supports data collection and reporting using eCQM specifications

Definitions

Description	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.
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	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.
Initial Patient 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
Denominator	Equals Initial Population
Denominator Exclusions	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. Exclude patients who are in hospice care for any part of the measurement period.
Numerator	Initiation of treatment includes either an intervention or medication for the treatment of AOD abuse or dependence within 14 days of the diagnosis.	Engagement in ongoing treatment within 34 days of initiation includes: Patients that initiated treatment with a psychosocial visit, and whose engagement criteria was fulfilled by a dispensed medication. Patients that initiated treatment with a psychosocial visit, and whose engagement criteria was fulfilled by two further psychosocial visits. Patients that initiated treatment with a dispensed medication, and whose engagement criteria was fulfilled by both a further medication dispense and a psychosocial visit. Patients that initiated treatment with a dispensed medication, and whose engagement criteria was fulfilled by two psychosocial visits.
Numerator Exclusions	–
Denominator Exceptions	–

Additional Information

Measure Type	Process measure
Measure Scoring	Proportion measure
Stratification	13-17 years 18 or greater years
Granularity	Patient
Improvement Notation	Higher score indicates better quality
Domain	Effective Clinical Care

Clinical Instructions

New UI Visit Encounter (valid RC202109+)

Original Visit Encounter

Evidence

Initial Patient Population

Name	Value Set
Diagnosis: Alcohol and Drug Dependence	2.16.840.1.113883.3.464.1003.106.12.1001
Encounter, Performed: Discharge Services - Hospital Inpatient	2.16.840.1.113883.3.464.1003.101.12.1007
Encounter, Performed: Discharge Services - Hospital Inpatient Same Day Discharge	2.16.840.1.113883.3.464.1003.101.12.1006
Encounter, Performed: Emergency Department Visit	2.16.840.1.113883.3.464.1003.101.12.1010
Encounter, Performed: Hospital Inpatient Visit - Initial	2.16.840.1.113883.3.464.1003.101.12.1004
Encounter, Performed: Hospital Observation Care - Initial	2.16.840.1.113883.3.464.1003.101.12.1002
Encounter, Performed: Office Visit	2.16.840.1.113883.3.464.1003.101.12.1001
Encounter, Performed: Online Assessments	2.16.840.1.113883.3.464.1003.101.12.1089
Encounter, Performed: Telephone Visits	2.16.840.1.113883.3.464.1003.101.12.1080

Denominator Exclusions

Name	Value Set
Encounter, Performed: Encounter Inpatient	2.16.840.1.113883.3.666.5.307
Intervention, Order: Hospice care ambulatory	2.16.840.1.113762.1.4.1108.15
Intervention, Performed: Hospice care ambulatory	2.16.840.1.113762.1.4.1108.15

Numerator

Name	Value Set
Encounter, Performed: Detoxification Visit	2.16.840.1.113883.3.464.1003.101.12.1059
Intervention, Performed: Alcohol and Drug Dependence Treatment	2.16.840.1.113883.3.464.1003.106.12.1005
Intervention, Performed: Psych Visit - Psychotherapy	2.16.840.1.113883.3.526.3.1496
Medication, Order: Opiate Antagonists	2.16.840.1.113883.3.464.1003.198.12.1132

Source(s)

Enterprise Health Documentation

Last Updated: Thu, 28 Apr 2022 13:40:33 UTC

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