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Reducing Substance Use Disorders: Quality Measures

The goal of the Medicaid Innovation Accelerator Program’s (IAP) the Reducing Substance Use Disorders (SUD) area  is to support states to introduce policy, program, and payment reforms to better identify individuals with SUD, expand coverage for effective treatment, enhance care and practices delivered to beneficiaries, and develop payment mechanisms for SUD services that will provide better outcomes.

The Centers for Medicare & Medicaid Services (CMS) has contracted with Mathematica Policy Research and its partners, Brandeis University and the National Committee for Quality Assurance, to develop three measures for IAP:

  1. Continuity of care after medically-managed withdrawal from alcohol and/or drugs
  2. Use of pharmacotherapy for opioid use disorder
  3. Continuity of care after inpatient or residential treatment for substance use disorder

Continuity of care after medically-managed withdrawal from alcohol and/or drugs (NQF 3312): percentage of discharges from a medically managed withdrawal episode for adult Medicaid beneficiaries, ages 18–64, that was followed by a treatment service for substance use disorder [including the prescription or receipt of a medication to treat a substance use disorder (pharmacotherapy)] within 7 or 14 days after discharge. This measure is reported across all medically managed withdrawal settings.

Use of pharmacotherapy for opioid use disorder (NQF 3400): the percentage of Medicaid beneficiaries ages 18–64 with an Opioid Use Disorder (OUD) who filled a prescription for or were administered or dispensed an FDA-approved medication for OUD during the measure year. The measure will report any medications used in medication assisted treatment of opioid dependence and addiction and four separate rates representing the following types of FDA-approved drug products: buprenorphine; oral naltrexone; long-acting, injectable naltrexone; and methadone.

Continuity of care after inpatient or residential treatment for substance use disorder (NQF 3453): percentage of discharges from inpatient or residential treatment for substance use disorder (SUD) for Medicaid beneficiaries, ages 18–64, which were followed by a treatment service for SUD. SUD treatment services include having an outpatient visit, intensive outpatient encounter or partial hospitalization, telehealth encounter, or filling a prescription or being administered or dispensed a medication for SUD. (After an inpatient discharge only, residential treatment also counts as continuity of care.) Two rates are reported, continuity within 7 and 14 days after discharge.

Measure Dissemination Webinar

Webinar on New Quality Measures for Medicaid Beneficiaries with Substance Use Disorders (PDF, 380.66 KB)