Initiation & Engagement of Alcohol & Other Drug Dependence Treatment: Age 18 & Older (Engagement Rate)

About This Measure

This measure reports the percentage of adults ages 18 and older with a newly diagnosed episode of alcohol and other drug (AOD) dependence who initiated timely treatment within 14 days of diagnosis and continued treatment with two or more AOD services within 30 days of the initial visit. Higher rates are better.

The data presented below are taken from the Adult Core Set for Federal Fiscal Year (FFY) 2016. Reporting is currently voluntary and reporting methods can vary by state.  For example, some states have access to different data on populations covered under fee-for-service as compared to populations covered under managed care. This variation in data availability can impact measure performance. Readers should review the detailed measure notes located after the graph to better understand states’ reported rates.

Treatment for AOD dependence can improve health, productivity, and social outcomes. It can also save millions of dollars on health care and related costs.

Recommended care for individuals with newly diagnosed AOD dependence includes initiating treatment within 14 days of diagnosis (initiation rate), and then continued treatment with two or more AOD services within 30 days of the first visit (engagement rate).

State performance on the engagement rate appears below. For information on state performance on the treatment initiation rate, see Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: Age 18 and Older (Initiation Rate).

The red dashed line represents the median, or middle of all values reported.

m12

Stem plot with a median of 14% and the states and values:

State Percent
California 18%
Connecticut 20%
Dist. Of Col. 1%
Delaware 16%
Georgia 5%
Hawaii 14%
Iowa 19%
Illinois 9%
Kentucky 10%
Louisiana 10%
Massachusetts 18%
Minnesota 13%
Missouri 17%
North Carolina 4%
New Hampshire 15%
New York 19%
Ohio 14%
Oklahoma 5%
Oregon 19%
Pennsylvania 19%
Rhode Island 19%
South Carolina 7%
Tennessee 10%
Texas 6%
Vermont 16%
West Virginia 5%

Source: Mathematica analysis of MACPro reports for the Adult Core Set FFY 2016 reporting cycle; see 2016 Child and Adult Health Care Quality Measures.

Notes:

The following states did not report data to CMS for this measure: AK, AL, AR, AZ, FL, ID, IN, KS, MD, ME, MI, MS, MT, ND, NE, NJ, NM, NV, SD, UT, VA, WA, WI, and WY.

This figure excludes CO, which did not use Adult Core Set specifications to calculate the measure.

Measure Specific Tables (MSTs) available on Medicaid.gov provide important context for understanding state performance on each measure. MSTs include information about variation in included populations, methods, and data sources used to calculate the measure, as well as deviations from Core Set measure specifications.

Unless otherwise specified:

  • States used Adult Core Set specifications, based on HEDIS 2016 specifications. This table excludes CO, which reported the measure but did not use Adult Core Set specifications to calculate the measure. 
  • The measurement period for this measure was January 1, 2015 to November 5, 2015. MN reported data for CY 2015. 
  • Rates displayed reflect state reporting for Medicaid beneficiaries ages 18 to 64 or age 18 and older.

The Adult Core Set specifications include guidance for calculating this measure using the administrative method. Unless otherwise specified, the administrative data source is the state’s Medicaid Management Information System and/or data submitted by managed care plans, including behavioral health plans.

Denominators are assumed to be the measure-eligible population for states using the administrative method. Some states reported exclusions from the denominator, as noted in the state-specific comments below.

State-Specific Comments:

CA: Rates include FFS and managed care populations (26 MCOs). Rates exclude Medicare-Medicaid Dual Eligibles. Value sets do not include Healthcare Common Procedure Coding System (HCPCS) codes for residential treatment (H0018 and H0019). In the state, the inpatient 01xx revenue codes do not occur on the same dates as H0018/H0019 codes. Codes indicative of inpatient hospital encounters usually occur on dates preceding the series of H0018/H0019 encounter dates. State counted continuous days for H0018 and H0019 as the start and end dates of treatment. If a beneficiary had 30 continuous days of treatment past the index episode, state counted the beneficiary in the numerators for both initiation and engagement. Rates are provisional due to changes in the Medicaid program and data systems during this period.

CT: Rates include FFS population age 18 and older. Rates exclude Medicare-Medicaid Dual Eligibles.

DE: Rates include managed care population (2 MCOs), representing 85 percent of the population. Rates exclude FFS population, representing 15 percent of the population.

DC: Rates include managed care population (2 MCOs) age 18 and older, representing 28 percent of the population. Rates exclude 2 MCOs and FFS population, representing 72 percent of the population. The District attributes lower rates on this measure to separation of physical and mental health services and challenges for MCOs of obtaining complete mental health service records.

GA: Rates include FFS and managed care populations (4 MCOs). Rates exclude Medicare-Medicaid Dual Eligibles and Planning for Healthy Babies (P4HB) demonstration members per CMS Special Terms and Conditions.

HI: Rates include managed care population (6 MCOs) age 18 and older. Rates were calculated by the state's EQRO.

IL: Rates include FFS, PCCM, and managed care populations (13 MCOs). Rates exclude Medicare-Medicaid Dual Eligibles. Rates include paid and rejected claims, but exclude pending claims because they are adjudicated in sufficient time to not impact measurement. Rate was audited by the state's EQRO.

IA: Rates include FFS, PCCM, and managed care populations (1 MCO). Rates exclude Medicare-Medicaid Dual Eligibles. Multiple engagement visits on the same day were not allowed. Rates include ICD-9 codes that were used in claims after October 1, 2015. State used a criterion of one-month gap per full calendar year for continuous enrollment.

KY: Rates include managed care population (5 MCOs) age 18 and older, representing 81 percent of the population. Rates exclude FFS population, representing 19 percent of the population. Rates were calculated by the state's EQRO and data analytics contractor.

LA: Rates include FFS and managed care populations (5 MCOs). Rates exclude Medicare-Medicaid Dual Eligibles.

MA: Rates include PCCM and managed care populations (6 MCOs), representing 66 percent of the population. Rates exclude FFS population (representing 34 percent of the population), but most FFS beneficiaries would not be eligible for the measure, including beneficiaries who have other insurance (commercial or Medicare), reside in a long-term care institution, or receive limited or temporary Medicaid benefits.

MN: Rates include FFS and managed care populations (8 MCOs). Rates include paid claims only.

MO: Rates include populations with FFS, managed care (3 MCOs), or both FFS and managed care coverage during the year. Rates exclude Medicare-Medicaid Dual Eligibles.

NH: Rates include managed care population (2 MCOs), representing 79 percent of the population. Rates exclude FFS population (representing 21 percent of the population) as well as Medicare-Medicaid Dual Eligibles.

NY: Rates include FFS and managed care populations (56 MCOs). Rates exclude Medicare-Medicaid Dual Eligibles.

NC: Rates include FFS and PCCM populations. Rates exclude Medicare-Medicaid Dual Eligibles.

OH: Rates include FFS and managed care populations (5 MCOs). Rates exclude Medicare-Medicaid Dual Eligibles.

OK: Rates include FFS and PCCM populations. Rates exclude home- and community-based services waiver enrollees, representing 9 percent of the adult Medicaid population. State used a continuous enrollment criterion of any number of allowable gaps up to 45 days in either the measurement year or the year prior.

OR: Rates include managed care population (16 CCOs), representing 77 percent of the population. Rates exclude the FFS population, representing 23 percent of the population.

PA: Rates include managed care population (9 MCOs) age 18 and older. Rates exclude Medicare-Medicaid Dual Eligibles. This measure is part of a pay for performance behavioral health-physical health integrated care plan (ICP) program in the state. State modified the measure to facilitate reporting for the ICP project. As a result, the denominator includes enrollees who were in the same physical health and behavioral health MCO during the continuous enrollment period for the measure. Rates include all encounters that were available at the time of reporting, but may not include all encounters that occurred through the end of the measurement period because some encounters may not have been reported to the program by the date the measure was reported for FFY 2016.

RI: Rates include managed care population (2 MCOs) age 18 and older, representing more than 90 percent of the population. Rates exclude FFS population (representing less than 10 percent of the population) as well as Medicare-Medicaid Dual Eligibles.

SC: Rates include FFS and managed care populations (6 MCOs). Rates exclude Medicare-Medicaid Dual Eligibles.

TN: Rates include managed care population (4 MCOs) age 18 and older. Rates exclude Medicare-Medicaid Dual Eligibles. Rates were calculated by the state's EQRO.

TX: Rates include FFS and managed care populations (25 MCOs) age 18 and older. Rates exclude Medicare-Medicaid Dual Eligibles. Rates were calculated by the state's EQRO.

VT: Rates include FFS population. Medication-assisted treatment (MAT) in the state is billed as one unit per month. State adjusted the rates to count the multiple visits each week at MAT opioid treatment programs. Rates were calculated by the state's EQRO and data analytics contractor.

WV: Rates include FFS and managed care populations (4 MCOs). Rates only include events on separate dates of service and paid claims. State cannot determine "detoxification-only chemical dependency" Medicaid benefits. Rates were calculated by the state's EQRO and data analytics contractor.