The Department seeks comments on the proposed measure for inclusion in the 2019 Value-Based Payment (VBP) HARP Category 2 Quality Measure Set:

1. Continued Engagement in Substance Use Disorder (SUD) Treatment (CET)

This measure focuses on individuals engaged in treatment for alcohol and other drug dependence for at least 6 months following initiation of treatment. The length of time spent in treatment has been one of the most reliable predictors of post?treatment outcomes in national evaluations in the United States.¹, ² There is evidence that SUD patients who engage in more continuing outpatient care after intensive inpatient treatment have better outcomes. A Continued Engagement in Substance Use Disorder Treatment measure has the potential to be a useful tool to help providers monitor continuation of SUD care and to alert them where improvement of care is needed.

The measure was field–tested with 2016 Medicaid claims and encounters and the OASAS Client Data System. The overall rate of Continued Engagement in SUD treatment was 24.9% for measurement year 2017.

The Department seeks feedback on this measure, the technical specification, and responses to the following questions:

1. Should follow–up visits be restricted to primary Alcohol or Other Drug (AOD) diagnosis and/or primary AOD procedures only? We are interested in whether this restriction captures SUD follow–up visits.
2. This measure requires a visit every 30 days for 6 months to meet the measure. Should this measure allow for at least 1–month gap in a 6–month engagement period? If yes, please explain.

+Continued engagement in Substance Use Disorder (SUD) Treatment (CET)

DRAFT
Description
The percentage of individuals with a new episode of Substance Use Disorder (SUD) treatment within the intake period and at least one subsequent SUD treatment every 30 days through 180 days from the date of the initial SUD treatment.
Definitions
Intake Period	July 1 of prior year to June 30 of present year. The intake period is used to identify a new episode of SUD treatment service.
Direct Transfer	A direct transfer is when the discharge date from one inpatient rehabilitation setting and the admission date to a second inpatient rehabilitation setting are one calendar day apart or less. For example: An inpatient rehabilitation discharge on June 1, followed by an admission to another inpatient rehabilitation setting on June 1, is a direct transfer. An inpatient rehabilitation discharge on June 1, followed by an admission to an inpatient rehabilitation setting on June 2, is a direct transfer. An inpatient rehabilitation discharge on June 1, followed by an admission to another inpatient rehabilitation setting on June 3, is not a direct transfer; these are two distinct inpatient rehabilitation stays. Use the following method to identify admission to and discharges from inpatient rehabilitation settings. Identify all acute and nonacute inpatient stays (Inpatient Stay Value Set). Identify if the inpatient stay includes a primary diagnosis of one of the following: NYS Alcohol Value Set, NYS Opioid Value Set, NYS Stimulant Value Set, NYS Other Drug Value Set. Identify the admission and discharge dates for the stay. To combine direct transfers, keep the first admission date of the first admission and the discharge date of the last discharge date as one episode.
Eligible Population
Product Lines	HARP.
Ages	18 years and older as of December 31, of the reporting period.
Continuous Enrollment	60 days (2 months) prior to the ISD through 180 days after the ISD.
Allowable Gap	No gaps in enrollment.
Anchor date	None.
Benefits	Medical and chemical dependency (inpatient, residential, and outpatient).
Event/diagnosis	The earliest SUD service during the intake period. Follow the steps below to identify the eligible population.
Step 1	Identify the Initial Service. Identify members who during the intake period had a primary diagnosis of SUD and one of the following: An outpatient visit, intensive outpatient visit, residential, opioid treatment service or partial hospitalization. Any of the following code combinations meet these criteria: Initiation & Engagement of Treatment (IET) Stand Alone Visits Value Set with a primary diagnosis using one of the following: NYS Alcohol Value Set, NYS Opioid Value Set, NYS Stimulant Value Set, NYS Other Drug Value Set. IET Visits Group 1 Value Set IET POS Group 1 Value Set and with IET POS Group 1 Value Set and a primary diagnosis using one of the following: NYS Alcohol Value Set, NYS Opioid Value Set, NYS Stimulant Value Set, NYS Other Drug Value Set. IET Visits Group 2 Value Set with IET POS Group 2 Value Set and a primary diagnosis using one of the following: NYS Alcohol Value Set, NYS Opioid Value Set, NYS Stimulant Value Set, NYS Other Drug Value Set. An acute or nonacute inpatient discharge identified with codes in the Inpatient Stay Value Set with a primary diagnosis using one of the following: NYS Alcohol Value Set, NYS Opioid Value Set, NYS Stimulant Value Set, NYS Other Drug Value Set. For Medication Assisted Treatment (MAT): Identify members who during the intake period had ANY diagnosis of SUD and one of the following: If the Initial Service was for a diagnosis of Alcohol Dependence (NYS Alcohol Value Set) a MAT dispensing event (MAT for Alcohol Abuse or Dependence Medications List) or claim for MAT (Medication Assisted Treatment Value Set. If the Initial Service was for a diagnosis of Opioid Dependence (NYS Opioid Value Set), a MAT dispensing (MAT for Opioid Abuse or Dependence Medications List) or a claim for MAT (Medication Assisted Treatment Value Set). Identify the discharge date for the stay. For members with more than one SUD treatment visit, use the first service. Select the Index Episode Start Date (IESD).
Step 2	Test for Negative History. Exclude members who had an inpatient, outpatient, residential or opioid treatment claim/encounter with a primary diagnosis of SUD or MAT with any SUD diagnosis during the 60 days before the IESD. For an inpatient IESD, use the admission date to determine the 60-day Negative History.
Step 3	Calculate continuous enrollment. Members must be continuously enrolled for 60 days before the IESD through 180 days after the IESD, with no gaps.
Administrative Specification
Denominator	The eligible population.
Numerator	At least one treatment visit for an inpatient, outpatient, residential or opioid service with a primary diagnosis of SUD or MAT with any SUD diagnosis every 30 days through 180 days from the IESD during the covered period. If one treatment service is being provided over the 180-day period, then that service meets numerator compliance. Any of the following code combinations meet the numerator criteria: An outpatient visit, intensive outpatient visit, residential, opioid treatment service or partial hospitalization. Any of the following code combinations meet these criteria: IET Stand Alone Visits Value Set with a primary diagnosis using one of the following: NYS Alcohol Value Set, NYS Opioid Value Set, NYS Stimulant Value Set, NYS Other Drug Value Set. IET Visits Group 1 Value Set with IET POS Group 1 Value Set and a primary diagnosis using one of the following: NYS Alcohol Value Set, NYS Opioid Value Set, NYS Stimulant Value Set, NYS Other Drug Value Set IET Visits Group 2 Value Set with IET POS Group 2 Value Set and a primary diagnosis using one of the following: NYS Alcohol Value Set, NYS Opioid Value Set, NYS Stimulant Value Set, NYS Other Drug Value Set An acute or nonacute inpatient discharge identified with codes in the Inpatient Stay Value Set with a primary diagnosis using one of the following: NYS Alcohol Value Set, NYS Opioid Value Set, NYS Stimulant Value Set, NYS Other Drug Value Set. A MAT dispensing event (MAT for Alcohol Abuse or Dependence Medications List; MAT for Opioid Abuse or Medications List) or claims for MAT (Medication Assisted Treatment Value Set).
Medication–Assisted Treatment for Opioid or Alcohol Abuse or Dependence.
Description	Prescription
Alcohol Dependence Treatment	Acamprosate Naltrexone (oral) Naltrexone (injectable) Disulfiram
Opioid Dependence Treatment	Methadone Buprenorphine Naltrexone (oral) Buprenorphine/naloxone Depot Naltrexone/Naltrexone implants

Note: Review NCQA website for NDC codes

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