Percentage of discharges from a medically managed withdrawal episode for adult Medicaid beneficiaries, ages 18–64, that were 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.
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1.5 Measure Type1.7 Electronic Clinical Quality Measure (eCQM)1.20 Testing Data Sources
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1.14 Numerator
Discharges in the denominator who have an inpatient, intensive outpatient, partial hospitalization, outpatient visit, residential, or drug prescription or procedure within 7 or 14 days after discharge from an inpatient hospital, residential addiction program, or ambulatory medically managed withdrawal.
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1.15 Denominator
Adult Medicaid beneficiary discharges from medically managed withdrawal from January 1 to December 15 of the measurement year.
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Exclusions
Not applicable: the measure does not have denominator exclusions.
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1.13a Data dictionary not attachedNo
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Most Recent Endorsement ActivityEndorsed Behavioral Health and Substance Use Spring Cycle 2022Initial EndorsementLast Updated
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StewardSubstance Abuse and Mental Health Services Administration (SAMHSA)Steward Organization POC EmailSteward Organization URLSteward Organization Copyright
Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. RTI International disclaims all liability for use or accuracy of any CPT or other codes contained in the specifications. Professional organizations frequently update their codes. We recommend that states seek input from their clinical experts to identify current codes.
Current Procedural Terminology (CPT) codes © 2024 American Medical Association. All rights reserved. CPT is a trademark of the AMA. No fee schedules, basic units, relative values or related listings are included in CPT. The AMA assumes no liability for the data contained therein. Applicable FARS/DFARS restrictions apply to government use. CPT® codes are also known as Level I HCPCS codes.Level II HCPCS codes in these specifications are approved and maintained jointly by the Alpha-Numeric Panel (consisting of CMS, the Health Insurance Association of America and the Blue Cross and Blue Shield Association.)
The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) is published by the World Health Organization (WHO). ICD-10-CM is an official Health Insurance Portability and Accountability Act standard. All Rights Reserved.
The American Hospital Association (AHA) holds a copyright to the National Uniform Billing Committee (NUBC) codes contained in the measure specifications. The NUBC codes in the specifications are included with the permission of the AHA. The NUBC codes contained in the specifications may be used by states, health plans and other health care delivery organizations for the purpose of calculating and reporting Measure results or using Measure results for their internal quality improvement purposes. All other uses of the NUBC codes require a license from the AHA. Anyone desiring to use the NUBC codes in a commercial product to generate Measure results, or for any other commercial use, must obtain a commercial use license directly from the AHA. To inquire about licensing, contact [email protected].The National Drug Code (NDC) Directory is published by the U.S. Food and Drug Administration and is made available under the Open Database License at http://opendatacommons.org/licenses/odbl/1.0 [opendatacommons.org]. Any rights in individual contents of the database are licensed under the Database Contents License at http://opendatacommons.org/licenses/odbl/1.0 [opendatacommons.org]. NDC codes are subject to frequent changes so measure users should update these codes.
Measure Developer Secondary Point Of Contact Email
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Risk AdjustmentRisk adjustment approachOffRisk adjustment approachOffConceptual model for risk adjustmentOffConceptual model for risk adjustmentOff
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6.1.2 Current or Planned Use(s)
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