This measure reports the percentage of a provider’s patients who were Medicaid beneficiaries ages 18 to 64 with an OUD diagnosis who filled a prescription for, or were administered or ordered, a FDA-approved medication to treat OUD within 30 days of the first attributable OUD treatment encounter with that provider.
Beneficiaries ages 18 to 64 with an OUD who filled a prescription for, or were administered or ordered, an FDA-approved medication for the treatment of OUD within 30 days of the first attributable encounter with an OUD diagnosis with the provider.
Denominator
1.15 Denominator
Number of Medicaid ages 18 – 64 beneficiaries with at least one medical claim for an encounter with an OUD diagnosis with that provider (where the provider is identified by a National Provider Identifier (NPI) code).
Exclusions
Exclusions
Dual eligible Medicare/Medicaid beneficiaries are excluded. Rationale: Individuals who are covered under Medicare would receive coverage for follow up treatment medications (e.g. medication assisted treatment) under Medicare Part D and Medicare Part D claims are not captured in Medicaid claims databases. Therefore, follow-up would be missed. Individuals under 18 are excluded. Rationale: There is limited evidence regarding the efficacy of MOUD for this population. Individuals over 64 are excluded: Rationale: Most individuals over age 64 are covered under Medicare. Services covered by Medicare would not be capture in the Medicaid claims data and therefore follow-up treatment would be missed.
Measure Record
Most Recent Endorsement Activity
Endorsed Behavioral Health and Substance Use Fall Cycle 2020
Public Comments