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.
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1.5 Measure Type1.7 Electronic Clinical Quality Measure (eCQM)1.8 Level Of Analysis1.9 Care Setting1.20 Testing Data Sources
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1.14 Numerator
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.
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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).
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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.
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Most Recent Endorsement ActivityEndorsed Behavioral Health and Substance Use Fall Cycle 2020Initial EndorsementLast Updated
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StewardRTI InternationalSteward Organization POC EmailSteward Organization Copyright
The Prescription or administration of pharmacotherapy to treat opioid use disorder (OUD) measure and specifications were developed by and are owned by RTI International. The measure specifications are not clinical guidelines and do not establish a standard of medical care. RTI makes no representations, warranties, or endorsement about the quality of any organization or provider that uses or reports performance measures and RTI has no liability to anyone who relies on such measures or specifications. RTI holds a copyright for these materials and can alter these materials at any time. These materials may not be modified by anyone other than RTI. Anyone desiring to use or reproduce the materials without modification for a non-commercial purpose may do so without obtaining any approval from RTI. All commercial uses must be approved by RTI and are subject to a license at the discretion of RTI. ©2020 RTI
Limited proprietary coding is contained in the measure specifications for user convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. RTI disclaims all liability for use or accuracy of any coding contained in the specifications.
Some proprietary codes are contained in the measure specifications for convenience of the user. Use of these codes may require permission from the code owner or agreement to a license.
ICD-10 codes are copyrighted © World Health Organization (WHO), Fourth Edition, 2010. CPT © 2010 American Medical Association. CPT is a registered trademark of the American Medical Association. All rights reserved.
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Risk Adjustment
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6.1.2 Current or Planned Use(s)
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