Percentage of Medicaid discharges, ages 18 to 64, being treated for a substance use disorder (SUD) from an inpatient or residential provider that received SUD follow-up treatment within 7 or 30 days after discharge. SUD follow-up treatment includes outpatient, intensive outpatient, or partial hospitalization visits; telehealth encounters; SUD medication fills or administrations; or residential treatment (after an inpatient discharge). Two rates are reported: continuity within 7 and 30 days after discharge.
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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
Medicaid discharges, ages 18 to 64, with a principal/primary substance (SUD) diagnosis treated at an inpatient or residential provider that received SUD follow-up treatment within 7 or 30 days after discharge. SUD treatment includes outpatient, intensive outpatient, or partial hospitalization visits; telehealth encounters; or SUD medication fills or administrations; or residential treatment (after an inpatient discharge. Two rates are reported: continuity within 7 and 30 days after discharge.
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1.15 Denominator
The denominator are Medicaid beneficiaries, ages 18-64, discharged from inpatient or residential provider with a principal diagnosis of SUD on the inpatient/residential treatment encounter claim.
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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. opioid use disorder medications) under Medicare Part D and Medicare Part D claims are not captured in Medicaid claims databases. 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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StewardSteward Organization EmailSteward Organization Copyright
The Continuity of Care After Receiving Hospital or Residential SUD Treatment 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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