Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment (IET)

HEDIS Measure

Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment (IET)

Line of business: Commercial Medicaid Medicare

Data Collection Method: Administrative (Claims)

Measure Description

The percentage of new substance use disorder (SUD) episodes that result in treatment initiation and engagement.

Two rates are reported:

• Initiation of SUD Treatment. The percentage of new SUD episodes that result in treatment initiation through an inpatient. SUD admission, outpatient visit, intensive outpatient encounter, partial hospitalization, telehealth visit or medication treatment within 14 days.
• Engagement of SUD Treatment. The percentage of new SUD episodes that have evidence of treatment engagement within 34 days of initiation.

Numerator Compliance

Initiation of SUD Treatment - Initiation of SUD treatment within 14 days of the SUD Episode Date.

Engagement of SUD Treatment, Visits or Medication Treatment Events - At least two of the following (any combination) on the day after the initiation encounter through 34 days after the initiation event:

• Engagement visit
• Engagement medication treatment event

NOTE: Two engagement visits may be on the same date of two events.

An engagement visit on the same date of service as an engagement medication treatment event meets criteria (there is no requirement that they be with different providers).

Intake period - November 15 of the year prior to the measurement year–November 14 of the measurement year.

SUD episode - An encounter during the intake period with a diagnosis of SUD. For visits that result in an inpatient stay, the inpatient discharge is the SUD episode (an SUD diagnosis is not required for the inpatient stay; use the diagnosis from the visit that resulted in the inpatient stay to determine the diagnosis cohort).

SUD episode date - The date of service for an encounter during the intake period with a diagnosis of SUD. For a visit (not resulting in an inpatient stay), the SUD episode date is the date of service.
For an inpatient stay or for withdrawal management (i.e., detoxification) that occurred during an inpatient stay, the SUD episode date is the date of discharge.
For withdrawal management (i.e., detoxification), other than those that occurred during an inpatient stay, the SUD episode date is the date of service. For direct transfers, the SUD episode date is the discharge date from the last admission (an SUD diagnosis is not required for the transfer; use the diagnosis from the initial admission to determine the diagnosis cohort).

Best Practices

• Discuss the importance of timely, recommended follow-up visits
• Use the same diagnosis for substance use at each follow-up
• Coordinate care between behavioral health and primary care
• Share progress notes and updates
• Reach out to patients who cancel appointments and assist them
• Consider telemedicine visit when in-person visits are not available

NOTE: The use of a non-substance diagnosis code will not fulfill this measure

Quality Value Set Directory Coding Tips

Alcohol Abuse and Dependence

Buprenorphine Implant

Buprenorphine Injection

Buprenorphine Naloxone

Buprenorphine Oral

Buprenorphine Oral Weekly

BH Outpatient

Community Mental Health Center POS

Methadone Oral

Methadone Oral Weekly

Naltrexone Injection

Inpatient Stay

Non-residential Substance Abuse Treatment Facility POS

Observation

Online Assessments

Opioid Abuse and Dependence

Other Drug Abuse and Dependence

OUD Monthly Office Based Treatment

OUD Weekly Drug Treatment Service

OUD Weekly Non Drug Service

Outpatient POS

Partial Hospitalization or Intensive Outpatient

Partial Hospitalization POS

Substance Use Disorder Services

Telehealth POS

Telephone Visits

Visit Setting Unspecified