HEDIS® Tip Sheet

Initiation and Engagement of Substance Use Disorder Treatment (IET)

Line of business: BlueAlliance (Commercial) & BlueAlliance Care+ (Medicaid)

Measure Description

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

Two rates are reported:

  • Initiation of SUD Treatment – Percentage of new SUD episodes that result in treatment through an inpatient SUD admission, outpatient visit, intensive outpatient encounter, partial hospitalization, telehealth visit, or medication treatment within 14 days.
  • Engagement of SUD Treatment – Percentage of new SUD episodes that have evidence of treatment engagement within 34 days initiation.
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Compliance for Initiation of SUD Treatment (within 14 days of the SUD episode)

  • The following occurring on the SUD episode or during the 13 days after qualifies:
    • Acute or nonacute inpatient admission.
    • Outpatient visit.
    • An Intensive outpatient encounter or partial hospitalization.
    • Non-residential substance abuse treatment facility visit.
    • Community mental health center visit.
    • Telehealth visit.
    • Substance use disorder service.
    • Observation stay.
    • Telephone visit
    • E-visit or virtual check-in.
    • Weekly or monthly opioid treatment service.
    • Medication assisted treatment (only applies to members with an alcohol or opioid abuse or dependence diagnosis).
  • If the SUD episode was an inpatient discharge, the inpatient stay is considered initiation of treatment.
  • If the SUD episode was an opioid treatment service that bills monthly, the opioid treatment services is considered initiation of treatment.
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Compliance for Engagement of SUD Treatment (within 34 days of the SUD episode)

  • At least two engagement services are needed for engagement of SUD treatment. No more than one of the services can be a medication treatment.
    • Acute or nonacute inpatient admission.
    • Outpatient visit.
    • An Intensive outpatient encounter or partial hospitalization.
    • Non-residential substance abuse treatment facility visit.
    • Community mental health center visit.
    • Telehealth visit.
    • Substance use disorder service.
    • Observation visit.
    • Telephone visit
    • E-visit or virtual check-in.
    • Weekly or monthly opioid treatment service.
    • Weekly or monthly opioid treatment service.
    • Medication assisted treatment (only applies to members with an alcohol or opioid abuse or dependence diagnosis).
  • Long-acting SUD medication administration event. Any of the following meet criteria:
    • For SUD episodes with an alcohol use disorder. an alcohol use disorder medication treatment dispensing event or a medication administration event.
    • For SUD episodes with the opioid use disorder cohort, an opioid use disorder medication treatment dispensing event or medication administration event.
  • If initiation of SUD Treatment was an inpatient admission, the 34-day period for engagement begins the day after discharge.
  • SUD episodes that are not compliant for initiation of SUD Treatment are not compliant for Engagement of SUD Treatment.
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Notes

  • New substance use disorder episodes are captured between November 15th of the year prior to the measurement year to November 14th of the measurement year.
  • This measure applies to members aged 13 years and older.
  • There are three SUD diagnosis cohorts and a total rate.
    • Alcohol use disorder
    • Opioid use disorder
    • Other substance use disorder.
  • SUD episodes are included in all SUD diagnosis cohorts for which they meet criteria.
    • For example, if a SUD episode includes both a diagnosis of alcohol use disorder and opioid use disorder, that episode will be in both the alcohol use disorder and opioid use disorder cohorts.
  • For all initial events except medication treatment dispensing events and medication administration events, initiation on the same day as the SUD episode date must be with different providers to be compliant.
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Best Practices

  • Schedule an initial follow-up appointment within 14 days during the first service
  • Discuss with the patient the importance of timely follow ups and what type of follow up visits are recommended.
  • Behavioral Health and primary care providers work together on care coordination.
  • Make follow up calls to assist with rescheduling patients who miss appointments.
  • Telemedicine is approved for this measure. Ensure diagnosis code used for the visit is a substance use diagnoses code.
  • Notify patients of Recovery Talk 24/7 Recovery Support.
  • Utilize SAMHSA resources on substance abuse prevention.

Alcohol Use Disorder Treatment Medications



Opioid Use Disorder Treatment Medications



Note:

Methadone is not included on the medication list. Methadone for opioid use disorder is only administered or dispensed by federally certified opioid treatment programs and is not billed through pharmacy claims. 

Coding Disclaimer

The analysis of any medical coding question related to a measure is dependent on the measure’s technical specifications including the factual situations present related to the member, the practice, the professionals, and the medical services provided.

Questions  

Should you have specific coding or other questions related to the measure, please send your questions to BlueAlliance@bcbsnd.com.

 

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