Access to SUD treatment

Metric description: The percentage of Medicaid beneficiaries, 12 years of age and older, with a substance use disorder treatment need identified within the past two years, who received at least one qualifying substance use disorder treatment during the measurement year.

Metric specification version: Washington State Department of Social and Health Services, Research and Data Analysis Division, Cross-System Outcome Measures for Adults Enrolled in Medicaid – “Substance Use Disorder Treatment Penetration (May 29, 2018, v.2)”

These specifications were developed by the Washington State Department of Social and Health Services, in collaboration with Medicaid delivery system stakeholders, as part of the 2013 Engrossed House Bill 1519 (Chapter 320, Laws of 2013) and Second Substitute Senate Bill 5732 (Chapter 338, Laws of 2013) performance measure development process.

Data collection method: Administrative only.

Data source: ProviderOne Medicaid claims and enrollment data; RSN/BHO encounter data and DBHRpaid behavioral health services for non-integrated managed care regions; Medicare Parts A and B claims and Medicare Part D encounters for dual eligibles.

Claim status: Include only final paid claims or accepted encounters in metric calculation.

Identification window: Measurement year and the year prior to the measurement year.

Direction of quality improvement: Higher is better.

Useful Links: https://www.hca.wa.gov/assets/program/P4P-substance-use-disorder-treatment-penetration-opioid-18.pdf