DEPARTMENT OF HEALTH & HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop S2-26-12 
Baltimore, Maryland   21244-1850 
 
 
 
CMCS Informational Bulletin  
 
DATE:    November 27, 2019 
 
FROM:  Calder Lynch, Acting Deputy Administrator and Director 
    Center for Medicaid and CHIP Services (CMCS) 
 
SUBJECT:    New Reporting Measures for Substance Use Disorder (SUD)-focused Health 
Homes 
 
This informational bulletin describes new reporting measures that CMS will make available to 
states that have an approved SUD-focused health home state plan amendment (SPA) under 
section 1945(c)(4) of the Social Security Act (the Act).  CMS is announcing the new measures, 
and adding them to the existing Medicaid Health Home Core Set of reporting measures, in 
advance of rulemaking.  CMS intends to propose through the rulemaking process that states that 
must submit reports under section 1945(c)(4)(B) of the Act would be required to use specific 
measures when they submit the required reports, and intends to propose that the required 
measures would include these two new measures.  However, as noted in the January 15, 2013 
State Medicaid Director letter (https://www.medicaid.gov/federal-policy-
guidance/downloads/smd-13-001.pdf), and as described further below, until regulations are 
promulgated, the existing Health Home Core Set of measures is voluntary, and so are these new 
measures.  CMS is sharing this information in advance of rulemaking, so that states that have, or 
may be considering, a SUD-focused health home SPA can opt to use CMS-provided measures 
when submitting the required reports.  This bulletin serves as a follow-up to the May 7, 2019 
informational bulletin regarding the availability of an extension of the enhanced Federal Medical 
Assistance Percentage (FMAP) period for Medicaid health homes for individuals with SUD 
(https://www.medicaid.gov/federal-policy-guidance/downloads/cib050719.pdf). 
 
Background  
 
On October 24, 2018, the Substance UseDisorder Prevention that Promotes Opioid Recovery 
and Treatment for Patients and Communities Act, (Pub. L. No. 115271) (referred to in this 
document as the SUPPORT for Patients and Communities Act, or SUPPORT Act), was signed 
into law.  Section 1006(a) of the SUPPORT Act, Extension of Enhanced FMAP for Certain 
Health Homes for Individuals with Substance Use Disorders, amended section 1945 of the Act 
to permit an extension of the enhanced FMAP period for certain health homes for individuals 
with SUD.  As described in the May 7, 2019 informational bulletin, states with a SUD-focused 
health home SPA approved on or after October 1, 2018, may request to extend the enhanced 
FMAP period for payments for the provision of health home services to SUD-eligible 
individuals, such that there could be a total of 10 fiscal year quarters of enhanced FMAP, 
provided that certain conditions are met. 
  CMCS Informational Bulletin  Page 2 
 
 
Reporting Measures for SUD-Focused Health Homes 
 
There are new reporting requirements for states that receive approval for an extended enhanced 
FMAP period for a SUD-focused health home SPA.  Section 1945(c)(4)(B) of the Act requires 
these states to submit a report to CMS on the following with respect to SUD-eligible individuals 
provided health home services under the SUD-focused SPA: (1) the quality of health care 
provided to these individuals, with a focus on outcomes relevant to the recovery of each such 
individual; (2) the access of these individuals to health care; and (3) the total expenditures of 
these individuals for health care.  Section 1945(c)(4)(B) also provides that states must submit the 
required report at the end of the period of such [SPA.]  Because most health home SPAs are 
not approved for a specific or limited period of time, CMS interprets the statute to require states 
to submit the report at the end of the extended enhanced FMAP period.  Additionally, because 
states will need time to compile data and prepare a report, we are interpreting this language to 
mean that while the report should provide data relating to the enhanced FMAP period, states can 
submit the report within six months after the enhanced FMAP period ends. 
 
To help states meet these new reporting requirements, CMS is adding two new SUD measures to 
the existing Health Home Core Set.  Again, unless and until CMS makes specific measures 
mandatory through rulemaking, states are not required to use any of the CMS-provided health 
home measures, although states with an extension of the enhanced FMAP period for a SUD-
focused health home SPA must submit the statutorily required reports. 
 
The new SUD measures to be added to the Health Home Core Set include:  
(1) Use of Pharmacotherapy for Opioid Use Disorder  
(2) Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or 
Dependence (FUA-AD).   
More information on each of the new measures can be found in the attached chart.   
In an effort to promote alignment across programs, these two new measures are either currently 
included in the Medicaid Adult Core Set (the FUA-AD measure) or have been recommended for 
addition (the Use of Pharmacotherapy for Opioid Use Disorder measure) to the 2020 Adult Core 
Set by the Annual Core Set Review Workgroup.1 Reporting on these new SUD measures 
broadens the scope of the existing Health Home Core Set.  If states report on all the existing 
Health Home Core Set measures, along with the two new measures, this would be sufficient to 
address the section 1945(c)(4)(B) reporting topics on quality and access.  The current (2019) set 
of Health Home Core Set measures is available at https://www.medicaid.gov/state-resource-
center/medicaid-state-technical-assistance/health-home-information-resource-
center/downloads/2019-health-home-core-set.pdf.  States that receive approval for an extended 
enhanced FMAP period for a SUD-focused health home SPA are also expected to report on the 
total expenditures for health care of SUD-eligible individuals receiving health home services 
under their SUD-focused health home SPA. 
                                                           
1 https://www.mathematica-mpr.com/features/-/media/internet/files/additional-
documents/coresetreview2020finalreport.pdf?la=en   CMCS Informational Bulletin  Page 3 
 
CMS will release additional reporting guidance on these new measures and will update technical 
specifications in the spring of 2020 for the new SUD measures in MACPRO, as well as for the 
existing Health Home Core Set.   
Timing of Reporting -Next Steps 
 
As discussed above, states that receive approval for an extended enhanced FMAP period for a 
SUD-focused health home SPA must report on the topics listed in section 1945(c)(4)(B) of the 
Act at the end of the extended enhanced FMAP period under their SPA. CMS will add the two 
new SUD measures mentioned above and make them available for reporting as part of the 2020 
updates to the Health Home Core Set. The FFY 2020 reporting cycle will begin in the early fall 
of 2020.   
The two new SUD measures were created specifically for states with an extended enhanced 
FMAP period for a SUD-focused health home SPA, and only these states will be expected to 
report on the topics listed in section 1945(c)(4)(B) of the Act at the end of their extended 
enhanced FMAP period. However, CMS encourages other states with health homes that are not 
SUD-focused to consider reporting on these new SUD measures as well.  The data gathered 
could help CMS and states to better understand and meet the needs of the beneficiaries served by 
their health homes. If states opt to use CMS-provided measures in the reports required by section 
1945(c)(4)(B) of the Act, then they should report not only the information captured in the two 
new measures, but should also report the expenditure data mentioned in the statute, and on all the 
measures from the existing Health Home Core Set. Additionally, as noted above, unless CMS, 
through rulemaking, requires states with an extended enhanced FMAP period for a SUD-focused 
health home SPA to use these specific measures, these states could use alternative measures to 
report on the statutorily required topics, subject to CMS approval.  Any such alternative 
measures must be sufficient to cover the required reporting topics. 
For states with questions about the Health Home Core Set measures or for further assistance with 
reporting and quality improvement strategies regarding their health home, please submit 
questions or requests to: MACQualityTA@cms.hhs.gov. 
 
 
 
 
 
 
 
 
 
 
 
 
 
Attachment 
 
  CMCS Informational Bulletin  Page 4 
 
Measures for SUD-Focused Health Home SPAs 
 
Measure name  Use of Pharmacotherapy for Opioid Use Disorder 
 
Description  Percentage of Medicaid beneficiaries ages 18 to 64 with an opioid 
use disorder (OUD) who filled a prescription for or were 
administered or ordered an FDA-approved medication for the 
disorder during the measure year. The measure will report any 
medications used in medication-assisted treatment of opioid 
dependence and addiction and four separate rates representing the 
following types of FDA-approved drug products: buprenorphine; 
oral naltrexone; long-acting, injectable naltrexone; and 
methadone. 
 
Measure steward  Centers for Medicare & Medicaid Services (CMS), Center for 
Medicaid & CHIP Services (CMCS) 
 
NQF number (if endorsed)  3400 
 
Core Set domain   Behavioral Health Care 
 
Measure type    Process 
 
Recommended to replace  No 
current measure?   
Ages  Ages 18-64 
Data collection method  Administrative  
Denominator  Number of Medicaid beneficiaries ages 18 to 64 with at least one 
encounter with a diagnosis of opioid abuse, dependence, or 
remission (primary or other) at any time during the measurement 
year. 
 
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 disorder during the measure year. 
 
Exclusions  None 
 
Continuous enrollment  Not specified 
period  CMCS Informational Bulletin  Page 5 
 
Level of reporting for which  State-level. 
specifications were 
developed 
Recommended to replace  No 
current measure? 
Target of the measure  Quality 
 
 
 
 
Measure name  Follow-Up After Emergency Department Visit for Alcohol and 
Other Drug Abuse or Dependence (FUA-AD) 
 
Description  Percentage of emergency department (ED) visits for beneficiaries age 
18 and older with a principal diagnosis of alcohol or other drug (AOD) 
abuse or dependence who had a follow up visit for AOD abuse or 
dependence. Two rates are reported:  Percentage of ED visits for AOD 
abuse or dependence for which the beneficiary received follow-up 
within 30 days of the ED visit (31 total days)  Percentage of ED visits 
for AOD abuse or dependence for which the beneficiary received 
follow-up within 7 days of the ED visit (8 total days) 
 
Measure steward  National Committee for Quality Assurance 
NQF number (if endorsed)  2605 
Core Set domain   Behavioral health Care 
Measure type    Process 
Recommended to replace  No 
current measure? 
Ages  18 and up 
Data collection method  Administrative 
Denominator  Age 18 and older as of the ED visit. An ED visit (ED Value Set) with a 
principal diagnosis of AOD (Abuse or Dependence Value Set) on or 
between January 1 and December 1 of the measurement year where the 
beneficiary was 18 years or older on the date of the visit. The 
denominator for this measure is based on ED visits, not on 
beneficiaries. If a beneficiary has more than one ED visit, identify all 
eligible ED visits between January 1 and December 1 of the 
measurement year and do not include more than one visit per 31-day 
period as described below. Note: Removal of multiple visits in a 31-day 
period is based on eligible visits. Assess each ED visit for exclusion 
before removing multiple visits in a 31-day period. If a beneficiary has 
more than one ED visit in a 31-day period, include only the first 
eligible ED visit. For example, if a beneficiary has an ED visit on 
January 1, then include the January 1 visit and do not include ED visits 
that occur on or between January 2 and January 31; then, if applicable, 
include the next ED visit that occurs on or after February 1. Identify 
visits chronologically including only one per 31-day period. 
  CMCS Informational Bulletin  Page 6 
 
Measure name  Follow-Up After Emergency Department Visit for Alcohol and 
Other Drug Abuse or Dependence (FUA-AD) 
 
Numerator  30-Day Follow-Up: A follow-up visit with a mental health practitioner 
within 30 days after discharge. Do not include visits that occur on the 
date of discharge. 7-Day Follow-Up: A follow-up visit with a mental 
health practitioner within 7 days after discharge. Do not include visits 
that occur on the date of discharge. For both indicators, any of the 
following meet criteria for a follow-up visit.  An outpatient visit (Visit 
Setting Unspecified Value Set with Outpatient POS Value Set) with a 
mental health practitioner, with or without a telehealth modifier 
(Telehealth Modifier Value Set)  An outpatient visit (BH Outpatient 
Value Set) with a mental health practitioner, with or without a 
telehealth modifier (Telehealth Modifier Value Set)  An intensive 
outpatient encounter or partial hospitalization (Visit Setting 
Unspecified Value Set with Partial Hospitalization POS Value Set) with 
a mental health practitioner, with or without a telehealth modifier 
(Telehealth Modifier Value Set)  An intensive outpatient encounter or 
partial hospitalization (Partial Hospitalization/Intensive Outpatient 
Value Set) with a mental health practitioner  A community mental 
health center visit (Visit Setting Unspecified Value Set with 
Community Mental Health Center POS Value Set) with a mental health 
practitioner, with or without a telehealth modifier (Telehealth Modifier 
Value Set)  Electroconvulsive therapy (Electroconvulsive Therapy 
Value Set) with (Ambulatory Surgical Center POS Value Set; 
Community Mental Health Center POS Value Set; Outpatient POS 
Value Set; Partial Hospitalization POS Value Set) with a mental health 
practitioner  A telehealth visit: Visit Setting Unspecified Value Set 
with Telehealth POS Value Set with a mental health practitioner, with 
or without a telehealth modifier (Telehealth Modifier Value Set) 
Exclusions  Exclude ED visits followed by an admission to an acute or nonacute 
inpatient care setting on the date of the ED visit or within the 30 days 
after the ED visit, regardless of principal diagnosis for the admission. 
To identify admissions to an acute or nonacute inpatient care setting: 1. 
Identify all acute and nonacute inpatient stays (Inpatient Stay Value 
Set). 2. Identify the admission date for the stay. These events are 
excluded from the measure because admission to an acute or nonacute 
inpatient setting may prevent an outpatient follow-up visit from taking 
place 
Continuous enrollment  Not specified 
period 
Level of reporting for which  State-level. 
specifications were 
developed 
Index Prescription Start Date  N/A 
Target of the measure  Access and Quality