Use of Opioids at High Dosage (OHD, CMS Adult Core Set)

Rate per 1,000 Medicaid enrollees age 18 and older without cancer who received prescriptions for opioids with a daily dosage greater than 120 mg morphine equivalent dose (MED) for 90 consecutive days or longer.

Measure Identifier: CMS_A_OHD

Please see Report Details below for more information on selected subgroups, organizations, and aggregation.

Tables

Data


License Agreements and Acknowledgements

Utilizing the Technical Specifications and Resource Manual for the Adult and Child Core Set and data from this report indicates your agreement and acceptance of the following license agreements and acknowledgements.

The American Medical Association (AMA), the American Dental Association (ADA), and the American Hospital Association (AHA) permit the use of Current Procedural Terminology (CPT), Current Dental Terminology (CDT), and National Uniform Billing Committee (NUBC) UB-04 codes solely for the purpose of reporting state data on Medicaid and CHIP Core Set measures to the Centers for Medicare & Medicaid Services (CMS).

The National Committee for Quality Assurance (NCQA), the Pharmacy Quality Alliance (PQA), The Joint Commission (TJC), and the National Association of State Directors of Developmental Disabilities Services (NASDDDS)/Human Services Research Institute (HSRI) permit the use of their technical specifications solely for the purpose of reporting state data on Medicaid and CHIP Core Set measures to the Centers for Medicare & Medicaid Services (CMS).

-----------------------------------------------------------------------------------------------------

For the CMS Use of Pharmacotherapy for Opioid Use Disorder measure in the Adult Core Set:

The Use of Pharmacotherapy for Opioid Use Disorder (OUD) measure was developed by Mathematica under the Quality Measure Development and Maintenance for Centers for Medicare & Medicaid Services (CMS) Programs Serving Medicare-Medicaid Enrollees and Medicaid-Only Enrollees contract HHSM-500-2013-13011I, Task Order #HHSM-500-T0004.

For Proprietary Codes:

Limited proprietary coding is contained in the measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. Mathematica disclaims all liability for use or accuracy of any CPT or other codes contained in the specifications. Professional organizations frequently update their codes. Code lists for calculation of this measure were accurate as of April 2019.

The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) is published by the World Health Organization (WHO). ICD-10-CM is an official Health Insurance Portability and Accountability Act standard.

Level II HCPCS codes in these specifications are approved and maintained jointly by the Alpha-Numeric Panel (consisting of CMS, the Health Insurance Association of America, and the Blue Cross and Blue Shield Association.)

The National Drug Code (NDC) Directory is published by the U.S. Food and Drug Administration and is made available under the Open Database License at http://opendatacommons.org/licenses/odbl/1.0/. Any rights in individual contents of the database are licensed under the Database Contents License at http://opendatacommons.org/licenses/dbcl/1.0/.

For the PQA measures in the Adult Core Set:

PQA, Inc. retains all rights of ownership to the PQA measure specifications and value sets and can rescind or alter the measures at any time. No use of any PQA measure is authorized without prior PQA approval of such use. All uses of PQA measures are subject to such conditions as PQA specifies, and certain uses of the measures may be subject to a licensing agreement specifying the terms of use and the licensing fee. Users of the measure shall not have the right to alter, enhance, or otherwise modify the measures.

By agreeing to this statement, user accepts the following limitations of the use of the PQA measures: User acknowledges that the PQA measure specifications and value sets will only be used for the sole purpose of reporting state data on Medicaid and CHIP Core Set measures to the Centers for Medicare & Medicaid Services (CMS) and will not be used for other purposes. Except for the purpose indicated above, the PQA measure specifications and value sets will not be used in any other commercial product, service, or value-added benefit. User also acknowledges that the PQA value sets will not be forwarded or provided to anyone outside of their organization.

-----------------------------------------------------------------------------------------------------

CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CPT. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this file/product is with CMS and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this agreement.

CMS Disclaimer

The scope of this license is determined by the AMA, the copyright holder. Any questions pertaining to the license or use of the CPT should be addressed to the AMA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.