Commonwealth of Massachusetts
Executive Office of Health and Human Services
Office of Medicaid
www.mass.gov/masshealth

 	
	

MassHealth 
Family Planning Agency Bulletin 13
August 2013

	TO:	Community Health Centers Participating in MassHealth 
	FROM:	Kristin L. Thorn, Acting Medicaid Director                                                                        

	RE:	Improving Treatment for Substance Use Disorders


Purpose

Improving initiation and engagement of patients who are diagnosed 
with substance dependency helps reduce drug-related illnesses 
and deaths, overuse of health care services, and economic and 
social difficulties associated with substance use disorders. 
MassHealth is working to improve the rate that members receive 
timely initiation and engagement of treatment for alcohol and other 
drug (AOD) dependencies, following identification of an AOD 
diagnosis. 
This bulletin offers practice tips and resources to help MassHealth 
providers support high-quality care and to ensure proper billing of 
the services they deliver.

Background

MassHealth managed care plans have collected Healthcare 
Effectiveness Data and Information Set (HEDIS) information since 
1996. HEDIS performance rates provide a mechanism for 
MassHealth to compare scores across health plans and uncover 
health care quality improvement opportunities. Although 
MassHealth initiation and engagement HEDIS rates have improved 
from 2005 to 2011, the current performance rates of 52.7 percent 
for initiation and 19.9 percent for engagement suggest room for 
statewide improvement.

When a member is diagnosed with AOD, the following two HEDIS 
rates are collected. 

1.	Initiation of Treatment: the percentage of members diagnosed 
with AOD that begin treatment either through an inpatient or 
outpatient admission or emergency department visit and any 
other AOD service within 14 days.
2.	Engagement in Treatment: the percentage of members who 
complete two AOD services within 30 days after treatment 
initiation.



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MassHealth
Family Planning Agency Bulletin 13
August 2013
Page 2



Background
(cont.)

Exception: Care that includes a detox code (including those listed 
below) does not count toward the initiation or engagement of AOD 
treatment.  
HCPCS
ICD-9-CM Procedure
UB Revenue
H0008-H0014
94.62, 94.65, 94.68
0116, 0126, 0136, 
0146, 0156



Tips for Working with 
Your Patient


Improving initiation and engagement of your patients who are 
diagnosed with substance dependency helps reduce drug-related 
illnesses and deaths, overuse of health care services, and 
economic and social difficulties associated with substance use 
disorders.  

Practice Tips
*	Include family members and other people whom your patient 
welcomes in support of his or her AOD care.
*	Provide written educational material. (For resources, see 
below.)
*	Use motivational interviewing techniques. 
o	Express empathy with a warm, nonjudgmental stance, 
active listening, and reflecting back what is said. 
o	Develop discrepancy between the patient’s choice to drink 
or use drugs and his or her goals, values, or beliefs. 
o	Roll with resistance by acknowledging the patient’s 
viewpoint, avoiding a debate, and affirming autonomy. 
*	Support the patient’s belief that he or she can succeed by 
expressing confidence and pointing to strengths and past 
successes of the patient. 




Tips for Your Practice


Visits and Follow-up to Encourage Sobriety

*	Each time you identify a patient as having a primary or 
secondary diagnosis indicating dependence on alcohol or other 
drugs, schedule a follow-up visit within 14 days.
*	Contact the patient after the scheduled follow-up visits with a 
specialist to ensure that the appointments were kept.
*	When notified of a hospital discharge for a patient with an AOD 
diagnosis, schedule a follow-up visit within 14 days and refer 
the patient to a specialist, or schedule two additional visits 
within 30 days.

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MassHealth
Family Planning Agency Bulletin 13
August 2013
Page 3

	
Billing

When treating a member for issues related to an AOD diagnosis, code 
the diagnosis on every claim using ICD-9 diagnosis codes from the 
series in the following chart.
ICD-9-CM Diagnosis: Codes to Identify AOD
291-292, 303.00-303.02, 303.90-303.92, 304.00-304.02, 
304.10-304.12, 304.20-304.22, 304.30-304.32, 304.40-304.42, 
304.50-304.52, 304.60-304.62, 304.70-304.72, 304.80-304.82, 
304.90-304.92, 305.00-305.02, 305.20-305.22, 305.30-305.32, 
305.40-305.42, 305.50-305.52, 305.60-305.62, 305.70-305.72, 
305.80-305.82, 305.90-305.92, 535.3, 571.1

Claims with dates of service on and after October 1, 2014, will require 
ICD-10 diagnosis codes.

Best-Practice Resources

*	    Massachusetts Department of Public Health, Bureau of 
Substance Abuse Services (BSAS) Principles of Care and 
Practice Guidance offers practice improvements in substance use 
disorder prevention, treatment, and recovery systems of care. 
www.mass.gov/eohhs/gov/departments/dph/programs/substance 
abuse/providers/program/-licencing/principles-of-care-and-practice-
guidance.html
*	    SAMHSA Treatment Improvement Protocol (TIP) Series are best-
practice guidelines for the treatment of substance use disorders. 
www.kap.samhsa.gov/products/manuals/tips/index.htm#assessment
 
Resources of National 
Organizations

*	    National Institute on Drug Abuse (NIDA) supports research to 
prevent and treat drug abuse and addiction and mitigate the impact 
of their consequences.  
www.nida.nih.gov/
*	National Institute on Alcohol Abuse & Alcoholism (NIAAA) leads 
the national effort to reduce alcohol-related problems by supporting 
research. 
       www.niaaa.nih.gov/

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MassHealth
Family Planning Agency Bulletin 13
August 2013
Page 4


Resources of National 
Organizations
(cont.)

*	
*	Health and Human Services (HHS), in collaboration with other 
agencies, supports comprehensive prevention campaigns to educate the 
public about the dangers of illicit drug use, particularly among youth, and 
tracks national substance use disorder patterns through six major 
surveys to help the nation to identify potential drug problem areas and 
ensure that resources are targeted to areas of greatest need. 
www.hhs.gov/ 
*	Substance Abuse and Mental Health Services (SAMHSA) works to 
improve the quality and availability of substance use disorder prevention, 
alcohol- and drug-addiction treatment, and mental health services. 
www.samhsa.gov/

Provider Survey

We would appreciate your completion of a survey created to help us 
learn about the usefulness of this bulletin to our providers.

www.surveymonkey.com/s/IET_BulletinSurvey  


Questions
If you have questions about the information in this bulletin, please 
contact MassHealth Customer Service at 1-800-841-2900, e-mail your 
inquiry to providersupport@mahealth.net, or fax the inquiry to 
617-988-8974.