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Medicaid Section 1115 SUD Demonstrations Monitoring Protocol (Part A) - Planned Metrics (Version 7.0) State Wisconsin Demonstration Name BadgerCare Reform blank row Table: Substance Use Disorder Demonstration Planned Metrics St andard i nf orm at i on on CMS- provi ded m et ri cs # St andard i nf orm at i on on CMS- provi ded m et ri cs Metric name St andard i nf orm at i on on CMS- provi ded m et ri cs Metric description St andard i nf orm at i on on CMS- provi ded m et ri cs Milestone or reporting topica St andard i nf orm at i on on CMS- provi ded m et ri cs Metric type St andard i nf orm at i on on CMS- provi ded m et ri cs Reporting category St andard i nf orm at i on on CMS- provi ded m et ri cs Data source St andard i nf orm at i on on CMS- provi ded m et ri cs Measurement period St andard i nf orm at i on on CMS- provi ded m et ri cs Reporting frequency St andard i nf orm at i on on CMS- provi ded m et ri cs Reporting priority St andard i nf orm at i on on CMS- provi ded m et ri cs State will report (Y/N) Basel i ne, annual goal s, and dem onst rat i on t arget Baseline period (MM/DD/YYYY- MM/DD/YYYY) Basel i ne, annual goal s, and dem onst rat i on t arget Annual goal Basel i ne, annual goal s, and dem onst rat i on t arget Overall demonstration target Al i gnm ent wi t h CMS- provi ded t echni cal speci f i cat i ons m anual Attest that planned reporting matches the CMS-provided technical specifications manual (Y/N) Al i gnm ent wi t h CMS- provi ded t echni cal speci f i cat i ons m anual Explanation of any deviations from the CMS-provided technical specifications manual or other considerations (different data source, definition, codes, target population, etc.)b,c Phased- i n m et ri cs report i ng State plans to phase in reporting (Y/N) Phased-in metrics reporting SUD monitoring report in which metric will be phased in (Format DY#Q#; e.g., DY1Q3) Phased- i n m et ri cs report i ng Explanation of any plans to phase in reporting over time 3 Medicaid Beneficiaries with SUD Diagnosis (monthly) Number of beneficiaries who receive MAT or a SUD-related treatment service with an associated SUD diagnosis during the measurement period and/or in the 11 months before the measurement period Assessment of need and qualification for SUD treatment services CMS-constructed Other monthly and quarterly metrics Claims Month Quarterly Required Y 01/01/2021-12/31/2021 Increase Increase N 1 - WI Medicaid does not have access and cannot provide subpopulation breakouts by criminal justice status. WI will research the feasibility of obtaining criminal justice status data and report on the feasability in a future report to CMS. 2 - WI will report data for remaining subpopulation categories and determine subpopulation categories based on the beneficiary characteristics as of the last day of the data period. Y 1 - WI Medicaid does not have access and cannot provide subpopulation breakouts by criminal justice status. WI will research the feasibility of obtaining criminal justice status data and report on the feasability in a future report to CMS. 2 - WI will report data for remaining subpopulation categories and determine subpopulation categories based on the beneficiary characteristics as of the last day of the data period. 4 Medicaid Beneficiaries with SUD Diagnosis (annually) Number of beneficiaries who receive MAT or a SUD-related treatment service with an associated SUD diagnosis during the measurement period and/or in the 12 months before the measurement period Assessment of need and qualification for SUD treatment services CMS-constructed Other annual metrics Claims Year Annually Required Y 01/01/2021-12/31/2021 Increase Increase Y 5 Medicaid Beneficiaries Treated in an IMD for SUD Number of beneficiaries with a claim for inpatient/residential treatment for SUD in an IMD during the measurement period. Milestone 2 CMS-constructed Other annual metrics Claims Year Annually Required Y 01/01/2021-12/31/2021 Increase Increase Y 6 Any SUD Treatment Number of beneficiaries enrolled in the measurement period receiving any SUD treatment service, facility claim, or pharmacy claim during the measurement period Milestone 1 CMS-constructed Other monthly and quarterly metrics Claims Month Quarterly Required Y 01/01/2021-12/31/2021 Increase Increase Y 7 Early Intervention Number of beneficiaries who used early intervention services (such as procedure codes associated with SBIRT) during the measurement period Milestone 1 CMS-constructed Other monthly and quarterly metrics Claims Month Quarterly Required Y 01/01/2021-12/31/2021 Increase Increase Y 8 Outpatient Services Number of beneficiaries who used outpatient services for SUD (such as outpatient recovery or motivational enhancement therapies, step down care, and monitoring for stable patients) during the measurement period Milestone 1 CMS-constructed Other monthly and quarterly metrics Claims Month Quarterly Required Y 01/01/2021-12/31/2021 Increase Increase N 1 - WI Medicaid does not have access and cannot provide subpopulation breakouts by criminal justice status. WI will research the feasibility of obtaining criminal justice status data and report on the feasability in a future report to CMS. 2 - WI will report data for remaining subpopulation categories and determine subpopulation categories based on the beneficiary characteristics as of the last day of the data period. 1 - WI Medicaid does not have access and cannot provide subpopulation breakouts by criminal justice status. WI will research the feasibility of obtaining criminal justice status data and report on the feasability in a future report to CMS. 2 - WI will report data for remaining subpopulation categories and determine subpopulation categories based on the beneficiary characteristics as of the last day of the data period. 9 Intensive Outpatient and Partial Hospitalization Services Number of beneficiaries who used intensive outpatient and/or partial hospitalization services for SUD (such as specialized outpatient SUD therapy or other clinical services) during the measurement period Milestone 1 CMS-constructed Other monthly and quarterly metrics Claims Month Quarterly Required Y 01/01/2021-12/31/2021 Increase Increase N 1 - WI Medicaid does not have access and cannot provide subpopulation breakouts by criminal justice status. WI will research the feasibility of obtaining criminal justice status data and report on the feasability in a future report to CMS. 2 - WI will report data for remaining subpopulation categories and determine subpopulation categories based on the beneficiary characteristics as of the last day of the data period. 1 - WI Medicaid does not have access and cannot provide subpopulation breakouts by criminal justice status. WI will research the feasibility of obtaining criminal justice status data and report on the feasability in a future report to CMS. 2 - WI will report data for remaining subpopulation categories and determine subpopulation categories based on the beneficiary characteristics as of the last day of the data period. 10 Residential and Inpatient Services Number of beneficiaries who use residential and/or inpatient services for SUD during the measurement period Milestone 1 CMS-constructed Other monthly and quarterly metrics Claims Month Quarterly Required Y 01/01/2021-12/31/2021 Increase Increase N 1 - WI Medicaid does not have access and cannot provide subpopulation breakouts by criminal justice status. WI will research the feasibility of obtaining criminal justice status data and report on the feasability in a future report to CMS. 2 - WI will report data for remaining subpopulation categories and determine subpopulation categories based on the beneficiary characteristics as of the last day of the data period. 1 - WI Medicaid does not have access and cannot provide subpopulation breakouts by criminal justice status. WI will research the feasibility of obtaining criminal justice status data and report on the feasability in a future report to CMS. 2 - WI will report data for remaining subpopulation categories and determine subpopulation categories based on the beneficiary characteristics as of the last day of the data period. 11 Withdrawal Management Number of beneficiaries who use withdrawal management services (such as outpatient, inpatient, or residential) during the measurement period Milestone 1 CMS-constructed Other monthly and quarterly metrics Claims Month Quarterly Required Y 01/01/2021-12/31/2021 Increase Increase N 1 - WI Medicaid does not have access and cannot provide subpopulation breakouts by criminal justice status. WI will research the feasibility of obtaining criminal justice status data and report on the feasability in a future report to CMS. 2 - WI will report data for remaining subpopulation categories and determine subpopulation categories based on the beneficiary characteristics as of the last day of the data period. 1 - WI Medicaid does not have access and cannot provide subpopulation breakouts by criminal justice status. WI will research the feasibility of obtaining criminal justice status data and report on the feasability in a future report to CMS. 2 - WI will report data for remaining subpopulation categories and determine subpopulation categories based on the beneficiary characteristics as of the last day of the data period. 12 Medication-Assisted Treatment Number of beneficiaries who have a claim for MAT for SUD during the measurement period Milestone 1 CMS-constructed Other monthly and quarterly metrics Claims Month Quarterly Required Y 01/01/2021-12/31/2021 Increase Increase N 1 - WI Medicaid does not have access and cannot provide subpopulation breakouts by criminal justice status. WI will research the feasibility of obtaining criminal justice status data and report on the feasability in a future report to CMS. 2 - WI will report data for remaining subpopulation categories and determine subpopulation categories based on the beneficiary characteristics as of the last day of the data period. 1 - WI Medicaid does not have access and cannot provide subpopulation breakouts by criminal justice status. WI will research the feasibility of obtaining criminal justice status data and report on the feasability in a future report to CMS. 2 - WI will report data for remaining subpopulation categories and determine subpopulation categories based on the beneficiary characteristics as of the last day of the data period. 13 SUD Provider Availability The number of providers who were enrolled in Medicaid and qualified to deliver SUD services during the measurement period Milestone 4 CMS-constructed Other annual metrics Provider enrollment database; Claims Year Annually Required Y 01/01/2021-12/31/2021 Increase Increase Y 14 SUD Provider Availability - MAT The number of providers who were enrolled in Medicaid and qualified to deliver SUD services during the measurement period and who meet the standards to provide buprenorphine or methadone as part of MAT Milestone 4 CMS-constructed Other annual metrics Provider enrollment database; Claims; SAMHSA datasets Year Annually Required Y 01/01/2021-12/31/2021 Increase Increase Y 15 Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (IET-AD) [NCQA; NQF #0004; Medicaid Adult Core Set; Adjusted HEDIS measure] Percentage of beneficiaries age 18 and older with a new episode of alcohol or other drug (AOD) abuse or dependence who received the following:

• Initiation of AOD Treatment—percentage of beneficiaries who initiate treatment through an inpatient AOD admission, outpatient visit, intensive outpatient encounter or partial hospitalization, telehealth, or medication treatment within 14 days of the diagnosis

• Engagement of AOD Treatment—percentage of beneficiaries who initiated treatment and who were engaged in ongoing AOD treatment within 34 days of the initiation visit The following diagnosis cohorts are reported for each rate: (1) Alcohol abuse or dependence, (2) Opioid abuse or dependence, (3) Other drug abuse or dependence, and (4) Total AOD abuse or dependence. A total of 8 separate rates are reported for this measure. Milestone 6 Established quality measure Annual metrics that are established quality measures Claims or EHR Year Annually Required Y 01/01/2021-12/31/2021 Increase Increase Y 17(1) Follow-up after Emergency Department Visit for Alcohol or Other Drug Dependence: Age 18 and Older (FUA-AD) [NCQA; NQF #3488; Medicaid Adult Core Set; Adjusted HEDIS measure]d 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 which the beneficiary received follow-up within 30 days of the ED visit (31 total days).

- Percentage of ED visits for which the beneficiary received follow-up within 7 days of the ED visit (8 total days). Milestone 6 Established quality measure Annual metrics that are established quality measures Claims Year Annually Required Y 01/01/2021-12/31/2021 Increase Increase Y 17(2) Follow-up after Emergency Department Visit for Mental Illness: Age 18 and Older (FUM-AD) [NCQA; NQF #3489; Medicaid Adult Core Set; Adjusted HEDIS measure]e Percentage of emergency department (ED) visits for beneficiaries age 18 and older with a principal diagnosis of mental illness or intentional self-harm and who had a follow-up visit for mental illness. Two rates are reported: - Percentage of ED visits for mental illness for which the beneficiary received follow-up within 30 days of the ED visit (31 total days) - Percentage of ED visits for mental illness for which the beneficiary received follow-up within 7 days of the ED visit (8 total days). Milestone 6 Established quality measure Annual metrics that are established quality measures Claims Year Annually Required Y 01/01/2021-12/31/2021 Increase Increase Y 18 Use of Opioids at High Dosage in Persons Without Cancer (OHD- AD) [PQA, NQF #2940; Medicaid Adult Core Set] Percentage of beneficiaries age 18 and older who received prescriptions for opioids with an average daily dosage greater than or equal to 90 morphine milligram equivalents (MME) over a period of 90 days or more. Beneficiaries with a cancer diagnosis, sickle cell disease diagnosis, or in hospice or palliative care are excluded. Milestone 5 Established quality measure Annual metrics that are established quality measures Claims Year Annually Required Y 01/01/2021-12/31/2021 Decrease Decrease Y 21 Concurrent Use of Opioids and Benzodiazepines (COB-AD) [PQA, NQF #3389; Medicaid Adult Core Set] Percentage of beneficiaries age 18 and older with concurrent use of prescription opioids and benzodiazepines. Beneficiaries with a cancer diagnosis, sickle cell disease diagnosis, or in hospice or palliative are excluded. Milestone 5 Established quality measure Annual metrics that are established quality measures Claims Year Annually Required Y 01/01/2021-12/31/2021 Decrease Decrease Y 22 Continuity of Pharmacotherapy for Opioid Use Disorder [USC; NQF #3175] Percentage of adults 18 years of age and older with pharmacotherapy for OUD who have at least 180 days of continuous treatment Milestone 1 Established quality measure Annual metrics that are established quality measures Claims Year Annually Required Y 01/01/2021-12/31/2021 Increase Increase Y 23 Emergency Department Utilization for SUD per 1,000 Medicaid Beneficiaries Total number of ED visits for SUD per 1,000 beneficiaries in the measurement period Milestone 5 CMS-constructed Other monthly and quarterly metrics Claims Month Quarterly Required Y 01/01/2021-12/31/2021 Decrease Decrease Y 24 Inpatient Stays for SUD per 1,000 Medicaid Beneficiaries Total number of inpatient stays per 1,000 beneficiaries in the measurement period Other SUD-related metrics CMS-constructed Other monthly and quarterly metrics Claims Month Quarterly Required Y 01/01/2021-12/31/2021 Decrease Decrease Y 25 Readmissions Among Beneficiaries with SUD The rate of all-cause readmissions during the measurement period among beneficiaries with SUD Milestone 6 CMS-constructed Other annual metrics Claims Year Annually Required Y 01/01/2021-12/31/2021 Decrease Decrease Y 26 Overdose Deaths (count) Number of overdose deaths during the measurement period among Medicaid beneficiaries living in a geographic area covered by the demonstration. The state is encouraged to report the cause of overdose death as specifically as possible (for example, prescription vs. illicit opioid). Other SUD-related metrics CMS-constructed Other annual metrics State data on cause of death Year Annually Required Y 01/01/2021-12/31/2021 Decrease Decrease Y 27 Overdose Deaths (rate) Rate of overdose deaths during the measurement period among adult Medicaid beneficiaries living in a geographic area covered by the demonstration. The state is encouraged to report the cause of overdose death as specifically as possible (for example, prescription vs. illicit opioid). Milestone 5 CMS-constructed Other annual metrics State data on cause of death Year Annually Required Y 01/01/2021-12/31/2021 Decrease Decrease Y 32 Access to Preventive/ Ambulatory Health Services for Adult Medicaid Beneficiaries with SUD [Adjusted HEDIS measure] The percentage of Medicaid beneficiaries with SUD who had an ambulatory or preventive care visit during the measurement period. Other SUD-related metrics Established quality measure Annual metrics that are established quality measures Claims Year Annually Required Y 01/01/2021-12/31/2021 Increase Increase Y 36 Average Length of Stay in IMDs The average length of stay for beneficiaries discharged from IMD inpatient/residential treatment for SUD. Milestone 2 CMS-constructed Other annual metrics Claims; State-specific IMD database Year Annually Required Y 01/01/2021-12/31/2021 Decrease Decrease Y Q1 Number of Prescription Drug Monitoring Program (PDMP) users, number of checks Total number of active prescribers, dispensers & delegates as of the last day of the month

Total number of checks made by all prescribers, dispensers and delegates during the calendar month Other SUD-related metrics State-specific Other quarterly and monthly metric PDMP Month Quarterly Required Y 01/01/2021-12/31/2021 Increase Increase n. a. Q2 Number of Prior Authorizations. Number of High-Intensity RSUD PAs real-time approved during the calendar month Number of Low-Intensity RSUD PAs real-time approved during the calendar month Other SUD-related metrics State-specific Other quarterly and monthly metric Prior Authorizations Month Quarterly Required Y 01/01/2021-12/31/2021 Increase Increase n. a. Q3 Individuals (18 and older) reported as a percentages of state members that have experienced Pain Med misuse, Opioid misuse and Heroin Use in the past year. % Pain Med Misuse in the past year % Opioid Misuse in the past year % Heroin Use in the past year Other SUD-related metrics State-specific Other annual metrics Department of Public Health Year Annually Required Y 01/01/2021-12/31/2021 Decrease Decrease n. a. DY12Q3 This metric will be updated in October/November of the calendar year and report on the previous Calendar Year. So DY12Q3 will report on FY 2024. Baseline, annual goals, and demonstration target Alignment with CMS-provided technical specifications manual Phased-in metrics reporting Standard information on CMS-provided metrics