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Feature ID: CL-21
Status: 🏗️ Scaffolded (event contracts are placeholders)
Spec Reference: CL-21-medication-assisted-treatment-moud-tracking.md
Last Updated: 2026-02-23

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Overview

CL-21 defines MAT/MOUD enrollment, medication events (ordered, prescribed, administered, dispensed, held, missed), and monitoring events (UDS, hepatic panel, etc.) for opioid treatment and behavioral health programs. It integrates with CL-05 (medications), CL-06 (e-prescribing), CL-10 (outcomes/CBE #3400), CL-11 (consent/42 CFR Part 2), PM-07 (charge triggers), PF-10 (alerts), and PF-70 (terminology).

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Quick Reference

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Pattern Library

  • Consent-gated MAT access: Always resolve consent via consent_id on enrollment or chart-level SUD consent; enforce in RLS with SECURITY DEFINER helpers (no direct query to RLS-protected tables).
  • Charge context: Pass enrollment/medication/monitoring context to PM-07 for encounter-to-charge mapping.
  • Alerts: Publish overdue monitoring / missed-dose events via PF-10 when event contracts are defined.

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Common Mistakes

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Pre-Flight Checklist

  • CL-11 consent enforcement in place for all MAT tables.
  • Permission keys seeded (PF-30); UI gated by cl.moud.*.
  • UPDATE policies include WITH CHECK on organization_id.
  • No direct queries to RLS-protected tables inside policies.

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Decision Tree (major choices)

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Integration Points (from Spec)

  • consent_id on cl_moud_enrollments is optional only for non-SUD MAT cases. For SUD MAT, a linked 42 CFR Part 2 consent must be used.
  • When consent_id is null, the system falls back to chart-level SUD consent flags (CL-11) via RLS policies before any read/write access to MAT enrollment or related events.
  • When consent_id is present, it ties to a specific consent record for that MAT episode.
  • All access to cl_moud_enrollments and related events (cl_moud_medication_events, cl_moud_monitoring_events) must pass the CL-11 consent check—either the linked consent_id or the chart-level SUD consent flag—enforced in RLS via SECURITY DEFINER helpers. See CL-11 Consent Integration.

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Integration Type Mapping (for CROSS_CORE_INTEGRATIONS matrix)

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API Contracts

  • PM-07 charge triggers: Inputs for MAT encounters and services (enrollment/medication/monitoring context) for charge capture. Document in API_CONTRACTS.md or CL-PM Encounter-to-Billing when implemented.
  • Enrollments: cl_moud_enrollments — enrollment, phase, status; consumed by CL-10 and reporting.
  • Medication events: cl_moud_medication_events — dosing and adherence; feeds CL-10 numerator/denominator logic.
  • Monitoring events: cl_moud_monitoring_events — UDS/lab due and completion; drives PF-10 alerts.
(Add request/response or event schemas here when APIs or events are defined.)

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Event Contracts

  • PF-10 (Platform): Overdue monitoring and adherence-risk alerts published via Platform Notifications (Platform Integration Layer).
  • Event contracts are defined in EVENT_CONTRACTS.md as:
    • cl_moud_monitoring_overdue
    • cl_moud_adherence_risk
  • See EVENT_CONTRACTS.md for payload definitions.

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Security and RLS

  • PHI/SUD: strict RLS and CL-11 consent enforcement before access.
  • RLS on cl_moud_enrollments, cl_moud_medication_events, cl_moud_monitoring_events via SECURITY DEFINER helpers; no direct queries to RLS-protected tables in policies (constitution §5.7).
  • UPDATE policies must include WITH CHECK on organization_id (constitution §5.2.4).
  • Permission keys: cl.moud.view, cl.moud.enroll, cl.moud.medication-event.create, cl.moud.monitoring.manage, cl.moud.report.view (seed in migration per PF-30).